Periodic limb movement disorder (PLMD) has been reported in the scientific literature for more than three decades. However, its diagnostic criteria have changed substantially over time, complicating cross-study comparisons and weakening the evidence base. In a companion paper, we proposed research diagnostic criteria (RDC) for PLMD in adults to operationalize current ICSD-3TR elements and support transparent classification in research settings. We systematically searched PubMed, Scopus, and Google Scholar from inception through April 2025 using predefined PLMD-related terms. We then applied modified RDC to classify PLMD status across all eligible published samples. More than half of the reviewed samples (55.6% of 180 samples from 149 studies) were incompatible with a PLMD diagnosis under contemporary standards, most often because of exclusionary comorbidities such as restless legs syndrome or untreated sleep-related breathing disorders. A further 28.3% could not be classified because critical diagnostic information was missing. Only 29 samples (16.1%) met criteria for possible or probable PLMD, and only four (2.2%) approached definite PLMD. These findings show that the diagnosis of PLMD has been applied inconsistently across diagnostic eras, resulting in widespread misclassification under current criteria. Clear diagnostic criteria and reporting standards are needed to build a reliable evidence base and advance PLMD research.
Studies of Long COVID or Post-COVID-19 condition in children and young people have varied considerably in their reported prevalences. We aimed to examine the methodological heterogeneity underlying this variability and explore whether methodological characteristics were correlated with reported Long COVID outcome prevalence, in order to inform recommendations to improve reporting in future pandemic-related epidemiological research. We conducted an overview of reviews with a narrative synthesis, identifying systematic reviews and meta-analyses and extracting their included primary studies. We identified reviews of Long COVID in children & young people in PubMed and Embase using a systematic search strategy. We extracted key methodological details including study design, sample size, sample and control group characteristics, data collection and reporting methods, as well as time-point(s) of surveying and frequency of follow-up. We explored correlations between these factors and prevalence of Long COVID via Spearman's rank correlation coefficients or the Kruskal-Wallis test. 69 studies, from identified reviews, met the inclusion criteria with outcome symptom prevalence varying between 0 and 90% at > 3-months post-COVID-19 infection. Only 19% of studies used an established Long COVID definition to guide analyses. There was substantial heterogeneity in the design and outcome reporting of Long COVID studies. We did not find Long COVID prevalence varied by examined methodological factors (p ≥ 0.08 for all correlations). While substantial methodological heterogeneity was observed across studies of paediatric Long COVID, no statistically significant correlations were identified between examined methodological factors and reported prevalence. Such variability limits comparability across studies and highlights the need for more standardised definitions, outcome measures, and reporting approaches in future pandemic-related epidemiological research: we discuss reporting guidelines and recommendations for future paediatric epidemiological research during a pandemic.
To address the limited robustness of single-sensor detection in complex environments, this paper proposes a cooperative search algorithm for unmanned aerial vehicle (UAV) swarm based on heterogeneous sensor fusion (HS-CS). The algorithm leverages the complementary detection capabilities of visible-light and infrared sensors as its core, and establishes a framework tailored to heterogeneous detection characteristics. Initially, the mission area is discretized into a grid, and a four-state map model-comprising undetected, visible-only, infrared-only, and heterogeneous fusion coverage-is constructed. Collaborative update and distributed fusion operators are designed to achieve accurate map updates. Subsequently, dual optimization objectives, total coverage and fusion coverage, are established, and a fast non-dominated sorting approach is employed to derive the Pareto optimal solution set. Finally, a multi-dimensional evaluation index is defined, and a four-stage adaptive evaluation function, integrated with a stochastic exploration mechanism, is developed to determine optimal actions for the UAVs. Simulation results demonstrate that, in a scenario containing 50 targets, 25 of which require fused detection as difficult targets, the proposed algorithm achieves an average fusion coverage rate of 97% and an average difficult target detection rate of 97.1% over 50 independent repeated experiments. These results indicate the potential of the HS-CS algorithm for cooperative search tasks.
Tropical areas, particularly Brazil, are home to a significant portion of the world's biodiversity, with the Brazilian Atlantic Forest (BAF) being a crucial biome recognized as a global biodiversity hotspot. However, the BAF has been subject to severe degradation due to anthropogenic activities, resulting in extensive habitat loss and fragmentation. These changes have prompted numerous studies on their effects on biodiversity, focusing on forest fragments and protected areas. Despite this research, there is a notable lack of meta-data on biodiversity in human-modified landscapes within the BAF- where only 31% of the land remains as native forest. Most of the biome has been transformed by human activities, primarily for pasture and agriculture. By recognizing these knowledge gaps, researchers have begun investigating biodiversity in anthropogenically altered landscapes, to better understand species' responses to human-induced changes and inform conservation policies. A comprehensive literature search was conducted to answer the following primary question: "What is the diversity of birds and mammal species in agricultural fields and their adjacent areas of natural vegetation?" We aimed to address this question by creating a systematic map summarizing current knowledge about avian and mammalian species' presence in the BAF's agricultural matrix. This research also aimed (i) to identify common species in agricultural landscapes, (ii) to compare species richness in-crop (inside the agricultural field) and off-crop (non-cultivated areas outside the agricultural field), (iii) to determine crops with high species visitation, and (iv) to highlight areas for future research. We conducted a systematic literature map on bird and mammal biodiversity in agricultural landscapes within the BAF and adjacent natural vegetation areas. The search covered Web of Knowledge, Scopus, the National Library of Medicine, and the "Biblioteca Digital Brasileira" (Brazilian Digital Library) database for grey literature (dissertations and theses). Citation records were surveyed based on predefined criteria through title/abstract screening and full-text analysis. Eligible publications were used for meta-data coding and systematic map construction. Our systematic map identified 207 eligible publications included in the final evidence base. Research effort was distributed across taxonomic groups, with 78 studies focusing on birds, 126 on non-flying mammals (NFM), and 22 on bats. The most frequently studied agricultural systems were pasture and eucalyptus, followed by sugarcane, coffee, cacao, rubber tree, pinus, grape, araucaria, and corn. Extracted meta-data showed that studies reported species occurrences in both agricultural fields and adjacent natural areas. The map revealed significant knowledge clusters and gaps, particularly regarding the distribution of research across different crop types and the inclusion of species with varying conservation statuses. This systematic map identifies 846 species across 48 crop types in BAF agricultural landscapes, potentially indicating their use by wildlife; however, further quantitative synthesis is necessary to assess the relative importance of these areas. By mapping knowledge clusters and gaps-such as underrepresented regions and specific crop-taxa associations-this work provides a foundation for future systematic reviews and informs the development of more targeted environmental risk assessments and conservation policies.
There is growing appreciation of the role of community engagement and involvement (CEI) in designing context-specific interventions for individuals with acquired brain and spinal injuries (ABSI). This realist review evaluates CEI strategies in ABSI research in both high-income (HICs) and low- and middle-income countries (LMICs). A realist review. Following RAMESES guidelines, a six-stage systematic search of the following databases: Medline, EMBASE, PsycINFO and Global Index Medicus was conducted from inception to March 2025. Studies assessing CEI in ABSI research design and implementation were included. Neurodegenerative pathologies and studies focusing solely on perspectives or attitudes were excluded. Data were extracted and synthesised using context-mechanism-outcome configurations to explain how CEI strategies were used to improve outcomes. 22 studies were included. Data showed three context-specific focus areas in HICs and LMICs. In HICs prominent contexts were (a) low self-efficacy, (b) untailored rehabilitation services and (c) poor digital literacy. These were addressed through (a) recognising volitional barriers, (b) creating modular programmes and (c) end-user-tested tele-education tools. Whereas in LMICs, the data showed high rates of (d) stigma, (e) poor workforce capacity for community care and (f) barriers to accessible community support. These were addressed through (d) involving community champions, (e) task-shifting addressing workforce gaps and (f) state-level policy changes. Most common CEI interventions in both HICs and LMICs were community advisory boards, Delphi method and integrated knowledge-translation approaches. This study describes how different contextual factors affecting ABSI populations in HICs and LMICs interact with CEI strategies to trigger mechanisms that improve research engagement and patient outcomes. The study also highlights the dearth of CEI reported in neurosurgical trials. CEI should be embedded in experimental research to account for varying economic, social and infrastructural contexts, particularly in rural and LMIC settings.
Orofacial pain in older adults with dementia is often overlooked due to cognitive decline and impaired communication, impairing patients' quality of life and exacerbating neuropsychiatric behavioural symptoms. This scoping review aimed to map available evidence regarding prevalence, assessment tools, clinical management strategies and research gaps, with the aim of informing clinical practice and guiding future research. Systematic literature searches were performed in PubMed, Web of Science, Embase and Cochrane Library from database inception to December 2025. Two independent reviewers performed literature screening and data extraction, and any disagreements were resolved via consensus discussion. Narrative synthesis was adopted to summarise findings, and the review strictly followed PRISMA-ScR guidelines. This review was retrospectively registered on the Open Science Framework on 5 March 2026 (OSF: https://osf.io/qmg64). The literature search was completed prior to registration. Twenty one studies were included. Orofacial pain prevalence varied: 7.4%-21.7% in community-dwelling older adults; 11.9% (rest) and 21.9% (mastication) in hospitalised patients; up to 48.8% in nursing home residents with severe dementia. A meta-analysis (n = 6115) reported a pooled prevalence of 19.0%. Nearly half (50.3%) of patients without self-reported pain had underlying oral pathological lesions. Based on limited validation studies, the OPS-NVI demonstrates relatively stronger psychometric properties compared to other available tools, though evidence remains preliminary and head-to-head comparisons are lacking, while the OHAT-NL may be suitable for community screening by caregivers. Paracetamol is frequently recommended as a first-line option for mild to moderate pain based on general geriatric pain guidelines, but direct evidence for orofacial pain in dementia is limited. Multidimensional non-pharmacological strategies, including staged oral care, caregiver training and multidisciplinary collaboration, are generally suggested. Major systemic barriers include limited dental service access, insufficient caregiver training, and information fragmentation. Orofacial pain represents a substantial underrecognised burden among older adults with dementia. Immediate priorities include integrating oral health assessment into routine care, promoting scenario-specific use of validated tools, and strengthening caregiver education. Future research should prioritise subtype-specific investigations and translate existing evidence into implementable clinical protocols.
One of the most frequently used plant cell lines is the tobacco cell line BY-2, which was established from Nicotiana tabacum L. cv. Bright Yellow 2 plants. However, surprisingly, after more than 50 years, the original information about the authors, the place and the method of its establishment is quite laborious to obtain. This could be important for any de novo derivation of highly proliferative cell lines. In this brief reflection article, we summarise the publicly available information on the origin of BY-2 in the 1960s, when it was used in applied research at the Central Research Institute of Japan Tobacco & Salt Public Corporation (JTS). Thanks largely to Professor Toshiyuki Nagata's activities, it spread to the rest of the world in the 1980s, becoming a cellular model for basic research into the cell cycle, membrane and cytoskeletal dynamics, and many other processes. Available literature suggests that the BY-2 cell line was derived from calli induced on the stems of seedlings of the Bright Yellow-2 Virginia-type tobacco cultivar. We hope that the information we have gathered will be useful for everyone working with, or planning to use, the BY-2 cell line. We also hope that it will encourage efforts to search for more details in old Japanese patent records that could be used to establish new, highly proliferating lines.
Pregnant individuals may receive antenatal corticosteroids for various conditions, including congenital adrenal hyperplasia (to prevent virilisation in female fetuses) and preterm birth risk (to hasten fetal maturation and improve perinatal survival). This narrative review aimed to evaluate the evidence of sexually-dimorphic offspring outcomes following antenatal corticosteroids for such conditions and explore the potential underlying mechanisms. A comprehensive MEDLINE search identified twenty-eight studies for inclusion: seven focused on congenital adrenal hyperplasia and twenty-one focused on preterm birth risk. For congenital adrenal hyperplasia, evidence suggests that antenatal corticosteroids are associated with sexually-dimorphic outcomes across cognition, behaviour and brain structure. Females demonstrated more consistently negative outcomes, particularly within the congenital adrenal hyperplasia-affected population, where females were exposed to longer treatment durations than males. The outcomes for males were more heterogenous. For preterm birth, some studies suggest preterm males remain at increased risk for mortality and morbidity, while in term-born infants, females may have worse outcomes. The nature of these effects, however, differed with antenatal corticosteroid types, and conflicting findings also existed. Potential mechanisms for sexually-dimorphic outcomes include differences in placental enzyme and receptor expression and activity, fetal hypothalamic-pituitary-adrenal (HPA) axis function, and susceptibility to developing respiratory conditions. The current literature suggests potential sex differences following antenatal corticosteroids, which differ between congenital adrenal hyperplasia and preterm birth risk. Owing to surmounting evidence of negative outcomes and the retracting use of antenatal corticosteroids for congenital adrenal hyperplasia, further research will be challenging. Whereas studies concerning sexually-dimorphic responses to antenatal corticosteroids for preterm birth risk are essential, given their widespread use. Further research in this area may help to understand whether the clinical management of preterm birth should be adjusted according to sex.
Separation anxiety disorder (SAD) is a common childhood condition characterised by excessive distress related to separation from attachment figures, often leading to social, emotional, and academic difficulties. If untreated, SAD can increase the risk of future psychopathology, highlighting the importance of effective interventions. This scoping review systematically maps and analyzes the current evidence on intervention strategies to reduce separation anxiety and promote emotional and social well-being in children. Following Arksey and O'Malley's framework and PRISMA-ScR guidelines, a comprehensive search was conducted across multiple databases (PubMed, PsycINFO, Scopus, etc.) for studies published from 2005 to 2025. Inclusion criteria focused on original peer-reviewed research evaluating therapeutic, parental, or educational interventions targeting separation anxiety in children. Eight studies from diverse settings demonstrated that interventions such as child-centred group play therapy, attachment-based play, art therapy, storytelling, laughter yoga, and schedule-based paradoxical therapy effectively reduced separation anxiety symptoms. These approaches also improved social-emotional skills, resilience, and parent-child relationships. Combining therapies and involving parents enhanced outcomes, while the importance of school transition strategies was highlighted. Findings suggest that multimodal, relationship-focused interventions are most effective in alleviating separation anxiety and fostering broader emotional development. Incorporating expressive activities and strengthening attachment bonds are crucial, and tailored, culturally sensitive approaches are recommended. A comprehensive, developmentally sensitive framework integrating therapeutic, familial, and educational strategies holds promise for effective management of childhood separation anxiety. Further research with larger, diverse samples is needed to confirm long-term benefits.
Allogeneic haematopoietic stem cell transplantation (HSCT) is a cornerstone therapy for haematological and genetic disorders. Owing to the limited availability of HLA-identical related donors, umbilical cord blood (UCB) has become a valuable alternative source of haematopoietic progenitors. However, many UCB units are excluded from banking based on quality criteria, despite potentially harbouring rare and underrepresented HLA profiles, particularly within certain demographic groups. This study evaluated the strategic value of immunogenetically rare but low-quality UCB units in expanding donor options for patients with uncommon HLA profiles. HLA-A, -B, and -DRB1 typing was performed on 577 UCB units, and allelic, haplotypic, and genetic diversity analyses were conducted using the HLA-net GENE[RATE] tool. Units were categorised using the Search Prognosis Application as good (6/6), fair (5/6), or poor (< 5/6 matches). Genotype frequency was used as a proxy for immunogenetic rarity and evaluated as an operational criterion for defining retention thresholds. ROC analyses were interpreted as concordance analyses between genotype frequency and Search Prognosis classification rather than as independent predictive validation. Statistical significance was assessed by chi-square and residual analyses. The cohort displayed remarkable allelic diversity, particularly at the HLA-B locus, strong linkage disequilibrium among loci, and a large proportion of unique genotypes. Matching-prognosis classification identified 66.72% of units as good, 31.54% as fair, and 1.73% as poor. Caucasian genotypes were overrepresented in the good category, whereas Asian-Pacific-Islander and African-American haplotypes were enriched in poorer matching-prognosis categories. ROC analysis showed strong concordance between genotype frequency and Search Prognosis classification (AUC 0.80-0.99) and population-specific genotype frequency thresholds. Our findings suggest that immunogenetic rarity provides complementary value to conventional quality metrics. While low-cell-dose units may have limited direct clinical utility, those with rare HLA genotypes may retain strategic importance, particularly for patients with uncommon immunogenetic profiles. Integrative approaches combining biological and immunogenetic parameters may improve cord blood banking strategies.
The global prevalence of End-Stage Renal Disease (ESRD) is increasing, with estimates suggesting that more than 5 million people worldwide require renal replacement therapy (RRT), and this burden falls disproportionately on low- and middle-income countries (LMICs), highlighting the urgent need for effective strategies to support patient self-management. This scoping review synthesizes evidence on the types, delivery methods, and reported outcomes of educational support programs for individuals with ESRD undergoing hemodialysis (HD). This review followed the six-stage methodological framework by Arksey and O'Malley and adhered to the PRISMA Extension for Scoping Reviews guidelines. Studies examining educational interventions for ESRD patients on HD were included. A comprehensive search of MEDLINE, CINAHL, Scopus, PubMed, and Web of Science was conducted for English-language articles published between 2011 and 2021. Search terms included combinations of "end-stage renal disease," "ESRD," "hemodialysis," and "haemodialysis" with "educational program," "support program," "patient education," and related terms. Pairs of reviewers independently screened titles and abstracts and assessed full-text articles, resolving discrepancies through group discussion. Data were extracted using a standardized form capturing key study characteristics and synthesized using descriptive statistics and content analysis. Eighteen studies (n = 18) from ten countries met the inclusion criteria. All studies reported that educational interventions, regardless of delivery mode or design, positively influenced quality of life (QOL) and treatment adherence among ESRD patients. Specifically, improvements were documented in serum phosphate control, intradialytic weight gain, psychological well-being (anxiety, depression, stress), self-esteem, dietary knowledge, and physical functioning. Structured self-management programs, particularly those incorporating nutritional education and psychological support, demonstrated the greatest breadth of benefit across clinical and psychosocial domains. This review maps the evidence on educational support programs for HD patients, revealing variability in intervention types, delivery methods, study designs, and outcome measures. These inconsistencies highlight the need for more rigorous, standardized research particularly in LMICs to determine the most effective educational strategies. The findings provide a foundation for developing evidence-based, patient-centered educational programs adaptable to diverse global populations.
Total hip arthroplasty is the surgical treatment of choice to improve the quality of life of patients with advanced osteoarthritis. This treatment aims to increase functional capacity and reduce pain. However, anxiety is one of the most frequently described uncomfortable experiences associated with this surgery. Although there has been extensive study of techniques to treat preoperative anxiety, little is known about interventions targeted at reducing postoperative anxiety associated with the fear and uncertainty of adjusting to life changes after surgery. To conduct a systematic review of the literature to identify the non-pharmacological interventions that have been performed to reduce postoperative anxiety in patients undergoing hip arthroplasty and their effectiveness. A bibliographic search was conducted in Pubmed, Scopus, and Web of Science until April 2026. Search was based on the following selection criteria: randomized clinical trials, quasi-experimental pre-post studies with or without control groups. Study selection and data analysis were conducted according to the predefined eligibility criteria and analytical approach, and the reporting was conducted according to the PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and ROBINS-I for non-randomized studies. Included studies assessed technology-assisted interventions (immersive virtual reality, telemedicine, and video-based health education), nursing-led educational or behavioral programs (including self-efficacy-enhancing and continuous nursing care models), multimodal rehabilitation-based approaches, and complementary therapies such as aromatherapy. Overall, the most consistent reductions in anxiety were observed in studies evaluating immersive virtual reality and self-efficacy-enhancing interventions. Nursing-led and continuous care models also reported improvements, although findings were more variable. Educational and eHealth-based approaches showed benefits primarily in the short term. Telemedicine and aromatherapy demonstrated limited or inconsistent effects on anxiety. Substantial heterogeneity in interventions, outcome measures, and follow-up periods precluded quantitative synthesis; therefore, a structured narrative synthesis was performed. Multicomponent nursing-led and technology-assisted interventions, particularly immersive virtual reality and self-efficacy-based programs, show the most consistent evidence for reducing postoperative anxiety following THA. Educational and eHealth-based interventions demonstrate short-term benefits, whereas telemedicine and complementary approaches such as aromatherapy show more limited or inconsistent effects. However, the overall evidence base remains heterogeneous and methodologically variable. Future research should prioritise adequately powered, multicentre trials with standardised outcome measures and longer follow-up periods.
Innovative clinical trials, including adaptive and Bayesian designs, can improve efficiency and prioritise patient-centric approaches. Despite their recognised advantages, the global adoption of innovative clinical trial designs remains uneven, with substantial variation observed across socioeconomic and gender-related contexts. This study investigates the global distribution of innovative trial designs and their association with the Inequality-adjusted Human Development Index (IHDI) and Gender Inequality Index (GII). We conducted a cross-sectional observational analysis of interventional studies registered on ClinicalTrials.gov between 1990 and 2024. Innovative trial designs were identified using a predefined keyword-based search applied to study description fields. Trials published before 1990 or lacking descriptive information were excluded. Country-level IHDI and GII data were obtained from the United Nations Human Development Reports and linked to trials by study location. Logistic regression with restricted cubic splines was used to model associations. Given the strong correlation between IHDI, penalised regression approaches were applied to ensure model stability. The proportion of innovative trials increased after 2015, likely reflecting regulatory support and global initiatives. These trials were more common in regions with higher IHDI scores, particularly the Americas and Europe, while Africa showed the lowest prevalence. Higher GII values, indicating greater gender inequality, were associated with lower adoption of innovative designs. However, IHDI and GII were strongly correlated, suggesting that they capture closely related structural dimensions of development. Paediatric trials and non-industry-funded studies were more likely to adopt innovative designs, while gender-specific trials were less likely to do so. Significant geographical and gender-related disparities exist in the global adoption of innovative clinical trials. More favourable structural contexts, characterised by higher socioeconomic development and lower gender inequality, were associated with greater adoption of innovative trial designs. However, due to the strong correlation between these indicators, their independent contributions cannot be disentangled, and findings should be interpreted as reflecting broader contextual environments rather than causal effects. Addressing these disparities requires targeted efforts to improve inclusivity and research capacity in underrepresented regions. Collaborative international initiatives and policy strategies may help promote more equitable access to innovative clinical trial methodologies.
Menstrual disturbances are common among female medical students and may affect academic functioning, well-being, and daily activities, especially in Southeast Asia. This systematic review and meta-analysis aimed to estimate the prevalence of menstrual disturbances and synthesize associated factors among female medical students in Southeast Asia. PubMed, Embase, Scopus, Google Scholar, manual searching, and citation tracking were searched for studies published from January 1, 2000 to May 6, 2026. Eligible studies were observational studies that reported the prevalence of menstrual disturbances and associated factors among female undergraduate medical students in Southeast Asia. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Random-effects meta-analyses were conducted for outcomes with sufficient data, while associated factors were synthesized narratively. 17 studies involving 7,080 participants from Vietnam, Thailand, Indonesia, and Malaysia were included. Dysmenorrhea was the most frequently reported outcome, with a pooled prevalence of 78.11% (95% CI: 67.07%-86.21%; I² = 97.9%). The pooled prevalence was 30.10% for irregular menstruation (95% CI: 18.54%-44.89%; I² = 98.0%), 39.60% for premenstrual syndrome/premenstrual dysphoric disorder (95% CI: 20.13%-63.05%; I² = 98.5%), and 22.58% for abnormal menstrual cycle duration (95% CI: 15.48%-31.72%; I² = 95.0%). Family history showed the most consistent positive association with menstrual disturbances, with aOR ranging from 1.47 to 3.76. Psychological distress, functional impairment, caffeine intake, limited rest, and low or irregular physical activity were also reported as potential correlates, although evidence was heterogeneous. However, extremely high heterogeneity (I² >95%) was observed across all pooled outcomes; these estimates should therefore be interpreted with caution. Menstrual disturbances are commonly reported among female medical students in Southeast Asia. However, the evidence is limited by cross-sectional designs, inconsistent outcome definitions, high heterogeneity, and frequent risk of bias. These findings should therefore be interpreted as exploratory rather than confirmatory. PROSPERO CRD420251178169.
The impact of climate change on health is well recognised, yet its influence on postoperative complications remains underexplored. This systematic review examines how climatic factors-particularly temperature, humidity and seasonal variations-affect surgical outcomes. Systematic review with narrative synthesis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A comprehensive search of PubMed, Web of Science and the Cochrane Library from June 2015 to June 2025 was conducted. An additional supplementary PubMed search was performed to identify further relevant studies. Included were studies published in English or German that examined associations between climatic factors, including temperature, humidity, precipitation or seasonality and postoperative outcomes in surgical patients. Studies without a surgical or climatic focus, animal studies, reviews and commentaries were excluded. Two reviewers independently screened studies and extracted data using predefined criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to methodological heterogeneity, findings were synthesised narratively. Fifteen studies were included. High ambient temperatures were frequently associated with increased risks of surgical site infections (SSIs). Some large studies reported that even a one-degree rise significantly elevated infection rates. Humidity was also linked to higher infection rates, with evidence suggesting an independent effect in some cases. Seasonal changes influenced complication rates across regions and surgical disciplines, with infection and pneumonia peaks in summer or winter months. A few studies reported increased risks during heavy rainfall or institutional transitions such as the 'July effect'. Overall, elevated temperature and humidity appear to be associated with increased postoperative risks, especially SSIs. Seasonal patterns may further influence outcomes depending on geography and procedure type. While the available evidence supports a link between climate and surgical complications, methodological differences and limited adjustment for confounders highlight the need for more rigorous studies.
The aim of this scoping review was to summarize and to synthesize the existing literature on the most performed functional tasks and their associated biomechanical outcomes following total hip arthroplasty (THA). Five databases, including Medline, Embase, CINAHL, Web of Science, and Ergonomics Abstracts were searched based on 3 main concepts: Total hip arthroplasty, functional tasks and biomechanical outcomes. Studies were screened based on titles and abstracts, followed by a full text reading conducted by two authors following inclusion and exclusion criteria. Eighty three studies with a total of 2047 THA and 170 hip resurfacing arthroplasty (HRA) patients were included. Postural balance was the most frequently evaluated functional task, followed by sit-to-stand and stair negotiation. Most participants were older than 60 years, and the surgical approach was infrequently reported. Patient-reported outcome measures were rarely reported alongside motion analysis, with the Harris hip score and the Oxford Hip Score being the most commonly used. Factors such as age, population characteristics, surgical approaches and follow-up durations may influence the biomechanical outcomes of hip replacement. Therefore, caution is warranted when generalizing these findings to all THA population. Further research on young THA and HRA patients in more demanding task such as squat and work-related tasks are required to better understand functional recovery and implant performance under higher mechanical loads.
Accurate molecular property prediction is a cornerstone of modern chemical science, driving progress in drug discovery, materials design, and environmental research. Yet, most existing models remain unimodal, while multimodal approaches often rely on simple aggregation, leaving much of the complementary chemical information underexploited. In this work, we present a multimodal feature fusion framework that unites the strengths of deep chemical language processing (CLP) models and molecular fingerprints, integrating sequential and structural representations for more comprehensive molecular characterization. Unlike previous heuristic combinations, our framework systematically investigates the principles of effective cross-modal fusion. We benchmark ten CLP architectures and eight fingerprint types through exhaustive combinatorial search to identify the most synergistic configurations. This exploration shows that aggregating multiple models does not necessarily improve performance; instead, successful fusion requires data-aware design guided by feature integration and complementarity. The proposed strategy effectively couples sequential features learned from SMILES with structural information captured by molecular fingerprints, resulting in a coherent and chemically interpretable molecular representation. Evaluated across 60 datasets from MoleculeNet and TOXRIC, our fusion models deliver consistent and substantial gains over state-of-the-art baselines. Beyond outperforming existing architectures, this work provides conceptual insights and practical guidelines for multimodal fusion in molecular property prediction, highlighting the importance of efficient fusion strategies in building robust and generalizable molecular models.Scientific contributionThis study provides a large-scale empirical evaluation of multimodal feature fusion for molecular property classification by systematically integrating SMILES-based chemical language representations with fingerprint-based structural descriptors across 60 benchmark datasets. The framework introduces a data-aware combinatorial fusion strategy to identify task-specific complementary feature combinations, improving robustness and interpretability compared with unimodal models and baseline approaches. The results clarify how sequence-based and structure-based molecular representations complement each other, providing practical guidance for designing multimodal models in cheminformatics.
Prolonged immobility contributes to pediatric intensive care unit (PICU)-acquired weakness and postintensive care syndrome (PICS). Early mobilization (EM) shows feasibility and potential benefits in adults, and pediatric experiences suggest safety, though data are limited and practice varies. There is a wide variability in Italy regarding EM practices. Thus, we aimed to develop consensus statements to standardize EM across Italian PICUs today while respecting local variability. This project was conducted by a 20-member multidisciplinary panel of Italian PICU experts, including nurses and physiotherapists. The project was endorsed by the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). A comprehensive search (2010-2015 July 2025) in PubMed, CINAHL, and PEDro was conducted. Eligible studies included prospective and retrospective studies, systematic reviews, meta-analyses, and guidelines. Nine EM research areas were defined; Statements were drafted using a Quaker-based consensus methodology and voted using the RAND/UCLA appropriateness method. From 8380 records, 113 studies met eligibility. Twenty-two statements and four tables were drafted; 20 statements and three tables achieved strong agreement in the first round. The remaining two statements and one table were revised and were classified with weak agreement. Attendance was 93% at online meetings. This EM consensus provides standardized, implementable statements to guide EM adoption across Italian PICUs while accommodating local practice differences; future work should focus on validation, implementation, and dissemination. • Prolonged immobility in the PICU is one of the modifiable factors associated with PICU-acquired weakness, delirium, and post-intensive care syndrome. • In Italy only 15% of patients admitted to PICU receives Early Mobilization practices with great variability across PICUs. • 22 pragmatic statements and four tables have been developed to promote standardized EM interventions across Italian PICUs, while accounting for variability of practices and equipment. • The provision of graded Early Mobilization, responsive to the child's condition and severity of illness, may promote functional recovery both during and beyond the PICU stay.
Non-attendance to healthcare appointments among young people with long-term conditions (LTCs) presents significant challenges to continuity of care and clinical outcomes. Although factors associated with non-attendance have been explored in broader populations, there remains an evidence gap concerning the specific drivers among adolescents and young adults aged 10-24 years living with chronic physical or mental health conditions. This review aims to identify and synthesise factors associated with healthcare appointment non-attendance among young people with LTCs. We will conduct a systematic review and narrative synthesis of peer-reviewed quantitative, qualitative and mixed-methods studies reporting factors associated with non-attendance among young people with LTCs. MEDLINE, Embase, PsycINFO, Scopus and CINAHL will be searched from database inception. Searches will be conducted in March 2026 and will include studies with no geographic restrictions, and with eligibility extended to any language where translated full text is available. Two reviewers will independently screen studies, extract data and assess risk of bias using the ROBINS-I (quantitative), Critical Appraisal skills programme (qualitative) or mixed-methods appraisal tool (mixed-methods). A narrative synthesis will be undertaken, grouping factors thematically and comparing findings by age subgroup, condition type (physical vs mental health) and socioeconomic/geographical context. Reporting will follow Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance. Ethical approval is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and relevant conference presentations. CRD420251080477.
Oral squamous cell carcinoma (OSCC) refers to a prevalent cancer in the neck and head region, with poor prognosis and a high risk of recurrence after surgery. Surgical margin (SM) and the margin to depth of invasion ratio (MDR) are critical factors influencing survival outcomes. Currently, the impact of SM width and MDR on prognosis remains controversial. This study seeks to systematically compare the predictive value of SM width and MDR for OSCC prognosis, providing evidence for optimizing SM evaluation standards. We systematically searched PubMed, Web of Science, Embase, and Cochrane Library for relevant studies from database inception to April 1, 2026. Two researchers separately reviewed the included studies and extracted the data. The quality of the included studies was assessed using the Quality In Prognosis Studies (QUIPS) tool. Meta-analysis was carried out via STATA 18.0 software, and the related summary plots were generated. A total of 41 studies involving 61,863 individuals were included. A poor SM was significantly associated with unfavorable overall survival (OS) (HR = 1.56, 95% CI 1.37-1.77, p < 0.001), disease-free survival (DFS) (HR = 1.72, 95% CI 1.29-2.28, p < 0.001), and recurrence-free survival (RFS) (HR = 1.99, 95%CI 1.53-2.58, p < 0.001). A low margin to depth of invasion ratio (MDR) was significantly associated with worse OS (HR = 1.36, 95% CI 1.21-1.54, p < 0.001) and DFS (HR = 1.40, 95% CI 1.12-1.74, p = 0.003). Subgroup analysis demonstrated that these associations might be influenced by different cutoff values, data analysis sources, and geographical factors. This study revealed significant associations between SM, MDR, and the OSCC prognosis. Nevertheless, the clinical value of these indicators may be affected by variability in cutoff values across studies. Future large-scale, multicenter prospective studies are required to validate these findings and further investigate the prognostic impact of varying cutoff values.