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Objective: This study describes a multidisciplinary, multi-generational case conference focusing on healthcare professionals' emotional conflicts and moral distress-what we call "moyamoya" in Japanese-in clinical practice. Materials and Methods: Five hybrid conferences were co-organized by Kyoto-Min-Iren and an independent study group. In each session, one anonymized case was presented. Discussions emphasized sharing emotional conflicts without criticism or seeking conclusions and encouraged dialogue from multiple professional perspectives. Participants included physicians, nurses, medical social workers, administrative staff, and medical students. Results: The conferences appeared to generate diverse discussions and serendipitous insights. The dialogue may have promoted reflection similar to Significant Event Analysis and may foster mutual understanding by making interprofessional perspectives visible. It also appeared to offer opportunities to reconsider the problem-solving orientation common in daily practice and to share an approach attentive to patients' life backgrounds. For young healthcare professionals and students, it may provide practical learning about the social determinants of health through socially vulnerable cases. However, the absence of thematic limits may pose challenges in facilitating discussions and aligning participants' interests. Conclusion: A case conference centered on emotional conflicts may foster reflective practice, interprofessional understanding, and learning beyond technical knowledge, while requiring structural refinement to enhance practical value.

Microsurgery is increasingly becoming the cornerstone of reconstructive surgical practice, yet training opportunities remain scarce in sub-Saharan Africa. To address this gap, a 2-day simulation-based microsurgery course was held in Kigali as part of the preconference activities of the Pan-African Conference in February 2025. This study aims to demonstrate the feasibility of short-term microsurgery training and evaluate the preliminary impact of the course on participants' microsurgical skills. Pre- and posttraining surveys were administered to course participants, assessing comfort and confidence across 6 core skill domains: microscope handling, instrument manipulation, needle control, vessel preparation, end-to-end anastomosis, and judging the patency of an anastomosis as well as anxiety related to performing microsurgery. Responses were recorded on a Likert-type scale using a 0-100 format. Paired analysis was performed using Wilcoxon rank sum tests. Qualitative feedback was also collected to assess the perceived value and suggested improvements for future sessions. Eighteen participants completed pre- and/or posttraining surveys (14 completed both). Statistically meaningful improvements were observed in participants' comfort and confidence across all skill domains (P < 0.05). Participants reported a significant decrease in anxiety (P < 0.02). Qualitative responses emphasized high satisfaction with the course, with many requesting more frequent sessions and earlier integration of microsurgical skills into training. Short-duration, simulation-based microsurgery training had a positive, measurable impact on technical confidence and psychological readiness among surgical trainees in Rwanda. These findings highlight the feasibility and importance of expanding access to structured microsurgical education across sub-Saharan Africa and support efforts to integrate such training into national surgical training frameworks.

The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were developed to improve the completeness and transparency of reporting of reliability and agreement of health measurement instruments. However, since their publication in 2011 methodological standards, both for reporting guideline development and reliability, agreement and measurement error studies have advanced, highlighting the need for aligning and updating. In addition, related initiatives like COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) have emerged, offering opportunities to harmonise terminology and promote consistency across diverse types of measurement instruments. This method review aims to (1) systematically identify and synthesise commentaries on and evaluations of the original GRRAS and (2) map recent methodological developments in the planning, conduct and interpretation of reliability, agreement and measurement error studies in health science, psychology and education that should be reflected in the reporting, to inform the development of the GRRAS-COSMIN reporting guidelines. Two complementary search strategies will be employed. First, forward direct citation tracking of the original GRRAS publications will be conducted in Web of Science. We will include sources providing critique, commentaries or suggestions related to the GRRAS. We will exclude publications that used GRRAS just for structuring their report, withdrawn or retracted articles, textbooks, peer reviews, supplements and conference materials without full-text publications. Included articles will be analysed using descriptive content analysis. Second, we will perform a systematic search in MEDLINE, PsycInfo, Embase, ERIC and CINAHL supplemented by key references identified by or known to the author team. We will include studies, reviews, commentaries, editorials, methodological papers, tutorials and guidance documents that discuss or critically reflect on methodological aspects of the measurement properties reliability and/or agreement/measurement error published between 1 January 2015 and 30 June 2026 in health sciences, psychology or education. Eligibility will be assessed by two independent reviewers and included sources will be analysed using 'codebook' thematic analysis. Findings will be presented narratively supplemented by visuals and tables if appropriate. This study involves publicly available data. No ethical approval is needed. Results will be disseminated through an open-access journal publication following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension and conference presentations.

Natural language processing (NLP) techniques offer promising solutions for semi-automating the time-consuming process of abstract screening in systematic reviews. The exponential growth of published literature has created significant bottlenecks, with review teams manually assessing thousands of abstracts over weeks to months. Single reviewers can miss 5-13% of relevant studies, necessitating dual screening that further increases workload. Advances in artificial intelligence, including deep learning models such as BERT and its successors, show potential for automating this critical step, but comprehensive evidence on optimal approaches, performance, and practical feasibility remains limited. This systematic review aimed to assess techniques, performance, and feasibility of NLP approaches for title and abstract screening by characterizing the range of NLP methods used, summarizing performance on key metrics like workload reduction and recall, evaluating real-world implementation feasibility, and identifying research gaps and future directions. We searched PubMed, Web of Science, Embase, CINAHL, The Cochrane Library, Scopus, and gray literature sources from inception to December 2024. The search strategy, developed with an information specialist and peer-reviewed using PRESS guidelines, targeted keywords related to natural language processing, machine learning, abstract screening, and systematic reviews. Additional sources included conference proceedings, preprint servers, reference lists, forward citation tracking, and expert consultation. We included primary studies of any design describing development or evaluation of NLP techniques for automating title and abstract screening in evidence syntheses. Eligible studies reported on NLP methods, screening performance (workload reduction, recall, precision), or implementation feasibility. Studies using only rule-based approaches without machine learning, systematic reviews of NLP methods, commentaries, and conference abstracts were excluded. No language or date restrictions were applied. Two reviewers independently screened titles, abstracts, and full texts using Covidence software, with disagreements resolved through discussion. Data extraction covered study characteristics, NLP techniques, training approaches, performance metrics, and feasibility considerations. Risk of bias was assessed using a modified ROBIS tool. Given diverse techniques and outcomes, we conducted narrative synthesis following SWiM guidelines, grouping studies by NLP approach. From 4,105 records, 19 studies met inclusion criteria, with 68.4% published since 2023, reflecting rapid field advancement. Studies employed diverse approaches from traditional machine learning (Support Vector Machines, Random Forests) to advanced deep learning models, particularly BERT variants. Most achieved >90% recall with workload reductions of 13-96%, representing substantial time savings. Deep learning models with transfer learning consistently outperformed traditional approaches. However, implementation faced significant barriers including requirements for high-quality training data, specialized computational resources, technical expertise, and user-friendly interfaces. Performance was generally better for targeted reviews with lower inclusion prevalence. NLP techniques, especially deep learning with transfer learning, show substantial promise for semi-automating abstract screening with potential for large workload savings while maintaining high recall. However, challenges remain regarding training data quality, computational requirements, technical expertise needs, and user-centered design. Realizing full potential requires interdisciplinary collaboration to develop reliable, generalizable tools integrating seamlessly with human expertise and existing workflows. Future priorities include creating standardized datasets, conducting prospective evaluations, developing user-friendly interfaces, and establishing implementation best practices to revolutionize evidence synthesis efficiency. Declarative title: Natural language processing substantially reduces abstract screening workload but requires significant expertise and specialized computing resources. The review in brief Natural language processing techniques can reduce manual abstract screening workload by 30-90% while maintaining over 90% recall of relevant studies, with deep learning models showing the greatest promise for systematic review automation. What is this review about? Problem statement: Systematic reviews are the highest level of evidence for policy and practice, but exponential literature growth has made abstract screening a major bottleneck, taking weeks to months. Single reviewers miss 5-13% of relevant studies, making dual independent screening the gold standard, at significant cost in time and resources. What is the aim of this review? This systematic review examines the techniques, performance, and feasibility of natural language processing methods for automating title and abstract screening in systematic reviews. What are the main findings of this review? What studies are included? This review includes 19 studies that evaluated NLP techniques for automating abstract screening in systematic reviews, rapid reviews, scoping reviews, and other evidence syntheses. Studies came from diverse global regions, with 68.4% published in 2023 or later. Studies varied in design and corpus size (hundreds to tens of thousands of articles), mostly from medical literature, and demonstrated generally good methodological quality. Do NLP techniques reduce workload while maintaining accuracy? NLP techniques consistently demonstrate substantial workload reductions while maintaining high recall of relevant studies. Workload reductions range from 13-96%, with most studies achieving reductions of 30-60%. Most studies achieve recall rates exceeding 90%, meaning they successfully identify over 90% of relevant articles. Precision varied widely (10-99%), primarily affecting the volume of articles requiring manual review rather than the risk of missing relevant studies. Which NLP approaches perform best? Deep learning models, particularly those leveraging transfer learning with large pretrained language models like BERT and its variants (BioBERT, PubMedBERT), consistently outperform traditional machine learning approaches. Traditional approaches such as Support Vector Machines perform well but are generally outperformed by these modern architectures. What factors affect implementation feasibility? Several key factors influence the practical implementation of NLP systems. High-quality training data and specialist technical expertise are prerequisites. Computational resources vary from standard computing for simpler models to specialized GPU infrastructure for advanced deep learning approaches. User-friendly interfaces and domain generalizability remain key challenges for broader adoption. What do the findings of this review mean? NLP offers substantial promise for reducing the abstract screening burden. Workload reductions of 30-90% could accelerate evidence synthesis and policy translation. However, successful implementation requires careful planning, technical expertise, and adequate computational resources. Standardized datasets, user-friendly tools, and clearer best-practice guidance are needed to realise this potential. How up-to-date is this review? The review authors searched for studies up to December 2024.

Understanding congenital heart disease requires a 3D mental framework, yet clinicians typically rely on 2D imaging. Multi-disciplinary case management conference (CMC) discussions often involve review of complex anatomy utilizing cross-sectional imaging. Mixed reality (MR) offers immersive 3D visualization that may enhance these discussions. Our objectives were to demonstrate the feasibility of integrating MR-guided discussions into CMC and assess Heart Center perceptions of its use.&#xa0;This prospective, single-center study was conducted during multi-disciplinary CMCs. Baseline and post-presentation Likert-scale questionnaires were administered. EchoPixel True3D (Santa Clara, CA) was used to present 3D MR models from cardiac CT datasets. Participants used electronic glasses wirelessly linked to a 3D projector to view the MR models in conference, which were manipulated in real-time.&#xa0;On the baseline survey (n&#x2009;=&#x2009;46), 67% agreed that complex cardiac anatomy is difficult to interpret with 2D imaging. Twelve MR cases were presented. On the post-survey (n&#x2009;=&#x2009;100), 93% rated the MR model quality as good/excellent, 75% felt that MR improved their understanding of the cardiac anatomy, and 89% supported regular use of MR in CMC. Among surgeons and interventionalists, 82% reported improved procedural planning and 57% altered their procedural approach.&#xa0;Mixed reality imaging can be successfully incorporated into CMC presentations and discussions, with positive participant responses. MR provides a virtual 3D framework that closely replicates patient anatomy and supports pre-procedural planning and execution.

To systematically review and report patient-reported outcome measures (PROMs), rates of return to sport, and secondary surgeries in dancers and flexibility sport athletes who underwent hip arthroscopy. Using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, a systematic review was performed with a literature search of the PubMed and Embase in August 2025. Inclusion criteria were studies investigating surgical outcomes on dancers and flexibility sport athletes undergoing hip arthroscopy. Exclusion criteria included non-English language studies, reviews, meta-analyses, systematic reviews, case reports, conference abstracts, and editorial commentaries. Data for patient demographics, follow-up time, PROMs, and rates of return to sport and secondary surgeries were collected. The minimal clinically important difference and patient acceptable symptom state rates were reported when available. Seven articles were included with 440 patients (460 hips). All studies had a retrospective study design, with mean follow-up times from 23 to 79.1&#x2009;months, with most of the patients being females (ranged from 61.2% to 100%). All studies reported baseline and postoperative PROMs data with significant improvement. Two studies reported minimal clinically important difference rates ranging from 76.9% to 85.7%. Return-to-sport rates ranged from 75.6% to 97%. Rate for revision hip arthroscopic surgery ranged from 0 to 9.8%. Dancers and flexibility sport athletes who underwent hip arthroscopy showed significant improvement in PROMs with minimal clinically important difference rates ranging from 76.9% to 85.7%, a high average rate of return to sport of 84.6%, and an average revision hip arthroscopy rates ranging from 0% to 9.8% at short-to-mid-term follow-up. Level IV, systematic review of Level III and IV studies.

Firefighters suppressing wildland urban interface (WUI) fires may be exposed to smoke from burning vegetation as well as structures and vehicles. To better understand firefighters' internal dose exposures in the WUI environment, 250 firefighters from Southern California were enrolled into the Fire Fighter Cancer Cohort Study (FFCCS) in 2019, providing urine samples at enrollment and post-fire. One-hundred and twenty-five post-fire samples were collected from 89 participants. Samples were analyzed for metal(loid)s and metabolites of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and organophosphate esters (OPEs). We assessed the difference between creatinine-corrected urine concentrations for each chemical at enrollment compared with post-fire, controlling for the individual participant. We also compared these concentrations to the general U.S. population concentrations from the National Health and Nutrition Examination Survey (NHANES) and the American Conference of Governmental Industrial Hygienists Biological Exposure Indices (BEIs) when available. All seven PAH and 11 VOC metabolite concentrations increased significantly from enrollment to post-fire. Diphenyl phosphate, antimony, and cadmium also significantly increased from enrollment to post-fire. Maximum post-fire concentrations in firefighters also exceeded the BEI for 1-hydroxyprene and trans,trans-muconic acid (a metabolite of benzene). Firefighters assigned to structure defense had significantly higher increases in PAH metabolites compared to those assigned to wildland firefighting tasks. Personal protective equipment (PPE) usage was not evaluated in this study, but future studies could combine personal sampling with the collection of detailed PPE usage to develop effective practices and decontamination strategies during WUI fire responses.

Polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), is a common endocrine and metabolic disorder in reproductive-age women, characterized by marked clinical and biological heterogeneity. Accumulating evidence suggests that gut microbiota dysbiosis is associated with metabolic disturbances, hormonal imbalance, and ovarian dysfunction in PMOS. However, the pathways linking gut microbiota alterations to PMOS pathogenesis remain incompletely understood, and most evidence remains associative. This review aims to summarize current evidence regarding interactions between gut microbiota and PMOS, clarify the roles of key microbiota-derived metabolites, and evaluate the potential and limitations of gut microbiota-targeted interventions. A major novelty is the proposal of an integrated gut-metabolism-endocrine-ovary axis incorporating phenotypic heterogeneity, methodological variability, and evidence grading across clinical and preclinical studies. A narrative review with a systematic literature search was conducted. PubMed, Web of Science, Embase, and CNKI were searched from inception to March 2026 using terms related to PMOS, gut microbiota, microbial metabolites, and microbiota-targeted interventions. Eligible studies included human observational or interventional studies, animal experiments exploring microbiota-PMOS mechanisms, and peer-reviewed full-text articles in English or Chinese. Case reports, letters, conference abstracts, non-English publications, and irrelevant studies were excluded. Duplicate records were removed. Two authors independently screened records and resolved disagreements by consensus. No meta-analysis was performed, and clinical registration was not applicable. Gut microbiota dysbiosis may contribute to PMOS through chronic low-grade inflammation, insulin resistance, and hyperandrogenism. Microbiota-derived metabolites link intestinal dysbiosis with metabolic and endocrine dysfunction. Bile acids and short-chain fatty acids exert regulatory effects, whereas amino acid disorders and LPS-mediated endotoxemia amplify metabolic and inflammatory abnormalities. Considerable heterogeneity exists across studies regarding obesity, insulin resistance, hyperandrogenism, diet, ethnicity, region, and methodology. Microbiota-targeted interventions show potential, although evidence quality varies and most findings remain associative. Gut microbiota dysbiosis is a critical regulatory node within the integrated gut-metabolism-endocrine-ovary axis in PMOS. This review highlights phenotypic stratification, evidence hierarchy, and clinical translation potential. Although microbiota-targeted strategies may serve as adjunctive therapies, their causal roles and long-term efficacy require confirmation in well-designed longitudinal and randomized controlled trials.

We conducted a systematic review and meta-analysis to compare the effectiveness of shunts with and without anti-siphon devices (ASDs) or other flow-regulating systems in preventing cerebrospinal fluid (CSF) overdrainage and its associated complications. Following established guidelines, we searched PubMed, Embase, Scopus, Cochrane, and Web of Science for clinical studies evaluating adult patients diagnosed with NPH who underwent CSF shunting with ASDs or flow-regulating valves, and included a control group of patients with standard CSF shunts lacking such mechanisms. Non-English studies, conference abstracts, and case reports were ineligible. We included seven studies with 928 patients. Although most outcomes showed no statistically significant difference between the intervention and control groups, ASDs had reduced incidences of subdural hygroma (OR = 0.33; p = 0.0368) and subdural hematoma (RR = 0.35; p = 0.0014), indicating a clear benefit in preventing these adverse events. ASDs significantly reduced the development of subdural hygroma and subdural hematoma, playing a vital role in preventing neurological sequelae.

Glaucoma is an increasing global health problem and the leading cause of irreversible blindness which affects millions of people worldwide. Multiple studies on the cost-effectiveness of glaucoma screening conducted at community, clinic or hospital in developed and developing countries have been conducted, but evidence from systematic reviews is lacking. Therefore, this systematic review aims to assess the cost-effectiveness of glaucoma screening among adult populations across various countries and healthcare settings. A systematic search will be conducted in databases including PubMed using a combination of Medical Subject Headings such as glaucoma and cost-effectiveness analysis along with relevant keywords like screening. Following the predefined inclusion criteria, two reviewers will independently screen the titles, abstract and full text, and any disagreements will be discussed or resolved by a third reviewer. Methodological quality will be assessed using the Joanna Briggs Institute (JBI) checklist for economic evaluations. Data will be extracted using the JBI economic evaluation data extraction form with any suitable modifications. JBI Dominance Ranking Matrix for economic evaluations will be used to summarise and compare the results for data synthesis. All reported costs will be converted into a single currency and year prior to synthesis. Cost-effectiveness evidence will be synthesised on the basis of cost per case detected or blindness prevented, cost per quality-adjusted life year gained or cost per disability-adjusted life year averted. Grading of Recommendations, Assessment, Development and Evaluation assessment will be conducted to evaluate the certainty of economic evidence, such as use of resources and expenditures, and to incorporate the results into the decision-making process. This systematic review will analyse published peer-reviewed studies and targeted grey literature only and does not require ethics committee approval. Results will be disseminated through publication in a peer-reviewed journal and through conference presentations. Extracted data and supporting materials will be made available on reasonable request. CRD42017057560.

Objectives The COVID-19 pandemic disrupted in-person medical school teaching, and certain parts of the curriculum were disproportionately affected, including traditional hands-on training in point-of-care ultrasound (POCUS). It is challenging to find interactive methods for teaching POCUS while conveying image acquisition techniques via online video-conference platforms for distance learning. Our objective was to evaluate the effectiveness and learners&#xa0;perceptions of POCUS gamification distance learning. Methods This was a cross-sectional study at an academic center. Study participants were third-year medical students (MS3) with minimal ultrasound experience. A pre-test was administered. Point-of-care ultrasound (POCUS) fellowship-trained emergency medicine (EM) faculty gave an online 1-h review lecture on basic POCUS applications and ran an online POCUS Pictionary session, where a student was randomly chosen to illustrate a POCUS topic. After each turn, the instructor reviewed teaching points. Students completed a post-test and survey. Descriptive statistics were used to summarize the data. Survey responses were reported as percentages of total respondents with 95% confidence intervals, and a two-sample t-test was performed to determine the statistical significance of pre-&#xa0;and post-test performances. Results A total of 73 students completed the pre-test, post-test, and survey. The average pre-test score was 53.3% (&#xb1;15.9%), and the post-test score was 84.0% (&#xb1;13.2%). Performance improvement was statistically significant (p<0.001). Before the sessions, students had the lowest familiarity with Extended Focused Assessment with Sonography in Trauma (eFAST), peripheral nerves, and soft-tissue ultrasound. After the sessions, the majority of students reported being more confident in performing almost all the reviewed applications. The vast majority (90.4%) stated that if possible, they would prefer in-person hands-on sessions for POCUS training. Conclusion Medical students' POCUS knowledge improved significantly after a didactics session and a gamified point-of-care ultrasound distance-learning session. Although the sessions increased their confidence in image acquisition and interpretation, students preferred in-person, hands-on training and practice when given the opportunity.

Objective: To review the emerging evidence supporting the use of nerandomilast (Jascayd), a selective phosphodiesterase-4B (PDE4B) inhibitor, for the treatment of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). The review aims to summarize its mechanism of action, efficacy, safety, and potential role as monotherapy or in combination with existing antifibrotic therapies. Data Sources: A literature search was conducted using PubMed, Embase, ClinicalTrials.gov, and relevant conference proceedings from January 2018 through December 2025. Search terms included nerandomilast, BI 1015550, Jascayd, phosphodiesterase-4B inhibitor, idiopathic pulmonary fibrosis, progressive pulmonary fibrosis, interstitial lung disease, FIBRONEER-IPF, and FIBRONEER-ILD. Human studies published in English were included. Study Selection and Data Extraction: Original clinical studies, phase II and phase III trials, subgroup analyses, and regulatory publications evaluating nerandomilast in patients with IPF or PPF were reviewed. Studies were selected based on relevance to efficacy, safety, mechanism of action, and clinical outcomes. Data regarding study design, patient population, forced vital capacity (FVC) outcomes, adverse events, and concomitant antifibrotic use were extracted and qualitatively synthesized. Data Synthesis: Nerandomilast was approved in October 2025 for the treatment of IPF and PPF, representing the first PDE4B inhibitor approved for fibrotic lung disease. By inhibiting PDE4B, nerandomilast increases intracellular cyclic adenosine monophosphate (cAMP) levels, resulting in reduced inflammatory cytokine production and decreased fibroblast activation. Clinical trials, including the phase III FIBRONEER-IPF study, demonstrated a significant reduction in the rate of FVC decline compared with placebo, indicating attenuation of disease progression. Benefits were observed both in patients receiving nerandomilast alone and in those receiving background antifibrotic therapy with pirfenidone or nintedanib. Overall, nerandomilast demonstrated a favorable benefit-risk profile and offers a mechanistically distinct approach compared with currently available antifibrotic agents. Conclusions: Nerandomilast provides a novel anti-inflammatory and antifibrotic treatment option for patients with IPF and PPF. Available evidence suggests meaningful reductions in lung function decline with acceptable tolerability, including use alongside established antifibrotic therapies. As longer-term and real-world data emerge, nerandomilast may become an important component of the therapeutic strategy for progressive fibrotic lung diseases.

Immune exclusion in cold tumors is a major mechanism of immunotherapy resistance, and TGF-&#x3b2; signaling acts as a key orchestrator of this process. The clinical development of TGF-&#x3b2;/PD-(L)1 dual-targeting agents has seen both setbacks and breakthroughs, and a critical examination of this strategy is therefore timely and translationally relevant. This work summarizes the mechanisms by which TGF-&#x3b2; drives immune exclusion through stromal remodeling, metabolic suppression, and immune cell regulation. It systematically analyzes preclinical and clinical evidence on bifunctional fusion proteins, represented by M7824 and SHR-1701, as well as bispecific antibodies. Key translational challenges, including therapeutic window constraints, biomarker development, and indication selection, are discussed. The literature search covered PubMed and major oncology conference proceedings on TGF-&#x3b2;/PD-(L)1 dual blockade. The success of TGF-&#x3b2;-targeted therapy depends on moving beyond broad pathway inhibition toward biomarker-guided patient selection and context-dependent intervention. Spatially or biologically restricted targeting, multi-parametric biomarker frameworks, and mechanism-driven combination regimens are likely to define the next phase of clinical development in this field.

Respiratory distress syndrome (RDS), or hyaline membrane disease, is a common condition in preterm infants (< 37 weeks' gestation) and a leading cause of neonatal morbidity and mortality. The risk is highest in extremely preterm (< 28 weeks) and very preterm (28 to < 31 weeks) infants due to immature lung and cardiovascular development. RDS results from a deficiency or dysfunction of pulmonary surfactant, which lines the alveoli to reduce surface tension, prevent atelectasis, and protect the lungs. Surfactant is primarily composed of dipalmitoylphosphatidylcholine (DPPC), other phospholipids, and four proteins that support its function, recycling, and innate lung defense. Surfactant replacement therapy improves lung compliance, reduces the need for ventilator support, and decreases the risk of pneumothorax, death, and the combined outcome of death or bronchopulmonary dysplasia. Its widespread use has substantially improved survival among preterm infants without increasing long-term neurological or developmental disability. Various surfactant preparations, including animal-derived, synthetic, and protein or peptide-containing formulations have been evaluated. Surfactant can be administered prophylactically immediately after birth or selectively once RDS develops. Both strategies are effective, with theoretical advantages and disadvantages. Prophylactic surfactant may prevent respiratory insufficiency, reduce the need for ventilator support, and distribute surfactant more evenly in fluid-filled lungs, lowering the risk of lung injury. Selective treatment targets only infants with clinical RDS, avoiding unnecessary therapy, potential risks, and costs for those who would not benefit. Administration methods include endotracheal tube, intubation with rapid extubation, thin catheter, laryngeal mask, hypopharyngeal deposition, and, more recently, aerosolized or nebulized approaches, though the effectiveness of the latter remains unproven. For this review, a prophylactic strategy refers to intubation and bolus surfactant administration immediately after birth, while selective therapy refers to administration once evidence of RDS is present. The effect of surfactant may differ in infants stabilized early on continuous positive airway pressure (CPAP) and those whose mothers received a complete course of antenatal corticosteroids. In these infants, the benefits of prophylactic surfactant appear less pronounced than in neonates who did not receive early CPAP or antenatal steroids. In this update, we explored these factors in subgroup analyses, as in the previous version of the review. Additionally, we examined how the threshold of FiO&#x2082; (fraction of inspired oxygen) used to initiate selective treatment, as well as the method of surfactant administration, might influence the effect of the surfactant replacement strategies. To compare the effect of prophylactic surfactant administration versus selective surfactant administration on morbidity and mortality in preterm infants at risk of respiratory distress syndrome (RDS). We searched CENTRAL, MEDLINE, Embase, and CINAHL on 31 January 2025. To identify any studies not captured by our search of bibliographical databases, we also searched clinical trial registers, conference proceedings, and reference lists of included studies and surfactant reviews. We included randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic surfactant administration in preterm infants at risk of RDS versus surfactant treatment of preterm infants with established RDS. We used standard Cochrane methods. Our main outcomes were mortality, neurodevelopmental disability, and complications of preterm birth including pneumothorax and chronic lung disease. We performed meta-analysis and expressed our results using mean difference (MD), standardized mean difference (SMD), or risk ratio (RR), with 95% confidence intervals (CIs). We used GRADE to assess the certainty of the evidence. We identified 10 relevant individually randomized controlled trials (involving 3151 preterm infants). All trials were conducted in North America and Europe. Eight were conducted in the 1990s, and two were published more recently, at a time of greater use of antenatal steroids and nasal continuous positive airway pressure (CPAP). Nine trials were at risk of performance and detection bias. When all studies are considered, prophylactic surfactant probably results in little to no difference in the risk of chronic lung disease (CLD) at 36 weeks' postmenstrual age compared to selective use of surfactant (RR 1.13, 95% CI 1.00 to 1.28; I&#xb2; = 0%; RD 0.04, 95% CI 0.00 to 0.08; NNTH 25 95% CI 13 to > 1000; I&#xb2; = 0%; 5 trials, 1874 infants; moderate-certainty evidence). There may be little to no difference between the prophylactic and selective approaches in moderate to severe neurodevelopmental impairment (RR 0.83, 95% CI 0.57 to 1.21; 1 trial, 976 infants; I2 not applicable; low-certainty evidence). Prophylactic surfactant may result in a slight reduction in pneumothorax compared to selective surfactant administration (RR 0.76, 95% CI 0.56 to 1.04; I&#xb2; = 12%; 8 trials, 3094 infants; low-certainty evidence). In studies in which infants were stabilized on CPAP, the use of prophylactic surfactant, compared with selective surfactant administration, may make little to no difference to the risk of chronic lung disease and probably slightly increases mortality, while the evidence remains uncertain regarding the effect of prophylactic surfactant on all other outcomes, including pneumothorax. In contrast, in settings without routine use of CPAP, prophylactic surfactant reduces mortality and may reduce pneumothorax slightly, with very uncertain evidence for CLD. In our view, these findings support managing neonates at risk of respiratory distress syndrome with initial stabilization using CPAP and then selective surfactant administration. We were not able to draw conclusions about our subgroup analyses conducted according to receipt of antenatal steroids, threshold used to apply selective treatment, and method of surfactant administration, which provided evidence of low to very low certainty. There were insufficient data to carry out subgroup analysis by gestational age. Studies of prophylactic surfactant administration in infants at risk of developing RDS that were conducted prior to widespread use of maternal prenatal steroids and routine early stabilization on CPAP demonstrated a decreased risk of mortality and slight reduction in pneumothorax compared with selective surfactant use in infants with established RDS. However, larger trials that reflect current neonatal care practices do not support this finding. Instead, they show that, compared with selective surfactant administration in infants stabilized on CPAP, prophylactic surfactant likely results in little to no difference in the risk of chronic lung disease and slightly increases mortality.

Falls affect approximately one-third of community-dwelling adults aged 65 years and older annually, with healthcare costs exceeding US$80&#x2009;billion in the USA alone. Home-based fall detection technologies have proliferated, yet cost-effectiveness evidence remains fragmented. To systematically identify, appraise and synthesise evidence on the cost-effectiveness of home-based fall detection and monitoring technologies for community-dwelling older adults. This protocol is reported following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will be conducted across MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and economic databases from database inception to the date the searches are executed. Two reviewers will independently screen studies using Covidence, extract data and assess quality using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and Drummond checklists. Narrative synthesis with meta-analysis where appropriate will be employed. Ethical approval is not required as this systematic review will analyse only previously published, aggregate data and will not involve primary data collection from human participants. Findings will be disseminated through peer-reviewed open-access publication, conference presentations and accessible formats developed with patient and caregiver advocacy organisations. The protocol is registered with PROSPERO (CRD420261433029).

Antipsychotic-induced weight gain (AIWG) is a major clinical concern, affecting approximately 30% of patients. Clinical predictors explain only part of AIWG risk. Genetic and molecular variations are hypothesized to contribute to susceptibility. The purpose of this review is to summarize recent results to identify replicated and novel findings. Applying PRISMA guidelines, we searched MEDLINE, Embase, and PsycINFO (May 2018-May 2026) for studies on genetic and molecular associations with AIWG, extending our prior review. Reviews, editorials, and conference abstracts were excluded. We extracted study characteristics (design, diagnosis, antipsychotic exposure, sample size, ancestry, genetic variants, and AIWG outcomes) (e.g., &#x2265;7% weight gain, BMI change). Fifty-three studies met inclusion criteria. In candidate gene studies, the most consistently replicated genes associated with AIWG were observed for DRD2, HTR2C, and MC4R. Multiple novel associations were identified by genome-wide association studies (GWAS) (e.g., MAP2K1, ZDBF2, PEPD), polygenic risk scores (PRS) (e.g., body mass index PRS), gene expression (e.g., CYP3A4, EP300), and epigenetic analyses (e.g., cg12034943 at CRTC1). Polymorphisms in candidate genes related to neurotransmission and appetite regulation continue to be investigated for associations with AIWG, while novel findings have emerged from GWAS, gene expression, and epigenetic studies. Evidence remains inconsistent due to limited replication, methodological variability, sparse ancestry data, and geographical underrepresentation. No single genetic variant is ready for clinical use, and multi-omic and multi-ancestry models are needed to improve prediction and clinical utility.