The aim was to analyze current orthodontic retention protocols in Croatia and their trend over a 10-year period. In a repeated cross-sectional survey, questionnaires were distributed to 150 orthodontists in Croatia in 2013 and 185 of them in 2023 (representing 69% and 85% of practicing orthodontists with response rates of 61% and 75%). Significant changes in retainer types across different malocclusions and treatment protocols were observed over a 10-year period. There was an increase in the use of VFR and a decrease in acrylic retention plates in both jaws (p≤0.001). Over the decade, the use of only fixed retention in the mandible declined from 20% to 7% (p=0.007), and the combination of fixed and removable retention in the maxilla dropped from 29% to 17% (p≤0.033). Increased use of removable retainers was noted in cases involving rotations, open bites, and extractions. Conversely, fixed-removable retainers were more frequently used in spacing cases (p≤0.001). There was a trend toward fewer check-ups (p=0.001) and toward increased patient self-monitoring (p=0.021). Personal experience as the primary reason for choosing a retention protocol increased from 39% to 62% (p<0.001). Additionally, the use of written information on retention rose from 39% to 69% (p<0.001). Retention practices in Croatia have evolved over the past decade, characterized by increased use of VFRs, more frequent implementation of dual retention in the mandible, and greater provision of written retention information. Additionally, follow-up protocols have shifted toward fewer scheduled visits, with increased emphasis on patient self-monitoring.
[This corrects the article DOI: 10.2147/IMCRJ.S476407.].
The increasing incidence of esotropia, potentially associated with excessive smartphone use, highlights the importance of ensuring the safety of strabismus surgery. This nationwide questionnaire survey, conducted as the Japanese Strabismus Surgery (JASS) study, aimed to estimate the incidence of severe complications associated with strabismus surgery and to characterize perioperative management practices in Japan. Nationwide, multicenter, questionnaire-based survey study. All strabismus specialists affiliated with the Japanese Association for Strabismus and Amblyopia. We conducted the survey between July and August 2025. We developed a structured questionnaire using Research Electronic Data Capture. Number of severe complications, including infectious endophthalmitis, orbital cellulitis, anterior segment ischemia (grade 3 or higher), and scleral perforation with retinal detachment, as well as perioperative management protocols. Of 210 specialists, 99 completed the questionnaire (response rate, 47.1%). After excluding 2 nonsurgical respondents, we analyzed data from 97 active surgeons (mean experience, 28.7 ± 12.2 years) covering 108 623 strabismus surgeries. Incidence rates (per 100 000 surgeries) of severe complications were 0.92 (95% confidence interval [CI], 0.02-5.13) for infectious endophthalmitis, 1.84 (95% CI, 0.22-6.65) for orbital cellulitis, 8.29 (95% CI, 3.79-15.73) for anterior segment ischemia, and 3.68 (95% CI, 1.00-9.43) for scleral perforation with retinal detachment. For perioperative management, nearly all surgeons (91.8%) used povidone-iodine immediately before surgery, all (100%) prescribed postoperative antibiotics, and most (74.2%) used adhesive drapes. A large majority (87.6%) conducted the first postoperative follow-up examination on day 1. This JASS study demonstrates that severe complications associated with strabismus surgery are exceedingly rare in Japan. Stringent, standardized management protocols, particularly for infection control and early postoperative follow-up, may contribute to this high level of safety. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Wheezing is a common respiratory symptom in infants and toddlers, and recurrent wheezing is a significant respiratory disorder affecting this age group. Given the multifactorial etiology of recurrent wheezing, clinical practice lacks standardized diagnostic and therapeutic protocols. Recent years have witnessed substantial progress in clinical research and therapeutic advancements, yielding robust evidence to inform clinical decision-making for recurrent wheezing in infants and toddlers. The guideline is developed by integrating the latest domestic and international clinical consensus statements, evidence-based guidelines, and relevant research findings. Meanwhile, this guideline comprehensively takes into account the actual situation in China and the opinions of Chinese experts. This guideline aims to provide clinicians with standardized protocols to enhance diagnostic accuracy and therapeutic efficacy in managing infants and toddlers with recurrent wheezing.
Oral cancer (OC) and oral potentially malignant disorders (OPMDs) remain major global public health challenges, particularly in low-and middle-income countries. Although early detection substantially improves prognosis, limited healthcare infrastructure restricts timely diagnosis. Artificial intelligence (AI) enabled, mobile phone-based diagnostic systems offer a promising, accessible solution, and multiple systematic reviews have demonstrated their potential. However, uncertainty persists regarding the comparative performance of AI models across diverse real-world settings. An umbrella review was aimed at evaluating the comparative performance of different AI models in detecting OC and OPMD. This research identified six systematic reviews from databases such as Medline (via PubMed), Web of Science, Scopus, and EMBASE through October 2024 which were checked at the title, abstract, and full-text levels. The risk of bias (ROB) was then assessed using the Joanna Briggs Institute's ROB assessment tool. Across included reviews, pooled sensitivity and specificity for AI-based detection ranged from 88% to 92%, with reported diagnostic odds ratios ranging from 114 to 2549, indicating strong discriminatory performance. Deep learning architectures such as EfficientNet and ResNet consistently demonstrated high diagnostic accuracy, while hybrid approaches (e.g., MLSO + SVM) showed promising performance in selected analyses. However, substantial heterogeneity was observed across studies (I 2 often >85%), reflecting variability in populations, image acquisition protocols, and model architectures. Deep learning models like EfficientNet and ResNet are favored in clinical diagnostics for their exceptional performance and adaptability. Hybrid approaches, such as MLSO + SVM, also show great potential by combining the strengths of traditional and modern methods effectively.
Surgical site infections (SSIs) remain a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs. To evaluate the incidence, risk factors, microbiological profile, preventive measures, and outcomes of SSIs to inform targeted perioperative strategies. A hospital-based surveillance cohort study included 4,632 patients undergoing 4,860 surgical procedures between January 2022 and December 2024. Multivariate logistic regression identified independent predictors. A total of 382 patients developed SSIs (8.25%), corresponding to an incidence density of 12.4 per 1,000 patient-days. Independent predictors included hypoalbuminemia (OR 2.91), contaminated wounds (OR 2.83), emergency surgery (OR 2.66), operative duration >120 min (OR 2.41), and >20 operating room door openings (OR 1.77). Additional risk was associated with diabetes, anemia, ASA ≥ III status, and perioperative transfusion. Adherence to timely antibiotic prophylaxis and chlorhexidine skin preparation significantly reduced the risk of SSI (OR 0.39-0.51). Staphylococcus aureus accounted for 31.4% of cases, while Gram-negative bacilli exhibited high multidrug resistance. SSIs prolonged hospital stay by 8.9 days, tripled ICU admissions, increased 30-day mortality fourfold, and added approximately USD 2,450 in direct costs. The predictive model demonstrated strong discrimination (AUC 0.84) and good calibration. SSIs impose substantial clinical and economic burdens. Optimized perioperative care, strict adherence to prophylactic protocols, and improved environmental control measures are critical to reducing infection rates and improving surgical outcomes.
For children aged 0-5 years, hospitalization is a very stressful experience. Even, the older children are quite tense during hospitalization for a serious illness, and want their parents to be available there. Play is a key aspect for any developing child which helps in promoting the child's growth and development. Toys are the 'tools' of play and age-appropriate toys can be helpful for reducing the trauma and stressful feelings during hospitalization. Appropriate use of toys and play therapy will aid in enhancing the recovery from the illness. Play therapy can be included in the care and treatment plan of hospitalized children. This review aimed to assess the available evidences in literature regarding effectiveness of Play therapy for harnessing development in hospitalized children. A search was made in PubMed using keywords "play therapy"[Title/Abstract] AND "Hospitalization"[Title/Abstract]; "Child Development"[Title/Abstract] AND "Play Sessions"[Title/ Abstract]; "Play"[Title/Abstract] AND "Hospitalization"[Title/Abstract]; "Play Therapy" AND "Child Development"[Title/Abstract]; "Therapeutic Play Session"[Title/Abstract], "Effectiveness" AND "Play Therapy"[Title/Abstract]; "play therapy"[MeSH Terms] AND "child development"[MeSH Terms]. Studies over the last 10 years were explored. A total of 125 published articles were obtained. After screening and applying inclusion/exclusion criteria, a total of 31 studies were shortlisted and imported to Zotero for further analysis. Most of the studies have established the effectiveness of Play Therapy in hospital settings in promoting the cognitive, behavioral, and socioemotional development and in reducing the hospitalization-related anxiety. A dedicated play session can be incorporated into the healthcare management protocols for pediatric inpatient settings.
Background Oral squamous cell carcinoma (OSCC) is a common malignancy with variable clinical outcomes and a high risk of recurrence. Conventional prognostic indicators often fail to fully capture tumor behavior. Serum growth factors and inflammatory mediators, such as the epidermal growth factor receptor (EGFR), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), may provide additional insights into disease progression and prognosis. This study aimed to evaluate the prognostic significance of serial serum levels of EGFR, IL-6, and TNF-α in patients with OSCC. Methodology This prospective cohort study included 120 patients with histopathologically confirmed OSCC. Serum samples were collected at baseline, 6 months, and 12 months and analyzed for EGFR, IL-6, and TNF-α using enzyme-linked immunosorbent assay. Clinical and pathological data were also recorded. Statistical analyses were performed. Intergroup comparisons were conducted using independent t-tests, correlations were assessed using Spearman's coefficient, and Cox proportional hazards regression analysis was used to identify predictors of recurrence-free survival. Results In total, 34 (28.33%) patients with recurrence showed significantly higher baseline levels of EGFR (82.3 ± 24.1 vs. 62.9 ± 19.4 ng/mL), IL-6 (26.4 ± 10.8 vs. 15.9 ± 7.1 pg/mL), and TNF-α (42.7 ± 16.3 vs. 28.6 ± 12.1 pg/mL) compared to non-recurrent cases (p < 0.001). Similar trends persisted at 6 and 12 months (p < 0.001). Significant positive correlations were identified between baseline biomarker levels and clinicopathological parameters. Tumor size showed moderate correlations with EGFR (r = 0.54), IL-6 (r = 0.48), and TNF-α (r = 0.42). Similarly, tumor-node-metastasis stage demonstrated strong correlations with EGFR (r = 0.61), IL-6 (r = 0.57), and TNF-α (r = 0.51). Lymph node metastasis also showed significant positive correlations with EGFR (r = 0.52), IL-6 (r = 0.49), and TNF-α (r = 0.45) (p < 0.001). Multivariate analysis identified the baseline EGFR (p < 0.001), IL-6 (p = 0.002), and TNF-α (p = 0.028) as independent predictors of recurrence of OSCC. Conclusions Serum EGFR, IL-6, and TNF-α may serve as potential prognostic indicators for OSCC. The findings of this study suggest that combining growth factors and inflammatory biomarkers could have clinical utility for improving prognostic assessment in OSCC. Serial monitoring may provide a dynamic approach for identifying patients at higher risk of recurrence, thereby facilitating timely therapeutic interventions and closer surveillance. Incorporation of these markers into routine clinical protocols might contribute to more personalized treatment strategies and potentially improve long-term outcomes. However, further large-scale studies are required to validate these findings and establish standardized clinical thresholds.
The demand for esthetically driven dental treatment has increased substantially with advances in adhesive dentistry. This case series describes three anterior esthetic rehabilitation scenarios: (i) direct composite veneering for correction of anterior malalignment in vital teeth, (ii) combined in-office bleaching and direct composite veneering for fluorosis-associated discoloration in vital teeth, and (iii) conservative rehabilitation of structurally compromised endodontically treated teeth with sodium ascorbate neutralization, and anatomic fiber post fabrication with adhesive core reconstruction. All cases demonstrated satisfactory immediate esthetic and functional outcomes. Follow-up evaluations showed stability of the restorations. Adhesive restorative procedures provide versatile and cost-effective solutions for anterior esthetic rehabilitation across a broad spectrum of clinical presentations. When executed with appropriate case selection, meticulous adhesive protocols, and systematic finishing and polishing, direct composite restorations and adhesive post-endodontic rehabilitation can provide predictable esthetic and functional outcomes.
Necrotic immature permanent teeth with open apices pose a difficult management problem in clinical endodontics. Conventional apexification techniques resolve infection but do not support continued root development, leaving the tooth structurally vulnerable. Regenerative endodontic procedures (REPs) have emerged as a biologically oriented alternative that harnesses stem cells, scaffolds, and growth factors to form new tissue within the root canal space and encourage root maturation. This narrative review discusses the biological principles underlying REPs, the clinical protocols currently in use, the reported treatment outcomes, the key prognostic factors, and the limitations of current evidence. Overall, REPs demonstrate favorable rates of periapical healing and continued root development, with platelet-rich plasma and platelet-rich fibrin scaffolds showing advantages over blood clot alone for dentinal wall thickening. Pulp sensibility recovery is variable and does not reliably confirm true pulp regeneration. Current outcomes more closely reflect biologically supported repair than consistent, predictable pulp regeneration. Standardized protocols and longer-term follow-up studies are needed to fully establish the evidence base for these procedures.
Understanding how gut microbiota support migratory birds is essential; yet, fecal sample freshness is often a challenge, particularly for rare species that cannot be captured directly. Here, we collected fecal samples from multiple captive migratory bird species at Nanchang Zoo and grouped them by post-defecation time (0, 1, 2, and 4 h). Using both relative and absolute quantification, we assessed the effects of host identity, short-term storage, and their interaction on gut microbiota composition. Species identity and quantification method significantly shaped microbiota profiles. Absolute quantification revealed Firmicutes (763,405.73 copies/μL) and Proteobacteria (340,231.03 copies/μL) as dominant in Grey-crowned Cranes, whereas relative quantification indicated Firmicutes (96.74%) predominated in Swan Geese and Proteobacteria (30.30%) in Black-necked Cranes. Red-crowned Cranes showed higher species richness than Black Swans and Swan Geese, with a significantly greater Shannon index than the latter. PCoA demonstrated clear interspecific differences, especially between crane and waterfowl lineages. Storage time had no significant effects on alpha and beta diversity across 6 species, except for reduced richness in Swan Geese at 2 and 4 h. While overall community structure was stable, a few conditionally rare taxa displayed time-sensitive shifts shortly after defecation. Our findings highlight that both host identity and quantification approach are critical determinants of avian gut microbiota profiles and emphasize that fecal sample freshness mainly affects rare taxa. This study provides methodological insights for optimizing fecal sampling protocols in field-based microbiome research on migratory birds.
Based on clinical experience and expert consensus from over a hundred medical centers across China, this technical specification systematically establishes a comprehensive operational framework for the standardized W-H fundoplication procedure in gastroesophageal reflux disease (GERD). To address common limitations of conventional techniques, such as postoperative dysphagia, bloating, and relatively high recurrence rates, this procedure incorporates a series of key innovations. These include precise hiatal repair with selective mesh reinforcement, restoration of the His angle, left-sided 180° fundoplication, reconstruction of the phreno-esophageal ligament, and novel three-dimensional fixation of the anti-reflux apparatus ("Wang fixation"). These techniques collectively enable physiological reconstruction of the anti-reflux barrier. The approach effectively balances anti-reflux efficacy with preservation of postoperative function while eliminating the need for routine division of the short gastric vessels. The technical specification comprehensively covers preoperative multidisciplinary evaluation, surgical indications, perioperative management, and a standardized surgical protocol (encompassing core components such as patient positioning/port placement, esophagus/hiatal dissection, hernia repair, mesh placement, fundoplication, posterior gastroesophageal junction fixation, and lesser omentum reconstruction), along with structured follow-up protocols. Its core philosophy places equal importance on both anatomical repair and functional recovery, integrating individualized surgical strategies with standardized procedures. This initiative aims to advance the standardization of GERD surgical management in China, providing clinicians with systematic and practical technical guidance and decision-making support.
This present study evaluated the utility of auricular acupressure (AA) in alleviating catheter-related bladder discomfort (CRBD). The efficacy and safety of current treatments for postoperative CRBD in male patients remain suboptimal. A randomized, placebo-controlled trial was conducted. This trial enrolled male patients postlumbar surgery from 1 July 2024 to 31 August 2024. Participants were allocated to an AA group (Group AA, n = 40) or a placebo control group (Group C, n = 40). Both groups received 3 days of intervention prior to surgery. Outcomes included the following: Moderate-to-severe CRBD at extubation; 24-h postoperative opioid requirement; CRBD severity (none/mild/moderate-to-severe) at 1, 6, and 24 h postextubation; postoperative pain; and patient satisfaction. Data were analyzed via SPSS 23 using t-tests, chi-square tests, and repeated-measures ANOVA. In this randomized trial of 80 male spinal surgery patients, AA significantly reduced moderate-to-severe CRBD incidence at extubation (T1): 22.5% (9/40) in Group AA vs. 52.5% (21/40) in Group C (RR: 0.263; 95% CI: 0.100-0.691; p = 0.006). AA decreased the subjects of 24-h supplemental opioid requirements (17.5% vs. 37.5%; RR: 2.829; 95% CI: 1.003-7.977; p = 0.045) and elevated patient satisfaction (median 5.0 vs. 4.0; p = 0.034). No between-group differences existed in morphine-equivalent consumption or CRBD severity beyond T1 (p > 0.05). AA is an effective, nonpharmacological intervention that reduces early postoperative CRBD severity and opioid demand while enhancing recovery satisfaction in catheterized males. As a noninvasive, side-effect-free intervention, AA warrants integration into enhanced recovery after surgery (ERAS) protocols for catheterized patients. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2400086089.
Classic Hodgkin lymphoma (CHL) constitutes a B-cell malignant lymphoid neoplasm derived from the germinal center. Despite current treatment protocols based on chemotherapy, radiotherapy, anti-cluster of differentiation (CD) 30 antibody-drug conjugates, immunotherapy, and hematopoietic stem cell transplantation (HSCT), between 10% and 20% of CHL patients fail to achieve a complete response. The reasons underlying this lack of treatment sensitivity remain unclear. Traditionally, clinical and analytical variables have constituted the cornerstone of CHL prognostic model development. However, in recent years, the distribution and spatial relationships of cancer and immune cells within the CHL tumor microenvironment (TME) have emerged as novel potential candidates for risk stratification and treatment personalization. Underpinning this field of research, advances in digital image analysis (DIA) and computational pathology (CP) tools have been fundamental, as these methods enable objective quantification of TME elements and the definition of their topological arrangement. Novel CHL prognostic models integrating data across DNA sequencing in peripheral blood (liquid biopsy), single-cell RNA sequencing (scRNAseq), spatial transcriptomics, positron emission tomography/computed tomography (PET/CT) imaging, and topological features of TME could inform better clinical decision-making in the near future. In this work, we review the current state of CP and DIA studies in CHL, emphasizing the transition from traditional histopathological characterization to computational biology, highlighting the prognostic value of TME components, and proposing an updated framework for CHL tumor evolution and cellular dynamics as ecological systems. This study aims to review the contributions of DIA and CP in clinical and translational research on CHL. The results of this study may contribute to the identification of new prognostic biomarkers and their use in both the design of risk stratification models and clinical trials for CHL.
Tropospheric ozone (O3) pollution and potentially toxic elements (PTEs) contamination are two of the most inescapable abiotic stressors threatening plant productivity and ecosystem stability. Independently, these stressors induce profound physiological and biochemical disruptions in plants, including oxidative stress, impaired stomatal function, and nutrient imbalances. Ozone primarily affects the apoplast, triggering reactive oxygen species (ROS)-mediated signalling, stomatal closure, and reprogramming of defense-related gene expression. While PTEs infiltrate cellular compartments, compromising photosynthesis, enzyme activities, and redox balance. Emerging studies reveal that their co-occurrence can produce antagonistic, synergistic, or additive possessions, depending on plant species, developmental stage, exposure intensity and experimental system. Both the stressors unite on oxidative stress (ROS) and antioxidant responses, stomatal behaviour, photosynthetic apparatus damage and altered nutrient and metal uptake/partitioning. However, insights into their combined impacts remain scarce. Literature is fragmented by methodological heterogeneity, limited crop coverage, and a lack of comprehensive omics, tracer and transport studies. This review scrutinizes the mechanistic responses of plants to individual and concurrent exposures to O₃ and PTEs, focusing on antioxidant defense systems, signaling networks, and key physiological traits. Additionally, we explore transcriptomic shifts that command acclimation or vulnerability, highlighting the molecular pathways that administrate plant responses under these stress conditions. Understanding these interactions is crucial for breeding resilient crop varieties and optimizing phytoremediation stratagems in polluted agroecosystems. Finally, this synthesis emphasizes the urgent need for multifactorial studies, standardized protocols, and validation under diverse soil and climatic conditions, crop genotypes and O₃ regimes to more accurately predict plant behaviour under real-world environmental stress scenarios. The online version contains supplementary material available at 10.1007/s12298-026-01723-5.
Obesity involves microbiota dysbiosis, low-grade inflammation, and insulin resistance, which interacts with multiple metabolic disorders. Fecal microbiota transplantation (FMT) is an emerging therapeutic approach in obesity that enhances intestinal barrier function and regulates energy metabolism. To provide a comprehensive overview of publication trends, research collaborations, hotspots, future directions, and the current clinical application status of FMT in obesity. Literature searches were conducted in the Web of Science (WoS) and PubMed databases. The primary analysis was performed using the WoS database for bibliometric analysis, while PubMed was searched to supplement the clinical research landscape, ensuring data comprehensiveness and methodological rigor. A total of 517 papers were finally included, of which 116 (22.44%) were published in the top 10 academic journals. Most publications originated from China (n = 246, 47.6%) and Zhejiang University contributed the most publications (n = 18, 3.5%). Gut Microbes ranked first (21 publications, IF 10.931), followed by Frontiers in Microbiology (19, IF 4.504) and Nutrients (14, IF 4.919). Research hotspots have shifted toward "targeting the gut microbiota." "Oral supplementation" and targeted "prebiotics" may be more accessible in the future. The mini literature review of 21 clinical trials revealed that metabolic improvements following FMT are often transient and highly variable across individuals. No standardized protocol for donor selection, delivery route, or outcome measurement currently exists, and most trials had small sample sizes. Although FMT shows promise, its clinical benefits remain transient and variable across individuals. Current evidence does not yet support routine clinical application. Targeted oral microbiota supplementation may represent a future direction, but high-quality, large-scale clinical trials are urgently needed to establish standardized protocols and evaluate long-term safety and efficacy.
Freezing of gait is among the most disabling motor complications of Parkinson's disease, markedly increasing fall risk and reducing quality of life. Repetitive transcranial magnetic stimulation has emerged as a non-invasive neuromodulation approach; however, evidence regarding its efficacy for freezing of gait remains heterogeneous and inconclusive. To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation for freezing of gait and motor outcomes in Parkinson's disease. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420261285716). PubMed, Scopus, Cochrane Library, and Web of Science were searched through January 2026 for randomized controlled trials. The primary outcome was freezing of gait severity measured by the Freezing of Gait Questionnaire. Pooled standardized mean differences were calculated using random-effects modeling. Twelve randomized controlled trials comprising 293 participants were included. Repetitive transcranial magnetic stimulation significantly improved freezing of gait severity as measured by the Freezing of Gait Questionnaire (standardized mean difference = -0.97, 95% confidence interval - 1.39 to -0.55; p < 0.001). Significant improvements were also observed in motor function, Timed Up and Go performance, gait speed, step/stride length, turn time, and turn steps, whereas cadence did not differ significantly. No serious adverse events were reported. Repetitive transcranial magnetic stimulation significantly improves freezing of gait and motor performance in Parkinson's disease, representing a safe and promising adjunctive therapy for gait disturbances refractory to conventional treatment. Future large-scale trials with standardized protocols are needed to confirm long-term efficacy.
As indications for anterior cruciate ligament reconstruction (ACLR) expand to older and more metabolically comorbid patients, diabetes mellitus (DM) has emerged as a potential determinant of surgical outcomes. However, existing evidence remains fragmented, with limited pooled data quantifying postoperative risk. The purpose was to systematically review evidence comparing postoperative complications between patients with and without DM undergoing ACLR. It was hypothesized that DM would be associated with an increased incidence of overall complications, but not of revision. Systematic review and meta-analysis; Level of evidence, 3. The PubMed, Embase, Web of Science, and Scopus databases were searched through March 2025 following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines. Observational studies reporting postoperative outcomes in patients with and without DM undergoing ACLR were included. Pooled risk ratios (RRs) with 95% CIs were calculated using fixed- or random-effects models, as appropriate. The primary outcome was revision, and secondary outcomes included infection, surgical-site infection (SSI), readmission, and venous thromboembolism (VTE). For studies with zero events in 1 arm, a continuity correction of 0.5 was applied to enable computation of pooled estimates and avoid division-by-zero errors. Risk of bias assessment across included studies was conducted using the Risk of Bias Assessment tool for Non-randomized Studies of Interventions Version 2. A total of 25 studies met the inclusion criteria. Compared with patient without DM, those with DM had significantly higher risks of postoperative infection (after sensitivity analysis, RR, 7.25 [95% CI, 3.07-17.08]; P < .001; I 2 = 17.9%), SSI (RR, 3.18 [95% CI, 1.74-5.81]; P = .0002; I 2 = 0%), readmission (RR, 2.04 [95% CI, 1.66-2.50]; P < .0001; I 2 = 0%), and VTE (RR, 2.19 [95% CI, 1.48-3.25]; P < .0001; I 2 = 0%). Revision rates did not differ significantly (RR, 0.68 [95% CI, 0.41-1.14]; P = .15; I 2 = 22.2%). Among the included studies, 18 had a moderate risk of bias, 5 had a low risk of bias, and 2 had a serious risk of bias. DM is associated with substantially increased risks of infection, SSI, readmission, and VTE after ACLR, although there was no significant difference in revision rates. These findings highlight the need for optimized perioperative strategies, including strict glycemic control, thoughtful graft selection, and tailored surgical protocols to improve safety and outcomes in patients with DM. CRD420251119493.
To systematically review and exploratorily analyze the effects of blood flow restriction combined with neuromuscular electrical stimulation (BFR-NMES) compared with neuromuscular electrical stimulation (NMES) alone on skeletal muscle strength and morphological adaptations in healthy adults. This systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420251141357). Relevant studies published up to September 2025 were retrieved from PubMed, Web of Science, and Embase. Randomized and non-randomized controlled studies comparing BFR-NMES with NMES alone were included. Primary outcomes included muscle strength (isometric and isokinetic strength) and muscle morphology outcomes (muscle thickness, cross-sectional area, muscle mass, and thigh circumference). Risk of bias was assessed using the ROB 2.0 tool, methodological quality was evaluated using the modified Jadad scale, and evidence quality was assessed using the GRADE approach. Due to substantial clinical and methodological heterogeneity among studies, the present study primarily adopted a qualitative synthesis combined with exploratory quantitative visualization analyses. Seven studies involving 124 healthy adults were included. Qualitative findings demonstrated that acute BFR-NMES interventions consistently induced greater immediate strength loss and neuromuscular fatigue, while simultaneously producing more pronounced acute muscle swelling and fluid shift responses. In contrast, long-term BFR-NMES interventions demonstrated more favorable trends in both muscle strength and muscle morphological adaptations compared with NMES alone. Exploratory forest plots further showed that acute studies generally favored NMES alone, whereas long-term studies consistently favored BFR-NMES. Collinearity analysis revealed substantial confounding between intervention duration and pressure prescription strategy: all long-term studies employed fixed-pressure protocols, whereas all acute studies adopted individualized arterial occlusion pressure (%AOP)-based strategies. No statistically significant differences were observed in the overall pooled analyses for muscle strength or rectus femoris thickness; however, substantial heterogeneity was present across studies. GRADE assessment indicated that the quality of evidence for most outcomes ranged from low to very low. Current evidence suggests that BFR-NMES may provide superior benefits over NMES alone in promoting acute muscle swelling and long-term muscle morphological adaptations, with potential advantages for long-term muscle strength development. However, the available evidence remains limited, and substantial confounding exists between intervention duration and pressure prescription strategies. Therefore, these findings should be interpreted cautiously. Future high-quality randomized controlled trials with larger sample sizes and independent manipulation of pressure strategies and intervention duration are warranted to clarify the true effects and optimal prescription strategies of BFR-NMES. PROSPERO, identifier: CRD420251141357.
Hyperthermia has emerged as a versatile modality in oncology, rehabilitation, and aesthetic medicine, yet conventional RF devices often suffer from insufficient penetration and collateral epidermal heating. This study proposes a miniaturized stacked cavity-backed antenna operating in the 2.4-2.5 GHz ISM band for depth-confined heating of facial subcutaneous fat. By leveraging the strong dielectric contrast at the skin-fat boundary, the design enhances the normal electric-field component in adipose tissue to promote preferential power deposition without active epidermal cooling. Electromagnetic simulations quantify field and SAR confinement, and multiphysics thermal simulations evaluate short-pulse therapeutic operation. The methodology is validated through ex vivo porcine experiments and a preliminary in vivo human feasibility test (10 W, surface thermography). The results confirm reproducible superficial warming at the target depth without adverse skin reactions. The study successfully demonstrates single-element hardware feasibility and effective depth-selective energy confinement within the subcutaneous fat layer. This research establishes the fundamental hardware capability for targeted facial hyperthermia. However, macroscopic treatment-uniformity protocols and long-term clinical efficacy remain topics for future clinical studies.