In April 2024, medical cannabis was removed from the list of narcotic drugs in Germany. This case study explores trends in the supply and demand of medical cannabis over a one-year period. Information on available cannabis flower products (including product names, sales prices, stock quantities and THC and CBD concentrations) was regularly accessed from one online dispensary in Germany. Product demand was ascertained by differences in stock quantity over time. Accounting for the impact of %THC and prices, the supply and demand of medical cannabis were explored. Between December 2024 (n=266) and November 2025 (n=401), the number of cannabis flower products available for purchase increased (total availability across the study period: n=996). Median %THC remained mostly stable, but the price per 10mg THC dropped by -0.003€ every week (95% Confidence Interval[CI]: -0.004 to -0.002€). Products with 20 to 29.9% THC made up more than two-thirds of total demand. Product demand quantities increased with every percentage point higher %THC (Incidence Rate Ratio[IRR]=1.13, 95% CI: 1.08 to 1.17) and decreased with every € higher price (IRR=0.59, 95% CI: 0.55 to 0.63; R2 = 0.38). The price changed at least once for about every second product, with price reductions being associated with demand increases. This case study suggests that a highly dynamic commercial market for medical cannabis is evolving in Germany. The increasing demand for cheap products with high %THC contrasts with the available evidence on the safe use of medical cannabis use. Current regulation of the medical cannabis market may not align with public health principles.
To evaluate emergency CT interpretation demand during major sporting events, characterize surge-related backlog and turnaround time, and estimate how threshold-based teleradiology support could affect queue performance during short event-related imaging boluses. We developed a Monte Carlo discrete-event simulation in Python to model an 8-h emergency radiology shift with baseline CT demand and a 2-h event-related surge. CT arrivals followed a Poisson process. Local and teleradiology radiologists were modeled as parallel servers with stochastic interpretation times. Two scenarios were compared across 500 Monte Carlo iterations: local radiologists only and local radiologists supplemented by a rapid-response teleradiology team activated when the unread CT backlog reached 10 cases. Primary outcomes included mean turnaround time, 90th percentile turnaround time, unread queue wait time, maximum unread backlog, number of cases delayed for more than 60 min, and time above the activation threshold. The model generated a mean of 132.7 CT examinations per shift in both scenarios. Local-only coverage resulted in a mean turnaround time of 48.7 min and a 90th percentile turnaround time of 89.6 min. With teleradiology support, the mean turnaround time decreased to 18.0 min, and the 90th percentile to 37.3 min. Mean maximum unread backlog decreased from 27.7 to 16.2 cases, and the mean number of cases delayed longer than 60 min decreased from 47.4 to 2.0. Sensitivity analysis showed that saturation risk increased sharply when surge arrivals rose and local staffing remained limited. Discrete-event simulation can help emergency radiology departments estimate when CT interpretation workflows may become saturated during major sporting events. In this model, threshold-based teleradiology reduced backlog and turnaround time but functioned as a surge buffer rather than a substitute for adequate local staffing and predefined escalation pathways.
This study aimed to investigate the factors associated with the use of different modern contraceptives (MCs) by Nigerian married or in-union women of reproductive age with a demand for family planning (DFP). These MCs are permanent methods and long-acting reversible contraceptives (PLARCs), medium-acting reversible contraceptives (MARCs), and short-acting reversible contraceptives (SARCs). An unweighted sample size of 9,983 women nested in a total of 1,118 communities was extracted from the 2024 Nigeria Demographic and Health Survey. A multilevel multivariable multinomial logistic regression analysis was carried out using Stata 17.0. Two levels of analysis were utilised: the individual and the community level, with the accompanying variables adjusted for. The DFP satisfied by modern methods (DFPSM) was approximately 33.9%, with the DFP satisfied by PLARCs, MARCs, and SARCs estimated as approximately 17.1%, 9.1%, and 7.8%, respectively. We found large remaining significant between-community variances in the odds of women satisfying their DFP with the different MCs. This was shown by the various estimated median odd ratios for the DFP satisfied by PLARCs, MARCs, and SARCs: approximately 3.870, 4.830, and 4.532, respectively. These remaining between-community variances were of greater relevance than the associated effects of most of the adjusted individual and household-level variables. This was with the exception of only the regression effects on DFP satisfied with MARCs of women in households with 1 to 2 dejure children at most 5 years old (aOR = 5.514, 95%CI = 2.226 to 13.658, p < 0.001); and those in households with no children at most 5 years old (aOR = 9.359, 95%CI = 3.656 to 23.954, p < 0.001). However, other variables that significantly increased the use of the different types of MCs by women with a DFP were their formal education level and women being usual residents of communities with high age at first marriage/cohabitation, low fertility clusters, and low polygyny clusters. To increase the very low DFPSM in Nigeria using different types of MCs, government policies/interventions aimed at improving the educational level of girls beyond the primary level should be implemented. A greater concentration should be within communities with low age at first marriage/cohabitation, high polygyny, and high fertility clusters.
Bacterial-infected wounds present a critical clinical challenge due to persistent inflammation, impaired angiogenesis, and the lack of real-time treatment monitoring. To address these issues, we developed an innovative colloidal crystal hydrogel microneedle (CT MNs) patch based on CuS nanoparticles (CuS NPs) and tannic acid-berberine nanoparticles (TB NPs). This system integrates synergistic antibacterial/antioxidant therapy with structural color-based drug release self-reporting capability. Specifically, the CT MNs combine photothermal CuS NPs for near‑infrared (NIR)-triggered hyperthermia and temperature‑controlled drug release, the release of TB NPs for potent antibacterial/antioxidant activities, and the color changes of the inverse opal colloidal crystal for real‑time monitoring of drug release. In vitro assays demonstrated strong antibacterial effects (95.65% and 95.92% against E. coli and S. aureus, respectively) and outstanding ROS‑scavenging capacity (92.93% for DPPH and 97.36% for ABTS⁺). In infected rat models, the CT MNs + NIR group achieved rapid wound closure (94.41% by day 10), significantly outperforming the controls. This accelerated healing was attributed to the synergistic effects of photothermal ablation, TB NPs-mediated bacterial clearance, and ROS-scavenging-driven inflammation alleviation. Therefore, this work presents a theranostic dressing that merges targeted combination therapy with non‑invasive optical monitoring of drug release, offering a promising strategy for intelligent wound management.
With the rapid expansion of hip arthroscopy, total hip arthroplasty (THA) following prior arthroscopic intervention is becoming an increasingly common clinical scenario. Yet the literature remains divided on whether the prior arthroscopy meaningfully degrades arthroplasty outcomes. Most patient-reported outcome data trend toward equivalence, while the largest and most recent matched and database studies consistently showed higher rates of dislocation, reoperation, and revision in the prior-arthroscopy cohort. Two patient subgroups warrant particular caution: those converting to THA within 1 year of arthroscopy and those proceeding to THA with minimal radiographic arthritis (Tönnis 0-1). In both groups, THA is more likely to disappoint because the pain generator may not be the joint at all. I argue that THA after failed hip arthroscopy should be a deliberate, evidence-supported decision, not a default endpoint, and that the diagnostic burden before arthroplasty should be raised, not lowered, in patients without clear radiographic disease.
This paper proposes a three-tier Stackelberg game-based hierarchical optimization framework for integrated electric vehicle (EV) battery swapping stations (BSS) and charging point operator (CPO) systems. The framework models the strategic interactions among three decision-making layers comprising grid operators, integrated CPO-BSS operators, and EV users within a multi-stakeholder energy management environment. A bi-level mixed-integer linear programming (MILP) formulation combined with backward-induction-based Subgame Perfect Nash Equilibrium (SPNE) analysis is developed to optimize dynamic electricity pricing, battery charging and swapping schedules, grid power utilization, and user service decisions under operational and grid constraints. The upper layer determines time-varying tariffs, demand-response incentives, and capacity charges to improve grid stability and social welfare, while the middle layer optimizes integrated charging-swapping operations and battery inventory management in response to grid signals and user behavior. The lower layer models EV users as rational followers responding to dynamic pricing through charging or swapping decisions. The proposed framework is validated using EV charging sessions from the publicly available ACN-Data corpus from which BSS swapping demand inputs were synthetically derived via a principled data-mapping procedure and Italian GME day-ahead electricity market price data. The results show that the proposed hierarchical framework reduces the operational cost of the system by 14.2-26.5% when compared with the unoptimized baseline system over the five-year simulation period (2020-2024), while reducing the peak grid demand by 26-28% (192-204 kW) compared with the unoptimized system and maintaining 96.8% service reliability. The coordinated strategy further enables effective load shifting toward low-price periods, enhances battery utilization efficiency, and improves demand elasticity through dynamic pricing mechanisms. Comparative analysis shows that the proposed framework captures 15-22% additional value over decentralized Nash equilibrium strategies while achieving near-optimal centralized social welfare performance under realistic institutional and operational constraints. Sensitivity and benchmarking studies confirm the robustness, computational tractability, and scalability of the proposed approach across varying tariff structures, battery inventories, and demand scenarios. The framework provides practical insights for EV infrastructure planning, grid-aware energy management, and regulatory policy design for future integrated charging and battery swapping ecosystems.
The decarbonization of urban energy communities increasingly requires coordinated integration of hydrogen, electricity, heat, and mobility under market-regulated environments. This study develops a hydrogen-driven digital transactions market embedded within a clustered, integrated energy hub architecture, where digital transactions markets, such as carbon emission trading (CET) and green certificate trading (GCT) mechanisms, are endogenously incorporated into operational scheduling. The framework coordinates hydrogen-diversified utilization, dual electric-hydrogen transportation systems, multi-vector storage, and renewable generation under carbon accounting constraints and social multi-stakeholder interactions. A decentralized multi-carrier optimization model is formulated to minimize system-wide scheduling cost while integrating CET/GCT revenues directly into dispatch decisions. Uncertainties in renewable generation, demand, and electricity prices are modeled using an inexact probabilistic stochastic programming approach with scenario generation and reduction. To extend evaluation beyond economic performance, a hydrogen-centric eco-social welfare layer comprising ten normalized indicators is introduced, quantifying emission mitigation, accessibility, equity, cost relief, and public acceptance. The model is validated on a four-hub clustered configuration under baseline and stress-test scenarios, including demand surges, renewable shortfalls, hydrogen price shocks, and market price fluctuations. Results demonstrate effective coordination between hydrogen production, storage, and mobility demand, with demand-side flexibility reducing operational costs by more than 16% in selected hubs. Carbon and certificate oracles market participation improves financial performance while enhancing emission compliance. Sensitivity analysis confirms robustness under combined worst-case disturbances. The proposed framework establishes a unified operational market structure that links hydrogen diversification, digital carbon-regulated transactions, and measurable eco-social welfare within sustainable urban energy systems.
Amid total knee arthroplasty (TKA) expansion and shrinking reimbursements, optimization is a priority. Out-of-pocket cost sharing has been shown to influence elective surgery scheduling, however, utilization patterns have yet to be demonstrated in TKA. The purpose of this study was to evaluate the relationship between insurance cost-sharing and TKA utilization. A retrospective observational cohort study was conducted using a large database. Patients who had a diagnosis of knee osteoarthritis between January 1, 2018, and December 31, 2023, were included. The percentage of primary TKA procedures performed in this population during each calendar month and quarter was calculated. Patient payment contribution was compared across insurance plan types, and the association between payment and utilization was evaluated. A total of 450,125 patients received a diagnosis of knee osteoarthritis. Overall TKA utilization was 11.1, 11, and 10% among high-, average-, and low-costing sharing groups, respectively. Average- and low-cost-sharing groups had significantly higher utilization in Q1 compared to the high-cost-sharing group (High versus Average: 19.9 versus 22.7%, P < 0.001; High versus Low: 19.9 versus 23.1%, P = 0.007). The high-cost-sharing group had a significantly higher utilization in Q4 compared to the average and low groups (High versus Average: 35.7 versus 30.8%, P < 0.001; High versus Low: 35.7 versus 29.6%, P < 0.001). During Q1, high-, average-, and low-cost-sharing patient payment contributions averaged $1,761.5, $886.7, and $356.5, respectively. Pearson correlation testing demonstrated an inverse relationship between out-of-pocket cost and surgical volume, with higher patient payments significantly associated with lower TKA utilization (Pearson r = -0.42, P < 0.001). Across all insurance groups, there was a significant inverse correlation between patient payment and quarterly percent utilization, revealing periods of low utilization in Q1 and high in Q4. By anticipating periods of low demand and accommodating high-demand periods, hospital systems and surgeons can better maximize efficiency.
Atherosclerosis (AS) is a cardiovascular disease with high mortality and disability rates, and the increasing number of cases urgently demands more effective therapeutic options. AS is characterized by complex pathogenesis and multiple complications, where single-drug therapy has limited efficacy and combination therapy increases safety risks. Natural extracts (NEs) offer advantages such as multi-target, multi-pathway effects and low side effects, showing significant potential in AS prevention and adjunctive treatment. This article systematically reviews existing studies and analyzes the advantages and limitations of NEs in cardiovascular disease management. The development of novel formulations using modern biotechnology and drug delivery systems holds promise for better AS treatment. Although challenges remain in bioavailability and pharmacokinetics, ongoing advances in extraction techniques, delivery systems, and nanotechnology warrant further research into NEs for AS therapy.
Resting-state fMRI (rsfMRI) scans-acquired in the absence of experimentally controlled stimuli or task demands-are widely used to identify aberrant patterns of functional connectivity (FC) in clinical populations. To minimize interpretational uncertainty, researchers routinely control for across-cohort disparities in age, gender, comorbidities, and head motion. Yet, studies rarely consider the possibility that systematic differences in inner experience (i.e., how subjects think and feel during the scan) directly affect FC measures. Here, using an rsfMRI dataset comprising 469 scans with retrospective experiential annotations, we show that summary descriptors of in-scanner experience are reproducible across visits and subject-specific, consistent with trait-like characteristics. We further show that widespread significant differences in FC are observed between scans that are associated with different reported experiential profiles, and that FC can predict specific experiential dimensions with performance comparable to that reported for demographic, cognitive, and clinical variables. Together, these findings highlight the key role that in-scanner experience should play when interpreting FC in the context of rsfMRI. Given that the available experiential measures are retrospective summaries, these results speak to stable experiential tendencies rather than potential moment-to-moment, state-dependent relationships between ongoing experience and concurrent brain activity.
To identify which steps of the 360° scleral encircling (SE) procedure pose the greatest training challenges for retina fellows by analyzing surgical videos and evaluating changes in operative time across a two-year training period. We retrospectively analyzed videos of SE procedures performed by vitreoretinal fellows at a single academic center (2018-2024). Only cases involving 360° SE without concurrent vitrectomy or gas tamponade were included. For each case, total operative time and the duration of six predefined steps were measured. Cases with damaged videos or performed by fellows with ≤ 5 analyzable cases were excluded. Between-fellow comparisons and learning-curve trends were assessed using analysis of variance and correlation analyses. Fifty-five SE cases performed by six fellows met inclusion criteria. Mean total operative time was 132.27 ± 42.92 min, with significant inter-individual differences (p = 0.0007). Among all steps, binocular indirect ophthalmoscopy showed the greatest inter-individual variability (p < 0.0001), followed by scleral suturing (p = 0.0009) and tire positioning (p = 0.006). Across training, the duration of indirect ophthalmoscopy did not show measurable reduction for any fellow. Five of six fellows demonstrated a significant decrease in total operative time correlated with training progression (p < 0.05 for each), with a marked early decrease within their first five cases, followed by a plateau. Binocular indirect ophthalmoscopy demonstrated the largest variability and the least improvement during SE training. Prioritizing targeted instruction in this technically demanding step may accelerate skill acquisition and improve overall operative efficiency for early-career ophthalmologists.
Membrane aerated biofilm reactors (MABRs) create a unique counter-diffusion biofilm through bubble-free aeration, spatially decoupling oxygen penetration from bulk substrate diffusion and thereby reshaping electron competition among nitrogen transformation pathways. This reactor-specific redox stratification offers a distinctive platform for selective nitrous oxide (N2O) control under low-carbon-to-nitrogen (C/N) conditions. Here, an Electron Economy Framework (EEF) is proposed to reinterpret nitrogen removal and N2O dynamics in MABRs from the integrated perspectives of electron source expansion and pathway prioritization. Within this framework, existing strategies are unified into three synergistic dimensions: (i) inorganic electron source expansion using hydrogen, reduced inorganic sulfur compounds, and iron-based materials to alleviate electron scarcity; (ii) electron demand and pathway regulation through ammonia diversion by PN/A, algal assimilation for nitrification bypass, and bioelectrochemical electron channeling to reduce reductive burden or selectively suppress N2O formation; and (iii) EEF based on the electron expansion and pathway regulation was proposed to quantify electron allocation toward target denitrification pathways, thereby improving electron utilization efficiency and mitigating N2O emissions. This framework bridges reactor architecture with electron resource management, providing a theoretical basis for low-carbon, high-efficiency nitrogen removal with minimized N2O emissions in next-generation biological treatment systems.
Early cancer diagnosis demands rapid, sensitive and portable approaches for detecting cellular metabolic activities. Herein, we construct a portable time-resolved biosensing platform for visual and quantitative detection of xanthine oxidase (XOD) activity in circulating tumor cells (CTCs) based on a permanganate-peroxide coupling mechanism. In this strategy, XOD catalyzes the oxidation of xanthine to uric acid, accompanied by the generation of hydrogen peroxide (H2O2). The as-produced H2O2 subsequently reduces potassium permanganate (KMnO4) under mildly acidic conditions, resulting in a rapid decrease in the characteristic absorption of Mn(VII) species and a visually distinguishable color transition from purplish red to light yellow within 60 s. Since the yield of H2O2 generated is directly related to enzymatic turnover, XOD activity can be quantitatively translated into optical and digital colorimetric signals. The reaction can be monitored spectroscopically through absorbance changes at 526 nm or analyzed using smartphone-based RGB extraction for instrument-free quantification. Under optimized conditions, the optical response shows a good linear correlation with the logarithm of XOD activity with a detection limit of 0.0039 U/L (S/N = 3). Cellular studies revealed elevated XOD activity in cancer-derived CTCs compared with normal cells, as well as significant responses to XOD inhibition and oxidative stress. This platform provides a simple and portable tool for cellular enzyme profiling and point-of-care cancer diagnostics.
This qualitative instrumental case study examines the ethical considerations surrounding the infamous Nazi-era Pernkopf Atlas through an in-depth interview with Rabbi Joseph Polak, the primary drafter of the Vienna Protocol. Created using the bodies of Nazi victims, the Atlas presents a major moral dilemma for contemporary medical and surgical practice. The analysis identified five key interpretive domains: (i) the moral paradox of tainted greatness, (ii) the intrinsic dignity and consequentiality of human life, (iii) the Protocol as ethical mediation rather than resolution, (iv) the duty of historical witnessing, and (v) conditional ethical responsibility. The findings reveal that while the Jewish principle of piku'ah nefesh (preserving life) may permit the Atlas's exceptional clinical use, it demands strict disclosure and restricted access rather than silent normalization. Ultimately, the Vienna Protocol provides a model for confronting ethically compromised scientific knowledge, ensuring its clinical utility is never separated from its historical cost.
Long-term follow-up after total knee arthroplasty (TKA) is crucial to providing survivorship updates on available implants to guide patient expectations when undergoing this demanding procedure. Our group has previously shown the excellent long-term clinical and radiological results, using the ADVANCE® Medial Pivot (AMP) Knee System. In the present study, we further explore the continuing long-term outcomes of the aforementioned design and the patients' satisfaction after a postoperative period of minimum 25 years. In a previous study we reported our results from 325 patients (347 knees) which were available for clinical and radiological assessment from an initial cohort of 350 consecutive patients (385 knees) operated between April 1998 and October 2000 with the AMP Knee System. We recently collected medical record data of 156 patients, (167 knees). Minimum follow-up was 25 years (up to 27). At the 25-year follow-up, patients showed a mean range of motion of 115°, high satisfaction (68% excellent, 27% very good), and stable clinical and radiographic results. At the final follow-up a percentage of 10.7% of knees (18 cases) need a revision. The overall survival rate at final follow-up, with revision for any reason as the end point was 89.2%. The AMP prosthesis demonstrated excellent long-term survivorship, sustained functional outcomes, and high patient satisfaction over a follow-up of up to 27 years. These findings support the durability and clinical effectiveness of this implant design in primary TKA, with low revision rates and stable radiographic results confirming its reliability in long-term use.
Sleep problems affect 30%-95% of cancer patients. Cognitive Behavioral Therapy for Insomnia is recognized as the most effective treatment for insomnia. However, implementing it is challenging due to a lack of time, human resources, and financial support. Internet-Based Cognitive Behavioral Therapy (ICBT-I) is appreciated by patients, but it lacks professional guidance. The Sleep-4-All-2.0 study combined a validated ICBT-I program, lasting 6-12 weeks, with up to four individual, phone-based ICBT-I psychology sessions. The current study sought to explore patients' experiences of the program, focusing on their perceptions of the professional guidance. Cancer patients from three different hospitals were interviewed. Out of their discourse, a thematic analysis was conducted. 48 patients were included. Three themes were constructed: (1) Coping with the program, (2) Connections at play (professionals, family, patients, sleep interactions), (3) Benefits and limits of psychological guidance. Although most participants were delighted with the program and the guidance, they encountered numerous difficulties due to personal and external issues, as well as the demands of CBT. Participants highlighted the need to be connected to other patients, supported by their families, and to receive well-informed care from healthcare professionals (HCP). The phone guidance was important for pragmatic and motivational reasons. In order to improve program follow-up, clinicians should work beforehand to adjust expectations and take into account the specific vulnerabilities of certain patients.
Harsh-environment requirements of electrical and electronic systems demand advanced dielectrics with high energy storage density at elevated temperatures. Heat-resistant polymers are usually designed with densely packed molecular chains to maintain structural integrity. Unfortunately, the narrowed inter-chain spacing causes severe charge transfer under high electro-thermal fields, prohibiting capacitive energy storage beyond 200 °C. Here we report hyperbranched dielectric polymer networks as a solution to the persistent challenge. The hyperbranched topological junctions not only transform the linear polymer chains into a robust network to tolerate thermal stress, but also expand the inter-chain spacing to inhibit charge transfer. Results suggest that the hyperbranched networks exhibit suppressed secondary chain relaxation alongside expanded free volume. Moreover, the customizable chemical structure of hyperbranched centers renders this method general to capacitive polymer design. The hyperbranched polymer networks exhibit an exceptionally high discharged energy density of 4.9 J/cm3 above 90% efficiency at 250 °C, surpassing the existing polymeric dielectrics.
Preceptorship is a key component of medical student clinical experience. Demand for clinical preceptors is increasing. An updated understanding of why preceptors continue or discontinue these roles, particularly in pre-clerkship settings, is needed to optimize recruitment and retention. To inform recruitment and retention of pre-clerkship preceptors at a large public medical school, the authors examined preceptor motivations for precepting, reasons for leaving, and factors influencing a successful preceptorship. The authors conducted an explanatory sequential mixed-methods study (survey followed by semi-structured interviews) between September 2024 and December 2024. Participants were current and former pre-clerkship preceptors from 57 clinical sites across 22 organizations in academic and community clinical settings. Rapid qualitative methods using templated summaries and matrix analysis were applied to identify major themes. A total of 202 current and former pre-clerkship medical student preceptors participated in surveys characterizing their experiences: 158 current preceptors (including 36 planning to stop) and 44 former preceptors with a 70% response rate. Most preceptors cited a love of teaching as their primary motivation. Thematic analysis identified three themes: (1) Preceptors chose to precept because they love teaching-when they leave it is often related to life and work-related factors; (2) Heavy clinical workload was a barrier to a good preceptorship experience; (3) The importance of guidance flexibility, and supportive structures for preceptors. Pre-clerkship preceptors are primarily motivated by a passion for teaching, but personal and professional pressures contribute to attrition. Addressing clinical workload and providing flexible, supportive program structures may improve preceptor retention.
Endoscopic submucosal dissection (ESD) is an effective minimally invasive treatment for superficial gastric tumors. However, it is technically demanding and often associated with prolonged procedure time and a risk of adverse events. Traction-assisted ESD (TA-ESD) has been introduced to improve submucosal visualization and procedural efficiency; however, evidence regarding its benefit over conventional ESD (C-ESD) in gastric lesions remains inconsistent. This study aimed to compare procedural efficiency, resection quality, and safety between TA-ESD and C-ESD in patients with superficial gastric tumors. We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials comparing TA-ESD with C-ESD for gastric tumors. Five electronic databases were searched through November 8, 2025. Only trials reporting intention-to-treat or modified intention-to-treat analyses were included. The primary outcome was procedure time. Secondary outcomes included en bloc resection, R0 resection, perforation, delayed bleeding, and traction-related damage to the specimen. Pooled estimates were calculated using the mean difference (MD) and risk ratio (RR). Subgroup analyses were performed based on endoscopist experience, tumor location, and tumor size. Five randomized controlled trials comprising 463 patients (228 TA-ESD and 235 C-ESD) met the inclusion criteria. TA-ESD was associated with a shorter procedure time than C-ESD (mean difference [MD] = -12.45 min, 95% CI: -20.67 to -4.23; P = 0.003); however, this finding was sensitive to leave-one-out analyses, with statistical significance lost after exclusion of either the Bi 2024 or Nagata 2021 trial. Procedure time was lower for both upper/middle-third gastric lesions (MD = -21.21 min, 95% CI: -30.26 to -12.17; P < 0.0001) and lower-third lesions (MD = -10.72 min, 95% CI: -17.79 to -3.64; P = 0.003). En bloc resection rates (risk ratio [RR] = 1.00, 95% CI: 0.98-1.02; P = 0.98) and R0 resection rates (RR = 0.99, 95% CI: 0.93-1.06; P = 0.83) were comparable between groups. There were no differences in perforation (RR = 0.52, 95% CI: 0.07-3.97; P = 0.53) or delayed bleeding (RR = 0.78, 95% CI: 0.29-2.09; P = 0.61). Traction-related specimen damage was rare, with a pooled incidence of 1.3%. TA-ESD was associated with shorter procedure time than C-ESD, while maintaining comparable resection quality and safety. However, this association was sensitive to leave-one-out analyses and should therefore be interpreted cautiously. Furthermore, the overall certainty of evidence was limited, with three of five included trials judged to be at high risk of bias, and GRADE certainty for most secondary outcomes rated as low to very low. These limitations, together with the small number of available trials, underscore the need for further large, multicenter randomized studies using standardized traction techniques to better define the efficacy and safety of TA-ESD.