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The primary objective of this study was to assess the quality of life (QoL) in children with cochlear implants (CIs) from the children's and parents' perspectives through utilizing the Pediatric Quality of Life Inventory (PedsQL) and KINDL questionnaires. A secondary objective was to compare the QoL of children with CIs to those using hearing aids and to children with normal hearing (NH). A total of 1,830 records were obtained since the search was systematically carried out across databases, which are PubMed, Scopus, Web of Science, Google Scholar, and Ovid Embase. Following screening, 10 studies met the eligibility criteria, with 1,194 participants. This systematic review and meta-analysis were International Prospective Register of Systematic Reviews registered and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. It included research published in English that evaluated QoL using the PedsQL and KINDL questionnaires. The Appraisal Tool for Cross-Sectional Studies tool evaluated the risk of bias in the included studies. Data extraction focused on study characteristics, participant demographics, and QoL outcomes. Descriptive analysis and meta-analysis were used to synthesize the data. QoL was significantly lower in children with CIs when compared to peers with NH, according to the meta-analysis, specifically in the social and school functioning domains. Descriptive analysis revealed high heterogeneity among studies, with some children with CIs showing QoL comparable to children with NH. Despite the advantages of CIs, challenges remain high, specifically in social integration and academic performance. These findings are indicative of the necessity for long-term follow-up and personalized intervention to maximize the global QoL in children with CIs.

Our goal was to assess whether prophylactic compression garments reduce lower-limb lymphedema after pelvic/inguinal lymphadenectomy for gynecologic malignancies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses.-based systematic review. Eligible studies included primary interventional studies evaluating prophylactic lower-limb compression after pelvic and/or inguinal lymphadenectomy for gynecological malignancies; systematic/rapid reviews were considered for contextual background and reference checking; studies focused on treatment of established lymphedema or non-relevant populations/outcomes were excluded. The Population, Intervention, Comparison, Outcome question was: in women undergoing pelvic and/or inguinal lymphadenectomy for gynecological malignancy (P), does prophylactic use of compression garments (I), compared with no compression garments or non-compressive preventive strategies (C), reduce the incidence of lower-limb lymphedema (O)? PubMed, Scopus, Cochrane, LILACS, and SciELO were searched from inception through March8 2026, using Medical Subject Headings and free-text terms related to compression garments, lymphedema prevention, pelvic or inguinal lymphadenectomy, gynecological cancer, and lower-limb lymphedema. A total of 536 full-text reports were assessed; 6 gynecological oncology randomized controlled trials met the Population, Intervention, Comparison, Outcome criteria; one additional mixed-population randomized controlled trial was treated as indirect evidence. Two systematic/rapid reviews were used for contextual background/reference checking; multimodal prevention studies were discussed as evidence for multimodal pathways because compression effects could not be isolated. Randomized controlled trials were heterogeneous: small trials using class I to II stockings did not demonstrate a significant reduction in lower-limb lymphedema, although they suggested a potential benefit. One randomized controlled trial (n = 64) showed a reduction in lymphedema incidence (3.4% vs 38.7%) with class II (23-32 mmHg) stockings worn for 12 months, alongside education and physical activity. Prophylactic compression-particularly early, prolonged class II stockings within structured rehabilitation-was associated with lower lymphedema incidence in some studies; evidence remains limited by small, heterogeneous trials, no meta-analysis, and multimodal interventions where compression effects cannot be isolated.

Perovskite materials have emerged as versatile platforms for sustainable photocatalytic and photoelectrocatalytic applications, addressing critical challenges in environmental remediation and clean energy conversion. This Review comprehensively examines oxide perovskites (ABO3), lead-based and lead-free halide perovskites (ABX3, A3B2X9), layered architectures including Ruddlesden-Popper and Dion-Jacobson phases, and perovskite-derived catalysts for pollutant degradation, CO2 reduction, water splitting (HER/OER), and integrated waste-to-fuel conversion. Unlike previous reviews that separately focus on oxide or halide systems or isolated applications, this work establishes a unified environmental-energy catalysis framework that systematically compares diverse perovskite families while emphasizing the transition from Pb-based to Pb-free architectures. Particular attention is given to defect-mediated structure-function relationships, including A/B-site engineering, oxygen and halide vacancy regulation, and heterostructure design, which collectively enhance visible-light harvesting, charge separation, and multielectron redox kinetics. Side-by-side comparisons of lead-based and lead-free systems clarify the catalytic, environmental, and stability implications of Pb substitution. Although Pb-free perovskites offer significant sustainability advantages, challenges related to long-term durability, mechanistic understanding, and scalable synthesis remain unresolved. Future directions involving DFT- and machine learning-guided design, interface engineering, and pilot-scale implementation are highlighted to accelerate the development of next-generation sustainable perovskite catalysts.

Robotic platforms have expanded the indications and techniques for abdominal wall reconstruction (AWR). This comprehensive narrative review examines current evidence on the evolution, technical variations, clinical outcomes, and cost implications of robotic AWR (rAWR), taking data from systematic reviews, meta-analyses, randomized clinical trials, and large registry studies. Robotic platforms provide enhanced dexterity and three-dimensional visualisation, facilitating complex repairs such as transversus abdominis release using extraperitoneal, transabdominal, and hybrid approaches. Published data suggest rAWR is associated with comparable or reduced rates of visceral injury and surgical site occurrence compared with open repair, but shorter hospital stay (median 1 day vs. 3-4 days for open), and lower readmission rates. There are similar long-term recurrence rates across open, laparoscopic, and robotic approaches, though the learning curve impacts early outcomes. There is conflicting evidence regarding early postoperative pain. Despite higher upfront expenditure, hybrid approaches appear most cost-effective due to reduced complications and length of stay. rAWR is safe and effective, offering advantages in visualisation, and recovery, with outcomes comparable to or better than open repair. Future priorities include standardised credentialing, rationalization of technique selection, and generating long-term data registries. Finally, rAWR should be delivered within multidisciplinary abdominal wall teams to optimise patient selection and outcomes.

Despite advances in wearable mobile health (mHealth) technologies and their associated apps designed to promote physical activity, and the importance of adapting them to users, little is known about older adults' perceptions of these technologies. This review aimed to synthesize and analyze qualitative evidence exploring the perceptions of adults aged 50 years and older regarding areas to improve, barriers to, and facilitators of wearable mHealth technologies (activity trackers and companion apps) to promote physical activity. A qualitative systematic review and meta-ethnography was conducted. Comprehensive searches were performed across 8 databases (MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycINFO, ProQuest, and ÍnDICEs-CSIC) for articles published in English or Spanish between January 2013 and January 2024. The synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Ten articles met the inclusion criteria and were synthesized using meta-ethnography. Three main themes emerged: (1) barriers to promoting physical activity caused by wearable mHealth technologies: personal barriers (physical aspects, perceptions about technology, and personal preferences), technological barriers (functionality, content, design, alarms, availability, and accessibility), and environmental barriers (season of the year); (2) personal facilitators (consideration that these apps improve health, perceptions about technology, and personal preferences), technological facilitators (functionality, content, and design), relational facilitators (technological and social support), environmental facilitators (seasonal variations), and health care professionals (support and monitoring by health care services); and (3) personal areas (perceptions about technology and personal preferences), technological areas (functionality, content, and design), and relational areas (technological support). Although older adults acknowledge the potential of wearable mHealth technologies to promote physical activity, their effective engagement is hindered by distinct personal, technological, and environmental barriers. Bridging the digital divide requires designers to prioritize user-centered, age-friendly interfaces that are integrated with continuous support from health care professionals. To promote genuine health equity, future research must rigorously report intersectional demographics to ensure that mHealth interventions mitigate, rather than inadvertently exacerbate, existing disparities.

This article reviews geometric calibration methods for serial link manipulators, focusing on improving their absolute positioning accuracy. The review highlights key calibration steps, including model selection, data acquisition, and parameter identification, and emphasizes the role of measurement and optimization. The review compares traditional geometric models with advanced nonminimal parameterizations, highlighting their respective advantages. It also examines modern data acquisition techniques using optical systems, fiducial markers, and simultaneous localization and mapping (SLAM), alongside optimization strategies for parameter refinement. This article also outlines current challenges and future directions. This review supports researchers and practitioners in developing applications that require precise robot calibration.

An integrated, field-level synthesis of digitally enabled performance measurement and management systems (PM/PMS) in healthcare is provided, addressing fragmentation across tool-centered streams and limited cross-stage comparison of control configurations. The thematic structure of the field is mapped, themes are positioned along the balance between technical and social controls, and their placement across PM/PMS stages (design, implementation and use/revision) is made explicit. A bibliometric science-mapping design was applied to Web of Science Core Collection records from 2000 to 2025. Records were filtered by indices, document type (articles, reviews), language (English) and subject-category refinements aligned with health management and information-systems relevance. Keyword variants were harmonized using a domain thesaurus, and low-specificity tokens were filtered. VOSviewer generated keyword co-occurrence networks (full counting, a minimum occurrence of 10 and association-strength normalization) and an overlay by average publication year. Clusters were interpreted through control-balance and stage lenses, and descriptive profiles were produced by outlets, journals, periods and country groups. A coherent thematic structure is revealed, organized around infrastructures that stabilize measurement, implementation arrangements that make indicators governable through review routines and accountability and service contexts in which measures are enacted and revised. A temporal overlay indicates a recency gradient from established infrastructure and measurement foundations toward more recent emphases in distributed care and analytics-augmented practice. Artificial intelligence (AI), machine learning (ML) and natural language processing terms are positioned as extensions at the edge of improvement-oriented work rather than as a detached methods stream. Descriptive profiles indicate uneven anchoring across outlet types and country contexts. Coverage is limited by reliance on a single database and on author and indexer keywords, which can under- or overrepresent niche topics. Co-occurrence indicates conceptual proximity rather than causal effects, and indexing updates can change record counts over time. The geographic concentration of contributing country contexts also limits the transferability of findings across diverse health-system settings. Even with these constraints, field-level configurations are made visible in a transparent, reproducible way. Robustness could be tested by extending the corpus to Scopus and PubMed, using alternative vocabularies where available and examining longitudinal slices of the corpus. Implications are offered as navigation cues rather than prescriptive best practices. At design, attention can be directed to data quality, traceability and interoperability so that later routines receive reliable signals. At implementation, dashboards and indicator sets become consequential when coupled to explicit review cycles, escalation paths and role responsibilities that enable cross-boundary sensemaking. At use and revision, measures can be aligned with pathway and modality demands, including access, continuity and patient experience, with equity monitored explicitly. Where AI or ML is used, post-deployment monitoring and controlled updating can be integrated into existing review routines. System-level value can be supported when measurement is used for learning and coordination rather than compliance alone. Distributed care settings raise equity and access concerns and intensify demands for patient-facing coordination. Social-integrative control, including participation, leadership-enabled review routines and cross-boundary coordination, can help mitigate gaming and tunnel vision while sustaining improvement. Attention to equity stratification and patient-reported experience and outcome measures can help ensure that technical tools translate into fairer and safer care. A reproducible, map-based synthesis is offered that moves beyond tool-specific silos and interprets the field through combined lenses of technical versus social control and PM/PMS stages. An implementation-oriented bridge is surfaced between infrastructure and use, and AI-related vocabulary is positioned as embedded within improvement work. A recency gradient is identified that distinguishes established foundations from newer emphases in distributed care and analytics-augmented practice. Descriptive profiles across outlets, journals, periods and country groups add boundary conditions for transferability claims.

Driving restrictions for people with epilepsy are primarily based on the risk of seizure recurrence. Photosensitive epilepsy (PSE) could increase the risk of traffic accidents due to visually provoked seizures. However, the magnitude of this potential increase in risk remains unclear. Following a PRISMA-based methodology, a structured PubMed search was performed and subsequently complemented by an AI-assisted semantic literature search using Elicit. To maximize retrieval of relevant evidence on visually provoked seizures (VPS) and seizure-related traffic accidents in drivers with epilepsy, reference screening and citation tracking were additionally undertaken to identify studies not adequately captured by database searches alone. Studies were selected according to predefined eligibility criteria, with only relevant full-text publications included in the final analysis. The available literature on driving safety in PSE is extremely limited. The structured PubMed search yielded 31 records, of which only a limited number fulfilled the relevance criteria after screening. Most identified studies consisted of laboratory EEG investigations, mechanistic analyses, environmental simulation studies, retrospective reviews, or case reports. Several studies demonstrated VPS or photoparoxysmal responses (PPR) under laboratory conditions, whereas no study systematically demonstrated seizure induction during ordinary real-world driving. Despite retrieval of up to 1,000 semantically ranked publications per Elicit query, only one publication directly addressed VPS in a driving-related context. No confirmed traffic accidents directly attributable to VPS in PSE were identified. Current evidence regarding driving risk in PSE is remarkably sparse and largely indirect. Although VPS are biologically plausible under experimental conditions, it remains unclear whether ordinary traffic environments provoke seizures or contribute meaningfully to traffic accidents in real-world settings. Both conventional and AI-assisted literature searches failed to identify sufficient empirical evidence supporting current driving restrictions specific to PSE. Prospective real-world studies and registries are urgently needed to clarify the actual driving risk associated with PSE, and to evaluate the potential role of traffic-approved optical filters in risk reduction and evidence-based driving regulations.

Intensive care bed block has been a persistent problem worldwide. Current Australian evidence is mostly from single or small-scale multisite studies, and there is a lack of evidence on a bigger scale. To explore multidisciplinary ICU staff's perspectives on the facilitators and barriers to timely ICU patient discharge in Australia. A national cross-sectional online survey was distributed via professional organisations to ICU staff across Australia. The survey comprised 45 quantitative and eight qualitative items informed by systematic reviews and studies at end of the sentence. A total of 114 ICU staff completed the survey. Three-quarters (n = 77, 75%) reported the discharge process as 'extremely' or 'somewhat difficult', with the majority (n = 91, 80%) reporting ward bed unavailability as the primary cause of discharge delay. Respondents expressed that emergency departments and operating theatres were prioritised over ICUs during hospital bed allocation. Ward bed allocation was mostly communicated verbally (n = 44, 39%) or by phone (n = 71, 62%), with only 39% (n = 44) using digital methods. Facilitators included post-ICU ward follow-up assessment and management, ICU discharge liaison nurse coordination of patient transfer and assessment of ward staffing, skill-mix and bed readiness. Additional factors included early identification of dischargeable patients, the use of guidelines, and adherence to policies and checklists. Barriers included lack of ward-level clinical support, incompatibility of documentation platforms, staff shortages and discharge task inefficiencies. Few respondents reported existing strategies to address discharge delays in their hospitals. Respondents highlighted the need for improved digital systems, permanent discharge liaison or co-ordination roles, and post-ICU clinical support services with dedicated funding and appropriate or 24/7 coverage to support timely ICU discharge. Findings highlight the need for organisational-level and workflow-focused strategies to reduce ICU exit block to support timely and safe patient discharge across Australian ICUs.

Agriculture is widely acknowledged as a dangerous industry for workers. Agriculture workers are also older compared with other industries, which further increases the risks of occupational injuries. In recent years, a wide range of new technologies has come into use in the agriculture industry, so researchers need to consider how these technological advances can be used to improve occupational safety and health outcomes for agriculture workers. This scoping review aims to summarize the current evidence for the use of robotics and autonomous technologies in improving occupational safety and health outcomes for agricultural workers. A systematic literature search was performed on June 4 and 14, 2024, across the following databases - MEDLINE, Embase, IEEE, CAB Abstracts and Google Scholar. Two independent reviewers screened for eligibility in Covidence. Eligibility criteria included studies in the English language from 2015 onwards reporting on robotics or technologies for health and safety in agriculture. Literature reviews were excluded. The PRISMA Scoping Review statement guided the reporting. The search resulted in 845 studies. Of the 26 included studies, 13 studied robots or automated machines, four studied exoskeletons, three studied wearable sensors, four investigated the use of artificial intelligence and five studied other autonomous technologies. Automated milking systems (AMS) were the most studied autonomous technology in the review, with three studies finding farmers perceive a reduction in physically demanding labor when using AMS, and another finding a correlation between using AMS and improved mental health. Most included papers focused on occupational safety and physical health. Of the included studies, 12 were product development studies, meaning there is need for primary evidence studies (e.g. randomized trials, observational studies). There was also only one study that focused on mental health and improving accessibility for farmers with mobility impairments, so these are directions for future research. The results of this review show that there is some evidence for the use of a variety of autonomous technologies in improving farmer health and safety, although more work is required, especially regarding mental health and farmers with mobility impairments.

Bloodstain Pattern Analysis (BPA) is transitioning from an experiential, expert-dependent craft to a quantitative, multidisciplinary forensic science. This review critically evaluates the evolutionary trajectory of BPA, contrasting traditional macroscopic examination with modern computational advancements, including 3D laser scanning, terrestrial LiDAR, and artificial intelligence (AI)-driven computer vision models. While automated software platforms (e.g., HemoSpat, BackTrack) and deep learning networks significantly improve area-of-origin reproducibility and pattern classification speed, their operational integration remains constrained by severe methodological fragmentation, dataset bias, and a historical lack of multi-variable substrate validation. Furthermore, a critical translational gap persists regarding legal admissibility under Daubert-style frameworks due to insufficient error propagation modeling. To overcome these epistemological boundaries, this paper proposes a structured transition toward a hybrid forensic paradigm that synthesizes human expert reasoning with physicodynamically constrained algorithms. Future directions must prioritize the construction of validated ground-truth datasets, the implementation of Likelihood Ratio (LR) Bayesian inference models for objective uncertainty quantification, and universal compliance with international standardization initiatives (OSAC/ASB). Ultimately, establishing these quantitative frameworks is essential for safeguarding the evidentiary value and courtroom reliability of BPA in modern judicial decision-making.

Parkinson's disease (PD) is the most prevalent neurodegenerative movement condition. Tremors, stiffness, bradykinesia/akinesia, and postural instability are its primary motor symptoms; nevertheless, the clinical features also include non-motor and additional motor symptoms. Krüppel-like factor 4 (KLF4), a zinc finger transcription factor, is present in several human tissues and performs a range of cell-dependent regulatory actions. Various neurological diseases, such as PD, Alzheimer's disease (AD), and Huntington's disease (HD), have been linked to KLF4, which regulates some neurophysiological and neuropathological processes in the brain. Recent data indicate that KLF4 plays a crucial regulatory role in the neurophysiological and neuropathological processes underlying PD, suggesting that it might be a viable therapeutic target for neurodegenerative diseases. This review focuses on the potential molecular mechanism underlying KLF4-mediated neuroinflammation, oxidative stress, mitochondrial dysfunction, and apoptosis. KLF4-mediated pathways are clarified by the information gathered here, and targeting them appears to be a viable therapeutic strategy for treating PD. Nevertheless, there is insufficient information on this subject, and more investigations are needed to fully understand the translational significance of the KLF4-oriented therapeutic strategy in PD.

Links between childhood experiences and health problems are well documented. We here focus on one such exposure: overprotection. While considerable research has explored and summarized associations between overprotection and outcomes commonly labelled as psychiatric or mental, less is known about those commonly thought of as biological or somatic. We therefore aimed to comprehensively map and summarize the literature on the latter relationship. We conducted a scoping review. A systematic search for "overprotection" and relevant synonyms was performed in Embase, Medline and Web of Science in December 2025 and January 2026. We included studies that link overprotection as an exposure to biological or somatic outcomes, here understood as those that are objectively measurable, excluding self-reported variables. 62 studies were included in the review. Many studies examining outcomes related to weight (n = 14), HPA-axis activity (n = 8), neurophysiology/anatomy (n = 8), other stress-related physiology (n = 7), EEG- and fNIRS-measures (n = 5), inflammatory bowel disease (n = 3), DNA modifications (n = 3) and oxytocin levels (n = 2) suggested an effect of overprotection. Studies on outcomes related to glucose levels (n = 6), cardiovascular outcomes (n = 5), atopic dermatitis (n = 2), and reproductive lifespan (n = 2) yielded more ambiguous results. This study provides the first comprehensive review on associations between overprotection and outcomes considered biological or somatic. The findings indicate a possible relationship and highlight a need for more research to establish causal connections.

Cardiogenic shock (CS) remains a leading cause of early death in acute cardiac care, with 30-day mortality frequently approaching 40-50% despite advances in revascularization systems and critical care pathways. Contemporary CS management has progressed through standardized definitions, staging systems, and phenotyping frameworks that support earlier recognition and a more disciplined escalation strategy. However, evidence-based therapies that consistently reduce mortality remain limited, and device-related complications and heterogeneous etiologies continue to constrain outcome gains.Temporary mechanical circulatory support (tMCS) provides rapid hemodynamic stabilization, augments end-organ perfusion, and enables time for revascularization, recovery, durable left ventricular assist device (LVAD) implantation, or transplantation. The major tMCS modalities used in modern practice include intra-aortic balloon pump (IABP), percutaneous microaxial flow pumps, left atrial-to-arterial bypass devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO), with dedicated right-sided support strategies for right ventricular (RV) failure. Selection should be driven by (i) shock stage and trajectory, (ii) dominant ventricular lesion (LV, RV, or biventricular), (iii) oxygenation need, (iv) anatomical constraints and access options, and (v) intent (bridge to decision, recovery, durable LVAD, or transplant). Randomized evidence supports immediate culprit-lesion revascularization for myocardial AMI CS and suggests benefit from routine microaxial flow pump support in carefully selected AMI CS patients without major hypoxic brain injury risk, albeit at the cost of higher bleeding and limb ischemia. In contrast, routine early VA-ECMO in infarct-related CS has not demonstrated mortality benefit in randomized trials and is associated with increased complications; therefore, VA-ECMO should be reserved for selected phenotypes, including refractory shock with severe hypoxemia, profound biventricular failure, or circulatory collapse, and should be embedded within an explicit unloading, anticoagulation, limb-perfusion, and weaning protocol.

Physical and cognitive function, both of which decline with aging, are significantly interrelated. Although numerous studies have investigated the effect of physical exercise on cognitive function, relatively few have examined the impact of pure cognitive training on physical performance. This review aimed to summarize the effects of pure cognitive training on balance and mobility in older adults. Electronic databases (PubMed, Embase, CINAHL, and PsycInfo) were searched in February 2025. Randomized controlled trials that investigated the effect of pure cognitive training on balance and mobility in older adults were included. Pure cognitive training refers to a strictly nonphysical approach involving guided practice on a standardized set of cognitive tasks aimed at optimizing cognitive functioning. For the outcomes, balance performance focused on standing balance tests and comprehensive balance assessment scales. Mobility performance primarily focused on gait speed under a single-task condition (ie, walking only), gait speed under a dual-task condition (ie, conducting cognitive tasks while walking), and the Timed Up and Go test. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality. The level of evidence for the available outcomes was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Meta-analyses and sensitivity analyses of studies with high methodological quality were performed if 3 or more studies were obtained. Fourteen studies were eventually included. The methodological qualities of 8 (57%) studies were rated as good, while those of 6 (43%) studies were rated as fair. A meta-analysis of studies with high methodological quality showed that pure cognitive training has a significant effect on cognitive-motor dual-task gait speed (standardized mean difference [SMD] 0.39, 95% CI 0.04-0.75; n=376 participants; moderate-quality evidence) but not single-task gait speed (SMD 0.12, 95% CI -0.05 to 0.30; n=506 participants; moderate-quality evidence). No significant improvements were found in functional mobility (SMD 0.29, 95% CI -0.60 to 1.18; n=566 participants; low-quality evidence) or balance (SMD 0.18, 95% CI -0.34 to 0.69; n=139 participants; very low-quality evidence). Cognitive training does not improve balance or mobility under single-task conditions but does improve walking speed under cognitive-motor dual-task conditions in older adults. A cognitive training protocol targeting executive function, consisting of 40- to 60-minute sessions conducted 2 to 3 times per week over a period of 8 to 10 weeks, has been shown to be effective.

Cerebellar ataxia with neuronopathy and vestibular areflexia syndrome (CANVAS) is a rare, late-onset neurodegenerative disorder caused by biallelic intronic AAGGG repeat expansions in the RFC1 gene. Its phenotype is heterogeneous, ranging from isolated sensory neuronopathy to the full clinical triad. Although neuronopathy is present in the majority-if not all-of the cases, the prevalence and clinical significance of neuropathic pain remain insufficiently characterized. We report a genetically confirmed case of CANVAS in a 58-year-old woman presenting predominantly with asymmetrical neuropathic pain. Clinical, neurophysiological, vestibular, and genetic assessments were performed, with longitudinal follow-up over 3 years. Additionally, a case-driven systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in May 2026 in two databases (MEDLINE and Scopus) that identified cohorts of CANVAS cases with data on pain. Fourteen studies met our inclusion criteria. Pooled prevalence of neuropathic pain was calculated using a random-effects model. The systematic review included 445 patients with CANVAS. The pooled prevalence of neuropathic pain was 43.2% (95% confidence intervals 34.0-52.9%) with moderate heterogeneity across these studies (I2 = 65%). Evidence from included studies suggests that pain may occur early and represents a significant contributor to disease burden. Neuropathic pain is a frequent and potentially early manifestation of CANVAS, likely reflecting underlying sensory neuronopathy. CANVAS should be considered in patients with idiopathic sensory neuronopathy, even when pain is present. Early recognition and targeted genetic testing are essential to improve diagnosis and optimize patient management in this underdiagnosed condition.

Severe carotid artery stenosis (CAS) impairs cerebral blood flow and cognitive function. Revascularization may improve outcomes, but patient selection and timing remain challenging. This review synthesizes evidence on&#xa0;pre-revascularization risk factors. This systematic review synthesises pre-revascularization evidence on CAS-related cognitive decline and evaluates timing, restenosis, high-risk subgroups (dialysis, radiation-induced, sex), bilateral stenosis, hyperperfusion, and risk for stroke/death/MI outcomes. A systematic search of PubMed, Scopus, EBSCO, Web of Science, SciFinder, and Emerald databases identified&#xa0;22 published studies that reported quantitative prerevascularization data between 2013 and 2026. The search was restricted to English-language studies. &#xa0;Severe CAS (&#x2265;70%) impairs memory, attention, executive function (MMSE +0.9 post-revascularization, p=0.019; MoCA R=-0.359, p<0.001). Modern medical therapy reduced 120-day stroke risk to 1.97% (vs historical 5%); large CIL volume (&#x2265;4000 mm&#xb3;) predicts stroke (OR 4.6); urgent TFCAS riskier than CEA (6.5% vs 4.0%); restenosis higher after CAS (40% vs 18% CEA). High-risk subgroups: dialysis (4.7% 30-day mortality; 43.4% 3-year survival), radiation-induced (86% vulnerable plaques), female TFCAS (OR 2.85 stroke/death), contralateral occlusion (CAS OR 2.90), octogenarians (TF-CAS 6.6% vs CEA 2.5%). Bilateral stenosis requires CVR-guided staging. &#xa0;Pre-revascularization cognitive assessment identifies treatment-responsive deficits. Timing should be individualized (delay large CIL); CEA preferred for high-risk anatomy. Novel risk stratification (dialysis, radiation, female sex, bilateral CVR) guides patient selection beyond traditional stenosis degree.

SUMOylation regulates critical cellular processes, including DNA repair, transcription, and immune responses. Human herpesviruses (HHVs) have evolved mechanisms to hijack the SUMO pathway, promoting viral replication, immune evasion, and establishment of latency. This review explores how HHVs manipulate the host SUMOylation machinery, detailing key viral proteins and their effects, as well as antiviral defense mechanisms.

The term 'brain perfusion' is applied in clinical practice to a family of neuroimaging techniques that measure, in reality, quite different physiological quantities in the brain circulation. CT perfusion (CTP) and DSC-MRI track a contrast bolus to derive semi-quantitative haemodynamic parameters. ASL-MRI estimates cerebral blood flow (CBF) without contrast, but the result is sensitive to arterial transit time, haematocrit, and the patient's haemodynamic state on the day of the scan. DCE-MRI quantifies blood-brain barrier (BBB) permeability, a property of the neurovascular unit rather than a flow measurement. Perfusion SPECT provides a relative, normalisation-dependent CBF map that is distorted by cortical atrophy. [&#xb9;&#x2078;F]FDG-PET reflects synaptic glucose metabolism, but not blood flow. Because these techniques answer different physiological questions, their results are not interchangeable, and applying a threshold or pattern derived from one modality to interpret another is methodologically unsound - yet this conflation occurs with regularity in clinical practice. This narrative review synthesises the clinical applications, diagnostic performance, and interpretive pitfalls of each technique in Alzheimer's disease (AD)/mild cognitive impairment (MCI-AD), dementia with Lewy bodies (DLB)/Parkinson's disease dementia (PDD), frontotemporal dementia (FTD)/primary progressive aphasia (PPA), and mixed dementia with vascular pathology. Recognised limitations include the narrative study design and the small number of head-to-head multi-modal studies in pathologically confirmed cohorts. A comparative table and practical minimum reporting elements are provided.