Background: Percutaneous coronary intervention (PCI) during extracorporeal cardiopulmonary resuscitation (ECPR) before sustained return of spontaneous circulation (ROSC) is increasingly performed, yet most published reports fail to document ROSC status at the time of intervention-leaving this specific clinical phenotype poorly characterized. We aimed to clarify this ambiguity by systematically separating studies with explicit no-ROSC documentation from those in which the phenotype is only inferred and to describe selection, feasibility, and outcomes for the resulting cohorts. Methods: PubMed, Embase, and Cochrane CENTRAL were searched on 30 January 2026. Studies were pre-classified as DEFINITE (explicit no-sustained-ROSC documentation at PCI) or PROBABLE (workflow strongly implying no sustained ROSC). The 13 DEFINITE studies served as the primary analysis population; the 14 PROBABLE studies provided supportive evidence. Risk of bias was assessed using ROBINS-I (DEFINITE, primary) and JBI checklists (all studies). Sensitivity analyses excluded overlapping registries (ELSO, SAVE-J). Data were synthesized descriptively along three axes-selection, feasibility, and outcomes-without meta-analysis. Registered in PROSPERO (CRD420251252255); PRISMA 2020 compliant. Results: Twenty-seven studies encompassing 12,882 patients were included. In the DEFINITE primary cohort (13 studies, N = 3320), median survival to discharge was 30.3% (IQR 26.5-40.8; range 21.0-69.0; and n = 11) and favourable neurological outcome (CPC 1-2) 33.5% (IQR 16.8-45.8; range 10.4-92.0; and n = 12). Exclude-overlap sensitivity analysis (19 studies, N = 2741) yielded concordant estimates (survival 31.1%, IQR 27.2-37.0). PCI rates spanned 24-100% and post-procedural TIMI 3 flow 62.4-84.0%. ROBINS-I rated 9/13 DEFINITE studies at serious overall risk of bias and 4/13 at moderate (none low), predominantly from confounding by indication and selection bias-substantially more stringent than the JBI appraisal. Conclusions: PCI without sustained ROSC under ECPR is technically feasible, but the practice is widespread while remaining insufficiently standardized in ROSC reporting. Descriptive benchmarks from DEFINITE studies provide realistic outcome ranges for shared decision-making; no inference regarding comparative effectiveness is possible from observational data. Standardized documentation of ROSC status at PCI initiation is an immediate priority for future ECPR research.
Songbirds rely on an endogenous programme encoding spatio-temporal information necessary for naive individuals to perform their first migration. Timing programmes are generated by endogenous clocks and include responses to external cues, with photoperiod being the most important. Photoperiod can advance or delay the circannual cycle and, while it is well established as a trigger for initiating migration, it remains uncertain whether birds continue to integrate photoperiod into their programme during migration. This study investigated whether two passerine species incorporate photoperiod in their endogenous programmes during autumn migration. Photoperiod manipulation experiments were conducted on hatch-year individuals of European Robin (Erithacus rubecula; short-to-medium distance migrant), and Garden Warbler (Sylvia borin; long-distance migrant), monitoring their migratory activity and fuelling. The two species responded differently to the treatment, possibly due to different migratory distances, though effects of stage-appropriate responses cannot be excluded. European Robins were partially sensitive to photoperiodic cues regarding their migratory activity. Their fuelling was, however, unaffected by photic treatment. Garden Warblers showed little sensitivity to photoperiod, suggesting perhaps a stronger reliance on other external cues during migration. Garden Warblers, furthermore, exhibited an exceptionally high fuelling rate, compared to other species previously studied, likely an adaptation to their time-constrained, long trans-equatorial migration. The results suggest that different components of the migratory phenotype can be controlled by different cues, with species-specific differences in the response. Understanding how migratory timing programmes interact with environmental cues in various migration phases is crucial, especially as anthropogenic processes rapidly alter photic environments risking threatening migratory birds.
In this essay I review and summarize four older "thought" papers about how science is communicated and practiced. These papers were written by the Nobel Prize winner Peter Medawar, the eminent physiologist Julious Comroe, Eugene Robin a renowned clinical investigator, and David Horrobin an innovative scientist and early player in biotechnology. These papers all question how we frame what we do and tell stories about what we find. Several caution against excessive objectivity, hype, groupthink, and what we now call fear of missing out. They argue for imagination, creativity and critical thinking. While there are many threats to biomedical research beyond the control of individual scientists, I believe these papers offer insight about things we can do from the inside out to improve the practice and culture of science. I am also hopeful that insights from these papers, if broadly acted on, could help improve public confidence in and support for biomedical research.
Sedentarism and physical inactivity are growing concerns for global health institutions, especially with the rising number of adolescents failing to meet daily physical activity guidelines. These inactive lifestyles can adversely affect cognitive functions during development. Thus, a systematic review of observational studies was conducted to evaluate the impact of sedentary behavior and physical inactivity on cognitive performance in children aged 6 to 12. Eligible studies included English-language observational designs (such as cohort and case-control studies), enrolling neurotypical children classified as sedentary, insufficiently active, or physically inactive (experimental group), compared to active children (control group), according to ACSM recommendations. Studies were also required to report outcomes related to executive functions, academic performance metrics, memory, and attention. Systematic searches were conducted in MEDLINE (PubMed), Embase, Cochrane Library, Web of Science, and Scopus, from inception to February 2026. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies-of Exposure (ROBINS-E) tool. Data were synthesized through a narrative method. Of the 5438 articles initially identified, two studies directly compared inactive and active groups with contrasting results. One showed negative associations between light, moderate physical activity, and total activity time with verbal and perceptual skills in the active group, alongside positive effects of vigorous PA and sedentary behavior on verbal skills. The other pointed positive dose-response effects of sustained moderate-to-vigorous PA trajectories on academic achievement (reading, mathematics, language). However, caution is advised when interpreting these results due to the high risk of bias in both studies, lack of control for confounding variables, and insufficient information on missing data and blinding procedures. While other studies show significant associations between physical activity and cognitive measures, it is crucial to question whether group compositions accurately reflect the cognitive effects of exercise. Given the limited number of articles meeting international physical activity organization criteria, caution is recommended when interpreting the cognitive effects of physical activity-related exposures in children. This review introduces a novel data analysis approach that classified groups based on established physical activity recommendations, aiming to standardize group criteria. This method potentially sparks essential debates on group definitions and contributes to enhancing the methodological quality of future observational or experimental studies, enabling more robust and reliable data interpretation.
Maternal age is a well-established determinant of IVF success, primarily due to increased embryonic aneuploidy. Preimplantation genetic testing for aneuploidy (PGT-A) enables the selection of euploid embryos, potentially improving implantation and live birth rates. However, whether euploid embryo transfer can fully overcome the negative impact of advancing maternal age remains uncertain. This systematic review aims to evaluate the impact of euploid embryo transfer and maternal age on implantation and pregnancy outcomes in IVF-ET cycles. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase for studies published between 2021 and 2025. Eligible studies were retrospective cohort studies reporting implantation, clinical pregnancy, or live birth outcomes following euploid embryo transfer across different maternal age groups. The PICOS framework guided eligibility criteria. Risk of bias was assessed using the ROBINS‑I tool. A narrative synthesis was performed due to heterogeneity in study designs, age cut-offs, and outcome definitions. Eight retrospective cohort studies encompassing 7,537 patients were included. Three studies reported a significant decline in live birth rates with advancing maternal age, despite euploid transfer, particularly in women ≥38 years, with miscarriage rates as high as 22.6% in the oldest group. Two studies found no independent age effect after adjusting for embryo morphology and endometrial preparation. Euploid transfer demonstrated marked benefit in recurrent pregnancy loss patients (live birth rate 80% vs. 0% in controls) but no benefit in recurrent implantation failure. Blastocyst trophectoderm grade was a stronger predictor of live birth than maternal age in two studies. Oocyte origin (autologous vs. donor) did not affect outcomes in advanced maternal age patients. Six studies had low overall risk of bias, while two showed moderate-to-serious risk. Euploid embryo transfer significantly improves implantation and reduces miscarriage rates compared to untested embryos; however, maternal age continues to influence live birth outcomes in women aged 38 years and older. The benefit of PGT-A varies by clinical indication: strongly supported for recurrent pregnancy loss, equivocal for advanced maternal age, and not supported for recurrent implantation failure. Blastocyst morphology remains prognostically important even after ploidy selection. Prospective studies with standardized age cut-offs and cumulative live birth reporting are needed to refine patient selection for PGT-A.
Hyponatremia is the most common electrolyte disorder in hospitalized patients and is associated with increased morbidity and mortality. Correction is challenging because rapid increases in serum sodium may lead to osmotic demyelination. Desmopressin is used to stabilize free-water excretion, but the effectiveness of proactive administration has not been systematically evaluated. We searched PubMed-MEDLINE, Embase, and the Cochrane Library registries from inception through February 2026. We included studies enrolling adults with moderate-to-severe hyponatremia receiving standard therapy that compared proactive desmopressin with non-proactive usual-care strategies. Two reviewers independently extracted data and assessed risk of bias using ROBINS-I v2 and RoB 2. The primary outcome was serum sodium overcorrection using study-defined thresholds. Secondary outcomes included osmotic demyelination syndrome (ODS), mortality, hospital length of stay, worsening hyponatremia, and total hypertonic saline volume infused. Six studies including 1,881 patients were included, of whom 168 received proactive desmopressin. Proactive desmopressin was associated with significantly lower odds of overcorrection compared with non-proactive usual-care strategies (OR, 0.29; 95% CI, 0.19-0.45; p < 0.001; prediction interval, 0.14-0.62). This association was consistent across thresholds of > 8, >10, and > 12 mEq/L at 24 h and > 18 mEq/L at 48 h. Cases of ODS were rare and did not differ significantly between groups. Mortality, hospital length of stay, total hypertonic saline volume infused, and worsening hyponatremia also did not differ significantly between groups. In adults with moderate-to-severe hyponatremia receiving standard therapy, proactive desmopressin was associated with a lower risk of overcorrection. This reduction was not accompanied by clear differences in ODS, worsening hyponatremia, or mortality. Further prospective randomized studies are needed to better define the optimal timing, dosing, and patient selection for this strategy. CRD420251043907 CLINICAL TRIAL NUMBER: Not applicable.
Breast reconstruction after mastectomy can restore body image and improve quality of life. Implant-based reconstruction (IBR) offers shorter operative times without donor-site morbidity, whereas deep inferior epigastric perforator (DIEP) flaps may provide more natural outcomes. This systematic review compares outcomes of DIEP flaps and IBR. A systematic search of MEDLINE, CENTRAL, and Google Scholar was performed in June 2025 (PROSPERO ID: CRD420251081966) for studies comparing DIEP flaps and IBR after mastectomy. Studies reported BREAST-Q scores and complications, reconstruction failures, and revision procedures. Risk of bias was assessed using Cochrane RoB 2.0 for randomized trials and ROBINS-I for nonrandomized studies, with evidence graded using Grading of Recommendations, Assessment, Development, and Evaluations. Pooled mean differences and odds ratios with 95% confidence intervals were calculated. Twenty studies including 3106 patients (1068 DIEP and 2038 IBR) were analyzed. DIEP flap group showed higher overall BREAST-Q scores (mean difference +9.28; P = 0.008), with improvements in breast satisfaction, psychosocial well-being, and sexual well-being. Nipple satisfaction and chest physical well-being showed no significant differences. Infection, hematoma, and seroma rates were comparable. DIEP flap had lower reconstruction failure rate (odds ratio 0.15; P = 0.019), although donor-site morbidity and revision rates were higher. Anxiety and depression outcomes showed no significant differences. DIEP flap reconstruction offers better patient satisfaction and lower failure rates than IBR, without increased complications. These benefits must be weighed against operative complexity and resource demands. High-quality multicenter trials with standardized outcome reporting are needed for patient-centered decisions.
Molluscum contagiosum affects up to 11.5% of children, yet optimal treatment remains uncertain. Previous systematic reviews included mixed adult/pediatric populations, limiting applicability to children. We performed the first pediatric-specific network meta-analysis comparing molluscum contagiosum treatment efficacy and safety. We searched MEDLINE, Embase, Cochrane Library, and Web of Science through December 2025 for controlled trials evaluating molluscum contagiosum treatments in children. Two reviewers independently selected studies, extracted data, and assessed risk of bias using Cochrane Risk of Bias 2 and ROBINS-I tools. We performed frequentist network meta-analysis with random-effects modeling, calculating risk ratios (RR) with 95% confidence intervals (CI). Treatments were ranked using Surface Under Cumulative Ranking (SUCRA) scores. This systematic review and network meta-analysis was registered in PROSPERO (registration number CRD420251040622). Eighteen controlled trials involving 2377 pediatric participants evaluating 15 treatments were included. The network demonstrated consistency (inconsistency p = 0.77). Among treatments evaluated in multiple studies, salicylic acid + lactic acid 16.7% (RR 3.16, 95% CI 1.81-5.52, SUCRA 86.0%), cantharidin 0.7% (RR 3.25, 95% CI 1.39-7.58, SUCRA 81.2%), and potassium hydroxide 10% (RR 3.05, 95% CI 1.77-5.24, SUCRA 78.6%) demonstrated superior efficacy versus placebo. Single-study treatments including Backhousia citriodora oil and Candida albicans antigen achieved highest rankings but require validation. Potassium hydroxide demonstrated concentration-dependent efficacy and adverse events. Salicylic acid + lactic acid 16.7%, cantharidin 0.7%, and potassium hydroxide 10% demonstrate superior efficacy for pediatric molluscum contagiosum with robust multi-study evidence. Treatment selection should balance efficacy, safety, and patient factors. Top-ranked single-study treatments require validation before clinical recommendations.
To systematically evaluate the efficacy and safety of radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatectomy (CDP) for left-sided pancreatic cancer. Computerized searches were conducted in PubMed, Embase, Cochrane Library, CNKI, Wanfang Data and other Chinese and English databases to collect studies comparing RAMPS with CDP for left-sided pancreatic cancer published from January 2003 to October 2025. Two researchers independently completed literature screening and data extraction; the ROBINS-I tool was used for bias risk assessment; RevMan 5.4.1 software was used for effect size combination, and R software was used for sensitivity analysis and publication bias analysis. A total of 21 studies were included, involving 2,591 patients, among which 9 were propensity score-matched (PSM) studies. The results of the meta-analysis showed that compared with CDP, RAMPS could significantly increase the R0 resection rate (RR = 1.10, 95% CI: 1.03-1.18, P = 0.007) and the number of lymph nodes dissected (MD = 3.58, 95%CI 1.66 - 5.50, P<0.001). However, substantial heterogeneity was noted for these outcomes (I2 = 72%/93%). No significant differences were found in operative time, blood loss, hospital stay, overall complication rates, or perioperative mortality. Crucially, there were no significant differences in overall survival (HR = 0.93, 95% CI: 0.76-1.13, P = 0.46) or disease-free survival (HR = 1.01, 95% CI: 0.77-1.33, P = 0.92) between the two procedures. For left-sided pancreatic cancer, RAMPS may offer advantages in local tumor control and surgical radicality; however, such advantages have not been shown to translate into meaningful improvements in survival outcomes.
Background: Childhood obesity is increasingly associated with gut microbiome dysbiosis. This systematic review (PROSPERO CRD420251131354) evaluates evidence from studies published between 2020 and 2026 assessing how nutritional and lifestyle interventions influence gut microbiota in children with obesity. Methods: A systematic search of PubMed, EMBASE and EBSCO identified 21 interventional studies involving children aged 5-18 years with obesity, with the last search conducted in April 2026. Interventions comprised prebiotics, probiotics, synbiotics, postbiotics, high-fiber diets, calorie-restricted dietary approaches, and lifestyle modifications such as physical activity. Microbiome outcomes were analyzed using 16S rRNA sequencing, quantitative real-time polymerase chain reaction (qPCR), or metagenomics. Risk of bias was evaluated using the RoB 2 and ROBINS-I (version 2) tools. Due to substantial heterogeneity in study design, participant characteristics, intervention types, and analytical methods, a meta-analysis was not feasible. Results: Across 21 studies, nutritional interventions included measurable but heterogeneous alterations in gut microbiome composition. Inulin supplementation was associated with a significant increase in alpha diversity and with higher relative abundances of Bifidobacterium, Blautia, Megasphaera, Subdoligranulum, and Eubacterium coprostanoligenes. Synbiotic supplementation increased Prevotella and Dialister and reduced the Firmicutes/Bacteroidetes ratio. High-fiber dietary interventions increased Faecalibacterium, Bifidobacterium, and Clostridium, while reducing Bacteroides, and were associated with shifts in metabolic pathways related to carbohydrate, lipid, and nucleotide metabolism. Calorie-restricted diets and combined diet-exercise interventions increased beneficial taxa such as Akkermansia muciniphila, improved microbial diversity, and correlated with favorable metabolic and anthropometric outcomes. Overall, nutritional and lifestyle interventions in pediatric obesity were associated with taxon-specific and context-dependent microbiome changes, rather than uniform restructuring. Conclusions: Nutritional interventions can modulate gut microbiota diversity, composition, and predicted function in pediatric obesity; however, the observed effects vary substantially across studies. The limited number of trials, small sample sizes, and methodological heterogeneity underscore the need for larger, standardized studies to better define clinical and therapeutic implications.
Background: Sleep deprivation is one of the major public health and performance risk factors, with documented effects on vigilance, executive function, emotional regulation, and safety-critical behaviour. This review examines how event-related potentials (ERPs)-which provide millisecond-level resolution of cognitive processing stages-can clarify which neural processes are most affected by sleep loss, from early sensory encoding to later evaluative and control-related stages. Materials and Methods: This study was conducted as a systematic review of human studies on sleep deprivation and ERPs. Eligible studies included human participants, focused primarily on acute/total sleep deprivation, and reported ERP outcomes (e.g., amplitude, latency, topography, or related event-locked EEG measures). Searches were performed in major biomedical/psychology databases using sleep deprivation and ERP terms, with additional forward/backward citation searching. Data was extracted in a structured format (participant characteristics, deprivation protocol, ERP methods, behavioural outcomes, ERP findings, and recovery/countermeasure effects). Due to substantial heterogeneity in paradigms, protocols, and ERP methods, findings were synthesised narratively rather than meta-analysed. Risk of bias was assessed with RoB 2 and ROBINS-I. Results: The search identified 854 records, of which 82 studies were included following deduplication, screening, full-text review, and citation chasing. Samples were typically small, highly selected, and dominated by healthy young adults, with frequent attrition related to prolonged wakefulness and EEG data-quality constraints. Across studies, sleep deprivation produced stage-specific and task-dependent ERP effects rather than a single uniform pattern. The most consistent findings involved mid-to-late components. These components typically showed prolonged latency and reduced amplitude. In some cases, amplitude increases were observed and interpreted as compensatory recruitment. Early sensory/pre-attentive components (e.g., P1/N1/MMN/P50) were often relatively preserved, but showed selective vulnerability, including latency slowing, reduced filtering/gating, or decreased phase locking. A recurring observation was a behaviour-ERP dissociation, where ERP abnormalities were detectable even when behavioural impairment was modest, indicating covert neural inefficiency or compensation. Recovery sleep, naps, and countermeasures (e.g., modafinil, caffeine) produced partial, component-specific recovery, with amplitude and latency often recovering at different rates. Conclusions: The evidence indicates that sleep deprivation primarily disrupts higher-order, late-stage, and temporally coordinated neural processing, while earlier sensory processing is often preserved but becomes slower and less stable. Among ERP markers, the P300/P3 family is the most robust and informative signature of sleep loss effects and recovery. ERPs are therefore a sensitive tool for detecting neural dysfunction and compensation under sleep deprivation, including changes that may precede overt behavioural decline. Future research must improve the generalisability and reproducibility of ERP findings by employing larger, more diverse samples, alongside more standardised methodological, recording, and reporting practices.
Background/Objectives: Peritoneal metastases from breast cancer (PMBC) are rare, aggressive, and lack standardized management. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a potential locoregional strategy for highly selected patients. This PRISMA-informed narrative review used a structured and reproducible search and study-selection process, SWiM-guided narrative synthesis, and descriptive pooled individual-patient data (IPD) analysis to evaluate the feasibility, safety, and reported oncologic outcomes of CRS plus HIPEC in PMBC. Methods: The English-language literature was searched in PubMed/MEDLINE, Embase, and Google Scholar up to 31 December 2025. Eligible peer-reviewed full-text articles reported PMBC patients treated with CRS plus HIPEC and at least one perioperative or oncologic outcome. Patient-level data were extracted when explicitly reported and were summarized descriptively; no inferential survival analysis was performed. Risk of bias was assessed using JBI checklists for case reports/series and ROBINS-I for the multicenter cohort. Results: Six peer-reviewed studies were included (66 PMBC patients); 30 patients underwent CRS plus HIPEC. Five studies provided sufficient patient-level data for descriptive pooled IPD analysis (n = 17). Median age at CRS/HIPEC was 56 years (n = 13 with reported age), and the median interval between breast cancer diagnosis and PMBC was 12 years (range 0-30 years; available-case analysis). Median PCI was 21.5 (n = 16), and complete cytoreduction (CC-0) was achieved in 9 of 17 patients. Major postoperative morbidity occurred in 17.6%, while no in-hospital or 30-day mortality was reported. Reported disease-control and survival outcomes were heterogeneous and are therefore summarized only descriptively. In the multicenter cohort, curative-intent CRS with or without HIPEC was associated with a median overall survival of 61.5 months measured from diagnosis of peritoneal metastases; however, HIPEC-specific baseline characteristics and oncologic outcomes were not separately stratified. Conclusions: CRS plus HIPEC appears feasible in highly selected PMBC patients and may be associated with favorable outcomes when complete cytoreduction is achievable. However, the evidence is sparse, heterogeneous, and highly prone to selection and publication bias. Therefore, no causal inference regarding the independent benefit of HIPEC can be drawn, and this approach should be considered investigational pending prospective multicenter registries.
Background/Objectives: Respiratory tract symptoms, urinary symptoms, and acute fevers frequently prompt emergency urgent care visits. Distinguishing bacterial from viral or non-bacterial etiology remains difficult because clinical features overlap and laboratory microbiological tests are often non-specific or delayed. The MeMed BV® test is a rapid host-response assay that combines TRAIL, IP-10, and CRP into a composite score to differentiate between bacterial and viral/non-bacterial infections within 15 min. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy and clinical utility of the MeMed BV test in adults and children with suspected respiratory tract infections, urinary tract infections, and undifferentiated fever. Methods: The review followed PRISMA-DTA guidelines. Medline, Embase, CINAHL, and the Cochrane Library databases were searched. The risk of bias was assessed using the QUADAS-2, Cochrane RoB 2.0, ROBINS-I, and JBI tools. Where appropriate, meta-analyses were performed using a bivariate random-effects or HSROC model. Results: Sixteen studies (12 diagnostic test accuracy (DTA) studies and four non-DTA studies) were included. The pooled sensitivity was 91% (95% CI: 86-94%), and specificity was 92% (95% CI: 91-93%), with consistent accuracy in adults (Sensitivity 93%/Specificity 91%) and children (Sensitivity 88%/Specificity 93%). The non-DTA studies demonstrated that MeMed BV-guided management improved antibiotic stewardship: antibiotics were prescribed in 20.6% of viral versus 73.2% of bacterial cases, and clinician adherence to MeMed BV results reached 75-80%. Conclusions: The MeMed BV test demonstrates consistently high diagnostic accuracy and is associated with improved antibiotic decision-making, supporting its integration into clinical workflows.
Hip arthroscopy (HAS) is technically demanding, and surgeon's experience may influence outcomes. However, the magnitude and domain-specific effects of the learning curve remain unclear. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD420251185937). PubMed/MEDLINE, Embase and Scopus were searched through 31 December 2025 for studies comparing early versus late experience phases in HAS. Random-effects meta-analyses (Sidik-Jonkman estimator with Hartung-Knapp adjustment) were performed for operative and traction time, patient-reported outcomes, complications, revision arthroscopy and conversion to total hip arthroplasty (THA). Risk of bias was assessed using ROBINS-I and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Eighteen studies (2624 procedures; 1291 early and 1333 late cases) were included. Late cases showed significantly shorter operative time (-31.77 min; 95% confidence interval [CI] -51.40 to -12.14) and traction time (-15.67 min; 95% CI -25.42 to -5.92), with substantial heterogeneity. Functional outcomes favoured late experience, including higher improvement in minimal clinically important difference units (0.58; 95% CI 0.17 to 0.99) and modest gains in modified Harris Hip Score (2.78 points; 95% CI 0.16 to 5.41) and Non-Arthritic Hip Score (8.41 points; 95% CI 1.99 to 14.83). Complication rates and revision arthroscopy did not differ significantly, whereas conversion to THA was lower in late cases (odds ratio [OR] 0.10; 95% CI 0.01 to 0.98). Most studies were at moderate to serious risk of bias, and certainty of evidence was low to very low. Surgeon experience in HAS is associated with improved operative efficiency and modest functional gains, while safety outcomes remain largely unchanged. The lower THA conversion rate in late cases may reflect improved patient selection and decision-making, although confidence is limited by study design and heterogeneity. Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.
Herpes simplex virus (HSV) infections are a common clinical concern, often requiring effective antiviral treatments. Anti-microbial photodynamic therapy (aPDT) has gained attention as a potential adjunct to conventional therapies for managing HSV outbreaks. This systematic review aimed to evaluate the efficacy of aPDT in treating HSV infections. Following PRISMA guidelines, PubMed/MEDLINE, Scopus, Embase, and Web of Science online databases were systematically searched for relevant studies on July 2025. Healing time was considered as the primary outcome, and secondary outcomes included lesion size, viral load, and patient-reported outcomes. Clinical studies evaluating efficacy of aPDT against other therapeutic approaches with at least 10 patients were considered eligible. Quality appraisal of the included studies was conducted using the revised Cochrane risk-of-bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). In addition, the certainty of evidence was assessed with a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework adapted for reviews without quantitative synthesis. aPDT monotherapy demonstrated clinical outcomes comparable to conventional antiviral therapy, with reductions in viral load and edema but limited superiority in clinical healing parameters. In contrast, adjunctive use of aPDT with antiviral therapy consistently improved pain, inflammatory markers, viral load, healing outcomes, and recurrence rates compared with either treatment alone. aPDT appears to be an effective adjunctive therapy for HSV infections, but further high-quality studies are necessary to refine treatment protocols and confirm its clinical benefits.
Aristotelia chilensis (maqui berry) is a Chilean native fruit rich in anthocyanins with potential antioxidant, glycemic, cardiometabolic, and ocular benefits, but its clinical efficacy remains unclear. This systematic review synthesized and critically appraised human trials evaluating oral maqui supplementation in adults. Following PRISMA 2020 and a PROSPERO-registered protocol, five databases were searched, and risk of bias and certainty of evidence were assessed using RoB 2/ROBINS-I and GRADE. Twelve clinical trials published between 2014 and 2023 were included. Acute studies consistently showed reduced postprandial glucose and modulation of insulin response, whereas chronic interventions showed modest and inconsistent effects on HbA1c, lipid profile, and other cardiometabolic markers. Favorable changes were also reported for oxidative stress biomarkers and autonomic parameters, although these findings were mainly based on surrogate endpoints. The most consistent evidence was observed in the ocular domain, where maqui supplementation improved tear production, dry eye symptoms, and tear inflammatory markers. The overall certainty of evidence ranged from moderate to very low because of methodological heterogeneity, small sample sizes, and short intervention duration. Maqui berry supplementation shows promise, particularly for acute glycemic control and ocular surface health, but larger long-term randomized trials using standardized formulations are needed before definitive clinical recommendations can be made.
Pain management in children with molar-incisor hypomineralisation (MIH) presents a significant challenge, as affected teeth often respond poorly to local anaesthesia due to altered enamel and heightened pulp sensitivity. Overcoming these difficulties is crucial to achieving effective dental outcomes. To evaluate the effectiveness of pharmacological, desensitising and behavioural strategies for pain control in children and adolescents with MIH. Systematic search of multiple electronic databases identified studies published between 2001 and 2024. Eligible designs included randomised controlled trials, randomised crossover studies and clinical trials. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I V2 tools and certainty of evidence graded with GRADEpro. A random-effects meta-analysis was conducted to assess anaesthetic success with 4% articaine. Thirteen studies were selected, with six included in the meta-analysis. Pooled success rates for 4% articaine were 0.849 for inferior alveolar nerve block and 0.915 for intraosseous injection. Findings suggest improved anaesthetic success compared with 2% lidocaine. Pre-emptive ibuprofen, laser desensitisation and virtual reality distraction also showed benefits for reducing pain and anxiety. Current evidence suggests that an individualised, multimodal approach may improve pain management in children with MIH. However, further high-quality comparative studies are needed to guide clinical protocols. PROSPERO Registration: CRD42024474840.
Background: Breastfeeding enhances infant and maternal health, but global breastfeeding rates remain suboptimal. Virtual reality (VR) emerges as a promising tool for breastfeeding education. The objective of this review was to assess the effectiveness of VR-based interventions on breastfeeding outcomes in pregnant and postpartum women. Methods: PubMed, Embase, Web of Science, Scopus, and CENTRAL were searched until 10 January 2026, for randomized controlled trials (RCTs) and quasi-experimental studies comparing VR-based interventions (immersive simulations, 360° videos, or head-mounted displays) with standard care or non-VR comparators in pregnant or postpartum women. Primary outcomes included breastfeeding self-efficacy, motivation, and breastfeeding technique (LATCH score). Secondary outcomes included exclusive breastfeeding rates, milk production, and maternal anxiety. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools for RCTs and non-RCTs, respectively. A random-effects meta-analysis was conducted, with results reported as mean differences (MD) or risk ratios (RR), along with 95% confidence intervals (CIs). Certainty of the evidence was assessed using the GRADE approach. Results: Five studies (4 RCTs and 1 quasi-experimental; n = 344) were included. VR improved prenatal breastfeeding self-efficacy (2 studies, MD: 13.93; 95% CI: 10.96-16.90), motivation (1 study, MD: 2.88; 95% CI: 1.66-4.10), and LATCH score (1 study, MD: 1.72; 95% CI: 1.37-2.07), and reduced time to breastfeeding initiation (1 study, MD: -22.4 min; 95% CI: -29 to -15.9), the certainty of evidence was low to very low for these outcomes. No significant effects were observed for postnatal self-efficacy, exclusive breastfeeding, or maternal anxiety. Formal assessment of publication bias could not be done. The small sample sizes for most outcomes, heterogeneity, the open-label nature of the trials, and the subjective nature of the outcomes should be considered when interpreting these results. Conclusions: VR-based interventions may improve process outcomes, such as prenatal breastfeeding self-efficacy, motivation, breastfeeding technique, and early breastfeeding initiation; the certainty of evidence is low to very low. Evidence for clinically important outcomes, including exclusive breastfeeding and maternal anxiety, remains inconsistent. Larger, well-designed RCTs are warranted before these interventions can be considered in routine practice.
Proton pump inhibitors are widely used to manage acid-related gastrointestinal disorders; however, prolonged use has been associated with gut dysbiosis, including reduced microbial diversity and the proliferation of opportunistic pathogens. Herbal medicines and natural products, characterized by multitarget effects, have been proposed as potential strategies for modulating the gut microbiota and restoring microbial homeostasis. This systematic review aims to evaluate the effects of these interventions on the gut microbiota in patients receiving acid suppression therapy. This protocol is registered in the PROSPERO international prospective register of systematic reviews (CRD420261346672) and will be conducted in accordance with the PRISMA-P guidelines. A comprehensive literature search will be performed in PubMed, Scopus, Web of Science, CENTRAL, and CNKI from database inception to March 2026. Randomized controlled trials and nonrandomized controlled clinical studies evaluating herbal or natural product interventions in adult patients receiving acid suppression therapy will be included. Two independent reviewers will perform study screening, data extraction, and risk-of-bias assessment using the RoB 2 and ROBINS-I tools. The overall certainty of the evidence will be evaluated using the GRADE approach. Findings will be synthesized narratively, with a focus on taxonomic shifts (from the phylum to genus level) and diversity indices (alpha and beta diversity). Where sufficient data are available, a quantitative meta-analysis will be conducted using a random-effects model. Subgroup analyses will explore differences according to herbal intervention type (e.g., single extracts vs. multiherb formulations) and microbiome assessment methods. This review will provide a structured overview of the microbiota-modulating effects of herbal and natural product interventions during acid suppression therapy. By bridging traditional medicine and modern microbiome science, the findings may help inform integrative therapeutic strategies and guide the design of future high-quality clinical trials.