Chronic pancreatitis (CP) progressively destroys pancreatic parenchyma and predisposes patients to pancreatogenic type 3c diabetes mellitus (T3cDM). We conducted a systematic review and meta-analysis of cohort studies enrolling adults with clinically and/or instrumentally confirmed CP and no pre-existing diabetes at baseline. Systematic review and meta-analysis of cohort studies. Scopus, Web of Science Core Collection, and PubMed were searched from inception to August 2025. Random-effects models estimated pooled incidence of new-onset diabetes and the proportion requiring insulin. Prespecified subgroup analyses were stratified by follow-up duration (<60 months, 60-120 months, >120 months). Meta-regression explored demographic, behavioral, and clinical moderators. Nineteen studies met the inclusion criteria and contributed to the primary meta-analysis of incident diabetes after CP. The pooled incidence of diabetes was 30% (95% CI: 27-34; I² = 94.8%), with a prediction interval of 15%-49%. Exploratory follow-up-stratified analysis suggested a time-dependent increase: 18% (95% CI: 14-22) at <60 months, 25% (95% CI: 15-35) at 60-120 months, and 44% (95% CI: 24-66) at >120 months (p for subgroup differences = 0.0184). Among patients who developed diabetes, 59% (95% CI: 46-71; 7 studies; I² = 91.7%) required insulin therapy. Meta-regression did not identify statistically significant study-level moderators, although pancreatic calcification showed a non-significant positive trend. CP is associated with a substantial and time-dependent incidence of diabetes; however, the pooled estimates should be interpreted cautiously because the included studies were observational and highly heterogeneous. These findings support long-term glycemic monitoring and careful classification of pancreatogenic diabetes in patients with CP, while optimal screening intervals and treatment timing require further prospective evidence. PROSPERO CRD420251136931. How chronic pancreatitis leads to diabetes: what we learned from reviewing studies on long-term risk Chronic pancreatitis is a long-lasting inflammation of the pancreas. Over time, this condition damages the pancreas and reduces its ability to produce digestive enzymes and hormones, including insulin. When the pancreas can no longer make enough insulin, a specific type of diabetes—called type 3c diabetes—can develop. Many patients and clinicians want to know how common this is and how the risk changes over time. We reviewed all available high-quality research studies that followed adults with chronic pancreatitis who did not have diabetes at the start. We searched three major scientific databases and included studies that tracked people over several years. We then combined the results using statistical methods that allow us to calculate an overall estimate. We found 19 studies including more than 11,000 people. Overall, about 1 in 3 people with chronic pancreatitis developed diabetes during follow-up. The longer a person lived with chronic pancreatitis, the higher their chance of developing diabetes. Within the first 5 years, about 18% developed diabetes. Between 5–10 years, about 25% developed diabetes. After more than 10 years, the risk rose to 44%. Among those who did develop diabetes, nearly 60% eventually needed insulin, meaning their pancreas was no longer able to produce enough on its own. We also looked at factors that might influence the risk, such as age, sex, smoking, and whether pancreatitis was caused by alcohol. These did not seem to change the risk. There was a small suggestion that people with pancreatic calcifications—hard deposits in the pancreas—might be at higher risk, but this was not certain. In simple terms, chronic pancreatitis carries a high and increasing risk of diabetes over time. Regular blood-sugar monitoring, early diagnosis, and timely treatment—including insulin when needed—are essential for good long-term care.
This systematic review looks at burn injuries in the Gulf region over the past five years, focusing on how often they occur, their survival and complication rates, and current prevention efforts. To gather the data, two reviewers independently searched five major databases and checked article reference lists to make sure no relevant studies were missed. The team then used the Newcastle-Ottawa Scale (NOS) to evaluate the quality and potential bias of the gathered research. The following sections present these regional findings and discuss the need for better burn management systems and stronger prevention strategies across the Gulf countries. (1) To examine burn epidemiology. (2) To assess morbidity and mortality. (3) And to cover preventative strategies in the gulf countries (Qatar, UAE, Oman, Bahrain, Saudi Arabia) over the past 5 years. (1) Data extraction was performed independently by two reviewers utilizing a standardized form. To ensure data integrity, this instrument was initially piloted on three studies, with iterative modifications implemented as necessary before full-scale deployment. (2) A systematic literature search was conducted across five major electronic databases: PubMed, Embase, Google Scholar, Web of Science, and Scopus. To ensure literature saturation, the reference lists of all relevant articles were manually screened to identify additional eligible studies. (1) A quantitative meta-analysis was precluded by substantial heterogeneity in study methodologies, patient cohorts, and outcome assessments. Regarding methodological quality, twelve trials (60%) exhibited a moderate risk of bias, while two demonstrated a low risk and four presented a high risk. Evaluation via the Newcastle-Ottawa Scale (NOS) indicated that nine to ten studies maintained high transparency in both data collection and methodological reporting. (2) Highest rate of mortality was found in saudi arabia (17.6%) and second highest in Kuwait (10.9%). (1) There is a high degree of variation in burn epidemiology, mortality, and prognosis among various Gulf countries. Which emphasizes a need for a uniform burn management system. (2) To effectively reduce burn-related morbidity and mortality, a comprehensive escalation of current preventative strategies is required.
Perimenopause is a natural physiological transition associated with declining ovarian function and bothersome systemic symptoms. Menopausal hormone therapy (HT) remains the primary treatment, but safety concerns persist. Commercial Chinese polyherbal preparations (CCPPs) combined with HT are increasingly used, yet comparative evidence remains limited. This network meta-analysis (NMA) evaluated the effectiveness and safety of CCPPs plus HT for perimenopausal symptoms. Chinese and English databases were searched for randomized controlled trials (RCTs) evaluating CCPPs plus HT. The study followed the reporting guideline for network meta-analyses and was registered in PROSPERO (CRD420261335785). Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Data were synthesized in Stata 18.0, and surface under the cumulative ranking curve values were estimated as exploratory summaries. Seventy-three RCTs (n = 8,314) involving 11 CCPPs were included. Most studies had some concerns or high risk of bias, mainly owing to inadequate blinding and subjective-outcome vulnerability. Five CCPP + HT regimens significantly reduced the Kupperman Index (KI) compared with HT alone. Linglianhua Granule plus HT showed the largest KI estimate, but was supported by only two trials and low-certainty evidence. Given the very large standardized mean differences and the subjective nature of KI assessment in mostly unblinded trials, these results should be interpreted cautiously. For the Menopause-Specific Quality of Life questionnaire, only Kuntai Capsule plus HT showed significant improvement. The overall effective rate was treated as auxiliary because definitions varied. Dingkun Pill plus HT and Kuntai Capsule plus HT showed favorable estimates versus HT alone for estradiol elevation and follicle-stimulating hormone/luteinizing hormone reduction, respectively. CCPP + HT did not significantly increase reported short-term adverse reactions, but monitoring and follow-up were insufficient to establish safety superiority, equivalence, or long-term safety. CCPP + HT may be associated with improvements in selected symptom-related and endocrine outcomes compared with HT alone, but the evidence was generally of low to moderate certainty and derived mostly from unblinded trials. Ranking results, particularly for KI, should be considered exploratory summaries and not clinically actionable treatment hierarchies. Further high-quality blinded RCTs with standardized outcome assessment, adverse-event monitoring, and longer follow-up are needed. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335785, identifier CRD420261335785.
This study aimed to systematically evaluate and compare the effects of different types of prenatal exercise on neonatal outcomes, and to assess their relative effects and rankings for birth weight, gestational age, 1-minute Apgar score, and 5-minute Apgar score. We searched PubMed, the Cochrane Library, Embase, Scopus, and Web of Science for studies examining the effects of prenatal exercise on pregnancy and neonatal outcomes, from database inception to January 2026. According to exercise type, the interventions were classified into aerobic exercise (AE), resistance exercise (RE), mind-body exercise (MBE, referring to exercise modalities such as yoga and Pilates that emphasize breathing regulation, postural control, and mind-body coordination), and combined exercise (CE, referring to interventions composed of two or more exercise components, such as combined aerobic and resistance exercise). A network meta-analysis (NMA) was performed to synthesize the evidence. A total of 61 studies involving 11,036 pregnant women were ultimately included. For the 1-minute Apgar score, mind-body exercise was associated with a higher score compared with no intervention (MD = 0.33, 95% CI: 0.18 to 0.47). In the network comparison, mind-body exercise showed a higher 1-minute Apgar score than combined exercise (MD = 0.24, 95% CI: 0.06 to 0.42). For the 5-minute Apgar score, a statistically significant increase was observed only for mind-body exercise compared with no intervention (MD = 0.18, 95% CI: 0.04 to 0.32). Regarding birth weight, mind-body exercise was associated with a higher birth weight than combined exercise (MD = 104.41, 95% CI: 1.28 to 207.54). For gestational age, no statistically significant differences were observed between any intervention and no intervention or among different interventions. The cumulative ranking probability plots showed that mind-body exercise had the highest probability of ranking first across all four outcomes. The CINeMA assessment indicated that the confidence in the evidence for this network meta-analysis was mainly moderate to low. The effects of different types of prenatal exercise on neonatal outcomes were not consistent. Mind-body exercise showed a relative advantage in improving Apgar scores and may have a potential effect on birth weight; however, there is insufficient evidence to indicate that it can significantly improve gestational age. https://www.crd.york.ac.uk/prospero/CRD420251241770, identifier CRD420251241770.
Donation after circulatory death (DCD) liver transplantation is currently limited by inferior outcomes compared with donation after brain death (DBD), predominantly due to ischaemia-reperfusion injury and biliary complications. Abdominal normothermic regional perfusion (aNRP) is an emerging graft-preservation technique that aims to improve graft viability, patient outcomes and reduce rate of complications in DCD liver transplantation. The aim of this review is to appraise the current literature on the utility of aNRP in liver transplantation surgery. The PRISMA guidelines for systematic reviews were followed and relevant databases searched. Primary outcomes were graft and patient survival rates. Secondary outcomes were primary non-function, early allograft dysfunction, biliary complications including ischaemic cholangiopathy (IC)/ischaemic type biliary lesions (ITBL) and retransplantation rates. Risk-of-bias analysis was conducted. Narrative synthesis was performed due to marked heterogeneity in the included studies. Fourteen studies (2014-2026) encompassing 1,278 transplanted aNRP liver grafts were included in this review. aNRP was associated with a reduction in IC/ITBL rates, lower rates of primary non-function and lower early allograft dysfunction compared with conventional retrieval (super rapid recovery followed by static cold storage). Graft loss and retransplantation rates were also lower in aNRP cohorts. Compared with DBD transplantation, aNRP outcomes were similar with near-zero rates of IC in both groups. No significant differences were also observed between aNRP and ex situ normothermic machine perfusion (NMP). aNRP is associated with reductions in biliary complications, graft loss and retransplantation compared with conventional DCD retrieval, with outcomes comparable to DBD and ex situ NMP and offers a solution to expand the donor pool.
Post-exercise hypotension is an acute systemic recovery response that links exercise physiology with blood pressure control, yet the response to all-out sprint interval exercise is less clearly defined than responses to moderate-intensity continuous or submaximal interval exercise. Six databases were searched from inception to 1 February 2026. Controlled acute human studies were eligible when they examined a single bout of sprint interval exercise (SIE) or a closely equivalent all-out, repeated-sprint, Wingate-based or supramaximal interval protocol and reported post-exercise blood pressure. Two reviewers independently screened records, extracted data and assessed risk of bias. Study-level mean differences were organized by comparator family and assessment window. Because exact passive-control data were sparse, crossover-aware exploratory quantitative summaries were retained only as descriptive aids, using an assumed within-participant correlation of 0.50 with sensitivity analyses. Values available only as figure-digitized means without extractable dispersions were retained for descriptive synthesis only. Nine randomized crossover studies involving 136 participants were included. The exact passive/no-exercise control evidence was small: three studies with 31 participants contributed systolic blood pressure (SBP) data and two studies with 21 participants contributed diastolic blood pressure (DBP) data at the first extractable exact time point beyond 60 min. Study-level SBP mean differences were -3.0, -5.0 and -8.0 mmHg, indicating a directionally consistent short-term systolic reduction after SIE. Study-level DBP mean differences were -3.0 and -7.0 mmHg, providing only sparse preliminary evidence for DBP. In protocol-comparator studies, all three 45-min peripheral SBP estimates favored longer over shorter recovery intervals (-7.0, -7.5 and -5.0 mmHg). Exploratory quantitative summaries are reported in the full text and figures as descriptive aids only. Evidence for 24-h ambulatory blood pressure was limited to one study and did not establish a durable sprint-specific effect beyond the acute recovery window. Single-bout sprint interval exercise may elicit short-term post-exercise reductions in SBP and possibly DBP, but the evidence remains constrained by very small crossover study samples, heterogeneous protocols, incomplete paired-data reporting and reliance on assumed within-participant correlations. The findings support sprint interval exercise as an acute cardiovascular physiology stimulus, but they are not clinically definitive and do not establish superiority over other exercise modes. Registration: PROSPERO CRD420261366067; registered after screening had begun and before final quantitative synthesis. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261366067.
Cardiac troponin is a highly sensitive marker of myocardial injury, although its interpretation after non-cardiac surgery remains challenging. Postoperative troponin elevation is common, frequently asymptomatic and associated with a markedly increased risk of short-term mortality, yet it is often misinterpreted or overlooked in surgical practice. We performed a narrative review of contemporary evidence and international guidelines addressing perioperative troponin measurement, myocardial injury after non-cardiac surgery (MINS), and perioperative myocardial infarction (MI), with a focus on their relevance to surgical teams. MEDLINE and Embase were searched for adult English-language studies, prioritising the past 10-15 years and key consensus statements. Studies relevant to postoperative outcomes, risk stratification and management were synthesised into a pragmatic stepwise approach for surgical teams. Studies including VISION and POISE demonstrate that even modest postoperative troponin rises are independently associated with substantially increased 30-day mortality, most often in the absence of ischaemic symptoms. Differentiating type 1 MI, type 2 MI and non-ischaemic myocardial injury is difficult in the perioperative setting because clinical features, electrocardiography and baseline troponin values are frequently non-specific. Contemporary European and North American guidelines now support targeted perioperative troponin surveillance in high-risk patients to allow early detection and risk stratification. Postoperative troponin elevation represents a powerful prognostic marker rather than a single disease entity. A structured, stepwise approach incorporating preoperative risk assessment, serial troponin measurement, clinical correlation and selective imaging can help surgical teams distinguish clinically significant myocardial injury from chronic or non-ischaemic elevation, enabling timely multidisciplinary management and potentially improving outcomes.
(1) the acute effects of RWU on physical performance, body temperature (BT), and rating of perceived exertion (RPE) in basketball players; and (2) individual-level performance improvements across different RWU methods. Three databases were searched for RWU studies in basketball players. An individual participant data meta-analysis was conducted using a two-stage approach with multilevel models, including adjustments for small sample sizes. Effect sizes were expressed as standardized mean changes (SMC) for within-group comparisons and standardized mean differences (SMD) for between-group comparisons. Seven studies (n = 82; 35 females, 47 males) were included, with individual raw data obtained from three. Compared with the control condition, the RWU resulted in better preservation of jumping (SMD = 0.64) and change-of-direction (COD) performance (SMD = -0.83), while showing no significant differences in isometric mid-thigh pull (IMTP) peak force (SMD = 0.34), BT (SMD = 0.72), or RPE (SMD = 0.61). These effects were largely driven by greater declines in the control than in the RWU for jumping (SMC = -1.24 vs. -0.53), COD (SMC = 1.00 vs. 0.44), and IMTP peak force (SMC = -0.68 vs. -0.28). Across five interventions from three studies with individual data, the plyometric protocol showed the highest proportion of improvements (CMJ: 100%; COD: 93.3%) compared with the control condition. Preliminary evidence suggests that RWU may be an effective strategy to maintain physical performance and BT in basketball players. However, given the limited number of studies and the high degree of individual variability, further research is required.
AI shows substantial potential in health care; however, the absence of standardized evaluation frameworks limits its safe and effective clinical implementation because of inconsistent validation requirements and fragmented ethical principles. Existing guidelines vary in structure, methodological rigor, and ethical integration, creating uncertainty. This study aimed to systematically map, characterize, and critically analyze existing evaluation frameworks for clinical AI, focusing on three core dimensions: methodological rigor, validation strategies (internal validation, including reporting of technical and clinical performance; external validation, including real-world applicability), and alignment with the United Nations Educational, Scientific and Cultural Organization (UNESCO) AI ethical considerations. A scoping review was conducted following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Six databases (PubMed, Embase, BVS, EBSCOhost, ProQuest, and Sage) and the Enhancing the Quality and Transparency of Health Research Network were searched without language or date restrictions up to February 2026. Eligible documents included peer-reviewed papers, gray literature, and organizational guidelines describing evaluation or reporting frameworks for clinical AI. Editorials, commentaries, and conference abstracts lacking a clearly defined evaluative framework or clinical applicability were excluded. Two reviewers independently screened records and extracted data. Data were extracted across three domains: (1) general characteristics, (2) methodological rigor and validation parameters, and (3) ethical integration and were synthesized using a dot plot-based gap map. Ethical adherence was assessed using a 10-domain UNESCO-based scoring matrix. No formal risk-of-bias assessment was conducted, consistent with scoping review methodology. From 3363 records, 46 frameworks met the inclusion criteria. Mapping revealed a rapidly expanding but fragmented landscape. Most frameworks targeted investigational use (88%), with limited focus on clinical applicability. Frameworks varied in structure, methodology, and scope, with a predominance of reporting guidelines and few validated tools. Most (63%) were developed through multi-institutional collaborations, and 32.6% incorporated transdisciplinary participation. Only 31.8% reported technical metrics (commonly area under the curve, sensitivity, and specificity), and 15.9% provided clinical indicators (eg, predictive values or calibration). Only 11.4% achieved methodological rigor, incorporating validation aligned with intended use, while most relied on partial validation strategies, highlighting a gap between model development and clinical evaluation. Ethical integration was heterogeneous: only 5 frameworks achieved high compliance (≥80%), whereas 4 scored <10%. The most frequently addressed UNESCO principles were awareness and education (71.1%) and transparency and explainability (70%), while human oversight (24.4%) and adaptive governance (33.3%) were least represented. Findings indicate a misalignment between framework design, validation requirements, and clinical implementation. Evaluation frameworks for clinical AI remain heterogeneous and oriented toward investigational contexts. Critical gaps persist in methodological rigor, validation aligned with intended use, and fragmented ethical coverage. These findings highlight the need for standardized, robust, and ethically grounded frameworks to enable safe, reliable, and scalable integration of AI into clinical practice.
Stroke is a leading cause of disability and mortality in older adults. Post-stroke cognitive frailty (CF) increases the risk of adverse outcomes. However, evidence regarding the prevalence of CF remains limited and inconsistent. This study aims to systematically evaluate the prevalence of CF among older adults with stroke in China and identifies factors associated with variation in prevalence, thereby informing future research directions and potential clinical considerations. We searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang Database for relevant studies reporting the prevalence of CF in Chinese older adults with stroke. The search covered the period from each database's inception to November 2024. Eligible studies were assessed for quality, and data were extracted. All analyses were performed using Stata 18.0 software. Four Chinese studies involving 1,337 participants were included. Meta-analysis revealed a pooled prevalence of CF among older adults with stroke of 33% (95% CI: 28-39%). Subgroup analysis indicated a significantly higher prevalence of CF in stroke patients aged ≥80 years compared to those aged 60-79 years (p < 0.05). Furthermore, the prevalence was significantly higher among those who consumed alcohol than among non-consumers (p < 0.05). Notably, subgroup estimates for patients with malnutrition and depression were markedly high, at 47% (95% CI: 34-60%) and 62% (95% CI: 53-71%), respectively. Available evidence suggests that the prevalence of CF among older adults with stroke in China appears to be substantial, with significant variations associated with alcohol consumption and advanced age. The particularly high prevalence estimates in patients with malnutrition or depression warrant increased clinical attention and further investigation into their relationship with post-stroke CF. Caution is warranted given the limited evidence base (n = 4), high heterogeneity, and exclusively hospital-based Chinese setting; larger studies are needed to confirm these observations. Early identification and evidence-based interventions targeting CF in this population may be crucial to mitigating adverse health outcomes pending further validation. This systematic review was prospectively registered with PROSPERO (registration number: CRD42025643159).
This systematic review and meta-analysis evaluated the effects of interval training (IT) combined with blood flow restriction (BFR) on physiological adaptations and exercise performance in male intermittent-sport athletes and examined potential moderators. Several databases were searched up to March 2026. Pooled effects were calculated using Hedge's g (g) via a three-level random-effects meta-analysis. Moderator analyses were performed based on training status, interval type, training intensity, pressure modes, and restriction mode. A meta-regression analysis was conducted to investigate the potential moderating effect of the training duration on anaerobic capacity. Thirteen studies were included (n = 306 males). IT combined with BFR (IT + BFR) was more effective than IT alone for improving anaerobic capacity (g = 0.51, 95% CI = 0.08 to 0.93), muscle fitness (g = 0.40, 95% CI = 0.23 to 0.57), sprint performance (g = 0.40, 95% CI = 0.18 to 0.62) and endurance performance (g = 1.17, 95% CI = 0.62 to 1.72) in male intermittent-sport athletes. Subgroup analyses indicated that the moderating effect of training intensity on muscle fitness approached significance (p for subgroup = 0.058). Specifically, high-intensity IT (g = 0.55, 95% CI = 0.29 to 0.81) appeared to be superior to moderate-intensity IT (g = 0.21, 95% CI = -0.04 to 0.46) in enhancing muscle fitness. Muscle fitness improved significantly following small-sided games (g = 0.49, 95% CI = 0.19 to 0.78) and among well-trained male intermittent-sport athletes (g = 0.47, 95% CI = 0.24 to 0.71), with no subgroup differences (all p for subgroups > 0.05). The training duration was a significant moderator of anaerobic capacity (β = 0.30, 95% CI = 0.04 to 0.55, p = 0.021). The main findings suggest that IT + BFR effectively enhances physiological adaptations (anaerobic capacity and muscle fitness) and exercise performance (sprint and endurance) in male intermittent-sport athletes. These potential benefits appeared to be more pronounced with high-intensity IT + BFR for muscle fitness. Furthermore, a possible association was found between longer training duration and greater improvements in anaerobic capacity. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261371749.
Hypertension guidelines generally recommend uniform sodium restriction although determinants of salt sensitivity, or sodium-blood pressure responsiveness, remain incompletely quantified. We estimated the population sodium-blood pressure dose-response, identified clinical modifiers, quantified high salt sensitivity prevalence, and derived the number needed to restrict sodium intake to prevent 1 cardiovascular event across clinical strata. PubMed, Embase, and Cochrane were searched from inception to April 2025 for sodium intervention trials and observational studies. Blood pressure response was standardized per 50-mmol/d sodium difference. Random-effects metaregression evaluated clinical modifiers. A highly salt-sensitive phenotype was defined a priori as a systolic blood pressure (SBP) decrease ≥3 mm Hg per 50-mmol/d reduction. We included 160 studies (255 estimates; n=16 443). Each 50-mmol/d higher urinary sodium excretion was associated with 1.76-mm Hg higher SBP (95% CI, 1.54-1.98). Age and baseline SBP were the strongest modifiers (0.41 mm Hg per 5 years; 0.23 mm Hg per 5 mm Hg). Salt-sensitive phenotype prevalence rose from 12.5% (age <40 years) to 56.5% (>60 years) and from 16.3% (SBP <120 mm Hg) to 54.1% (≥130 mm Hg). Under a policy-relevant 100-mmol/d sodium reduction, number needed to restrict ranged from ≈1334 in younger, normotensive, lean individuals (age <60 years, SBP <130 mm Hg, and body mass index <25 kg/m2) to ≈87 in older adults with hypertension and elevated body mass index (age ≥60 years, SBP ≥130 mm Hg, and body mass index ≥25 kg/m2), a 15-fold gradient. Salt sensitivity varied across age, SBP, and body mass index strata. These findings suggest that routinely measured clinical characteristics may help identify populations with greater expected blood pressure response to sodium reduction.
Glymphatic transport, meningeal lymphatic drainage, and meningeal immunity have been implicated in metabolic waste clearance, cerebral edema formation, and the regulation of neuroinflammation after stroke. However, the available evidence remains fragmented and has not been systematically integrated. This review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, the Cochrane Library, and Web of Science were searched from database inception to April 3, 2026, for studies investigating glymphatic pathways, the meningeal lymphatic system, meningeal immune responses, and related imaging biomarkers in patients with clinical stroke or in experimental stroke models. Two investigators independently screened studies, extracted data, and assessed study quality. Because of substantial heterogeneity in study design, imaging methodology, experimental models, and outcome measures, findings were synthesized narratively. A total of 64 studies were included, comprising 17 clinical studies and 47 preclinical studies. Clinical studies, which were largely based on MRI-derived glymphatic imaging biomarkers, suggest that glymphatic dysfunction is associated with stroke severity, cognitive impairment, and clinical outcomes. Preclinical evidence indicates that AQP4 dysregulation, impaired meningeal lymphatic drainage, and border-associated immune activation may influence waste clearance, cerebral edema, inflammation, and tissue repair after stroke. Future studies should establish standardized imaging frameworks, conduct prospective longitudinal validation, define mechanistic differences across stroke subtypes, and facilitate the translation of targeted interventions. https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420261359988.
Traumatic brain injury (TBI) induces systemic responses, including neurogenic cardiac injury via the brain-heart axis, manifesting as electrocardiographic (ECG) abnormalities that may predict outcomes. This systematic review aimed to evaluate the diagnostic and prognostic utility of ECG monitoring in patients with TBI, identify knowledge gaps, and guide future research. Following PRISMA guidelines, we searched PubMed and Google Scholar (January 2020 - March 2025) for studies on adult patients with TBI (≥ 16 years) who underwent acute ECG assessment (≤ 72 hours post-injury). The inclusion criteria focused on observational/cohort studies that reported ECG changes, severity correlations, and outcomes. The exclusion criteria were pediatric cases, pre-existing cardiac conditions, and non-English articles. Data were extracted from the eligible studies. Six studies (1,642 patients) revealed ECG abnormalities in 10-88% of cases, increasing with TBI severity (e.g., prolonged QTc in 3% of mild cases vs. 15% of severe cases). Common changes included repolarization issues (QTc prolongation and ST-segment/T-wave alterations), arrhythmias, and conduction disturbances. Abnormalities often resolved within days, improved post-neurosurgery (e.g., reduced QTc), and predicted mortality (e.g., QTc prolongation/ST depression as independent factors) and cardiac dysfunction. ECG changes are prevalent in TBI, correlate with severity, and have prognostic value for risk stratification. Routine monitoring is recommended, and larger, standardized studies are needed to optimize management.
Post-stroke fatigue (PSF) is a common, persistent, and disabling complication in stroke survivors that significantly impairs quality of life. While most existing studies have used quantitative methods, qualitative evidence concerning patients' fatigue experiences and the perceptions and coping strategies of relevant stakeholders remains limited. This study aimed to synthesise the experiences of fatigue among patients with PSF based on the Theory of Unpleasant Symptoms and to explore the perceptions and attitudes of patients, caregivers, and healthcare professionals. A qualitative systematic literature review and meta-synthesis was conducted following JBI methodology. Nine databases, including PubMed, Web of Science, and CNKI, were searched from inception to 25 March 2025. Eligibility criteria were developed using the PICoS framework. Qualitative studies and mixed-methods studies with extractable qualitative data involving patients with PSF, caregivers, or healthcare professionals were included. Study quality was assessed using the JBI Critical Appraisal Checklist for Qualitative Research. Twelve studies were included. The synthesis of 30 research findings generated four synthesised findings: (1) the fatigue symptom experience of patients with PSF is multidimensional; (2) the influencing factors are multifaceted and significantly affect patients' coping attitudes; (3) awareness of PSF among patients, caregivers, and healthcare professionals needs to be improved, while rehabilitation needs remain unmet; and (4) PSF management primarily depends on patient self-management, with healthcare professionals and caregivers playing complementary roles. PSF is characterized by a multidimensional symptom experience influenced by physiological, psychological, and situational factors. There is an urgent need to develop appropriate measurement tools, strengthen education, implement personalized management strategies, and increase caregiver involvement. PROSPERO (CRD420251037784). https://www.crd.york.ac.uk/PROSPERO/view/CRD420251037784.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease defined by the combination of clinical symptoms of esophageal dysfunction and histological evidence of eosinophilic infiltration (≥15 eosinophils per high-power field [eos/hpf]) once secondary causes have been excluded. Tissue remodelling and impaired motility cause dysphagia and food impaction. Budesonide oral suspension (BOS) is a topical corticosteroid formulated to enhance mucosal contact and reduce inflammation. This systematic review and meta-analysis evaluated the efficacy and safety of BOS in improving dysphagia and achieving histological remission in EoE. Following the PRISMA 2020 statement, PubMed, Scopus, Web of Science, and EMBASE were searched from inception to October 14, 2024, with an update verified up to the date of submission. Randomized controlled trials (RCTs) comparing BOS (1-2 mg twice daily) versus placebo in pediatric or adult EoE patients treated for ≥12 weeks were included. The primary outcome was histologic remission (<15 eos/hpf). Secondary outcomes included endoscopic findings (Eosinophilic Esophagitis Endoscopic Reference Score, EREFS), patient-reported symptom severity (assessed with validated symptom instruments, including the Dysphagia Symptom Questionnaire, DSQ), and treatment-emergent adverse events. Random-effects meta-analyses were performed using the Paule-Mandel estimator, and certainty of evidence was graded with GRADE. Mean difference (MD; the average between-group difference in the unit of the outcome) and odds ratio (OR) were reported with 95% confidence intervals (CI). Four RCTs (n = 523) met the inclusion criteria. BOS significantly improved histologic outcomes versus placebo (MD = -54.62 eos/hpf; 95% CI -68.19 to -41.05; I2 = 34.3%). Endoscopic severity improved (MD = -1.68; 95% CI -3.09 to -0.26). Patient-reported symptom severity also improved (pooled MD = -3.29 points; 95% CI -6.17 to -0.40), although the contributing trials used different validated symptom instruments, so this estimate reflects a composite symptom-severity effect. Treatment-emergent adverse events, mainly oropharyngeal/esophageal candidiasis, did not differ meaningfully between groups; serious adverse events were rare. BOS effectively reduces esophageal inflammation and alleviates dysphagia in EoE, supporting its use as a first-line topical therapy. The novel contribution of this synthesis is a strictly homogenous BOS-versus-placebo evidence base in which formulation, dose range, and follow-up are aligned across the four RCTs, complementing-rather than duplicating-broader meta-analyses that pooled heterogeneous budesonide preparations. https://www.crd.york.ac.uk/PROSPERO/view/CRD42025631228, identifier CRD4202525631228.
Noncontact anterior cruciate ligament (ACL) injuries are common and carry long-term consequences for the athlete. Altered foot and ankle biomechanics, landing patterns, and prior ankle injury have been implicated in ACL injury risk and may inform prevention strategies. To identify key biomechanical risk factors associated with the foot and ankle that may contribute to ACL injury risk. Systematic review; Level of evidence, 4. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, Cochrane, and SPORTDiscus databases were searched for English-language studies (2010-2025) evaluating ACL injuries and reporting on the foot or ankle. Screening was performed using Rayyan, followed by full-text review. Data were extracted, and then risk of bias was assessed using the methodological index for non-randomized studies (MINORS). Out of 1772 studies evaluated, a total of 48 (2.7%) studies met inclusion criteria. Overall, 33 studies (68.8%) identified variables associated with increased ACL injury risk, while 11 (22.9%) reported decreased risk and 9 (18.8%) found no association. Foot and ankle biomechanics were examined in 32 studies (66.7%), foot strike pattern in 8 (16.7%), toe direction in 7 (14.6%), and prior ankle injury history in 5 (10.4%). Statistically supported findings were present in 81% of studies. Greater dynamic rearfoot motion (eversion/inversion), increased dorsiflexion, and medial arch collapse (eg, navicular drop) were commonly associated with increased risk. Forefoot landings were protective, while rearfoot and flatfoot strikes, as well as toe-in or toe-out positions, were consistently linked to higher injury risk. Sex-specific analysis showed that female athletes demonstrated more high-risk biomechanical patterns than their male counterparts. Sport-specific analysis revealed basketball (n = 14), soccer (n = 8), and handball (n = 6) as the most studied sports, with >75% of these studies identifying ≥1 foot- or ankle-related ACL injury risk factor. Study quality was generally low, with predominantly noncomparative designs and modest MINORS. Foot and ankle factors, including prior injury, alignment, foot strike patterns, and toe progression, contribute meaningfully to ACL injury risk, yet their precise influence on knee stabilization remains unclear. The foot and ankle are understudied, with few investigations addressing their role in dynamic tasks that challenge knee stability. High-quality comparative research that accounts for sex and sport differences is needed to inform targeted prevention and improve risk stratification.
Postoperative depressive symptoms may impair recovery and quality of life in patients undergoing breast cancer surgery. Esketamine has shown potential antidepressant and analgesic effects in the perioperative setting. This meta-analysis evaluated the efficacy and safety of perioperative esketamine for postoperative depressive symptoms in patients undergoing breast cancer surgery. PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WanFang were systematically searched from database inception to 18 May 2026. Randomized controlled trials comparing perioperative esketamine with control interventions in patients undergoing breast cancer surgery were included. The primary outcome was postoperative depressive symptom score. Secondary outcomes included postoperative pain scores and adverse events. Random-effects models were used as the primary analytical approach. Risk of bias and certainty of evidence were assessed using the RoB 2 tool and the GRADE approach, respectively. Fifteen randomized controlled trials involving 1,515 patients were included. Perioperative esketamine was associated with significantly lower postoperative depressive symptom scores at postoperative day 1 (SMD = -0.78, 95% CI: -1.08 to -0.48), postoperative day 3 or 48-72 h (SMD = -1.07, 95% CI: -1.63 to -0.51), postoperative day 7 (SMD = -0.79, 95% CI: -1.10 to -0.49), and long-term follow-up (SMD = -1.16, 95% CI: -1.68 to -0.64). For postoperative pain, esketamine was associated with lower postoperative pain scores at postoperative day 1 or 24 h (MD = -0.66, 95% CI: -1.11 to -0.21) and postoperative day 3 or 48-72 h (MD = -0.66, 95% CI: -1.09 to -0.23), but not at postoperative day 7. However, substantial heterogeneity and wide prediction intervals were observed for pain outcomes. The incidences of nausea and vomiting, postoperative delirium, and dizziness did not differ significantly between the esketamine and control groups. The certainty of evidence ranged from low to very low across outcomes. Perioperative esketamine may reduce postoperative depressive symptom scores and provide short-term analgesic benefits in patients undergoing breast cancer surgery. However, substantial heterogeneity, methodological limitations, and low to very low certainty of evidence warrant cautious interpretation. Further high-quality randomized trials are needed. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251173178, identifier CRD420251173178.
Emergency department (ED) nurses and allied health professionals (AHPs) face persistent occupational stressors that threaten workforce sustainability. Burnout prevalence exceeds 50% among ED nurses, and post-traumatic stress disorder (PTSD) prevalence among paramedics ranges from 11% to 37%. Despite growing research interest, the team-based and organisational resilience-enhancement strategies targeting both ED nurses and AHPs have not been comprehensively reviewed. This narrative review synthesises current evidence on team-based and organisational resilience-enhancement strategies targeting ED nurses and AHPs in emergency and acute care settings globally. A systematic search informed by JBI scoping methodology and reported in line with PRISMA 2020 was conducted across three databases (Scopus, PubMed, Web of Science) for studies published between January 2016 and March 2026. Search terms combined three concept blocks-emergency care personnel (eg, "emergency nurs*", "paramedic*", "allied health professional*"), resilience constructs (eg, "resilien*", "coping", "hardiness", "post-traumatic growth"), and emergency/acute care context (eg, "emergency department*", "prehospital", "ambulance service*")-using Boolean operators. The Population-Concept-Context (PCC) framework guided eligibility. Studies scoring ≥70% on JBI critical appraisal checklists were included; a sensitivity analysis examined the effect of relaxing this threshold to ≥50%. Data were charted using a standardised JBI extraction form and synthesised narratively. From 766 identified records, 160 duplicates were removed, 606 titles/abstracts were screened, and 196 full texts were assessed. Forty-nine empirical studies met the inclusion criteria; one record initially retrieved was a registered trial protocol with no outcome data and was excluded from synthesis. Of the 49 studies, 32 (65.3%) focused on ED nurses, 12 (24.5%) on AHPs/paramedics, and 5 (10.2%) on mixed teams. Five intervention categories were identified: organisational support (n=17, 34.7%), system-level reforms (n=12, 24.5%), structured training programmes (n=11, 22.4%), peer/team-based support (n=7, 14.3%), and leadership development (n=2, 4.1%). Controlled intervention studies reported positive effects: a three-arm randomised controlled trial (RCT) demonstrated significant improvement in psychological resilience (p<0.05), and a violence-coping programme produced a large effect on resilience (F=59.41, p<0.001). The Cochrane meta-analysis included reported a moderate pooled effect on resilience (standardised mean difference [SMD]=0.45) and stress (SMD=-0.61). Cross-sectional studies reported moderate-to-strong associations between perceived organisational support and resilience (eg, r=0.549). This narrative review identified five intervention categories addressing resilience in emergency care teams, with organisational support and system-level reforms most frequently reported. Controlled studies, although few, consistently reported positive effects. Critical gaps exist in leadership-focused strategies (4.1%) and AHP-specific research (24.5%). Future studies should prioritise longitudinal designs, standardised resilience outcome measures, and culturally adapted interventions. Why was this review done? Emergency departments are high-pressure workplaces where nurses and other health professionals regularly face traumatic events, heavy workloads, and emotional exhaustion. More than half of emergency nurses (over 50 in every 100) experience burnout, and many consider leaving their jobs. This can lead to staff shortages and poorer patient care. We wanted to bring together what is known about strategies that hospitals and teams—rather than individuals alone—have used to help these frontline workers cope and stay in their jobs. What did we do? We searched three major research databases for studies published between 2016 and 2026. We used search words covering three ideas: the workers (such as emergency nurses and paramedics), resilience and coping, and the emergency-care setting. After careful screening, we included 49 studies from 19 countries. What did we find? The 49 studies described five main types of strategies. We counted how many studies looked at each type: workplace support from managers and organisations (17 of 49 studies), system-wide changes such as better staffing levels (12 of 49 studies), formal training programmes (11 of 49 studies), peer support among colleagues (7 of 49 studies), and leadership development (only 2 of 49 studies). The small number of well-controlled trials reported positive results. For example, one randomised trial showed a meaningful improvement in resilience, and a structured coping programme produced a large improvement. What does this mean? Most strategies focus on what organisations and systems can do, rather than on individual workers alone. However, very few studies tested leadership training, and few focused on paramedics and other allied health professionals. More high-quality, long-term studies are needed, especially for these under-studied groups.
In recent years, hybrid surgery (HS) has emerged as one of the major surgical modalities for the treatment of multisegmental cervical degenerative disease (CDD). Two types of HS have been introduced (HS1, 1-level TDR with 2-level anterior cervical discectomy and fusion, ACDF or HS2, 2-level TDR with 1-level ACDF), and the clinical and radiological results could differ. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The Web of Science Core Collection, PubMed and Embase were comprehensively searched from inception to December 19, 2025. Five studies were included in this network meta-analysis. The Neck disability index (NDI) in the HS1 was significantly lower than that in the ACDF. The C2-7 range of motions (ROMs) in the HS1 and HS2 were both significantly greater than those in the ACDF. The C2-7 ROM in the HS1 was significantly lower than that in the HS2. The ROMs of the upper and lower segments in the HS1 and HS2 were both significantly lower than those in the ACDF. No significant difference was identified in the ROM of the upper or lower segment between the HS1 and the HS2. HS1, HS2 and ACDF are all safe and effective surgical options for three-level CDD. HS1 and HS2 could better preserve the C2-7 ROM. ACDF is associated with an increased ROM of adjacent segments. Compared with HS1, HS2 could better preserve the C2-7 ROM. HS1, HS2 and ACDF presented similar incidences of ASD. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271417, PROSPERO (CRD420251271417).