The number of surgical interventions in infants to resolve ankyloglossia (tongue-tie) has been increasing. However, there seems to be no consensus on the criteria used to indicate frenotomy or frenectomy. To identify the assessment tools and criteria used to support surgical decision-making in cases of ankyloglossia in infants. A scoping review was conducted. Studies were retrieved from six electronic databases: PubMed, Embase, Central, LILACS, Scopus, and ProQuest. The articles were assessed in two stages: (1) title/abstract screening and (2) full-text analysis. Clinical trials and observational studies involving infants less than 23 months of age with tongue-tie and submitted to frenotomy or frenectomy were included. Data on the assessment tools and criteria used to diagnose ankyloglossia and indicate surgery were extracted from the studies. A total of 606 documents were identified and 53 were included. Surgical decision-making was based on assessment tools, such as the Coryllos classification (n = 17), Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF; n = 12), Bristol Tongue Assessment Tool (BTAT; n = 3), and Lingual Frenulum Evaluation Protocol for Infants/Tongue-Tie Test (n = 4). Other studies adopted a combination of clinical criteria and complaints related to breastfeeding. The findings show that heterogeneity in the choice of assessment tool differences in cut-off points, and in the interpretation of anatomical, functional, and breastfeeding-related findings used to justify surgery. This underscores the need for standardized, evidence-based criteria to guide when frenotomy should be recommended in infants with ankyloglossia.
Residents in pediatric endocrinology subspecialty units encounter diverse educational scenarios spanning theory, skills, and attitudes; yet, brief residencies frequently limit their exposure to certain clinical cases. Research in medical education demonstrates that e-learning can address such challenges efficiently. We implemented a blended learning model grounded in the Kolb learning cycle that uses structured, case-based e-learning. We aimed to evaluate the utility and usability of blended learning using a novel e-learning tool. We used a problem-solving approach and used the physical separation of case-based e-learning (interactive, patient scenario-based online modules) and theoretical content delivery as the educational model for residents in a pediatric endocrinology and diabetology unit. Residents worked asynchronously (on their own time, not simultaneously with others) on clinical scenarios and completed formative assessments (practice tests designed to provide feedback for learning rather than grades) with immediate feedback using a flipped classroom teaching method, in which students review material before group instruction. In addition, all cases could be discussed with specialists during face-to-face learning opportunities through a blended learning approach that combines online and in-person elements. We evaluated Kirkpatrick level 1 (reaction, how participants respond to training) and level 2 (learning, measured as an increase in knowledge or capability) outcomes using the postgraduate Medical E-learning Evaluation Survey (MEES) and the User Experience Questionnaire (UEQ), which assesses users' perceptions of e-learning platforms. Questionnaires from 12 pediatric residents and 1 questionnaire from a fourth-year medical student were evaluated. The main strengths identified were the tool's support for applying content to daily clinical work (12/13, 92% users), provision of timely summaries (n=9, 69% users), access to reliable information sources (n=9, 69% users), and immediate feedback on responses (n=8, 62% users). Key weaknesses included device compatibility for e-learning (n=5, 38% users), limited content personalization (n=4, 31% users), and a lack of a navigation aid (n=4, 31% users). No significant functional issues were reported. The UEQ evaluation showed that dependability received the lowest rating, while attractiveness and stimulation received the highest rating. Our e-learning proposal provides a practical way to apply theoretical knowledge through interactive clinical cases. Evaluations show that users are highly motivated to engage with e-learning, highlighting our tool's adaptability and effectiveness for postgraduate medical education in pediatric endocrinology. Identifying strengths and weaknesses will guide future improvements. Evaluating various aspects of e-learning remains crucial, as these aspects can affect learning outcomes. However, more longitudinal evaluations of e-learning are necessary to achieve a comprehensive understanding of its effectiveness.
The Psoriasis Epidemiology Screening Tool (PEST) is a 5-item questionnaire designed to identify patients with psoriasis who have co-existing psoriatic arthritis (PsA). This analysis investigated the longitudinal performance of the PEST questionnaire in the prospective, observational PURE registry. The PURE registry included 2132 patients with psoriasis who completed the PEST at baseline, 3 and 6 months then every 6 months for 5 years. Baseline diagnostic performance was assessed using existing PsA diagnoses as the reference standard. PEST positivity changes over time were assessed, and regression models determined factors linked to baseline PEST status and conversion from negative to positive. Cronbach's alpha assessed internal consistency, while exploratory factor analysis evaluated changes in individual PEST questions over time. At baseline, 906 patients (42.5%) were PEST positive and 373 (17.5%) had PsA, for a diagnostic sensitivity of 89% and a negative predictive value of 97%. Overall, the proportion of patients who became PEST positive increased from 42.5% at baseline to 63.9% at 5 years, rising from 89.0% to 95.8% and 32.6% to 57.2% respectively in those who were PEST positive or negative at baseline. Regression modeling confirmed that increased age (p < 0.0001), weight > 90 kg (p < 0.0001), female sex (p = 0.0107) and prior biologic exposure (p < 0.0001) were related to PEST status at baseline and of which the first three were also related to change from negative to positive during follow-up. Cronbach's alpha showed high internal consistency of the PEST questionnaire (0.693). Exploratory factor analysis found that responses to questions 1, 2, 4, and 5 increased over time, while question 3 decreased. Eigenvalues revealed consistent dominance of question 1 and two-factor structure in the questionnaire. The PEST questionnaire is an informative, easy-to-use tool which may be useful to monitor and identify patients with psoriasis who are at risk of PsA over time. ClinicalTrials.gov ID NCT02786186; date of registration May 30, 2016.
The alpha-proteobacterium Zymomonas mobilis exhibits exceptional ethanologenic physiology, which makes it a traditional alcoholic beverage producer and a promising chassis for biofuel production. Although genetic tools for this organism have expanded in recent years, a fundamental aspect of its chromosome organization remains to be understood. In particular, Z. mobilis has been suggested to exhibit polyploidy, but this feature is not fully confirmed because of discrepancies among studies reporting the copy number of chromosomes. Here, we tagged the chromosome-partitioning protein ParB with a fluorescent marker to visualize its cellular localization and estimate chromosome copy number in individual cells. Imaging showed that Z. mobilis exhibits several distinctive ParB foci throughout the cytoplasm and an accumulated focus at the pole, indicating that a single Z. mobilis cell contains >5 copies of the chromosome at the oriC regions. We then sought to establish an efficient counter-selection system, which is crucial for engineering multiple copies of the chromosome. We assessed the efficacy of levan-sucrase (SacB) toxicity in Z. mobilis. We found that, despite Z. mobilis secreting a native extracellular sucrase SacB, heterologous periplasmically localized Bacillus subtilis SacB rendered Z. mobilis cells sensitive to sucrose. We successfully used this effect for counter-selection when deleting and inserting targeted DNA sequences into the Z. mobilis genome. Together, this work provides important insights and tools for advancing Z. mobilis genetics and its biotechnological applications. Zymomonas mobilis is a promising industrial bacterium with the capacity to convert sugars into ethanol at nearly maximum theoretical yield. With its expanding use in industrial applications, it is crucial to clarify if individual Z. mobilis cells carry multiple copies of the chromosome, as this has important implications for genome engineering. Two previous studies have used quantitative PCR to address this question, but their reported chromosome copy numbers varied widely from 20 to 100. Here, we used a cell biological approach to estimate the copy number and confirmed that a single Z. mobilis cell possesses multiple copies. In addition, we show that a SacB-based counter-selection works in Z. mobilis, enabling efficient and complete mutation of all chromosome copies.
The Taiwan-specific fracture risk assessment tool (FRAX) model is widely used to estimate 10-year fracture risk. However, FRAX with bone mineral density (BMD) may underestimate fracture risk, particularly in older adults. To evaluate the predictive performance and calibration of the Taiwan-specific FRAX calculator using complete 10-year real-world outcomes and to establish data-driven, population-specific screening thresholds. A total of 1,976 participants aged ≥ 40 years were recruited from two population-based cohorts in Taiwan (2009-2010) and followed for 10 years via linkage with the National Health Insurance Research Database. Ten-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were estimated using Taiwan-specific FRAX calculators. Model calibration was evaluated using observed-to-expected (O/E) ratios. Statistically optimal thresholds were determined via receiver operating characteristic analysis maximizing the Youden index. During follow-up, 213 (10.8%) participants experienced MOF, and 93 (4.7%) experienced HF. FRAX without BMD demonstrated strong calibration for both MOF (O/E = 1.08; 95% CI: 0.94-1.24) and HF (O/E = 1.10; 95% CI: 0.89-1.34). Conversely, FRAX with BMD systematically underestimated risk, particularly among individuals aged ≥ 65 years (MOF O/E = 1.23; 95% CI: 1.06-1.42). Age, female sex, prior fracture, and low BMD were significant independent risk factors. Crucially, population-specific data-driven thresholds were identified via ROC analysis at 9.0% for MOF and 4.5% for HF using FRAX without BMD, and 8.5% for MOF and 4.0% for HF using FRAX with BMD, respectively. FRAX® remains a useful and widely applied tool for fracture risk prediction in Taiwan. However, fracture risk may be underestimated, particularly in adults aged ≥ 65 years. Taiwan-specific, data-driven thresholds may improve risk stratification and support more targeted fracture prevention strategies.
The influence of pelvic incidence (PI) on outcomes after hip arthroscopy for femoroacetabular impingement remains uncertain. This study evaluated whether PI was associated with one-year outcomes, pain, satisfaction, and willingness to repeat surgery. This retrospective multicentre cohort included 200 consecutive hips treated with hip arthroscopy for symptomatic femoroacetabular impingement and available standing EOS imaging. Hips were classified as low PI (≤ 40°), normal PI (40° < PI < 65°), or high PI (≥ 65°). Outcome analyses included 178 hips with available one-year Non-Arthritic Hip Score. Multivariable models adjusted for baseline outcome scores and prespecified covariates. Baseline characteristics did not differ significantly between PI groups. At one year, high PI was associated with lower Non-Arthritic Hip Score, modified Harris Hip Score, and International Hip Outcome Tool-12 scores, greater residual hip and low-back pain, lower satisfaction, and reduced willingness to repeat surgery. Improvement from baseline in Non-Arthritic Hip Score and International Hip Outcome Tool-12 did not differ significantly between groups. After adjustment, high PI remained associated with lower hip-specific scores, greater residual hip and low-back pain, lower global and activity-related satisfaction, lower odds of International Hip Outcome Tool-12 minimal clinically important difference achievement, and lower odds of answering "absolutely yes" to repeat surgery. Low PI was not significantly associated with adjusted outcomes. High PI was associated with inferior one-year postoperative status after hip arthroscopy for femoroacetabular impingement. However, most patients achieved clinically meaningful improvement, suggesting that high PI should guide counselling and risk stratification rather than contraindicate arthroscopy.
BackgroundSelecting optimal brain magnetic resonance imaging (MRI) protocols is a manual, error-prone process, often complicated by incomplete clinical information. Automated AI-based analysis of initial imaging sequences offers a potential strategy for dynamic protocol adaptation while the patient is still in the scanner.PurposeTo evaluate the diagnostic performance and agreement with neuroradiologists of an AI tool designed to automatically adapt brain MRI protocols based on the detection of critical findings (brain infarcts, acute hemorrhages, and mass lesions) using three initial imaging sequences.Material and MethodsWe retrospectively collected consecutive cohorts of brain MRI scans from two tertiary medical centers. The cohorts were consecutively enriched with positive findings of brain infarcts, hemorrhages, and mass lesions. An AI tool and neuroradiologists independently assessed three sequences (diffusion-weighted imaging, T2-FLAIR, SWI/T2*-GRE) for critical findings and recommended protocol adaptations from seven options. Diagnostic performance was compared against reference findings based on radiological reports and de novo imaging review.ResultsA total of 752 patients were included (325 men; mean age=61 years). The AI tool's pooled sensitivity for detecting infarcts, hemorrhages, and mass lesions was 92% (95% CI=86-96), 75% (95% CI=64-84), and 71% (95% CI=61-79), with pooled specificity of 93% (95% CI=90-95), 86% (95% CI=83-88), and 90% (95% CI=87-92), respectively. Agreement on protocol adaptation between the AI and neuroradiologists was moderate (κ=0.47), though concordance was high (84%-87%) for scans requiring no further adaptations.ConclusionThe AI tool demonstrated reasonable pathology detection, relevant protocol recommendations, and potential to ensure appropriate imaging protocols in high-volume, low-risk scan scenarios, but expert oversight is required.
The Killer-cell Immunoglobulin-like Receptor (KIR) is a highly polymorphic region in the human genome, associated with autoimmune diseases and organ transplantation. The sequences of KIR genes are highly similar among star alleles as well as in between individual genes, with the copy number of each KIR gene typically ranging from 0 to 4. In this study, we introduce Graph-KIR, a tool designed to estimate gene copy numbers and predict full-resolution (7-digit, encompassing both coding and non-coding sequence variations) from a whole genome sequencing (WGS) sample. Graph-KIR is capable of independently typing KIR alleles per sample with no reliance on the distribution of any framework gene in a cohort. In a set of 100 simulated samples, Graph-KIR demonstrated 99.2% accuracy in copy number estimation and high F1-score of allele typing: 91.79% at 7-digit resolution, 97.37% at 5-digit resolution, and 97.11% at 3-digit resolution. Graph-KIR outperforms existing tools such as Geny (96.39% F1-score), PING's WGS version (92.77% F1-score) and T1K (90.44% F1-score) at 5-digit resolution. By analyzing the results on 44 HPRC samples, Graph-KIR achieves better F1-score than Geny and PING at 7-digit resolution. The release of Graph-KIR adds another valuable tool to assist users in accurately estimating copy numbers and calling alleles of KIR genes from WGS samples. The Graph-KIR and paper-related pipeline codes are available at https://github.com/linnil1/KIR_graph.
Dosimetry audits are a key component of radiotherapy quality improvement, however lack of appropriate tools and resources may be hampering the adoption of audit practices for brachytherapy in particular. In this study, an audit method was developed around a 3D printed reference air kerma rate (RAKR) measurement jig and a pilot high dose rate (HDR) postal audit was completed across eighteen HDR centres across Australia and New Zealand. This pilot study allowed the performance of the 3D printed jig and accompanying audit spreadsheet to be assessed, to inform the design of future iterations of the 3D printed jig tool and provide baseline data for future brachytherapy audits.
Metabolic disorders like diabetes and obesity represent major global health challenges, largely driven by unhealthy dietary patterns and sedentary lifestyles. Growing interest in natural bioactives as complementary strategies is increasing. Betalains, primarily derived from Beta vulgaris, exhibit notable antidiabetic and anti-obesity properties, highlighting their therapeutic potential. This systematic review evaluates the antidiabetic and anti-obesity effects of betalains based on in vitro and in vivo evidence. Literature published between 2015 and 2025 was retrieved from PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar. Eligible studies assessed betalains effects on glucose and lipid metabolism, while reviews and irrelevant reports were excluded. Out of 508 identified studies, only 12 met the inclusion criteria. The systematic review was registered in PROSPERO under ID 1357942. Risk of bias was assessed using the OHAT tool for in vitro studies and the SYRCLE tool for animal studies. Betalains demonstrated significant metabolic benefits by reducing triglyceride accumulation, fasting blood glucose, insulin resistance, and NF-κB activation, while increasing insulin, adiponectin, and HDL-C levels. They also downregulated total cholesterol, LDL-C, and lipogenic markers (PPARγ, SREBP-1c). Overall, betalains show potential as natural agents against diabetes and obesity; however, well-designed clinical trials with standardized dosing are needed to confirm long-term efficacy.
Apraxia of speech (AOS) is a motor speech disorder defined by impaired planning and programming of movements necessary for accurate speech production. Assessment of AOS is typically qualitative, with limited standardized tools available for comprehensive evaluation. The Apraxia Battery for Adults - Second Edition (ABA-2) is a widely used English-language instrument that includes subtests assessing diadochokinetic rate, increasing word length, limb and oral apraxia, latency, and pronunciation time for polysyllabic words and repeated trials, as well as an articulation characteristics inventory. This study aimed to translate and validate the ABA-2 for Italian-speaking individuals. The test was translated and adapted into Italian. It was validated in healthy (N = 87) and neurological (N = 38) samples. The test showed excellent discriminant validity, inter-rater agreement, and test-retest reliability, supporting the use of the battery to identify the salient features required for a clinical evaluation of patients' specific articulatory abilities. This work provides a standardized tool in the Italian language for assessing apraxia of speech, facilitating reliable evaluations in both clinical practice and research.
Early breastfeeding cessation due to physiological and psychosocial factors limits long-term maternal and infant health benefits. Relactation, the reinitiation of breastfeeding, is a promising strategy to restore lactation and improve well-being. This study aimed to evaluate the effect of education and follow-up based on Pender's Health Promotion Model (HPM) on relactation success among mothers who had discontinued breastfeeding or experienced low milk supply. This randomized controlled trial was conducted between July and December 2023 in a hospital and five family health centers in eastern Türkiye. Seventy-three mothers (38 intervention, 35 control) with infants aged 15 days to 4 months who had ceased breastfeeding or used formula for 2-8 weeks were included. The intervention group received 8 weeks of relactation education and follow-up based on the HPM, whereas the control group received routine postnatal care. Data were collected using a personal information form, the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), the Breastfeeding Motivation Scale (BMS), the LATCH tool, and a tool for assessing the level of maternal milk intake (IMDAT). At the final follow-up, 65.8% of mothers in the intervention group achieved complete relactation, compared to 8.6% in the control group. The intervention group also had significantly higher BSES-SF, LATCH, and IMDAT scores. However, no significant differences were found in the BMS intrinsic motivation and identified regulation subscales. HPM-based education and follow-up significantly enhanced relactation success, self-efficacy, and breastfeeding skills.
BackgroundPosttraumatic stress disorder (PTSD) is common yet frequently underdiagnosed, in part due to barriers to systematic screening and the reliance on self-report instruments. Large language models (LLMs) have shown promise in extracting clinically relevant information from unstructured language, but their ability to infer item-level PTSD symptom severity from clinical interviews remains unclear.MethodsUsing the Distress Analysis Interview Corpus-Wizard of Oz (DAIC-WoZ), we analyzed 100 semi-structured clinical interview transcripts paired with item-level PTSD Checklist-Civilian Version (PCL-C) scores. Six LLMs (DeepSeek 3.1, Claude Sonnet 4, LLaMA 4 Scout, GPT-4o, GPT-5, and Gemini 2.5 Flash) used zero-shot prompting to predict all 17 PCL-C items. Performance was assessed for binary symptom endorsement (≥3 vs. < 3), 5-point Likert prediction, and DSM-IV symptom-cluster analyses using accuracy, F1 score, and Matthews correlation coefficient (MCC).ResultsFor binary prediction, Claude 4 achieved the highest mean accuracy (0.705; 95% CI, 0.681-0.728), followed by DeepSeek 3.1(0.699; 95% CI, 0.675-0.724) and Gemini 2.5 (0.698; 95% CI, 0.677-0.718). For Likert prediction, DeepSeek 3.1 performed best (accuracy = 0.438; 95% CI, 0.401-0.475), only modestly above the majority-class baseline (0.399; 95% CI, 0.355-0.443). Performance varied by symptom domain, with re-experiencing and hyperarousal symptoms generally predicted more accurately than avoidance/numbing symptoms. Across models, predicted item-level symptom patterns showed a meaningful alignment with observed PCL-C responses despite reduced accuracy in fine-grained severity estimation.ConclusionZero-shot LLMs' performance was insufficient for clinical application in predicting PTSD symptoms from semi-structured interview transcripts. While models showed some ability to capture overall symptom patterns, performance varied across domains and remained limited for fine-grained severity estimation. Given these constraints and the non-trauma-specific nature of the dataset, findings should be interpreted as preliminary, with only modest differences observed between models.Plain Language Summary TitleCan Artificial Intelligence Identify PTSD Symptoms from Conversations? A Study Using Clinical Interview TranscriptsPlain Language SummaryPost-traumatic stress disorder (PTSD) is a common mental health condition, but it is often missed in clinical settings. Screening usually relies on questionnaires that patients must complete themselves, which may not always happen due to time, stigma, or discomfort discussing trauma. Researchers are exploring whether artificial intelligence (AI) could help identify PTSD symptoms from conversations instead.In this study, we tested several advanced AI systems, known as large language models, to see if they could estimate PTSD symptoms based on written transcripts of clinical interviews. These interviews were not specifically designed to assess trauma, which makes the task more challenging but closer to real-world situations. We compared the AI predictions to participants' own questionnaire responses about their symptoms.We found that the AI models were somewhat able to recognize general patterns of PTSD symptoms, especially more visible ones like sleep problems or distressing dreams. However, they struggled with more internal or less obvious symptoms, such as avoidance or emotional numbness. Overall, their accuracy was moderate and not reliable enough for clinical use, particularly when trying to estimate how severe symptoms were.Importantly, differences between the AI models were small, and none performed well enough to replace existing screening methods. These findings suggest that while AI may have future potential as a supportive tool, it is not yet ready to be used for diagnosing or screening PTSD on its own.Further research using better data, improved methods, and real clinical settings is needed before this approach could be considered for practical use.
Transurethral resection of the prostate (TURP) specimens represent a low-prevalence, high-volume diagnostic task in which pathologists must identify rare malignant foci within large amounts of predominantly benign tissue. Although artificial intelligence (AI) has shown strong standalone performance in prostate pathology, its real-world impact on TURP diagnostic workflows remains insufficiently characterized. We developed an AI tool for slide-level detection of prostatic adenocarcinoma using 6,535 H&E whole-slide images from biopsies and TURP specimens, with feature extraction by UNI, classification through a CLAM framework, and presentation on a custom OpenSeadragon-based viewer. Five readers with different experience levels evaluated 102 TURP slides in two sessions, first unaided and then AI-assisted after an 8-week washout period. Primary outcome was per-slide review time; secondary outcome was diagnostic accuracy. AI assistance significantly reduced review time for all readers, with mean reductions ranging from 29.4% to 53.8%. In mixed-effects modeling, AI was associated with a mean reduction of 34.5 s per slide (95% CI, 30.0-39.0; p < 0.001). Time savings were greatest among less experienced readers. Overall diagnostic accuracy increased from 95.3% in the unaided setting to 98.2% with AI assistance. Non-inferiority was confirmed for all readers, and accuracy even improved significantly in the least experienced readers. Across all readings, classification errors decreased from 24 unaided to 9 aided. AI assistance improved TURP slide review efficiency while maintaining, and in some readers improving, diagnostic accuracy. These findings support AI as a workflow-oriented decision-support tool in TURP pathology, particularly for low-prevalence, high-volume diagnostic settings.
Sexual violence against women in armed conflicts has become a weapon with various strategic purposes. It is used as a tool to humiliate and demoralise the enemy, as well as to exert territorial control and "ethnic cleansing." Not only seeks the individual suffering but also destroys the social fabric of her community. This study aims to analyze the psychosocial impact of sexual violence experienced by women during armed conflicts, focusing on its effects on mental health and social relationships. Adhering to Preferred Reported Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we employed a systematic review of 30 scientific articles published between 2015 and 2025, extracted from the Scopus, ProQuest, PubMed, and Embase databases. These articles, qualitative and quantitative, address the psychosocial consequences of this violence on women in various conflicts. Of the initial 2,151 articles, 30 met the inclusion criteria. The main outcomes reveal severe psychosocial consequences in survivors. Post-Traumatic Stress Disorder is the main one, depression and anxiety are reported in 40% of the studies. Moreover, all of them agree that women experience severe deterioration in their social relationships, in 59% of cases they are abandoned or expelled by their partners. Added to this, 30% of studies highlight that physical health consequences worsen social exclusion and mental health. This study emphasises the need to develop holistic, comprehensive and culturally sensitive intervention and support strategies, from social, psychological, and medical professions that deal with the impact of sexual violence.
Previous research has shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have cardioprotective effects. However, their efficacy in acute myocardial infarction (AMI) is not yet well established. We conducted a systematic review and meta-analyses to assess the impact of GLP-1 RAs in AMI. We systematically searched major databases for studies in patients with ST-elevation (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). These included MEDLINE (accessed via PubMed), Excerpta Medica dataBASE (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar from their inception through February 2026. PRISMA guidelines were used to conduct this review. Both randomized controlled trials (RCTs) and observational studies were included in the systematic review. However, only RCTs were included in the meta-analyses. The primary outcome was infarct size relative to the area at risk (AAR). Secondary outcomes included major adverse cardiovascular events (MACE) and safety outcomes (nausea, hypoglycemia, pancreatitis). The Cochrane Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess risk of bias. We included eight studies with a total of 1,483 participants. GLP-1 RAs led to a smaller infarct size indexed to the AAR compared with placebo. The mean reduction was 10.14% points (95% confidence interval [CI]: -14.11--6.17; P < 0.001). The primary infarct-size analysis was based on only three RCTs. GLP-1 RAs led to an improvement in the left ventricular ejection fraction (LVEF). The absolute mean improvement was 2.93% points (95% CI: 0.18-5.67; P < 0.05). Subgroup analyses were conducted to explore the findings in greater detail. They revealed that liraglutide was associated with an even higher absolute increase in LVEF. The absolute mean improvement was 5.32% points (95% CI: 3.49-7.15; P < 0.01). Nausea was more frequent in the treatment group, while hypoglycemia and pancreatitis were not significantly increased. Limitations included relatively small sample sizes in the individual studies, short follow-up periods, and variability in study designs. In patients with AMI, GLP-1 RAs reduce relative infarct size and improve LVEF. No clear safety signal was detected in the available short-term trial data, except for increased nausea. These results indicate that GLP-1 RAs could be beneficial as an additional treatment in AMI.
People with Young Onset Dementia (YOD) are recognised as having a higher risk of being marginalised within society and in the care and support they receive. The consequences of stigma on people with YOD must be better understood to help reduce experiences of discrimination and increase awareness for this population. This qualitative systematic review aimed to synthesis the data on the experience of stigma within the YOD population globally. Five electronic databases (Scopus, MEDLINE, PubMed, Web of Science, and PsycINFO) were searched in December 2025. The quality of the studies was assessed using the Critical Appraisal Skills Programme Tool. Data were analysed using thematic synthesis. One researcher assessed the title and abstracts of the articles retrieved against the inclusion criteria. Included articles were then read in full by the same researcher. A second researcher reviewed 10% of these articles at both stages. 2994 articles were screened, and 17 studies were included in this review. Four themes were identified: Public perception and beliefs about YOD, Structural stigma and barriers to service access, The role of stigma in social isolation, and Overcoming stigma. This review highlights the pervasive and multifaceted nature of YOD, offering insights into individual and service level strategies needed to mitigate the negative consequences of stigma. The findings highlight the need for specialist age-appropriate support services alongside public and professional education on YOD to address misconceptions about dementia in younger adults. Community and government-led initiatives are recommended to help reduce negative stereotypes, social isolation and improve access to early diagnosis and tailored support for our YOD communities. Not applicable.
Glaucoma is the leading cause of irreversible blindness. Minimally invasive glaucoma surgery (MIGS) techniques, including those that open or enlarge Schlemm's canal (SC) behind the trabecular meshwork (SC-MIGS), have been introduced to help optimise control of intraocular pressure (IOP), which may slow the progression of glaucoma. This review supersedes and expands on the scope of a previous Cochrane review on ab interno trabecular bypass surgery with Trabectome for open-angle glaucoma. To assess the effects of minimally invasive Schlemm's canal surgery in comparison to medical, laser, or surgical treatment (including other MIGS techniques) in people with open-angle glaucoma. We used CENTRAL, MEDLINE, Embase, two other databases, and trial registries, together with reference checking, citation searching, and contact with study authors, to identify studies that are included in the review. The latest search date was 12 October 2025. We searched for randomised controlled trials (RCTs) comparing SC-MIGS with other treatments (other MIGS, laser, phacoemulsification, or medical therapy). Reported SC-MIGS procedures included gonioscopy-assisted transluminal trabeculotomy, ab interno canaloplasty, Kahook Dual Blade goniotomy, excimer laser trabeculotomy, and ab interno trabeculectomy. We excluded studies of non-SC-MIGS (e.g. iStent inject, Hydrus, or other microstents), conventional non-MIGS glaucoma surgery (e.g. trabeculectomy), and non-MIGS laser procedures (e.g. selective laser trabeculoplasty (SLT)). We included studies where procedures were combined with phacoemulsification and compared to phacoemulsification in combination with other glaucoma surgery or phacoemulsification alone. Critical outcomes were the proportion of participants medication-free at each time point and the rate of visual field progression (decibels/time) or proportion of participants whose visual field loss progressed during follow-up. Important outcomes included mean change in IOP; mean change in IOP-lowering drops taken per day; proportion of participants requiring further glaucoma surgery or laser; and mean change in health-related quality of life. Adverse event outcomes included loss of visual acuity, bleeding, endophthalmitis, and IOP spikes. All outcomes were measured in the short term (6 to 18 months), medium term (> 18 to 36 months), and long term (> 36 months or longer). We assessed risk of bias using the Cochrane RoB 2 tool. We used standard Cochrane methodology. We undertook meta-analysis where the data appeared to be clinically, methodologically, and statistically homogeneous. We used a random-effects model when there were three or more studies, otherwise we used a fixed-effect model. Where we could not perform a meta-analysis due to high heterogeneity, we provided a narrative summary of the data following guidance in the Cochrane Handbook. We included 10 parallel-group RCTs (639 participants). The mean age ranged from 41 to 74 years, and the proportion of male participants from 25% to 74%. Ethnicity was reported in five studies (Japanese (two), Caucasian/white (one), various ethnicities (two)). One study was multicentre and one multinational; the remainder were single-centre studies. Studies were conducted in Italy (two), Japan (two), and India, the United States and Latin America, Poland, Canada, and China (one each). There were five comparisons in this review. For comparison 1 (SC-MIGS versus non-MIGS surgical options), there was no evidence of a short-term difference in medication-free participants (without phacoemulsification: risk ratio (RR) 1.15, 95% confidence interval (CI) 0.88 to 1.51; 1 study; low-certainty evidence; with phacoemulsification: RR 1.04, 95% CI 0.86 to 1.27; I2 = 39%; 2 studies; very low-certainty evidence), IOP change (without phacoemulsification: mean difference (MD) -0.75 mmHg, 95% CI -2.85 to 1.35; 1 study; low-certainty evidence; with phacoemulsification: MD 3.70 mmHg, 95% CI -3.25 to 10.65; 1 study; very low-certainty evidence), change in IOP-lowering drops per day (with phacoemulsification: MD -0.71, 95% CI -1.79 to 0.37; 1 study; very low-certainty evidence), further surgery (with phacoemulsification: RR 2.70, 95% CI 0.13 to 58.24; 2 studies; very low-certainty evidence), or adverse events. One study narratively reported that there were no changes in the rate of visual field progression. For comparison 2 (SC-MIGS with phacoemulsification versus phacoemulsification only), in the short term, SC-MIGS may increase medication-free participants (RR 105.00, 95% CI 6.64 to 1660.79; 1 study; low-certainty evidence) and result in a greater mean IOP change (MD -8.70 mmHg, 95% CI -10.12 to -7.28; 1 study; low-certainty evidence). There was no evidence of a difference in further surgery (RR 0.33, 95% CI 0.02 to 7.24; 1 study; very low-certainty evidence). SC-MIGS may increase bleeding risk (RR 13.42, 95% CI 1.86 to 96.98; 2 studies; low-certainty evidence), with no evidence of a difference in other adverse events. For comparison 3 (SC-MIGS versus non-SC-MIGS), there was no evidence of a difference in medication-free participants (RR 1.07, 95% CI 0.92 to 1.24; 2 studies; very low-certainty evidence), IOP change (MD -0.25, 95% CI -1.13 to 0.63; 2 studies; very low-certainty evidence), change in IOP-lowering drops per day (MD -0.15, 95% CI -0.34 to 0.03; 2 studies; very low-certainty evidence), further surgery (no participants in either group), or adverse events. Comparison 4 (SC-MIGS versus other SC-MIGS) showed there were likely no differences between the groups in nearly all outcomes. Comparison 5 (SC-MIGS versus laser) showed there may be a greater reduction in mean IOP, but there may be a greater risk of bleeding in the SC-MIGS group. The available evidence is of low or very low certainty, and we are therefore able to draw only weak, uncertain conclusions about the effects of SC-MIGS. There may be little to no difference in the proportion of participants who are medication-free in the short, medium, or long term between SC-MIGS and non-MIGS surgical treatment. SC-MIGS may demonstrate a higher proportion of participants to be medication-free in the short term compared to phacoemulsification surgery alone; however, there may be a higher risk of bleeding. SC-MIGS may also be associated with a greater reduction in mean IOP compared to laser treatment. This Cochrane review was supported by the National Eye Institute, National Institutes of Health, USA; Public Health Agency, UK; Queen's University Belfast, UK; National Institute for Health Research, UK until March 2023. Protocol (2022): doi.org/10.1002/14651858.CD015186.
This study investigated the microbiological and geochemical characteristics of gold mining tailings and assessed the potential of a Pb-tolerant bacterial strain, Sphingobium sp. RO-01, for lead (Pb) removal through biomineralization. The tailings were dominated by fine particles (average 12.3 μm) with low permeability and high leaching potential, indicating a substantial risk of heavy-metal dispersion and acid mine drainage. X-ray fluorescence analysis showed Pb concentrations of 580 ppm, exceeding the EPA limit of 400 ppm, while X-ray diffraction suggested that Pb was primarily present in amorphous or adsorbed phases. Mineralogical data indicated that most Pb was associated with pyrite, jarosite, and Fe oxides-hydroxides. Microbial community profiling revealed Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria as the dominant phyla, consistent with microbial assemblages typically adapted to heavy-metal stress. The isolated Sphingobium sp. RO-01 strain, a urease-positive bacterium capable of tolerating up to 10 mM Pb, removed approximately 82% of soluble Pb after 48 h under planktonic conditions. Scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDS) confirmed Pb incorporation into CaCO₃ biominerals, indicating urease-mediated microbially induced calcite precipitation (MICP) as the principal immobilization mechanism. Furthermore, the strain substantially reduced the genotoxicity associated with soluble Pb, likely due to its transformation into stable mineral phases and the production of extracellular substances that mitigate oxidative stress. Overall, these findings highlight Sphingobium sp. RO-01 as a promising biotechnological tool for the remediation and stabilization of Pb-contaminated mining environments.
Accurate identification of neural structures is essential for safe ultrasound-guided regional anesthesia. Although artificial intelligence (AI)-generated color overlay has been introduced to support anatomical recognition, external validation using clinically oriented evaluation methods remains limited. We evaluated the diagnostic accuracy of an AI-generated color overlay for visualizing neural structures corresponding to the C5 and C6 nerve roots. In this prospective observational study, two anesthesiology trainees performed bilateral interscalene ultrasound scans in 20 healthy adult volunteers. During live scanning, ultrasound-system video recordings were saved from the initiation of scanning to acquisition of an optimal image, and still images were captured at the optimal image. Subsequently, with the operators blinded to the AI output, the color overlay generated in real time during ultrasound scanning was evaluated. Two board-certified anesthesiologists independently evaluated the datasets and assessed the accuracy of the color overlay in visualizing neural structures corresponding to the C5 and C6 nerve roots using a four-category classification: true positive, true negative, false positive, and false negative. Of the 160 evaluated nerve structures, six structures without expert consensus were excluded from analysis. Overall sensitivity, specificity, and accuracy were 93.8% (95% confidence interval [CI], 88.6-96.7), 88.9% (95% CI, 56.5-98.0), and 93.5% (95% CI, 88.5-96.4), respectively. Among all evaluated structures, false-positive and false-negative findings accounted for 0.7% and 5.8%, respectively. AI-generated color overlay demonstrated high accuracy in visualizing neural structures corresponding to the C5 and C6 nerve roots at the interscalene level on ultrasound images. This technology may enhance anatomical recognition and serve as a useful diagnostic and educational support tool, while complementing, rather than replacing, clinicians' own interpretation.