In 2014 the Cambia Health Foundation launched the Sojourns Scholar Leadership Program to promote, support, grow, and nurture a new generation of leaders in palliative care. As the program winds down after recruiting 108 scholars comprised of 10 cohorts of 10-12 professionals from across disciplines in our field, the members of its advisory board share the "secret sauce," three aspects of the program that we believe were the keys to success-recruit great people, provide strong program leadership and mentorship, and create and sustain a supportive, engaged community-to guide future initiatives in leadership development. Palliative care needs visionary leaders to address the challenges in health care and meet the demand for quality palliative care. We strongly encourage other organizations committed to improving the care of people with serious illness to use these lessons to invest in the development of new generations of leaders.
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This paper explores the psychoanalytic thought of Eugenio Gaddini, one of the most original and influential figures in Italian psychoanalysis. A detailed analysis of his writings and the cultural context in which his thought developed reconstructs his reflections on the early phases of mental development, the mind-body relationship, and the clinical implications of his theories. Particular attention is devoted to the concepts of primitive imitation, fantasies in the body, basic mental organisation, and acting out, with which Gaddini contributed to the understanding of the genesis of the Self and the birth of the psyche from the soma. The paper also sheds light on the relationship of Gaddini's thinking with the psychoanalytic tradition, in particular with Freud, Winnicott, and the anglophone schools, and his innovative approach to psychoanalytic theory and practice. Lastly, the relevance of his ideas to contemporary psychoanalysis is highlighted, especially in the treatment of pathologies characterised by non-represented mental states and psychosomatic disturbances.
Knowledge of past cultures relies heavily on surviving written material. Over the centuries, texts were copied, altered, and often lost, leaving scholars to reconstruct partial genealogies-stemmata-from shared innovations between surviving copies. Yet, a general understanding of the processes shaping textual transmission remains elusive. Within the broader topic of cultural evolution, text transmission provides a favorable context for integrating formal modeling with empirical evidence: explicitly identified items (texts), transmitted through deliberate manual replication, have left tangible artifacts (manuscripts)-traces of a dynamical, cultural, and historical process. Rethinking textual transmission through a complexity science approach, this study combines stochastic models and simulations, informed by historical scholarship, with empirical data from a corpus of circa 2,000 medieval manuscripts spanning four centuries. Our framework quantifies how variation in copying and destruction rates influences survival or extinction, and reproduces key stylized facts observed empirically in reconstructed stemmata, such as imbalance, a feature debated for over a century. Further, this approach provides broad trends estimates suggesting that up to 60%; of texts and more than 95%; of manuscripts may have been lost. Our findings highlight the role of drift in cultural transmission, while providing a formal basis to integrate drivers such as cultural selection and historical contingencies (eg the Black Death). It bridges philology and cultural evolution approaches, while providing a theoretical and empirical framework applicable to numerous other traditions-eg Classical literature, legal and scientific texts, religious canons-where replication and loss also shape what endures.
As an acute respiratory infectious disease, influenza continues to impose a substantial public health burden worldwide. This study aims to systematically review the progress of research on the treatment of influenza with Traditional Chinese Medicine (TCM) from 2005 to 2025, identify current research hotspots, and forecast future development trends, in order to provide a clear and systematic reference framework for subsequent research. A bibliometric and scientometric analysis was conducted using the Web of Science Core Collection (WOSCC), PubMed, and Scopus databases. Following the PRISMA 2020 guidelines, the retrieved records underwent a comprehensive deduplication process and stringent quality control checks. By comprehensively applying CiteSpace, VOSviewer, and the R-based Bibliometrix package, metrics and visualization were performed across multiple dimensions, including publication volume, geographical contribution, annual trends, national/regional influence, core authors and institutions, and keywords. A total of 1,527 publications were included in this study. Since 2014, publication output in this field has shown significant growth, with a rapid upward trend emerging after 2020. At the national and institutional level, China ranked first globally in both the number of publications and total citation frequency. Research institutions in China not only serve as the dominant force in this field but also act as hubs for international collaboration. Notable contributions were made by institutions such as the Chinese Academy of Sciences, Beijing University of Chinese Medicine, and the China Academy of Chinese Medical Sciences. Journal analysis revealed that the Journal of Ethnopharmacology is the most influential journal in this domain. In terms of scholarly impact, Yang Zifeng ranked first in both h-index and publication output, establishing them as the most prolific and influential core scholar in the field. Keyword analysis indicated that research focuses on core themes such as "herbal medicine" and "antiviral activity." The evolutionary trajectory demonstrates a shift from traditional clinical practice toward modern mechanistic investigation. Driven by emerging public health events such as COVID-19, the field has rapidly integrated cutting-edge methodologies like network pharmacology, reflecting distinct characteristics of contemporary responsiveness and interdisciplinary convergence. This analysis confirms that TCM for influenza has matured into a structured and interdisciplinary research field. Substantial evidence supports its multi-component and multi-target therapeutic model as a clinically effective strategy against influenza. Future efforts should prioritize the integration of mechanistic insights with standardized clinical translation to enhance global antiviral preparedness.
Tuberculosis (TB) remains a significant public health challenge in India. Malnutrition and TB form a vicious cycle, where malnutrition predisposes a child to acquire TB, while TB could exacerbate undernutrition. In India, Nutritional Rehabilitation Centers (NRCs) provide therapeutic nutrition and medical care to address malnutrition in children. The National Tuberculosis Elimination Program (NTEP) was integrated into India's NRCs in 2012 for early detection of TB among malnourished children; however, its implementation remains suboptimal. The present study aims to identify the challenges and barriers in implementing NTEP guidelines at NRCs in India through systematic review of literature. The systematic review was conducted across six databases including PubMed, Scopus, ScienceDirect, WHO Global Index Medicus, Semantic Scholar, and Google Scholar for studies published between 2010 and 2024. The systematic review protocol has been registered in the PROSPERO web portal with Registration ID No. CRD42025644172. The quality of individual studies included in the evidence synthesis was assessed using the Mixed Methods Appraisal Tool (MMAT) - Version 2018. A narrative synthesis approach, following the SWiM (Synthesis Without Meta analysis) guidelines, was employed for data analysis. Out of 1,374 records identified through database searches, four studies met the inclusion criteria and were included in the final synthesis. Key challenges and barriers reported in implementation of TB screening and diagnosis were (1) underutilization of diagnostics, (2) human resource constraints, (3) sample collection issues, (4) treatment gaps, and (5) infrastructural limitations. Addressing these barriers with context-specific innovative strategies is essential to improve TB screening and diagnosis among malnourished children admitted in NRCs. This systematic review highlights that while NRCs play a crucial role in managing SAM, the underutilization of diagnostic tools, limitations in human resources, difficulties in sample collection, and infrastructural and logistical barriers have resulted in the potential underdiagnosis of TB in this vulnerable population. This systematic review provides valuable insights into the issues that must be addressed to improve TB diagnosis among SAM children admitted at NRCs in India.
The public health sector is undergoing sustained change, shaped by complex health challenges, constrained resources, and evolving employment conditions that may affect the availability of stable and fulfilling career pathways for public health professionals. Within this context, the integration of entrepreneurial competencies into public health training has been proposed as one potential strategy to support innovation, workforce adaptability, and career diversification. This systematic review examined the reported landscape of entrepreneurial training within postgraduate public health programs and described the educational approaches through which such training is delivered. A comprehensive literature search was conducted across eight databases (PubMed, Scopus, ProQuest Central, Cochrane, EBSCO Medline Ultimate, Google Scholar, PsycINFO, and Semantic Scholar) for studies published between 2000 and May 2025. A complementary targeted scan of publicly available Master of Public Health (MPH) and related programs (13-15 August 2025) identified universities explicitly referencing entrepreneurship-related training. Three peer‑reviewed studies met the inclusion criteria, indicating a small and heterogeneous body of empirical work on public health entrepreneurship (PHE) education at the postgraduate level. Across included studies, PHE was inconsistently defined and most often positioned as an elective rather than a core curriculum component. Educational approaches primarily used experiential, team‑based, and mentor‑supported formats and addressed a broad, but not consistently specified, set of competencies, including innovation and opportunity recognition, networking, communication and stakeholder engagement, management and leadership, and basic legal, marketing, and financial knowledge. Outcomes were largely limited to short‑term, self‑reported perceptions, with little evidence on long‑term skill acquisition, career pathways, or workforce‑level effects. Reported constraints included limited faculty expertise and mentorship capacity, restricted institutional resources, and uneven access to entrepreneurship‑supportive ecosystems. Current evidence suggests that postgraduate PHE training is emerging but remains sparsely documented and weakly evaluated. Further research is needed to develop shared competency frameworks, apply more rigorous and longitudinal evaluation designs, and investigate scalable delivery models, including digital and AI‑enabled approaches, with particular attention to equity in access to entrepreneurship training within public health education.
Lipid metabolism plays a central role in host-pathogen interactions and immune regulation during bacterial sepsis, with its dysregulation contributing to organ failure and mortality. Blood-based lipidomics has emerged as a promising approach for identifying diagnostic and prognostic biomarkers in sepsis. However, discrepancies in lipid profiles between serum and plasma remain a major challenge for clinical translation. This systematic review synthesizes lipidomic evidence from serum and plasma in bacterial sepsis patients to identify reproducible lipid biomarkers, evaluate methodological heterogeneity and assess associations with clinical outcomes. A systematic search of five databases (Scopus, Pubmed, Ovid MEDLINE, Web of Science and Google Scholar) identified nine eligible studies published between 2016 and 2025 that applied untargeted or targeted lipidomics on human serum and plasma samples from adult bacterial sepsis patients (PROSPERO: CRD420251086177). Across both matrices, reproducible candidate lipid biomarkers included triacylglycerols (TAG), phosphatidylcholines (PC), lysophosphatidylcholines (LPC), sphingomyelins (SM) and ceramides. Synthesized findings revealed characteristically distinct directional trajectories: consistent elevation of TAG, bidirectional shifts of PC, depletion of LPC, bidirectional shifts of SM and elevation of SM. Preliminary trend within the literature indicates that serum-based studies more frequently captured prognostic alterations, whereas plasma-based studies often focused on diagnostic discrimination. Substantial heterogeneity was observed in sample handling, lipid extraction protocols and analytical platforms. Overall, both matrices offer valuable clinical insights, though these apparent differences in diagnostic or prognostic utility may reflect primary study designs rather than intrinsic matrix superiorities. Methodological heterogeneity limits reproducibility, highlighting the need for standardized workflows to enable translation of sepsis lipid biomarkers.
Metaplastic breast cancer (MpBC) is a rare and aggressive breast cancer subtype characterised by marked histological heterogeneity, therapeutic resistance and poor clinical outcomes. Despite increasing molecular research, existing evidence remains fragmented, heterogeneous and poorly integrated, limiting clinical translation and biomarker validation. We developed an integrative analytical framework combining systematic review, quantitative meta-analysis, transcriptomic profiling and interpretable machine learning to identify and prioritise molecular markers in MpBC. A Preferred Reporting Items for Systematic Reviews and Meta Analyses-guided systematic review was conducted across PubMed, arXiv and Semantic Scholar. Effect sizes were standardised to Cohen's d and synthesised using a random-effects model. Transcriptomic analysis was performed on the GSE165407 dataset using DESeq2 in R (RStudio version 1.1.463), with differentially expressed genes cross-referenced against literature-derived biomarkers. Supervised models including a multi-layer perceptron and boosted random forest were applied, with performance evaluated using receiver operating characteristic analysis. Model interpretability was assessed using SHapley Additive exPlanations. Eleven studies met inclusion criteria. Meta-analysis demonstrated low heterogeneity and a pooled effect size of d = 0.74 (95% CI 0.59-0.88), indicating a consistent moderate-to-large biomarker signal across studies. Pathway enrichment revealed convergence on PI3K/AKT/mTOR signalling, immune modulation and epithelial -mesenchymal transition. Transcriptomic profiling demonstrated concordance with literature-derived markers. The random forest model achieved strong classification performance (AUC = 0.91), with high specificity and minimal misclassification. SHapley Additive exPlanations analysis identified both canonical (PI3KCA, RPL39, EXO1) and non-canonical (CD55, LARGE2) contributors to model prediction. This study provides an integrated synthesis linking systematic evidence, transcriptomic validation and interpretable machine learning in MpBC. By reconciling fragmented literature with data-driven modelling, we identify a biologically coherent and clinically tractable molecular signature, offering a foundation for biomarker-driven stratification and translational validation.
HIV/AIDS in Bangladesh has historically remained below 0.01% prevalence in the general population; however, recent provisional epidemiological data indicate a concerning shift, with the highest annual increase recorded between November 2024 and October 2025 (1891 new cases; 254 AIDS-related deaths), signaling evolving transmission dynamics. Despite an overall low national prevalence, the epidemic remains highly concentrated among key populations, including people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), transgender individuals, and migrant workers, where prevention and service coverage gaps have been documented. This narrative review synthesizes evidence published between 2015 and 2025 on HIV epidemiology, prevention strategies, testing infrastructure, treatment outcomes, and structural barriers in Bangladesh. Data were drawn from peer-reviewed studies identified through systematic searches of PubMed/MEDLINE, Google Scholar, and Bangladesh-specific repositories, supplemented by national surveillance reports (National AIDS/STD Programme; Integrated Biological and Behavioral Surveys), international agency documents (UNAIDS, WHO, Global Fund), and recent programmatic reports. Both peer-reviewed and grey literature sources were included to capture the full range of available evidence. Findings reveal significant deficiencies across the HIV response cascade. Geographic availability of testing services is limited to 23 of 64 districts, and prevention coverage is suboptimal, reaching just 26% of MSM and male sex workers. Progress along the treatment cascade shows 82% of people living with HIV diagnosed (approximately 14,334 of an estimated 17,480), 74% of those diagnosed receiving antiretroviral therapy, and 91% of those on ART achieving viral suppression, all falling short of global 95-95-95 targets. Behavioral indicators highlight ongoing vulnerabilities; only 14.4% of MSM report condom use with commercial partners in the past 6 months and 27% of female sex workers reporting no condom use at last sexual encounter. Stigma and discrimination continue to undermine the response, with 68% of people living with HIV reporting feelings of shame and 54% reporting guilt related to their diagnosis, adversely affecting testing, disclosure, and care engagement. Despite these challenges, harm reduction programs and a pilot pre-exposure prophylaxis (PrEP) initiative demonstrate substantial promise. Strengthening targeted prevention, expanding testing and treatment access, and addressing stigma, funding constraints, and structural barriers are essential to sustaining Bangladesh's low-prevalence status and advancing toward the goal of ending AIDS as a public health threat by 2030. HIV/AIDS in Bangladesh: recent trends, prevention challenges, and community involvement HIV/AIDS has remained at a very low level in Bangladesh for many years, affecting less than 0.01% of the general population. However, recent data show a worrying increase in new cases, especially between November 2024 and October 2025. Although the overall number of cases is still low, HIV mainly affects certain high-risk groups such as people who inject drugs, men who have sex with men, sex workers, transgender people, and migrant workers. This review examined research published from 2015 to 2025 on HIV in Bangladesh, including trends in infection, prevention programs, testing services, treatment success, and social challenges. The findings show major gaps in the country’s HIV response. HIV testing services are available in only 23 of the 64 districts, and prevention programs reach only a small portion of people at highest risk. For example, only about one-quarter of men who have sex with men and male sex workers are covered by prevention services. Treatment results show mixed progress. While most people with HIV who receive treatment achieve good control of the virus, Bangladesh has not yet met the global targets for diagnosis, treatment, and viral suppression. Risky behavior remains common, with low condom use among both men who have sex with men and female sex workers. In addition, stigma remains a serious problem. Many people living with HIV feel ashamed or guilty about their condition, which discourages them from getting tested, sharing their status, or continuing care. Despite these challenges, some programs—such as harm reduction services and pilot projects for preventive medicines—have shown strong success. To protect Bangladesh’s low HIV rate and move toward ending AIDS by 2030, the country must expand testing and treatment services, improve prevention programs for high-risk groups, reduce stigma, and address funding and structural barriers.
To analyze the available evidence regarding the contribution of cone-beam computed tomography (CBCT) to the evaluation of osteolytic lesions resulting from multiple myeloma (MM) and to the early diagnosis of the disease. A comprehensive search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, Embase, LILACS, Google Scholar, and OpenGrey through November 2025, without restrictions on language or publication date. Studies that identified or described MM-related lesions using CBCT were included, whereas those involving patients with medication-related osteonecrosis of the jaws were excluded. Seventeen studies met the inclusion criteria, including 11 case reports, 2 case series, and 4 cross-sectional studies. In most case reports (9 studies), the initial clinical suspicion arose from oral alterations and/or the identification of osteolytic lesions on CBCT, prompting medical referral. The mandible was the most frequently affected site (13 studies). Various tomographic patterns were described, most commonly extensive lesions with irregular contours and ill-defined margins (10 studies) and punched-out lesions (5 studies). CBCT demonstrates potential as a valuable tool for the early identification and characterization of MM-related lesions in the head and neck region. However, the available literature remains limited and is predominantly composed of isolated case reports, indicating a substantial knowledge gap. These findings underscore the need for further research and for the training of dental professionals-particularly radiologists-to adopt a more sensitive and multidisciplinary diagnostic approach.
This scoping review examined the evidence on the use of supervised deep learning models for the classification of dental implants using radiographic images. A preliminary search was conducted in PubMed, Google Scholar, PROSPERO, JBI Evidence Synthesis, and the Open Science Framework, identifying a small number of relevant records. A comprehensive search was subsequently performed across 7 databases using adapted strategies without filters. Studies were included if they evaluated implant classification using supervised deep learning models applied to panoramic or periapical radiographs. Studies were excluded if they did not involve implant classification, were review articles, involved children, were unavailable in full text, or did not apply artificial intelligence methods. Data extraction was conducted by 2 independent reviewers, with disagreements resolved by a third reviewer. Descriptive statistics were used for data analysis. Of 274 records, 9 studies met the inclusion criteria. Studies published between 2020 and 2024 evaluated deep learning and machine learning approaches for dental implant identification and classification from radiographic images. A range of models was applied, predominantly convolutional neural networks. Dataset sizes ranged from 355 to 156,965 radiographs and included multiple implant brands. Few studies addressed ethical considerations related to recent data protection regulations. This scoping review indicates that most deep learning-based approaches to implant classification using dental radiographs primarily rely on implant brand or manufacturer as the labeling strategy. This reliance may limit model generalizability and long-term applicability due to the frequent discontinuation of implant systems. Future studies should focus on intrinsic radiographic characteristics, including macrogeometry and prosthetic connection types.
Obsessive-compulsive disorder (OCD) is one of the common mental disorders globally. However, there are limited studies on the prevalence of OCD and four other disorders categorized under obsessive-compulsive and related disorders, namely, hoarding disorder, excoriation disorder, body dysmorphic disorder, and trichotillomania. The authors sought to fill the epidemiological gap in the literature. PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Google Scholar were systematically searched from inception to June 8, 2025. Studies representative of national or subnational general populations, with diagnoses based on DSM or ICD-10 criteria, were included. A Bayesian hierarchical linear mixed model was used to estimate the lifetime prevalence of OCD at the global, regional, and national levels, with estimates reported with 95% credible intervals. The authors examined the association between OCD prevalence and the Socio-demographic Index (SDI), and estimated age-specific point prevalence of OCD. A total of 112 studies reporting prevalence rates for obsessive-compulsive and related disorders were included. The global lifetime Bayesian prevalence of OCD across all ages was estimated at 2.57% according to ICD-10 criteria, 3.10% according to DSM-III criteria, 2.28% according to DSM-IV criteria, and 3.21% according to DSM-5 criteria. Lifetime prevalence of OCD was negatively correlated with SDI, indicating lower prevalence estimates in countries with higher SDI. The age-specific prevalence of OCD increased sharply in the teen years and peaked in the late 20s to early 30s. Point prevalence ranged across studies from 0.98% to 5.81% for hoarding disorder, from 2.33% to 7.68% for excoriation disorder, from 0.44% to 15.21% for body dysmorphic disorder, and from 0.0% to 2.12% for trichotillomania. This study estimated the global prevalence of OCD according to diagnostic criteria, underscoring the role of diagnostic definitions in shaping epidemiological understanding.
Dual antiplatelet therapy (DAPT), combining aspirin with a P2Y12 inhibitor, remains central to secondary prevention after acute coronary syndrome and percutaneous coronary intervention. However, substantial interindividual variability in antiplatelet response, particularly clopidogrel resistance associated with CYP2C19 polymorphisms, has challenged the conventional "one-size-fits-all" approach and increased interest in precision-guided antiplatelet strategies. This narrative review synthesized literature identified through PubMed, Scopus, Web of Science, and Google Scholar, focusing on randomized trials, genotype-guided studies, platelet function testing (PFT), meta-analyses, guideline statements, and emerging artificial intelligence (AI)-based prediction models. Evidence suggests that genotype-guided therapy, PFT-guided treatment, and individualized DAPT duration may improve the balance between ischemic protection and bleeding risk in selected high-risk populations. However, routine implementation remains limited by inconsistent clinical outcome benefits, heterogeneous testing strategies, modest risk-score performance, cost, infrastructure barriers, and variable guideline recommendations. Precision-guided DAPT is promising, but broader adoption requires stronger prospective evidence, standardized testing pathways, and real-world validation.
To map and synthesize the available evidence on the use of Auracast technology in hearing aids (HA), in the context of auditory accessibility in public environments. This scoping review followed the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. The PCC framework was adopted (Population: individuals with hearing loss using HA; Concept: Auracast technology; Context: public environments). The search strategy was based solely on the keyword "Auracast" and applied to a defined time window from June 2022 (the official launch of Auracast) to April 2025. Information sources included scientific databases (PubMed, Scopus, IEEE Xplore, Dimensions Analytics) and gray literature sources (Google Scholar, websites of HA manufacturers, professional associations, and institutional repositories such as OSF and OpenGrey). Study selection and data extraction were conducted independently and blindly by two reviewers, with disagreements resolved by consensus. A total of 348 records were identified. After removing duplicates and applying eligibility criteria, 17 studies were included in the final synthesis. The available evidence suggests that Auracast could improve accessibility and autonomy in public settings, particularly when integrated with HA. However, most studies were technical or descriptive, lacking robust clinical evaluations. Auracast is an emerging innovation in auditory accessibility. Nevertheless, further empirical studies are needed to assess its effectiveness in educational, healthcare, and transportation settings. Large-scale adoption will depend on technical, financial, and social factors, especially in low-infrastructure contexts. Mapear e sintetizar as evidências disponíveis sobre o uso da tecnologia Auracast em dispositivos eletrônicos de amplificação sonora (DEAS), no contexto da acessibilidade auditiva em ambientes públicos. A revisão seguiu as diretrizes do Joanna Briggs Institute (JBI) e do PRISMA-ScR. Foi utilizada a estrutura PCC (População: indivíduos com perda auditiva usuários de DEAS; Conceito: tecnologia Auracast; Contexto: ambientes públicos). A busca foi realizada em abril de 2025 e abrangeu o período de junho de 2022 a abril de 2025, utilizando o termo “Auracast” como palavra-chave. As fontes de informação incluíram bases de dados científicas (PubMed, Scopus, IEEE Xplore, Dimensions Analytics) e fontes de literatura cinzenta (Google Acadêmico, sites de fabricantes de DEAS, associações profissionais e repositórios institucionais, como o OSF e o OpenGrey). A seleção e extração dos dados foram realizadas por dois revisores independentes e cegados, com resolução de conflitos por consenso. Foram identificados 348 registros. Após a remoção de duplicatas e a aplicação dos critérios de elegibilidade, 17 publicações foram incluídas na síntese final. As evidências disponíveis apontam para o potencial do Auracast em promover maior acessibilidade e autonomia em espaços coletivos, especialmente quando integrado a DEAS. Entretanto, as publicações encontradas são predominantemente técnicas ou descritivas, com escassez de avaliações clínicas robustas. O Auracast representa uma inovação emergente no campo da acessibilidade auditiva, mas ainda são necessários estudos empíricos que avaliem sua eficácia em ambientes educacionais, de saúde e de transporte. A adoção em larga escala dependerá de fatores técnicos, financeiros e sociais, especialmente em contextos com infraestrutura limitada.
To evaluate the effects of transitional care interventions on rehospitalization, functional outcomes, quality of life, mortality, and disability in stroke survivors. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in PROSPERO (CRD420251266063). PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL were searched from inception to May 13, 2026. Additional searches were conducted in ClinicalTrials.gov, Google Scholar, and grey literature sources. Randomized controlled trials comparing transitional care interventions with usual care in adult stroke survivors were included. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as standardized mean differences (SMDs), both with 95% confidence intervals (CIs). Subgroup analyses were conducted according to follow-up duration. Sensitivity analyses, small-study-effect assessment, and GRADE certainty assessment were performed where appropriate. Twenty-four randomized controlled trials involving 3,520 stroke survivors were included. Transitional care interventions reduced overall rehospitalization compared with usual care (RR = 0.59, 95% CI 0.40-0.88), with a more consistent effect within 3 months after discharge (RR = 0.49, 95% CI 0.29-0.82). Transitional care interventions improved activities of daily living (ADL) in the primary analysis (SMD = 0.43, 95% CI 0.20-0.67), although heterogeneity was substantial; after sensitivity analysis, the effect remained statistically significant but was attenuated (SMD = 0.22, 95% CI 0.07-0.37). Quality of life (QoL) improved overall (SMD = 0.67, 95% CI 0.37-0.96), particularly within 3 months (SMD = 0.74, 95% CI 0.54-0.94). No significant mortality reduction was observed (RR = 0.86, 95% CI 0.53-1.39). Transitional care interventions were associated with lower short-term disability measured by the modified Rankin Scale (mRS; SMD = -0.59, 95% CI -0.99 to -0.19), but this finding was limited by substantial heterogeneity. The certainty of evidence was moderate for short-term rehospitalization and short-term QoL, and low for ADL, mortality, and disability. Transitional care interventions probably reduce short-term rehospitalization and improve short-term QoL in stroke survivors. They may also improve ADL and short-term disability, but these findings should be interpreted cautiously because of heterogeneity, risk of bias, and possible small-study effects. Current evidence does not establish a clear mortality benefit.
Lung fibrosis encompasses a group of interstitial lung diseases (ILDs) characterized by progressive scarring of lung tissue, often leading to respiratory failure and high mortality. Contemporary diagnostic frameworks have evolved from diagnosis-centered to pattern-based approaches, incorporating the concept of progressive pulmonary fibrosis (PPF) as a unifying clinical entity. Accurate and timely diagnosis is critical for guiding appropriate management but remains challenging due to non-specific symptoms, overlapping radiological patterns, and limitations of existing diagnostic tools. We aimed to summarize the status, limitations, and emerging approaches in the diagnosis of lung fibrosis, with an emphasis on imaging modalities, histopathological techniques, molecular diagnostics, artificial intelligence (AI) applications, and to propose an updated diagnostic algorithm. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar to identify relevant literature published between January 2015 and February 2026. Priority was given to international clinical guidelines, consensus statements, systematic reviews, meta-analyses, and clinically relevant original studies addressing diagnostic approaches to lung fibrosis and interstitial lung diseases. The retrieved evidence was synthesized thematically, focusing on imaging modalities, histopathological techniques, molecular diagnostics, biomarkers, artificial intelligence, and multidisciplinary diagnostic frameworks. High-resolution computed tomography (HRCT) remains the gold standard for non-invasive diagnosis, with pattern classification guided by the 2022 ATS/ERS/JRS/ALAT guidelines. MRI, lung ultrasound, and functional imaging offer valuable adjuncts. Surgical lung biopsy provides histopathological confirmation but carries a risk that varies depending on patient selection; transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive alternative with diagnostic yields exceeding 80% in multidisciplinary settings. Emerging techniques, including gene expression profiling, telomere length assessment, circulating biomarkers, endobronchial optical coherence tomography, and AI-enhanced imaging, show promise for improving early and accurate diagnosis but remain adjuncts to multidisciplinary discussion (MDD) rather than replacements. Home-based monitoring technologies and molecular imaging have expanded capabilities for longitudinal disease monitoring. Despite these advancements, persistent challenges include diagnostic variability, limited access to advanced modalities, and the absence of standardized diagnostic algorithms. In summary, advances in imaging, molecular diagnostics, and artificial intelligence are improving the early and accurate diagnosis of lung fibrosis. Importantly, these tools are complementary to, not substitutes for, multidisciplinary care. Their integration into MDD-centered frameworks is essential to improve patient outcomes.
Adamantinomatous craniopharyngiomas (ACP) in children are rare benign tumours. Relatively few publications have addressed the long-term impact of this tumour and its treatment. We undertake a systemic review of the existing literature aiming to define the outcome of ACP beyond 10 years' follow-up. Ovid MEDLINE, Embase and Google Scholar were used to search the literature. The search criteria were children (aged under 18 at diagnosis), any intervention for and outcomes of ACP. Publications with less than 10 years' follow-up and single case reports were excluded. Twenty-one studies were included reporting on 1152 children, with a mean age of 8.8 years at diagnosis. Mean follow-up was 14 years. The most common presenting symptom was headache. The mean overall survival at 5, 10, 15 and 20 years post-diagnosis was 91.6%, 84.4%, 77.5% and 68.0%, respectively. In children undergoing gross total resection only or radiotherapy only, survival was higher than with combined treatments. Seventy-five percent of children had endocrine dysfunction after intervention; the most prevalent was hypothyroidism (81.9%). The prevalence of endocrinopathies was similar across all treatment groups. Lower QoL was reported than the general population, predominantly related to the effects of hypothalamic injury. One in ten patients suffered a late complication related to radiotherapy with vasculopathy being the most prevalent. The long-term morbidity and mortality for paediatric ACP remain high. The impact from hypothalamic injury cannot be understated and is likely the cause for this finding. As surgical treatment advances, less hypothalamic injury may arise and improved outcomes may follow. Gross total resection, if felt achievable without hypothalamic injury, should form the mainstay of treatment due to the late radiotherapy-related complications that arise.
Supplementation of reduced glutathione (GSH) in freezing media has been proposed to improve post-thaw boar sperm quality, although reported findings remain inconsistent. This study aimed to quantitatively evaluate the effects of reduced glutathione on post-thaw sperm quality through a systematic review and meta-analysis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scopus, PubMed, CAB Direct, EBSCOhost, and Google Scholar were systematically searched. Based on predefined inclusion and exclusion criteria, 15 in vitro studies comprising 19 experiments were included. Four outcomes were analyzed: total motility, progressive motility, viability, and acrosome integrity. Standardized mean differences (SMD) were calculated using random-effects models. Heterogeneity was assessed using Cochran's Q test, and the I2 statistic. Publication bias was evaluated using funnel plots, Egger's test, and trim-and-fill analysis, while sensitivity analyses were performed using Baujat plots and leave-one-out analysis. Reduced glutathione was positively associated with total motility (SMD = 0.74; 95% CI: 0.42-1.05; P<0.001), progressive motility (SMD = 0.90; 95% CI: 0.21-1.58; P=0.014), viability (SMD = 0.67; 95% CI: 0.11-1.23; P=0.022), and acrosome integrity (SMD = 0.72; 95% CI: 0.32-1.12; P=0.002). Low to high heterogeneity was observed across outcomes, indicating variability in the estimated effects across studies. Significant subgroup differences were identified according to GSH concentration, freezing media, and thawing media. Overall, the available evidence suggests a possible positive association between GSH supplementation and several post-thaw sperm quality parameters, although these subgroup findings are exploratory and require confirmation in well-standardized experimental studies.
Hemophilia A and B are inherited bleeding disorders caused by deficiencies of coagulation factors VIII and IX. The development of neutralizing alloantibodies (inhibitors) remains the most serious treatment complication, rendering factor replacement ineffective and substantially increasing morbidity, treatment complexity, and healthcare costs. A literature search was conducted using PubMed/MEDLINE, Embase, and Google Scholar for publications from January 2000 to March 2026 using combinations of the terms 'hemophilia A,' 'hemophilia B,' 'inhibitors,' 'immune tolerance induction,' 'bypassing agents,' 'emicizumab,' 'concizumab,' 'marstacimab,' 'fitusiran,' and 'gene therapy.' Relevant clinical trials, observational studies, guidelines, and review articles were evaluated. This review examines current and emerging therapies for inhibitor patients, including bypassing agents, immune tolerance induction, emicizumab, anti-tissue factor pathway inhibitor therapies, antithrombin suppression, next-generation factor mimetics, gene therapy, and immune-modulatory approaches. Pivotal clinical trials demonstrate major reductions in bleeding rates and significant advances in prophylactic care. Despite transformative progress, important unmet needs remain, including incomplete hemostatic control, lack of predictive biomarkers, limited laboratory standardization, and inequitable global access. Future advances will depend on biomarker-guided personalized therapy, rational combination strategies, and integration of immune-modulatory and gene-based approaches to achieve durable tolerance and potentially curative outcomes.