Pakistan journal of pharmaceutical sciencesHuang Ling, Zhang Yu, Deng Shu
BACKGROUND: Postoperative inflammation after arthroplasty contributes to pain, delayed mobilization and prolonged hospitalization. Recent randomized trials have evaluated pharmacological anti-inflammatory strategies within contemporary enhanced recovery pathways, but evidence after hip and shoulder arthroplasty remains scattered across different drug classes and perioperative regimens. OBJECTIVES: To synthesize recent randomized controlled trial (RCT) evidence on perioperative anti-inflammatory agents after hip and shoulder arthroplasty. METHODS: PubMed, Embase, Cochrane Library and Web of Science were searched for English-language RCTs published from January 2020 to March 2026. The 2020-2026 window was selected to update evidence generated under modern arthroplasty, anesthesia, multimodal analgesia and enhanced recovery after surgery (ERAS) pathways. Eligible trials included adults undergoing hip or shoulder arthroplasty and compared corticosteroids, cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal anti-inflammatory drug (NSAID)-based/local anti-inflammatory regimens, or related anti-inflammatory interventions with placebo, saline, no treatment, or the same regimen without the target component. Weighted mean differences (WMDs) were pooled using random-effects models. RESULTS: Nine RCTs involving 800 patients were included. Anti-inflammatory interventions significantly reduced postoperative C-reactive protein (CRP) [WMD=-32.18, 95% confidence interval (CI) (-41.16, -23.21), P<0.001], interleukin-6 (IL-6) [WMD=-31.25, 95% CI (-41.79, -20.77), P<0.001], rest pain [WMD=-0.41, 95% CI (-0.58, -0.23), P<0.001], activity pain [WMD=-0.56, 95% CI (-0.83, -0.29), P<0.001] and hospital stay [WMD=-0.54, 95% CI (-0.92, -0.15), P=0.006]. CONCLUSION: Recent RCT evidence suggests that perioperative anti-inflammatory interventions can attenuate early inflammatory responses and improve short-term pain and recovery after hip and shoulder arthroplasty. Because data were limited and clinically heterogeneous, the findings should not be interpreted as evidence favoring a specific drug class, dose, route, or timing.
Journal of foot and ankle researchLevi Kadiri, Anthony Maher, Andy Bridgen
BACKGROUND: Diabetic foot osteomyelitis (DFO) is a serious complication of diabetic foot ulcers and is associated with increased risk of amputation, morbidity, and mortality. Bone biopsy remains the most definitive diagnostic modality, yet controversy persists over its diagnostic utility This study reviews the diagnostic concordance of histopathology and microbiology in bone biopsy specimens from patients with DFO and examines the clinical implications of the findings. METHODS: A systematic review was conducted using PubMed, Medline, CINHAL, Cochrane Library, and Google Scholar. Studies included adult patients with DFO in whom bone biopsy specimens underwent both histopathological and microbiological analysis. Five core studies met the eligibility criteria. Data on study design, setting, population, diagnostic methods, concordance rates, and outcomes were extracted and synthesized utilising a quantitative narrative synthesis. RESULTS: Across the five studies (n = 308 patients), histopathology and microbiology showed modest concordance, with mean rates of concordant positive results of 43.4% and common discordant findings. Histopathology demonstrated higher specificity, while microbiology had higher sensitivity, ranging from 70% to 83.9% but greater susceptibility to contamination. Positive histopathology was more strongly associated with the need for revision surgery or extended antibiotic therapy. DISCUSSION: Histopathology appears to offer superior diagnostic specificity, whereas microbiology provides valuable information for antimicrobial management. Frequent discordance underscores the importance of interpreting results in a clinical context. Further robust, prospective studies are needed to clarify the optimal diagnostic approach and standardise definitions.
Journal of foot and ankle researchTaeseok Choi, Sangbin Lee, Wansuk Choi, Seoyoon Heo
OBJECTIVE: To systematically review the evidence for orthotic interventions on pain, balance, and plantar pressure distribution in individuals with flexible flatfoot. METHODS: Randomized and nonrandomized controlled trials of orthotic interventions for flexible flatfoot were included. Primary outcomes were pain, balance, and plantar pressure. MEDLINE via PubMed, EMBASE via Elsevier, and the Cochrane Library were searched from inception to October 16, 2025. All effect sizes were independently recomputed, and pooling required two or more compatible datasets. RESULTS: Eight studies with 382 participants were included: six randomized controlled trials, one nonrandomized controlled trial, and one within-subject repeated-measures study. No domain met the pooling condition, so all previously reported summary estimates and heterogeneity statistics are withdrawn. Pain against a comparator without arch support rested on Yurt et al. (n = 67): g = -1.02 [95% CI: -1.54, -0.49] on the trial's designated primary outcome, a 100 mm visual analog scale, but g = -0.28 on its Foot Function Index total. In Elsayed et al. (n = 40) both arms wore the same orthosis, so g = -0.97 [-1.62, -0.33] estimates added exercise, not the device. Balance rested on Yalfani et al. (n = 30): g = -0.86 [-1.59, -0.13]. In Khodaei et al. (n = 19), plantar load was redistributed rather than reduced, moving from the heel and lesser metatarsals (g = -1.93 to -1.09) to the medial midfoot (+1.76). Taspinar et al. were withdrawn as arithmetically irreproducible. CONCLUSIONS: Every domain rests on a single small study, so no general efficacy claim is supportable. The most defensible finding is mechanical: load shifts from the heel and lesser metatarsals to the medial midfoot, as a medial arch support is designed to do. The pain estimate is not robust to instrument choice within its own trial. GRADE certainty is very low for every outcome; certainty for plantar pressure began at low because the contributing study did not randomize allocation. The two nonrandomized studies were additionally appraised with ROBINS-I, at critical and serious risk, respectively. Adequately powered randomized trials with a defined comparator and a pre-specified primary outcome are required.
Journal of renal careAmir Faravan, Mansour Ghafourifard, Akram Ghahramanian, Azad Rahmani, Hossein Namdar Areshtanab, Mostafa Ghasempour
BACKGROUND: Patient-to-patient peer support has been identified as a promising approach for the management of chronic kidney disease and has been associated with improved clinical and psychosocial outcomes. Multiple factors may influence the implementation and effectiveness of peer support programs across different healthcare settings. OBJECTIVES: This qualitative meta-synthesis aimed to identify the key facilitators influencing peer support among patients with chronic kidney disease. METHODS: A systematic review and qualitative meta-synthesis were conducted. The electronic databases Web of Science, PubMed and Scopus were systematically searched to identify relevant studies. Thomas and Harden's three-stage thematic synthesis approach was used to synthesize the findings of the included qualitative studies. The methodological quality of the selected studies was assessed using the Critical Appraisal Skills Programme (CASP) tool. RESULTS: A total of 15 studies were included in the meta-synthesis. The analysis identified three main themes related to facilitators of peer support: (a) Cultivating a supportive culture through the healthcare system, (b) Weaving deep connections and good rapport and (c) Engaged and motivated peer supporters and recipients. CONCLUSIONS: This qualitative meta-synthesis demonstrates that successful implementation of peer support programs for people living with CKD depends on the interaction of organizational support, meaningful peer relationships and active participant engagement. These findings provide a conceptual framework that can inform the design, integration and strengthening of peer support programs within routine kidney care.
Scandinavian journal of caring sciencesNoora Puusa, Eeva Harju, Maija-Liisa Kalliomäki, Elina Haavisto
AIM: To analyse the use of opioids in children with cancer and the experiences of their family members regarding opioids used in pain management to improve family nursing. DESIGN: An integrative review. METHODS: A systematic literature search was carried out in four databases (CINAHL, MEDLINE, PsycInfo and Scopus) in August 2023, and was subsequently updated to include studies up to the end of 2024. Sixteen peer-reviewed research articles met the inclusion criteria and were included in a quality appraisal and analysis. RESULTS: Of the wide range of opioids used to treat pain in children with cancer, morphine and fentanyl stood out as the most used. The prevalent routes of opioid administration was intravenous and enteral. Limited research has been conducted on the experiences of family members of children with cancer in the context of opioids used for pain management. Furthermore, there is a scarcity of studies that describe the experiences of siblings from the same perspective. Parental experiences were particularly described as concerns about and a desire to refuse opioid use, although satisfaction with opioid use was also described. CONCLUSIONS: Opioids are particularly significant in managing pain among children with cancer. Therefore, the use of opioids in this patient group should be comprehensively studied, and healthcare professionals should receive sufficient training. The experiences of parents conclude that they require sufficient information and guidance on the management of their children's severe pain and the analgesics used to treat it. The notable lack of research regarding the experiences of siblings in connection with the use of opioids for the management of a child's pain addresses the need for further research from these perspectives. More research on experiences during the different phases of cancer treatment is needed. Further research employing qualitative methods will be essential for enhancing family nursing.
Bipolar disordersJana Radosavljevic, Deniz Bengi, Benicio N Frey
OBJECTIVES: Perimenopause has been associated with mood worsening in some individuals, including increased depressive symptoms. Yet, the link between bipolar disorder (BD) and perimenopause remains understudied. This review aimed to provide an update on recent original studies and contextualize findings within the broader literature to guide future research and clinical practice. METHODS: A systematic search was conducted on Embase (January 1, 2018 to August 5, 2026) to identify studies on BD (I, II, or NOS/BD spectrum) that directly or indirectly examined perimenopause and BD. Pooled samples were included if they reported separate BD results. Results were narratively synthesized. RESULTS: Fourteen studies were identified from Australia (n = 4), Italy (n = 3), UK (n = 2), Taiwan (n = 1), South Korea (n = 1), Sweden (n = 1), USA (n = 1), and one study of international trials. There is converging evidence showing that perimenopause is a period of higher risk of first onset BD. Among individuals with existing BD, increased depression and heightened anxiety during perimenopause were the most consistent illness-course findings, whereas findings for hypo/mania were mixed. Evidence concerning psychotherapy or pharmacological treatment, including hormone replacement therapy, was limited or absent. CONCLUSIONS: This review provides an updated perspective on BD and perimenopause, extending existing knowledge beyond mood symptoms and identifying several clinical and research gaps. Clinicians should consider the potential impact of perimenopause in BD management. Research using standardized menopause staging criteria (e.g., STRAW+10) is encouraged to inform mechanisms, illness trajectories, treatments, and to better support individuals with BD through perimenopause.
BACKGROUND: Chronic kidney disease (CKD) associated osteoporosis leads to an increased risk of bone fracture in patients with CKD. Evidence on the efficacy and safety of anti-osteoporotic medications is limited for this group. This systematic review aimed to examine the efficacy and safety of anabolic parathyroid hormone (PTH) treatment in patients with CKD Stages 4-5D. METHODS: MEDLINE, EMBASE and ClinicalTrials.gov were searched systematically for randomized controlled trials (RCTs) investigating teriparatide, natpara, or abaloparatide in adult patients with CKD Stages 4-5D, including kidney transplant recipients. The primary outcome was the change in bone mineral density (BMD) during follow-up measured at the lumbar spine (LS), femoral neck (FN) and total hip (TH). The secondary outcomes included bone turnover markers, fractures, histomorphometric results from bone biopsies and adverse events (AEs). RESULTS: Two RCTs were included. A subgroup analysis of patients with CKD Stage 4 (n = 5) showed that teriparatide improved BMD at the LS and FN. Another trial (n = 61) in CKD Stage 5D showed significant BMD improvement at the TH compared to the control group. AEs were observed with higher frequency in the teriparatide-treated group. CONCLUSION: Treatment with teriparatide seems to improve BMD in patients with CKD Stages 4-5D, but evidence on efficacy and safety is limited. TRIAL REGISTRATION: PROSPERO: CRD42024527086.
Nursing in critical careAbdullah Avcı, Mükaddes Avcı
BACKGROUND: Nurses working in intensive care units (ICU) are at high risk for stress and anxiety. Aromatherapy stands out as a non-pharmacological and easily implementable complementary approach for alleviating these symptoms. To our knowledge, this is the first systematic review specifically examining the effects of aromatherapy on stress and anxiety among ICU nurses. AIMS: This systematic review aimed to evaluate the effects of aromatherapy on stress and anxiety among ICU nurses and to assess the methodological quality of the evidence. STUDY DESIGN: In this systematic review, a literature search was conducted in the Scopus, PubMed, Web of Science and Cochrane Library databases without any time restrictions. The review includes randomised controlled, experimental and quasi-experimental studies evaluating the effects of aromatherapy interventions on stress and/or anxiety among ICU nurses. The selection of studies, data extraction and assessment of methodological quality were conducted independently by two researchers. RESULTS: This systematic review included five studies involving a total of 254 participants. Two of these studies are randomised controlled trials, and three are quasi-experimental studies. The studies included in the review demonstrate that aromatherapy is administered using various essential oils and application methods (inhalation, topical application, etc.). The findings suggest that aromatherapy interventions may reduce stress among ICU nurses, whereas evidence regarding anxiety reduction is mixed and less consistent across studies. CONCLUSION: Aromatherapy may have potential benefits for reducing stress among ICU nurses, whereas evidence for anxiety reduction remains limited and inconsistent. Further high-quality studies are needed before firm conclusions or routine clinical implementation can be recommended. RELEVANCE TO CLINICAL PRACTICE: Aromatherapy may be considered as an optional supportive intervention within staff well-being programs, provided that safety, scent sensitivity, infection-control procedures and individual preferences are taken into account. However, standardised protocols and further high-quality evidence are required to support its routine clinical use.
INTRODUCTION: Dyslipidaemia remains a major contributor to atherosclerotic cardiovascular disease (ASCVD), and many patients fail to achieve recommended low-density lipoprotein cholesterol (LDL-C) targets despite statin therapy or are unable to tolerate statins. Oral non-statin therapies have emerged as important alternatives; however, their comparative efficacy and safety remain unclear. METHODS: We systematically searched PubMed, Embase, Web of Science, and Cochrane Central up to December 2025 for clinical trials evaluating these medications in adults with dyslipidaemia. Primary outcomes were percent and absolute changes in LDL-C, while secondary outcomes included other lipid parameters and safety profile. A frequentist random-effects network meta-analysis was performed. RESULTS: Forty-three trials comprising 17,021 participants were included. Combination therapies showed the greatest efficacy, with obicetrapib 10 mg plus ezetimibe 10 mg achieving the largest reduction in percent LDL-C (-49.15%; 95% CI: -59.42 to -38.89), followed by bempedoic acid plus ezetimibe (-36.90%; 95% CI: -44.65 to -29.15). Obicetrapib also showed substantial improvements in HDL-C and ApoB. Safety outcomes were generally reassuring, with no significant increase in serious adverse events, myalgia, headache, or elevated liver enzymes; however, treatment discontinuation was higher with bempedoic acid 180 mg and colesevelam 3.75 g. The certainty of evidence was low to very low for many efficacy outcomes, primarily because of heterogeneity and imprecision. CONCLUSIONS: Oral non-statin combination therapies, particularly obicetrapib plus ezetimibe and bempedoic acid plus ezetimibe, provide the most effective LDL-C lowering and are valuable for patients with statin intolerance or residual risk. Ezetimibe remains a well-tolerated option. Long-term cardiovascular outcome trials are needed to confirm clinical benefit.
Early life stress (ELS) is a critical environmental factor influencing developmental trajectories of behavioral and emotional regulation. Increasing evidence suggests that such experiences can alter biological systems during sensitive developmental periods through epigenetic processes. This systematic review aims to synthesize empirical human studies examining how ELS contributes to the developmental programming of mental health via epigenetic regulation of stress-response systems. This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed/MEDLINE, Web of Science, Scopus, and PsycINFO databases was performed for studies published up to March 2026. Eligible studies included empirical human research investigating associations between ELS, epigenetic mechanisms (primarily DNA methylation), and mental health-related outcomes across developmental stages. A total of 14 studies met inclusion criteria and were synthesized using a qualitative approach. Findings indicate that ELS is associated with persistent epigenetic modifications in key genes regulating stress-response systems, particularly within the hypothalamic-pituitary-adrenal (HPA) axis. Altered DNA methylation patterns in genes such as NR3C1, FKBP5, SLC6A4, MAOA, and ANK3 were consistently linked to developmental alterations in emotional regulation and increased vulnerability to psychiatric conditions, including depression, anxiety disorders, and post-traumatic stress disorder. Importantly, evidence highlights early childhood as a sensitive developmental window during which environmental inputs exert stronger and more enduring biological effects. Some studies further suggest that epigenetic profiles may show partial plasticity in response to environmental or therapeutic changes across development. This review supports the concept that ELS contributes to the developmental programming of mental health through epigenetic mechanisms affecting stress-response systems. These findings underscore the importance of timing and environmental context in shaping long-term behavioral outcomes. However, the existing literature remains limited by methodological heterogeneity, including variability in developmental stages, tissue types, and measurement approaches. Future research should prioritize longitudinal and developmentally informed designs to better capture the dynamic interplay between environment, biology, and behavior across the lifespan.
Pain practice : the official journal of World Institute of PainHaneen Sabet, Ahmed Samir, Basant Lashin, Abdallah Abbas, Shrouk Ramadan, Mohamed El-Moslemani, Ahmed F Younis, Obai Yousef, Rovan Ahmed Rouby, Alaa Abd-Elsayed
OBJECTIVE: To evaluate the effectiveness and safety of proximal and distal ultrasound-guided greater occipital nerve block (US-GONB) in patients with migraine. METHODS: PubMed, Scopus, Web of Science, and the Cochrane Library were searched up to July 2025. Studies assessing US-GONB in migraine were included. Data were pooled using a random-effects model and expressed as mean difference (MD) with 95% confidence intervals (CI). Subgroup analyses were conducted based on the injection site. RESULTS: Twelve studies (658 patients) were included. US-GONB significantly reduced pain intensity (MD = -3.48 points, 95% CI [-3.84, -3.11]), monthly headache frequency (MD = -9.12 days, 95% CI [-11.65, -6.58]), headache duration (MD = -18.98 h, 95% CI [-26.86, -11.11]), and monthly analgesic use (MD = -10.01, 95% CI [-12.91, -7.11]). No significant subgroup difference was observed in pain intensity between injection sites. For monthly headache frequency, a significant subgroup difference was observed, with the proximal subgroup demonstrating numerically larger reductions than the distal subgroup (-10.83 vs. -6.36 days; p = 0.006). Adverse events were generally mild and transient: loss of pinprick sensation occurred in 80% of proximal vs. 100% of distal injections, dizziness in 22.7% vs. 3.9%, moderate-to-severe migraine attacks in 20.1% vs. 12.9%, and cerebellar-like symptoms in 12.5% vs. 0%, respectively. Vasovagal syncope (9.1%) and local pain (8.1%) were reported only in proximal injections. CONCLUSIONS: US-GONB appears to be a safe and effective intervention for migraine, significantly improving pain and headache burden. Proximal injections may be associated with greater reductions in headache frequency; however, these findings were based on indirect comparisons. Further comparative trials are warranted to optimize anatomical targeting.
Journal of viral hepatitisDemver P Gomez, Wilmyr F Hababag
Continuous nucleos(t)ide analogue (NA) therapy for chronic hepatitis B (CHB) effectively maintains viral suppression but rarely results in functional cure. Finite NA therapy has been proposed to increase rates of HBsAg loss; however, international guidelines provide conflicting recommendations. This study compares the efficacy and safety of finite versus continuous NA therapy in HBeAg-negative adults using randomized controlled trials. We included parallel-group randomized controlled trials (RCTs) comparing nucleos(t)ide analogue (NA) cessation versus continuation in non-cirrhotic, virally suppressed HBeAg-negative adults. Two reviewers independently screened studies and assessed risk of bias using Cochrane RoB 2. Random-effects Mantel-Haenszel meta-analyses with Hartung-Knapp adjustment and Paule-Mandel estimation were used to pool risk ratios (RRs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using the GRADE approach. Four RCTs (n = 357) met inclusion criteria. Discontinuation increased HBsAg loss vs. continuation (RR 5.02, 95% CI: 0.47-53.47; I2 = 21.8%; low certainty), corresponding to ~53 additional losses per 1000 patients. However, finite therapy markedly increased virologic relapse (RR 23.09) and retreatment (RR 21.94) while reducing sustained off-therapy virologic response (RR 0.46). Post-cessation ALT flares were frequent but self-limited or resolved with retreatment. No hepatic decompensation or serious adverse events occurred. In monitored, non-cirrhotic adults, finite NA therapy may increase the probability of HBsAg loss despite predictable relapse and retreatment. With no evidence of severe harm, these findings support finite therapy as a selective, patient-centered strategy toward functional cure in expert centers.
Dyslexic students faced psychological and educational challenges during the COVID-19 pandemic and online learning, including increased anxiety, low self-esteem, reduced reading interest, limited access to educational technologies, insufficient teacher support, and difficulties with reading fluency and concentration. Examining these challenges is crucial for implementing effective measures and enhancing post-pandemic learning. This study investigates the psycho-educational challenges of dyslexic children during the pandemic, highlighting the need for targeted interventions to support them in current and future contexts. This systematic review identified relevant articles through electronic searches of PubMed, Wiley, Scopus, Web of Science, Google Scholar, and ScienceDirect, supplemented by the snowballing technique, which involved examining the bibliographies of retrieved references. The study identified two main categories of challenges for dyslexic children: psychological (mental health, emotional well-being, behavioural issues, parental stress) and educational (socioeconomic status, technology access, special educational needs, teacher support, remote learning difficulties) affecting children with learning disabilities. The research results show that dyslexic children faced various psychological and educational difficulties identified in this review during the COVID-19 pandemic. Therefore, targeted, evidence-based strategies-such as teacher training, family-school collaboration, adaptive learning technologies, and psychological support-are needed to mitigate these challenges in the post-pandemic period.
Fundamental & clinical pharmacologyNatalia Kostakis, Jean-Christophe Lega, Remy Boussageon
BACKGROUND: The results of randomized controlled trials (RCTs) regarding the effect of vitamin D supplementation on mortality reduction are conflicting. OBJECTIVE: The aim of this study was to assess the level of evidence through a sensitivity analysis of the meta-analysis by Shah et al. (2024) using the Rebuilt the Evidence Base (REB) method. METHODS: The main inclusion criterion was a double-blind, placebo-controlled RCT design. The exclusion criteria were trials combining vitamin D with other nutrients and unpublished RCTs. The main outcome was all-cause mortality. A bias analysis was performed, followed by a hypothetico-deductive analysis to determine the confirmatory or exploratory nature of each RCT. The REB method was used to interpret the results and assess the level of evidence. RESULTS: Among the 25 RCTs included in the meta-analysis by Shah et al., the analysis was performed on 8 RCTs at low risk of bias including 30 320 participants. Seven RCTs raised some concerns, and two RCTs were at high risk of bias according to ROB2. Bias arose from the randomization process, deviations from intended interventions, missing outcome data, and selection of the reported results. The results were statistically significant, in favor of vitamin D supplementation: RR = 0.96 (95% CI [0.92, 1.00]), p = 0.04. No RCT was conclusive. CONCLUSION: According to the REB method, there is an evidence signal regarding the benefit of vitamin D supplementation in the population aged 75 and older, which remains to be confirmed.
Annals of medicineAtheer G Almutairi, Leena I Aloraini, Abeer G Almutairi, Houriah Nukaly, Saleha Khan, Asem Shadid, Azzam Alkhalifah
BACKGROUND AND OBJECTIVES: Lichen planus (LP) is a chronic, lymphocytic, inflammatory skin disorder that can affect the skin, hair follicles, nails, and mucous membranes. It has limited treatment options. The pathogenesis of LP includes inflammation driven by interferons and the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. Thus, Janus kinase inhibitors (JAKi) have been proposed as a viable therapeutic approach for LP. JAKi have recently been approved to treat some lymphocytic skin disorders such as alopecia areata and atopic dermatitis. The purpose of the systematic review was to assess the effects of JAKi on LP. MATERIALS AND METHODS: We searched PubMed, Scopus, and Google Scholar and included all studies published between January 2015 and May 2024 that assess the clinical effects of JAKi on lichen planus, including cutaneous and mucosal/adnexal variants. The risk of bias in included studies was assessed using Joanna Briggs Institute (JBI) tools, classifying bias as low, moderate and high concerns. RESULTS: A total of 57 full-text publications were evaluated, of which 34 papers were excluded because they did not match the criteria. Therefore, this systematic review included 23 papers, seven of them were case series and the remaining 16 were case reports. There were 13 papers on tofacitinib, six on baricitinib, and two papers each on ruxolitinib and upadacitinib. CONCLUSION: Several case series and case reports have shown beneficial effects of JAK inhibitors to treat LP. Few patients had minor adverse events.
The Journal of dermatological treatmentYanchen Liu, Haoran Hu, Linfeng Li
OBJECTIVES: Randomized evidence for systemic targeted therapies in prurigo nodularis (PN) has expanded, but cross-trial differences limit valid comparison. We mapped randomized evidence and assessed comparative effects using exact Week-16 ≥ 4-point itch numerical rating scale response (NRS4). METHODS: MEDLINE, Embase, CENTRAL, and Web of Science were searched through 14 August 2026. Studies with extractable randomized arm-level Week-16 NRS4 data were synthesized using a fixed-effect contrast-based network meta-analysis. Risk of bias was assessed with RoB 2 and confidence with CINeMA. RESULTS: Twenty-four randomized studies were represented by 117 reports, but only seven cohorts (1,435 participants; 19 arms; 10 active nodes) contributed to the aligned network. Dupilumab (OR 4.04, 95% CI 2.42-6.75; low confidence) and global phase III nemolizumab (OR 5.81, 95% CI 3.81-8.86; low confidence) were effective versus placebo. The indirect nemolizumab-versus-dupilumab comparison was imprecise (OR 1.44, 95% CI 0.74-2.79; low confidence). CONCLUSIONS: Indirect evidence did not establish superiority of either biologic. The randomized evidence bases substantially exceeded the quantitatively comparable network, reflecting incomplete results availability and cross-trial differences. REGISTRATION: PROSPERO CRD420261401106.
BACKGROUND: Diagnostic performance varies across glomerular disease (GD) subtypes, and whether artificial intelligence (AI) outperforms pathologists with different experience levels remains uncertain. OBJECTIVE: To evaluate pathology-based AI models for GD classification and compare their performance with pathologists. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched through 15 July 2026. Studies using pathology images and pathology diagnosis as the reference standard were included. Random-effects models pooled sensitivity, precision, accuracy, F1 score and area under the curve (AUC). RESULTS: Fifteen studies comprising 39,536 validation sample units, not necessarily unique patients, were included. For subtypes with at least 10 validation datasets, AI achieved high performance for membranous nephropathy (MN; sensitivity 0.96, precision 0.94, accuracy 0.96, F1 score 0.95, AUC 0.98), IgA nephropathy (IgAN; sensitivity 0.92, precision 0.91, accuracy 0.94, F1 score 0.90, AUC 0.96), and minimal change disease (MCD; sensitivity 0.92, precision 0.87, accuracy 0.96, F1 score 0.89, AUC 1.00). AI also showed higher accuracy than senior pathologists for IgAN, MN, and MCD; however, comparator evidence was sparse and should be interpreted cautiously. Most included studies were retrospective, and substantial heterogeneity was observed across datasets, imaging modalities, model architectures, and validation strategies. CONCLUSIONS: Pathology-based AI shows strong potential for GD classification, but current head-to-head evidence is insufficient to establish superiority over pathologists, particularly senior pathologists. Prospective multicenter studies integrating multimodal clinical data and standardized external validation are needed.
Renal anemia is a prevalent complication in patients undergoing peritoneal dialysis (PD). Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, but comparisons with erythropoiesis-stimulating agents (ESAs) require consideration of the specific regimens used. We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from inception to December 2025 for randomized controlled studies comparing roxadustat-based regimens with ESA-based regimens in adults receiving PD. Eligible evidence was restricted to PD-only randomized studies after rechecking dialysis modality and study design. Nineteen studies involving 1,636 participants were included. The average post-treatment hemoglobin level was higher in the roxadustat-based groups than in the study-specific ESA comparator groups (mean difference = 7.30 g/L, 95% CI: 5.43 to 9.16; I2 = 62.6%). However, hemoglobin target-attainment data were not defined or reported consistently enough for quantitative synthesis. Post-treatment hematocrit and red blood cell count also differed between groups, with substantial heterogeneity. The pooled reported adverse-event rate yielded an RR of 0.45 (95% CI: 0.27 to 0.74), but definitions and ascertainment were not standardized. Effects on iron indices, inflammatory markers, lipid indices, and cardiovascular outcomes were exploratory. Grading of Recommendations Assessment, Development and Evaluation certainty was low for hemoglobin and low to very low for most secondary outcomes. Available evidence is insufficient to determine the comparative clinical superiority of roxadustat-based over ESA-based strategies in PD because final values were pooled and comparator regimens were heterogeneous. Evidence concerning hemoglobin target attainment, high-density lipoprotein cholesterol, and long-term safety remains insufficient.
European journal of psychotraumatologySuyon Baek, Mikyoung Lee
Background: Indirect exposure to disasters and violence through continuous news and social media is increasingly common among adolescents. However, instruments designed to assess media-induced indirect trauma in this population remain limited and conceptually heterogeneous.Objective: This systematic review aims to synthesize the characteristics and psychometric evidence of instruments measuring media-induced indirect trauma and evaluate their suitability for adolescents.Methods: This review of outcome measurement instruments (OMIs) was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-COSMIN for OMIs 2024 guideline. Eight electronic databases were searched for peer-reviewed articles published between 1 January 2000 and 22 October 2025, in English or Korean. Reference list screening was also performed. Eligible studies used or developed self-report instruments assessing media-induced vicarious, secondary, or indirect trauma responses to potentially traumatic events. Methodological quality was evaluated using the COSMIN Risk of Bias checklist, and certainty of evidence was graded using a modified Grading of Recommendations Assessment, Development and Evaluation approach.Results: Seven instruments were evaluated, varying in conceptual focus, recall periods, and contextual framing. Evidence for structural validity and internal consistency was generally moderate, whereas content validity was rated very low across all instruments. Overall, while evidence for internal structure is relatively stronger, substantial gaps in content validity and longitudinal measurement properties limit confident application in adolescents.Conclusion: Future research should prioritize adolescent-inclusive validation; systematic content validity evaluations; and rigorous reporting of test-retest reliability, measurement error, responsiveness, and interpretability.
European journal of psychotraumatologyIrada Meoon, Aungsana Khlaisuk, Siriyupa Nansunanon, Teerapon Dhippayom
Background: Post-traumatic stress disorder (PTSD) is prevalent among children and adolescents, with cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) widely used treatment options. This study compared the effects of CBT and EMDR in children and adolescents using a meta-analysis approach.Methods: PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and PsycInfo were searched in March 2025. Randomized controlled trials that compared the effectiveness of CBT and EMDR on PTSD symptoms in children and adolescents aged 6-18 years who had been exposed to traumatic events were included. The Cochrane Risk of Bias version 2 was used to assess the methodological quality of the included studies. A random-effects model was applied to calculate the standardized mean difference (SMD) along with 95% confidence interval (CI), and the I2 statistic was used to quantify statistical heterogeneity.Results: Five trials (248 participants) were included. There was no statistically significant difference in PTSD symptoms between the CBT and EMDR groups, whether reported by children (SMD: 0.18; 95% CI: -0.07-0.43; I2 = 0%) or by parents (SMD: 0.23; 95% CI: -0.02-0.48; I2 = 0%). For anxiety, the pooled estimate did not reach statistical significance (SMD: 0.44; 95% CI: -0.19-1.07; I2 = 69%). Depression symptoms were higher in the CBT group than in the EMDR group (SMD: 0.44; 95% CI: 0.13-0.76; I2 = 0%).Conclusion: The comparative effects of CBT and EMDR in reducing PTSD and anxiety symptoms remain inconclusive. Although CBT was associated with higher depression symptoms compared with EMDR, the current evidence is based on a small number of trials, and the pooled estimates should be interpreted with caution.
Journal of the International Society of Sports NutritionDamoon Ashtary-Larky, Darren G Candow, Jose Antonio, Christian Quiceno, Fabrizio Angelini, Scott C Forbes, Sajjad Moradi, Fatemeh Kazeminasab, Reza Bagheri
AIM: Soccer places repeated demands on short-duration, high-intensity performance, including sprints, accelerations, jumps, and technical actions performed over the course of a match. Because these efforts depend heavily on rapid adenosine triphosphate (ATP) resynthesis, creatine is a plausible ergogenic aid for soccer players. However, findings in soccer-specific studies have been inconsistent, and previous reviews have addressed narrower questions using smaller evidence sets. This systematic review therefore examined the effects of creatine supplementation on performance, body composition, and recovery/fatigue-related outcomes in soccer players. METHODS: PubMed, Scopus, and Web of Science were searched from inception to 15 May 2025 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We included controlled clinical trials of creatine supplementation in male or female soccer players of any age or competitive level when an eligible placebo, control, or comparison condition was available. Outcomes were grouped into performance, body composition, and recovery/fatigue domains. Domains from the revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool were used to produce study-level methodological summaries rather than formal result-specific risk-of-bias assessments. Because the studies differed substantially in design, supplementation protocols, populations, and outcomes, findings were synthesised qualitatively rather than pooled in a meta-analysis. RESULTS: Source-level verification left 45 eligible reports representing 41 unique studies: 28 randomised parallel-group studies, 2 randomised crossover/repeated-condition studies, and 11 non-randomised or allocation-unverifiable controlled studies. Some trials reported favourable findings for repeated-sprint performance, anaerobic power, and muscular strength, but the comparative evidence was inconsistent and the certainty of evidence was very low. Findings for vertical jump performance and technical skills were mixed, while change-of-direction and endurance outcomes showed no consistent benefit. Recovery- and fatigue-related findings were also largely null or inconsistent. Body mass often increased, particularly after loading protocols, whereas evidence for gains in lean mass was limited and inconsistent. CONCLUSION: The soccer-specific evidence for creatine supplementation remains suggestive rather than conclusive. Favourable findings have been reported for some repeated-sprint, anaerobic-power, and strength outcomes, but the comparative evidence is heterogeneous, often limited by unclear or nonsignificant between-group effects, and of very low certainty. Firm conclusions about efficacy are therefore not possible. Body mass commonly increased, especially after loading protocols, while effects on lean mass, endurance, change-of-direction ability, and recovery/fatigue-related outcomes remain uncertain.
The journal of nursing research : JNRWen-Ling Chen, Siriluk Winitchayothin, Chun-Hung Cheng, Santo Imanuel Tonapa, Fan-Hao Chou, Peta-Anne Zimmerman
BACKGROUND: Nursing education requires innovative approaches to develop core competencies in knowledge, skills, and attitudes. Gamified learning interventions offer promising alternatives to traditional teaching methods for enhancing outcomes in undergraduate nursing education. PURPOSE: This systematic review and meta-analysis was conducted to evaluate the effectiveness of gamified learning interventions on knowledge acquisition, skill performance, and attitude enhancement among undergraduate nursing students and to investigate the differences in effects achieved across different gamification categories. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a comprehensive search was conducted across six databases (A+ Education, CINAHL, Embase, ERIC, PubMed, and Web of Science) on March 18, 2025. This search targeted randomized controlled trials designed to compare gamified learning with traditional teaching methods in undergraduate nursing education. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and evidence certainty was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. RESULTS: The findings of randomized controlled trials involving a total of 1,698 participants demonstrated significantly positive effects favoring gamified learning across all key domains, including knowledge acquisition (standardized mean difference [SMD]=0.81, 95% CI [0.55, 1.07]), skill performance (SMD=1.64, 95% CI [0.96, 2.32]), and attitude enhancement (SMD=0.54, 95% CI [0.07, 1.00]). The subgroup analysis revealed differential effectiveness across gamification categories, with serious games demonstrating large and consistent effects on knowledge acquisition (SMD=0.84, 95% CI [0.43, 1.25], I2=61%), while gamified web and mobile learning interventions showed moderate effects with greater variability (SMD=0.55, 95% CI [0.23, 0.87], I2=70%). Skill performance exhibited the largest overall effect sizes, although substantial heterogeneity was observed across all outcome domains (I2=82-95%). The results of the GRADE assessment support moderate-certainty evidence for all learning outcomes. CONCLUSIONS: The results of this systematic review and meta-analysis provide robust evidence that gamified learning interventions significantly enhance undergraduate nursing education across the knowledge, skills, and attitudes domains. Serious games demonstrated superior consistency for knowledge acquisition, while the strongest overall effects were identified for skill performance. The substantial heterogeneity observed underscores the critical importance of selecting appropriate gamification approaches based on specific educational objectives, institutional technological capabilities, and implementation contexts. These findings support the strategic integration of evidence-based gamified learning into nursing curricula as an effective supplement to traditional teaching methods. Future research should focus on assessing long-term competency retention and developing standardized implementation frameworks to guide the widespread adoption of effective gamified learning approaches in nursing education.
OBJECTIVE: The Mediterranean Diet (MedDiet) is a plant-rich dietary pattern associated with favourable adiposity profiles, making it a relevant model for studying obesity risk in children and adolescents. This study aims to investigate the association between adherence to the MedDiet and risk of obesity in children and adolescents. METHODS: An extensive search in databases PubMed/Medline, Scopus, Web of Science Core Collection, the Cochrane Library and Google Scholar up to October 2025 was conducted. Cohort studies which reported means and standard deviations for the body mass index (BMI) levels and MedDiet adherence scores, and crude and adjusted odds ratios (OR) for overweight or obesity among the children with high and low adherence to the MedDiet were eligible for inclusion. RESULTS: Twenty three articles (26 studies) met the inclusion criteria. Results demonstrated that the mean BMI levels in children adhering to the MedDiet were significantly lower than those who did not adhere to it (weighted mean difference [WMD] = -0.42 kg/m2, 95% CI: -0.61, -0.23, I2 = 65.15%, p < 0.001). Additionally, results indicated that children with overweight had a lower mean adherence score compared to children with normal weight (WMD = -0.44 scores, 95% CI: -0.76, -0.12, I2 = 85.95%, p < 0.001). CONCLUSION: This meta-analysis highlights that greater adherence to the MedDiet was associated with lower odds of obesity among children and adolescents. However, these findings should be interpreted cautiously because the evidence was entirely cross-sectional, heterogeneity was substantial across several pooled analyses and some estimates were sensitive to exclusion of individual studies.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyLuis Augusto Mendes Fontes, Guilherme Auler Brodt, Adna Thalita do Nascimento Silva, Isabela Regina de Lima Andrade, Livia Barboza de Andrade
OBJECTIVES: To evaluate differences in spatiotemporal gait parameters in individuals with transfemoral (TFA) and transtibial amputation (TTA) compared with physically able individuals. METHODS: This systematic review with meta-analysis was conducted according to the MOOSE guidelines. Cross-sectional studies or clinical trials that assessed spatiotemporal gait parameters in adults with unilateral TFA or TTA were included. Searches were performed in Medline (via PubMed), CINAHL, Scopus, LILACS, Cochrane Library, and Embase using descriptors related to amputation and gait. Risk of bias was assessed using the Joanna Briggs Institute scale for cross-sectional studies, whereas the meta-analysis was performed using quantitative data for the following outcomes: walking speed, step length, stride length, step width, cadence, stance time, swing time, step time, or stride time. RESULTS: A total of 12 cross-sectional studies involving 150 individuals with amputation (86 TTA and 64 TFA) and 138 healthy controls were included. Meta-analysis demonstrated a significant reduction in walking speed (mean difference of -0.24; 95% CI -0.32 to -0.17; p < 0.0001; I2 = 61%) and cadence (mean difference of -6.01; 95% CI -9.69 to -2.34; p = 0.001; I2: 54%) in patients with amputation compared with healthy individuals. A reduction in stride length (mean difference of -11.71; 95% CI -23.37 to -0.04; p = 0.05; I2: 85%) and an increase in step width (mean difference of 5.22; 95% CI 2.99 to 7.45; p < 0.0001; I2: 71%) were also observed. Step time showed no significant difference between groups (mean difference of 0.06; 95% CI -0.01 to 0.14; p = 0.11; I2: 93%). Patients with TFA amputation exhibited greater impairment in gait variables, particularly cadence, when compared with a healthy individual. CONCLUSIONS: Patients with lower limb amputation present with functionally compromised gait, characterized by reduced walking speed. Increased step width and reduced stride length are findings that may suggest compensatory strategies during gait and improved balance, which are important requirements for amputee patients. These findings reinforce the need for rehabilitation interventions focused on improving propulsion and postural safety. TRIAL REGISTRATION: PROSPERO: CRD42024620098.
Pakistan journal of pharmaceutical sciencesZhifeng Zhu, Fang Tao, Wei Li, Yutian Chang, Jing Ma
BACKGROUND: The Traditional Chinese Medicine (TCM) Inheritance Computing Platform (V3.0) provides advanced data-mining capabilities for analyzing large-scale clinical data, enabling systematic extraction of prescription patterns and therapeutic principles. OBJECTIVES: This systematic review applied the TCM Inheritance Computing Platform to summarize clinical practice patterns in rUTIs, focusing on the clinical experience of Professor Qu Wei and evidence from clinical trials conducted between 2022 and 2025. METHODS: Clinical trials were systematically retrieved from international registries (ClinicalTrials.gov, WHO ICTRP, ChiCTR, PubMed). Variables, including demographics, syndrome classification, interventions and outcomes, were standardized and encoded for analysis. Frequency analysis, association rule mining and hierarchical clustering were conducted to identify high-frequency symptoms, core prescriptions, herb compatibility patterns and therapeutic clusters. RESULTS: Thirty-eight clinical trials (3,462 patients) were analyzed, predominantly female (72.4%), aged 28-57 years, with 3-6 recurrent episodes annually. Damp-heat in the lower jiao (62.1%) was the most frequent TCM syndrome, followed by spleen-kidney qi deficiency (38.6%) and yin deficiency with heat (21.3%). Key herbs included Huang Bai (71%), Fu Ling (69%), Che Qian Zi (65%) and Bai Zhu (58%). Association rule mining highlighted core herb pairs such as Huang Bai-Fu Ling (support 61%, confidence 0.82). Cluster analysis revealed three therapeutic groups: (A) damp-heat clearing formulas, (B) damp-heat with qi stagnation and (C) kidney-tonifying prescriptions. Interventions reduced recurrence by 30-45%, improved symptoms, quality of life and showed immunomodulatory and microbiota-regulating effects. CONCLUSION: The TCM Inheritance Computing Platform effectively summarized rUTI practice patterns, validating damp-heat clearing and kidney-tonifying as core strategies. Herb pair associations strengthen evidence-based integration of TCM, offering a replicable, data-driven model for recurrent infection management.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide, are widely used for Type 2 diabetes mellitus (T2DM), obesity and related metabolic conditions. Evidence on potential neuropsychiatric effects remains inconsistent. This systematic review and meta-analysis evaluated depression risk among patients receiving semaglutide. Following PRISMA 2020 guidelines, major biomedical databases, trial registries, pharmacovigilance databases, conference abstracts and grey literature were searched from inception to January 2026. Eligible studies included randomised controlled trials, observational studies, large database analyses and pharmacovigilance disproportionality studies involving patients receiving semaglutide. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale. The pooled risk ratio for depression was 1.25 (95% CI: 0.95-1.65; I2 = 98%). For anxiety and suicidal ideation/attempt, pooled risk ratios were 1.22 (95% CI: 0.93-1.60; I2 = 99%) and 1.20 (95% CI: 0.90-1.62; I2 = 92%), respectively. No statistically significant differences were observed between semaglutide and comparator/placebo groups for outcomes. Pooled estimates did not show a statistically significant increase in depression, anxiety or suicidal ideation/attempt among patients receiving semaglutide compared with comparator groups. However, the certainty of evidence was limited by substantial heterogeneity, risk of bias and reliance on heterogeneous data sources, including spontaneous-reporting studies. These findings are reassuring but should be interpreted as the absence of a detected increased risk in the available evidence, rather than definitive proof of no psychiatric risk.
The Lancet. Public healthPhilip Broadbent, Alistair Carr, Erik Igelström, Micaela Calderon, Kirsten Hainey, Mhairi Campbell, Valerie Wells, Anna Pearce, Daniel Kopasker, Srinivasa Vitt…
BACKGROUND: Childhood socioeconomic circumstances are important determinants of adult health, yet no recent meta-analysis has quantified these associations or formally assessed evidence certainty. We aimed to synthesise evidence on associations between childhood socioeconomic circumstances and adult all-cause and cause-specific mortality. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, SocIndex, ASSIA, and ProQuest Public Health from inception to May 26, 2026, without language restrictions, supplemented by backward citation searching. We included cohort studies examining associations between childhood socioeconomic conditions (parental education and occupation, economic circumstances, housing and material conditions, and composite indicators) and adult mortality (age ≥18 years), reporting quantitative estimates with extractable data. No randomised controlled trials were identified; all included studies were observational longitudinal studies. Two reviewers independently screened records and extracted data. Risk of bias was assessed using ROBINS-E and evidence certainty using GRADE. We pooled hazard ratios (HRs) using random-effects meta-analysis with restricted maximum likelihood estimation and calculated the relative index of inequality (RII) to enable standardised comparisons across exposure definitions. This study is registered with PROSPERO (CRD42024594671). FINDINGS: Of 17 163 records screened, 102 studies (approximately 8·5 million participants across 24 countries) were included. Disadvantaged socioeconomic circumstances were associated with higher adult mortality across all exposure types, with harmful associations in 390 of 474 estimates (82%; 95% CI 79-86; p<0·0001). For father's occupation, the pooled HR for all-cause mortality was 1·26 (95% CI 1·18-1·35; I2=90·1%; 18 studies), corresponding to 181 (95% CI 125-243) excess deaths per 100 000 population per year. Cause-specific analyses indicated elevated risks for cardiovascular (HR 1·26, 95% CI 1·13-1·42), respiratory (HR 1·70-1·85 across sex specific analyses), and lung cancer mortality (HR 1·52 in both sexes). The RII was highest for economic circumstances (RII 2·33, 95% CI 1·51-3·60) and parental education (RII 2·28, 1·60-3·26). Findings were consistent across exposure types, world regions, and risk of bias strata. 50 (49%) included studies were at high or very high risk of bias, primarily due to inadequate confounding control; sensitivity analyses restricted to lower risk of bias studies yielded consistent results. GRADE certainty ranged from very low to moderate. INTERPRETATION: Disadvantaged childhood socioeconomic circumstances are associated with increased adult mortality across diverse measures of disadvantage and causes of death, supporting prioritisation of early-life interventions to reduce long-term mortality inequalities. FUNDING: None.
Journal of managed care & specialty pharmacyBijal D Shah, Chibuzo Iloabuchi, Sean Harrigan, Markqayne Ray, Aida Santaolalla Revenga, David Cobley, Francis Nissen, Steve Kanters, Olalekan O Oluwole
BACKGROUND: Brexucabtagene autoleucel (brexu-cel), a CD19 chimeric antigen receptor T-cell therapy, has shown efficacy in clinical trials for relapsed/refractory (R/R) mantle cell lymphoma (MCL) and B-cell acute lymphoblastic leukemia (B-ALL). However, although effectiveness and safety evidence is well established, real-world evidence (RWE) on health care resource use (HCRU), costs, and health-related quality of life (HRQoL) remains limited. OBJECTIVE: To systematically review and synthesize RWE on clinical, HCRU, and cost outcomes, and both RWE and trial evidence on HRQoL, for brexu-cel in adults with R/R MCL and B-ALL. METHODS: Systematic searches were conducted to identify studies reporting outcomes for adults with R/R MCL and B-ALL treated with brexu-cel. RWE was included for clinical, HCRU, and costs outcomes, and HRQoL outcomes. Effectiveness and safety were analyzed using meta-analysis, while HCRU, cost, and HRQoL were summarized descriptively. RESULTS: 69 publications representing 31 cohorts were identified (19 MCL, 7 B-ALL, 3 mixed). Pooled overall response and complete response rates in MCL were 88% and 76%, while B-ALL showed complete response and measurable residual disease negativity of 74% and 73%, consistent with pivotal trials ZUMA-2 and ZUMA-3, respectively. Median overall survival was 40.3 months in MCL and 23.3 months in B-ALL. Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome were the most common adverse events; severe events were less frequent in real-world cohorts compared with trials, potentially reflecting advances in safety management and earlier identification of toxicities. HCRU and cost evidence was limited; 1 MCL study reported reduced post-chimeric antigen receptor T costs. No real-world HRQoL data were identified. CONCLUSIONS: Brexu-cel provides substantial and durable benefit in R/R MCL and B-ALL, with real-world effectiveness and safety consistent with pivotal trials. However, evidence gaps remain for HRQoL and economic outcomes, underscoring priorities for future research.
Clinical and experimental dental researchChristianna Iris Papadopoulou, Nusha Paschaei, Giulia Brunello, Rebecca Jungbauer, Kathrin Becker
OBJECTIVE: The aim of this systematic review was to evaluate the skeletal and dental effects of skeletally-anchored (SA) maxillary protraction compared with conventional facemask (FM) therapy in growing patients with Class III malocclusion, while controlling for the confounding effect of rapid maxillary expansion (RME). MATERIALS AND METHODS: A systematic literature search (MEDLINE, Cochrane Library, Virtual Health Library, Web of Science, Google Scholar), which involved two screening stages, was performed until January 2026 and identified prospective clinical trials comparing SA with conventional tooth-borne FM therapy. Only studies in which expansion protocols were applied uniformly across groups were included. Risk of bias was assessed with RoB 2 and ROBINS-I tools, and random effects meta-analyses were conducted for cephalometric outcomes. The certainty of the evidence was evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) approach. RESULTS: Five prospective trials (3 RCTs, 2 CCTs; n = 194 participants) met the inclusion criteria. Random-effects meta-analyses showed a modest but significant greater increase in SNA for SA (MD 0.65°; 95% CI 0.18-1.13, I2 = 0.0%) and consistently fewer dental side effects with SA: upper-molar mesialization (-1.14 mm; -2.12 to -0.17, I2 = 10.3%), molar extrusion (-0.74 mm; -1.07 to -0.40, I2 = 0.0%), and maxillary incisor proclination (-2.47°; -4.14 to -0.80, I2 = 0.0%). The mandibular plane rotation did not differ significantly (-0.38°; -1.67 to 0.91, I2 = 45.6%). Risk of bias was assessed as "some concerns" in RCTs and "serious" in non-randomized studies. The certainty of evidence ranged from very low to moderate according to GRADE. CONCLUSIONS: Within the limitations of the available short-term evidence, and given the low-to-moderate certainty of the pooled estimates, SA was associated with fewer dental side effects and a statistically significant, though not clinically relevant, gain in skeletal efficacy. Future long-term, age-stratified randomized trials are needed to confirm the long-term stability of these findings.
The international journal of medical robotics + computer assisted surgery : MRCASAbdulazeez Omairi, Ryan Kenny, Oday Al-Dadah
INTRODUCTION: Robotic-assisted total knee arthroplasty (RTKA) is an emerging alternative to conventional total knee arthroplasty (CTKA) with uncertain effectiveness. This systematic and meta-analysis aims to compare clinical and radiological outcomes between RTKA and CTKA. METHODS: 52 studies were included (randomised controlled trials and observational cohorts). Outcomes compared were alignment (Hip-Knee-Ankle angle, femoral/tibial component angles), Patient Reported Outcome Measures (PROMs), operative time, length of stay (LOS), blood loss, and complications. Data were pooled using random-effect models, with heterogeneity assessed via I2 statistics using R. RESULTS: RTKA demonstrated superior accuracy in component alignment, and most PROMs showed minimal differences. Operative time was longer for RTKA, but hospital LOS was shorter. RTKA had lower blood loss. Inflammatory markers and revision rates showed few inconsistent findings. CONCLUSION: RTKA improves mechanical alignment and reduces outliers, with modest short-term advantages in PROMs and recovery metrics. Long-term clinical benefits necessitate further high-quality studies with standardised outcome measures. TRIAL REGISTRATION: This Systematic Review and Meta-Analysis was registered on PROSPERO (ID number: CRD42023410154).
Early intervention in psychiatryPasquale Scognamiglio, Anna Longobardi, Raffaele Rea, Alessandro Colella, Valeria Iniziato, Pasquale Saviano, Silvestro La Pia, Vassilis Martiadis
AIM: Early intervention in psychosis (EIP) is increasingly framed as a youth-oriented model of care, but its translation into reproducible service structures remains uneven across healthcare systems. Although clinical practice guidelines and quality standards address clinical high risk for psychosis (CHR-P) and first-episode psychosis (FEP), their organisational recommendations have received limited focused synthesis. This study examined the service-architecture recommendations embedded in international early psychosis guidance. METHODS: We conducted a secondary framework synthesis of a completed systematic review of 26 international guidance documents, comprising 24 clinical practice guidelines and two quality standards. Recommendations concerning service configuration and organisation were retained and mapped onto four service-design domains: access and entry, team model and service setting, coordination and continuity of care and youth-friendly delivery context. Endorsement frequencies and harmonised grading patterns were summarised descriptively at document level. RESULTS: Organisational recommendations were identified in 17 CHR-P-relevant and 22 FEP-relevant documents. The strongest convergence concerned specialised service structures, including multidisciplinary CHR-P services or dedicated pathways in 16/17 documents and specialised outpatient EIP teams in 20/22 FEP documents. Coordination and continuity components were also recurrent, particularly inter-service integration and assertive community treatment or intensive case management for FEP. Access arrangements, transition policies and youth-friendly delivery contexts were frequently mentioned, but were less consistently operationalised or supported by directive grading. CONCLUSIONS: International early psychosis guidance converges on a recognisable organisational architecture, but service-design domains are specified with unequal consistency. By reorganising recommendations already embedded in existing guidance, the framework may support service planning, benchmarking, pathway redesign and policy development, while identifying areas requiring more operational guidance.
Neurology. Clinical practiceShervin Badihian, Margarita Fedorova, Bradley Ashley Ong, Nicolas R Thompson, Neil Nero, Ken Uchino, Shumei Man
PURPOSE OF REVIEW: Digital health interventions are increasingly used in medicine to manage chronic conditions. However, the effectiveness, feasibility, and consistency of these interventions in poststroke risk factor management and secondary prevention remain uncertain. We conducted a systematic review and meta-analysis to evaluate the effect of digital health-supported interventions on vascular risk factor control among stroke survivors. We systematically searched MEDLINE, Embase, and Cochrane CENTRAL from inception through September 2025 for randomized, single-arm, and observational studies evaluating digital health interventions, defined as mobile health applications, wearable devices, or combined platforms, among adults with ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Outcomes of interest included systolic and diastolic blood pressure, lipid levels, weight, physical activity, medication adherence, quality of life, and clinical events. Random-effects meta-analyses were performed for outcomes reported by ≥ 3 studies. Feasibility outcomes, including recruitment, retention, adherence, and usability were synthesized qualitatively. RECENT FINDINGS: Twenty-nine studies encompassing 8,389 participants were included. Digital health interventions were associated with modest reductions in systolic blood pressure compared with control conditions, including usual care and minimal-intervention comparators (pooled between-group mean difference, -5.8 mm Hg; 95% CI -9.9 to -1.6). However, prediction intervals crossed the null value, and between-study heterogeneity was substantial. No consistent effects were observed for diastolic blood pressure, lipid levels, or weight. Reporting of physical activity, medication adherence, and quality-of-life outcomes was heterogeneous, precluding quantitative pooling, although most studies reported favorable trends. Overall feasibility was high, with an aggregate dropout rate of 3.6% (95% CI 3.2%-4.0%) and high user acceptability across studies. Most trials enrolled participants with mild functional impairment and short follow-up durations (median ≈3 months). Few studies were powered to assess recurrent stroke or mortality. SUMMARY: Digital health-supported interventions for secondary stroke prevention seem feasible and acceptable, with evidence of modest short-term improvements in blood pressure. However, clinical effectiveness across other vascular risk factors remains inconsistent. In addition, substantial heterogeneity, short follow-up, and limited high-quality evidence constrain causal inference and preclude conclusions regarding sustained clinical benefit.
Human brain mappingHannah S Savage, Linda Schlüter, Roberta Russo, Imogen Leaning, Christian F Beckmann, Andre F Marquand
We performed a systematic review of over 20 years of literature that implemented a variant of the emotional face matching task (EFMT). We aimed to quantify the heterogeneity in tasks used across studies, and to summarise the regions reported as activated when participants match the target face stimuli, as compared to matching the control stimuli, within and between patients with a mental health diagnosis and unaffected controls. Our results highlight the vast heterogeneity in all aspects of task design and implementation across studies. Our high-level synthesis of brain regions activated broadly confirms the involvement of the amygdala during emotional face matching, but shows that an increase in amygdala activation is inconsistent both within and across mental health conditions. We further highlight increased activation within the cingulate cortex as a transdiagnostic alteration (vs. controls) during emotional face matching. We introduce solutions to address the challenge of heterogeneity, including a standard version of the EFMT and applicable statistical methods, and provide recommendations for the field to progress our understanding of emotional face processing.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationAmanda Biete, Camila Biete, Vivian S S Gonçalves, Erika S O Patriota, Nathalia Pizato
INTRODUCTION: The coexistence of undernutrition and overweight, obesity, or diet-related noncommunicable diseases and micronutrient deficiency in pregnant women is defined by the WHO as a double burden of malnutrition (DBM). These coexistences are a critical aspect of maternal and antenatal care, especially in low- and middle-income countries. OBJECTIVE: To estimate the global prevalence of DBM in pregnant women through a systematic review and meta-analysis. METHODS: The systematic review was conducted in accordance with the PRISMA recommendations. Studies that reported prevalence measures of DBM in healthy pregnant women were included. DBM was considered as the coexistence of underweight with gestational diabetes mellitus (GDM), underweight with hypertension, overweight/obesity with anemia, overweight/obesity with vitamin D deficiency, overweight/obesity with vitamin B12 deficiency, and overweight/obesity with folate deficiency. The meta-analysis used a random-effects model with inverse-variance weighting. Risk of bias was assessed using Joanna Briggs Institute tools, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS: The systematic review included 62 articles totaling 1,386,245 pregnant women, at 8-42 gestational weeks and 13-45 years of age. The most common DBMs identified were overweight/obesity and vitamin D deficiency (21%; 95% CI: 14%-27%, n = 10 studies) and overweight/obesity and anemia (9%; 95% CI: 7%-10%, n = 18 studies). A meta-analysis of overweight/obesity and micronutrient deficiency was not conducted due to the small number of eligible studies. Most studies (66.3%) had high methodological quality; however, GRADE rated the overall certainty of evidence as low. CONCLUSION: A high prevalence of overweight/obesity with vitamin D deficiency and anemia were observed. These results emphasize the need for stronger public policies to ensure equitable access to healthy diets, evidence-based supplementation, and continuous nutritional monitoring during pregnancy.
Japan journal of nursing science : JJNSKayo Ueda, Yukiko Honda, Yuko Masuzawa, Mai Takeshita, Rie Toyomoto, Kumiko Adachi, Hiromi Eto, Yuriko Usui, Rieko Fukuzawa, Tomoko Nishino
AIM: To evaluate the benefits and harms of bathing during the first stage of labor among healthy women with uncomplicated singleton cephalic pregnancies at ≥ 36 weeks' gestation. METHODS: Randomized controlled trials comparing warm-water bathing during the first stage of labor with no bathing were included. MEDLINE (PubMed), Cochrane Database of Systematic Reviews, CENTRAL, and Ichu-shi Web (updated to December 2024) were searched for English- and Japanese-language studies. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 1.0 tool, and evidence certainty was appraised with GRADE. Random-effects meta-analyses reported risk ratios (RRs) or mean differences with 95% prediction intervals (PIs), and I2 statistics. RESULTS: Nine studies from eight countries (1994-2018; n = 1823) met inclusion criteria. Bathing did not significantly affect regional analgesia use (RR 0.91, 95% PI 0.82-1.01; I2 = 0%), perineal trauma, spontaneous vaginal birth, intact perineum, caesarean section, abnormal fetal heart rate patterns, neonatal infection, or episiotomy. Instrumental vaginal birth was reduced (RR 0.78, 95% PI 0.61-0.98; I2 = 0%). Satisfaction tended to be higher in the bathing group, though evidence was limited to two small heterogeneous trials. CONCLUSIONS: Evidence certainty was low to very low because of risk of bias, imprecision, lack of blinding, and limited woman-reported outcomes. Bathing appears safe for mothers and infants and may reduce instrumental delivery, but a clear analgesic-sparing effect was not shown. Implementation should ensure tub hygiene, water temperature regulation, and regular maternal and fetal monitoring. TRIAL REGISTRATION: Register name: Effect of Bathing for Pain Relief During the First Stage of Labor: A protocol for a systematic review and meta-analysis. Registration DOI: https://doi.org/10.17605/OSF.IO/J9GTS.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyNafisa Sarfaraz, Kalpana Zutshi, Ifra Aman, Heba Parwaiz
BACKGROUND: Hamstring flexibility can potentially affect the mobility and function of remote musculoskeletal areas, including the cervical spine and temporomandibular joint (TMJ), thereby increasing tension along the myofascial chain and potentially reducing mouth opening, contributing to orofacial discomfort. This review aims to inform clinical practice by exploring the integrated impact of these interventions within the framework of neuro-myofascial connectivity. METHODS: A comprehensive search was performed across PubMed, Scopus, Web of Science, and PEDro databases spanning the period from the year 2006-2025, restricted to studies published in the English language. Keywords and MeSH terms corresponding to hamstring stretching, mouth opening and Temporomandibular Joint (TMJ) mobility were used incorporating Boolean operators. Randomized control trials and experimental studies investigating acute or short term effects of hamstring stretching on Temporomandibular Joint (TMJ) pain and mouth opening were included. RESULTS: The preliminary results indicate that hamstring stretching can result in temporary improvements in pressure pain threshold and mouth opening; however, the results should be interpreted with caution and the number of the RCTs is small and heterogeneous. CONCLUSION: The findings support the possibility of myofascial and neural interconnections between the posterior chain and masticatory system; however, the current evidence is insufficient to establish definitive mechanistic conclusions. TRIAL REGISTRATION: PROSPERO number: CRD420251173297.
Journal of the International Society of Sports NutritionRichen Sun, Mingxin Su, Xiaolong Xu, Nan Wang, Zhiyanguan Li, Xiaoning Sun, Weilong Lin, Hengtong Wang
OBJECTIVE: To evaluate the relative effects of dietary supplements, the certainty of evidence, and the robustness of findings within separate networks for peak power (PP), relative peak power (RPP), vertical jump (VJ), and countermovement jump (CMJ). METHODS: PubMed, Web of Science, Embase, and the Cochrane Library were systematically searched, with the final search conducted on September 8, 2026. Eligible studies were randomised parallel-group and crossover controlled trials published in English through August 31, 2026, involving healthy individuals with physical activity or training backgrounds. Four separate Bayesian random-effects networks were constructed. Effects were assessed using mean differences (MDs) in change scores, 95% credible intervals (CrIs), and prediction intervals. Risk of bias and certainty of evidence were assessed using RoB 2 and CINeMA, respectively. Subgroup analyses, network meta-regression, and sensitivity analyses were also conducted. This review was retrospectively registered in PROSPERO (CRD420261283835). RESULTS: A total of 119 studies were included. The PP, RPP, VJ, and CMJ networks comprised 47, 33, 31, and 44 studies, respectively, with some studies contributing to more than one outcome. Compared with placebo, β-hydroxy-β-methylbutyrate (HMB) yielded MDs of 64.70 W (95% CrI: 19.15 to 110.50) for PP and 0.84 W·kg-1 (95% CrI: 0.42 to 1.28) for RPP. Favourable effects were also observed for β-alanine on PP and for creatine and vitamin D on RPP. Iron supplementation yielded an MD of 6.81 cm (95% CrI: 0.84 to 12.83) for VJ, supported by only one direct study. For CMJ, betaine yielded an MD of 3.72 cm (95% CrI: 1.24 to 6.18); the 95% CrIs for palmitoylethanolamide, caffeine combined with Rhodiola rosea, creatine, multi-ingredient supplements, and caffeine also excluded zero. The HMB findings for RPP remained relatively stable across multiple sensitivity analyses, whereas some other favourable comparisons had prediction intervals that included zero or showed attenuated findings in sensitivity analyses. Exploratory associations with training level and sport were observed for RPP, although interpretation was limited by sparse evidence and imbalanced covariate distributions. Of 1,636 pairwise comparisons, 17 were rated as moderate, 55 as low, and 1,564 as very low certainty. The HMB-versus-placebo comparisons for both PP and RPP were rated as moderate certainty. CONCLUSIONS: Some supplements showed favourable effects within their respective networks, with the HMB findings for RPP remaining relatively stable. However, direct evidence was limited, and the certainty of evidence was very low for most comparisons. Findings should be interpreted in the context of the populations and supplementation regimens studied. Differences between networks cannot establish that outcome type modifies supplementation effects, and rankings alone should not be used to guide individualised supplementation regimens.
Pediatric obesityAnna Wittmann, Pia Späth, Feline Zocher, Eckard Nagel, Michael Lauerer, Magdalena Schellenberg
BACKGROUND: Weight management and maintenance of healthy habits are crucial in combating paediatric obesity. This systematic review examines outcomes beyond BMI in teleintervention maintenance programmes, with a focus on sustaining a healthy lifestyle. METHODS: A PubMed, LIVIVO and Web of Science search was conducted for publications between 2012 and 4 November 2025 to identify primary studies evaluating teleintervention maintenance programmes of at least 12 weeks' duration, delivered to children and adolescents with overweight or obesity following structured obesity treatment. We extracted healthy lifestyle parameters (e.g., quality of life), behaviour change (e.g., diet) and clinician-reported outcomes (e.g., BMI). Quality assessment was tailored to study type. As data did not permit meta-analysis, we performed a narrative synthesis. RESULTS: Screening 2543 articles yielded 6 RCTs and 2 pre-post studies. Findings highlight improvements in psychosocial outcomes (e.g., social well-being), lifestyle modifications in daily choices (e.g., dietary patterns) and behaviours (e.g., screen time), and statistically significant outcomes including reductions in body fat percentage, metabolic profile improvements, cardiovascular enhancements and BMI stabilisation. Feasibility insights were also gained. CONCLUSION: Teleintervention maintenance programmes following structured paediatric obesity treatment were associated with stabilisation of previously achieved weight-related and behavioural gains, rather than greater weight loss than comparator care, alongside consistently high feasibility and substantial reductions in healthcare visits and cost. Given the heterogeneity of designs and outcomes, findings should be interpreted as directional rather than pooled effect estimates, and a human component may be necessary to sustain them.
Nursing inquiryAleix Fontanals-Jimenez, Marta Trapero-Bertran, Esther Insa-Calderón
Healthcare systems worldwide face mounting pressure to deliver high-quality care while enhancing efficiency and sustainability. Nurse-led interventions have emerged as promising strategies to optimize care delivery, particularly within value-based health systems. However, a comprehensive understanding of their clinical impact and economic value remains limited. This systematic review conducted following PRISMA guidelines, searched nine international databases to identify and synthesize formally evaluated nurse-led interventions, programs, and strategies. Twenty-eight studies were included, encompassing diverse care settings and patient populations. Most studies reported improvements in clinical outcomes, including reduced hospital readmissions, enhanced quality of life, and improved chronic disease management. Several interventions analyzed effectiveness, particularly those involving advanced nursing roles such as nurse practitioners and case managers. Findings suggest that clinical effectiveness does not necessarily translate into increased professional authority: nurse-led interventions consistently generate value across patient, organizational, and systemic dimensions, yet nursing leadership remains structurally subordinate within healthcare governance. A systematic agenda for rigorous economic evaluation embedded in nursing research programs is urgently needed, alongside structural reforms that redistribute authority-not merely develop competencies-within healthcare organizations.
Journal of marital and family therapyJeffrey B Jackson, Luca Codecá, Richard B Miller, Jessica E Simpson, Abigail M O'Leary, Samantha M Renner
This systematic review replicated and updated Baucom and colleagues' (1998) evaluation of empirically supported treatments (ESTs) for couple relationship distress using the Chambless criteria, the primary framework used by the American Psychological Association to classify ESTs. Applying these criteria to 40 eligible studies, we found that, in contrast to Baucom and colleagues, no couple therapy models met the standards for strong empirical support; insufficient sample size and lack of independent replication were the most frequent limitations. Seven models demonstrated modest support: behavioral, cognitive-behavioral, emotionally focused, Gottman, integrative behavioral, insight-oriented, and strategic couple therapies. Findings highlight the need for rigorous large-scale studies with more diverse couples to strengthen the empirical foundation and generalizability of couple therapies. Limitations of the Chambless criteria underscore the importance of evaluating couple therapy models with the recently adopted Tolin criteria, which synthesize a broader base of evidence via meta‑analysis and emphasize clinical significance to improve treatment recommendations.