Fever or inflammation of unknown origin (FUO/IUO), bacteremia, and sepsis represent challenging diagnostic scenarios in clinical practice. Over the past decade, multiple systematic reviews and meta-analyses have reported quantitative data regarding the diagnostic accuracy, clinical impact, and cost-effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography ([18F]FDG PET/CT) in these complex infectious and inflammatory conditions. We performed an umbrella review of published systematic reviews and meta-analyses to provide a comprehensive evidence-based summary of the diagnostic performance, clinical utility, and cost-effectiveness of [18F]FDG PET/CT across different patient populations and clinical scenarios. A comprehensive literature search of PubMed/MEDLINE and Cochrane Library databases was conducted to identify published evidence-based articles evaluating [18F]FDG PET/CT in adult FUO/IUO, pediatric FUO, bacteremia, sepsis, febrile neutropenia, and chronic Q fever. Quality assessment of included reviews was performed using the critical appraisal framework of the Oxford Centre for Evidence-Based Medicine (OCEBM). A total of 14 published systematic reviews met the inclusion criteria. [18F]FDG PET/CT demonstrated high diagnostic sensitivity (81-94%) in adult FUO/IUO with diagnostic yield ranging from 56-75%. In pediatric FUO, sensitivity was 83% with specificity of 77.6% and area under the curve of 0.83. In bacteremia and sepsis, particularly in critically ill patients, [18F]FDG PET/CT achieved sensitivity of 94%. The imaging modality showed diagnostic utility in specialized populations including chronic Q fever (focus detection rate 79.5%), febrile neutropenia (83% added clinical value), and ICU patients (mean sensitivity 94.6%). Management modifications were observed in 20-48% of patients based on [18F]FDG PET/CT findings. Cost-effectiveness analysis supports selective use in high-risk patient populations, with numbers-needed-to-scan ranging from 3-6 in complex bacteremia. Evidence from systematic reviews demonstrates that [18F]FDG PET/CT is a valuable diagnostic tool in FUO/IUO, bacteremia, sepsis, and related infectious/inflammatory conditions, with clinically significant impact on patient management. Strategic patient selection based on clinical risk factors optimizes cost-effectiveness. Future standardization of imaging protocols and prospective comparative studies are needed to define optimal clinical indications across different populations.

Chinese expert consensus on the prehospital management of major trauma.

Large Language Models (LLMs) show significant potential in healthcare, but their application in Traditional Chinese Medicine (TCM) lacks systematic evaluation. This study aims to comprehensively review LLMs tuning techniques, data construction strategies, evaluation methods, and application scenarios in TCM clinical practice. A scoping review following PRISMA-ScR guidelines was conducted. Researchers systematically searched seven databases for relevant studies published between database inception to May 2025. The analysis focused on identifying model characteristics, tuning techniques, data sources, evaluation methods, application domains and performance limitations to assess the current state and future directions of TCM-oriented LLMs. We included 27 studies (21 in English, 6 in Chinese). Application domains comprised TCM knowledge consultation (10 studies) and diagnostic assistance (13 studies), with 4 studies establishing TCM LLMs evaluation benchmarks. LoRA fine-tuning was most widely used (65.2%), often combined with prompt engineering (47.8%), continued pre-training (43.5%), and retrieval-augmented generation (39.1%). Most studies (87.0%) employed multiple technique combinations. Training data balanced theoretical knowledge (classics) with clinical experience (case records), though multimodal data remained severely insufficient. Evaluation methods were multidimensional, with accuracy (63.0%) and human assessment (77.8%) most frequently used. Specialized TCM evaluation benchmarks were gradually established. Current models excel at integrating heterogeneous knowledge, basic syndrome differentiation reasoning, and cross-language knowledge conversion, but show limitations in simulating complex TCM reasoning processes and individualized diagnosis. Although TCM-oriented LLMs demonstrate effectiveness in knowledge consultation and diagnostic tasks, they face significant challenges in capturing TCM's holistic paradigm, data quality, and clinical evaluation. Future research should develop TCM-compatible model architectures, build standardized multimodal data ecosystems, strengthen clinical translation, and create evaluation frameworks that reflect TCM's diagnostic process.

Calcium pyrophosphate deposition (CPPD) disease is a common, age-related crystalline arthropathy with diverse clinical presentations. While the knees and wrists are most frequently affected, shoulder involvement is increasingly recognized, occurring in up to 13% of cases, though often underdiagnosed. This mini-review provides a comprehensive overview of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of shoulder CPPD, contextualized by an illustrative case of a 78-year-old woman with atypical calcifications in the axillary recess and supraspinatus muscle. A key focus is the diagnostic challenge when synovial fluid analysis, the gold standard for crystal confirmation, is technically unfeasible, a common scenario in clinical practice. We systematically discuss modern imaging techniques (ultrasound, dual-energy computed tomography [CT], conventional radiography) and demonstrate the practical application of the 2023 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for establishing probable CPPD when crystal analysis is unavailable. The review addresses critical differential diagnosis considerations, particularly distinguishing CPPD from basic calcium phosphate (BCP) deposition disease, and summarizes evidence-based therapeutic strategies for acute pseudogout flares and chronic inflammatory arthritis, including emerging biologic therapies targeting the interleukin-1 (IL-1) pathway. This comprehensive resource aids clinicians managing shoulder calcifications in the absence of definitive crystal confirmation.

Multifunctional Thermal-responsive Bioglue Targeted at Suppurative Infection in Oral Cavity

Abstract Introduction Sarcopenia is associated with poorer prognosis in heart failure patients. However, measuring muscle mass in clinical practice remains challenging. Given the significant role of muscle mass in energy expenditure among healthy individuals, we hypothesized that resting energy expenditure (REE) could serve as a surrogate for muscle mass quantification in patients with heart failure and reduced ejection fraction (HFrEF), a hypothesis not previously tested. Objective To evaluate the relationship between REE and muscle mass quantification in HFrEF patients. Methods In this prospective cohort study, we recruited consecutive patients with HFrEF. Participants underwent dual-energy X-ray absorptiometry (DEXA) and a 30-minute resting metabolism test (RMT) at the same day. Muscle mass was quantified using DEXA, by subtracting bone mineral composition from the obtained whole-body lean mass and adjusted for body surface area. REE was estimated via indirect calorimetry based on the most stable 10-minute period over a 30-minute assessment. Statistical analysis was conducted using Pearson correlation and linear regression to assess the strength and direction of the relationship between these variables and determine the extent to which REE could predict muscle mass quantification. Results We recruited 24 patients (79% male, mean age 66; mean LVEF 38±7%). This cohort included patients with ischemic heart disease (n=14), dilated cardiomyopathy (n=5), valvular heart disease (n=4) and burnout hypertrophic cardiomyopathy (n=1). The mean muscle mass adjusted for body surface area was 23.4±2.5 kg/m2, and the mean REE was 1.56±0.35 kcal/min. Notably, there was a considerable disparity in the relationship between muscle mass and REE, with muscle mass ranging from 18.9 to 28.9 kg/m² and REE ranging from 1.07 to 2.23 kcal/min. A significant correlation was observed between REE and muscle mass (Pearson coefficient 0.752, p<0.001). Linear regression demonstrated a strong relationship between these two variables (Muscle mass = 14.67 + 5.7*REE; R² = 0.57) – Figure 1. Conclusion Resting energy expenditure showed a significant correlation with muscle mass quantification in patients with HFrEF, suggesting it could serve as a viable surrogate. Given the promising results of this pilot study, further validation of these findings in real-world settings is warranted. The next phase of this study will involve integrating a simplified resting metabolism protocol during the resting phase of cardiopulmonary exercise testing (CPET) to assess its applicability in a routine clinical practice scenario.

IntroductionSince 2018, WHO has endorsed the use of whole-genome sequencing (WGS) of Mycobacterium tuberculosis complex isolates to detect drug-resistant tuberculosis (DR-TB). This endorsement was based on the assumption that a faster and more detailed description of the resistance profile would improve treatment prescription for DR-TB by healthcare providers, and hence the treatment outcomes of patients. Nonetheless, this assumption has not been tested in routine clinical practice and different scenarios. In Brazil, WGS is not routinely used for the diagnosis of DR-TB, having been carried out in only a few centres for research purposes. With this trial, we will evaluate whether a WGS-based drug-resistance report improves treatment adequacy in patients with pulmonary DR-TB, compared with the current standard-of-care diagnostic methods used in the state of São Paulo, Brazil.Methods and analysisWe will conduct a non-randomised controlled clinical trial with two arms to compare the intervention group (ie, individuals receiving a WGS-based report) with a historical control group (i.e., individuals who received resistance diagnostics based on the standard of care of conventional genotyping and phenotyping techniques). The primary outcome will be the proportion of patients whose treatment scheme was adequate based on complete resistance profile determined by WGS and/or phenotypic drug-susceptibility testing (pDST). Other secondary outcomes will also be considered. The target sample size is 88 eligible patients per group. The intervention group will be prospectively recruited over 18 months and the control group will be composed of patients diagnosed with pulmonary DR-TB up to 2 years before the start of the trial. To ensure comparability, isolates from the control group will undergo WGS retrospectively, and pDST will be performed retrospectively in both groups. This clinical trial will take place in six medical centres for the treatment of DR-TB in the state of São Paulo. This study is intended to support the implementation of the WGS in the routine diagnosis of DR-TB in the state of São Paulo.Ethics and disseminationEthical approval was obtained from the Human Research Committee of the Institute of Biomedical Sciences, University of São Paulo, Brazil (CAAE: 79497924.1.1001.5467). Study results will be published in peer-reviewed journals and disseminated to policymakers and stakeholders.Trial registration numberU1111-1308-4669.

Objective.Anatomical changes in target volumes and surrounding organs-at-risk (OARs) commonly occur during radiation therapy (RT). Relying solely on the initial treatment plan can lead to suboptimal dose delivery and increased risk to healthy tissues. This study investigates a fluence map (FM) prediction-based method (FM_PD) for rapid plan adaptation. It enables online adaptive RT (OART) to better account for structural changes throughout treatment and assess its potential for improved normal tissue sparing.Approach.The planning target volumes (PTVs) and corresponding dose distribution were converted into 2D projection matrices during training. A 2D Dense-U-Net model incorporating a PTV-specific loss function (PTV_loss) was trained on a dataset of 93 intensity-modulated RT plans for hypopharyngeal carcinoma. Nine re-planning scenarios (time intervals: 32-47 days) were used for testing to simulate an OART setting. Predicted FMs were applied to the daily CTs to calculate updated dose distributions. These doses were compared to the original (non-adapted) plans to evaluate the dosimetric impact on OARs.Main results.FM_PD significantly reduced the dose to normal tissues while maintaining tumor coverage. The D2of the PTV decreased by 1.13 ± 5.85%, moreover, substantial dose decreases were observed in critical structures: Dmaxto the lens, optic nerves, and brainstem decreased by 18.67 ± 19.04%, 19.17 ± 19.57%, and 14.54%, respectively. The total body Dmeandecreased by 25.65 ± 15.44%. In cases where the PTV was adjacent to lung tissue, the Dmeandropped significantly by 46.40 ± 36.89%.Significance.FM_PD offers a rapid and effective approach for adapting RT plans in response to anatomical changes, significantly reducing doses to healthy tissues. Compared to maintaining the initial plan, FM_PD is a recommended strategy for cross-fraction adaptation scenarios in clinical OART practice.

Performance of Large Language Models in Analyzing Common Hypertension Scenarios in Clinical Practice

The purpose of this study was to evaluate the cost-effectiveness of photon-counting detector computed tomography (PCD-CT) compared to energy-integrating detector CT (EID-CT) for coronary artery disease (CAD) diagnostics in the Finnish healthcare context. Two decision trees, incorporating local cost data and diagnostic pathways, were developed based on previously published Coronary Artery Disease - Reporting and Data System reclassification data for PCD-CT and EID-CT. A bootstrapping Monte Carlo simulation was used to model 10,000 virtual patients across a 10-year scanner lifespan. Two diagnostic scenarios were considered: one based on the diagnostic pathway of a previously published study (scenario 1) and another reflecting local clinical practice (scenario 2). Downstream testing costs and total diagnostic costs of both PCD-CT and EID-CT branches were assessed. The break-even point for PCD-CT investment was determined by including an assumed €1,500,000 price premium over EID-CT. PCD-CT significantly reduced downstream diagnostic testing compared to EID-CT. In scenario 1, mean downstream costs per patient were €377.1±11.5 for PCD-CT and €569.7±11.7 for EID-CT, (33.8% reduction, p<0.001). In scenario 2, downstream costs were €831.7±19.7 for PCD-CT and €1138.2±18.3 for EID-CT (26.9% reduction, p<0.001). Total diagnostic costs, including CCTA, were also lower with PCD-CT. The cost-benefit threshold was reached after 7,880 and 4,950 patients for scenarios 1 and 2 respectively. PCD-CT would be a cost-effective alternative to EID-CT in high-volume centers, reducing unnecessary downstream tests through improved diagnostic accuracy. These findings support its adoption in Finnish healthcare systems.

Attitudes and awareness regarding the European consensus statement on the use of patient contact shielding.

Abstract Rationale: While guidelines exist for approaching ethically controversial scenarios involving decisions to withhold or withdraw life sustaining treatment (LST), there is limited understanding about how clinicians approach these specific scenarios in clinical practice. This study aimed to understand how clinicians approach decisions in the intensive care unit to withhold or withdraw LST for cases of 1) physiologic futility, 2) “potentially inappropriate” treatment, and 3) unrepresented patients without a surrogate decision-maker. Methods: We conducted semi-structured interviews with critical care physicians and nurses at three geographically diverse hospitals across the United States between July to October 2024. We asked clinicians about how they approach decisions to withhold or withdraw LST in three ethically controversial scenarios: 1) caring for patients where life support was deemed physiologically futile, 2) deemed “potentially inappropriate”, or 3) where patients were unrepresented without a surrogate decision-maker. Two trained research members developed a codebook using inductive and deductive approaches, double coding 25% of interviews. Discrepancies between reviewers was resolved with consensus adjudication. Results: Sixteen eligible physicians (n=8) and nurses (n=8) with median 5 years (range 2-36 years) in practice participated. Clinician approaches to all three cases varied. Clinicians shared that for a patient in whom cardiopulmonary resuscitation (CPR) is physiologically futile, they may provide full CPR, provide a limited trial of CPR, or withhold CPR. They also shared they may bring family to watch CPR and have repeated conversations with surrogates to encourage them to choose do-not-resuscitate status. Clinician approaches to “potentially inappropriate” treatment included providing “potentially inappropriate” treatment, withholding this treatment, finding a middle ground, going to court, and consulting ethics and palliative care. For unrepresented patients without a surrogate decision-maker, clinicians often engaged multiple approaches. These approaches included treating these patients as full code, seeking information about patient values and preferences, trying to find a decision-maker aided by social work and the police, and/or pursuing a court appointed guardian if no decision-maker is found. Conclusion: Clinicians varied in their approaches to providing treatments they judged to be physiologically futile or “potentially inappropriate.” Further study to needed to identify reasons why clinicians choose to pursue these varying approaches.

Fecal incontinence (FI) is a late toxicity consequence in prostate cancer patients treated with current radiotherapy schedules that remains poorly described and understood. The main objective of this work is to describe the incidence of appearance of FI in these patients, and to analyze whether this late radiotoxicity event affects the quality of life of survivors. Prospective follow-up study was performed on a cohort of 91 patients with non-metastatic prostate cancer undergoing moderately hypofractionated volumetric modulated arc therapy (VMAT at 2.5-3Gy/session) with image-guided radiotherapy (IGRT) in a real-world clinical practice scenario. The incidence of FI (using the Vaizey score) and FI-free survival time after completion of radiotherapy were presented. We additionally assessed the scores on the FI Quality of Life (FIQL) scale in both patients with and without FI. Within 2years after radiotherapy, 10 of 91 patients (11%) showed some degree of FI with an average onset at 13.59months. Patients with some degree of FI had worse FIQL scores than those without FI (p < 0.001). Patients with localized prostate cancer treated with moderately hypofractionated VMAT/IGRT had a significant incidence of fecal incontinence, which negatively affected the quality of life of survivors. The study protocol was registered on clinicaltrials.gov (NCT04262609) on 5 February 2020.

Abstract Background: Accidental ingestion of corrosive substances, such as sulfuric acid, is a rare but serious medical emergency, particularly in children. Such incidents can result in significant morbidity, including damage to the gastrointestinal tract, and require prompt and comprehensive management. This case is unique as it demonstrates the successful treatment of a 7-year-old boy who ingested sulfuric acid, providing valuable insights into effective clinical interventions. By documenting this case, we aim to expand the knowledge base for managing complex pediatric corrosive ingestion cases, offering a framework for similar scenarios in future clinical practice. Case Presentation: A 7-year-old boy accidentally ingested a mixture of sulfuric acid and water, presenting with severe vomiting and gastrointestinal bleeding. Upon arrival at the hospital, he was hemodynamically stable but exhibited signs of upper gastrointestinal distress. Initial evaluation included physical examination and imaging to assess the extent of damage. A multidisciplinary approach was adopted, starting with nasojejunal tube feeding to bypass the injured esophagus and ensure adequate nutrition. Medications, including proton pump inhibitors to reduce acid secretion and antibiotics to prevent secondary infections, were administered. The patient's vital signs were closely monitored, and a strict dietary plan was implemented, avoiding irritants and promoting gastrointestinal healing. Endoscopy was deferred to avoid further trauma to the already compromised tissue. Over several weeks, the patient showed significant improvement, with resolution of symptoms and no evidence of complications such as stricture formation or perforation. Follow-up care focused on nutritional recovery, psychological support, and education to prevent similar incidents. Conclusion: This case illustrates the critical importance of early recognition and immediate, targeted interventions in managing pediatric acid ingestion. The combination of nasojejunal feeding, vigilant monitoring, and tailored pharmacological and dietary management contributed to a positive outcome. The successful resolution of this complex case without long-term complications highlights effective strategies that can guide clinicians facing similar challenges. By sharing this case, we aim to contribute to the growing body of evidence on pediatric corrosive ingestion management, ultimately enhancing future clinical practices.

Most existing optic disc (OD) and cup (OC) segmentation models are biased to the dominant size and easy class (normal class), resulting in suboptimal performances on glaucoma-confirmed samples. Thus, these models are not optimal choices for assisting in tracking glaucoma progression and prognosis. Moreover, fully supervised models employing annotated glaucoma samples can achieve superior performances, although restricted by the high cost of collecting and annotating the glaucoma samples. Therefore, in this paper, we are dedicated to developing a glaucoma-specialized model by exploiting low-cost annotated normal fundus images, simultaneously adapting various common scenarios in clinical practice. We employ a contrastive learning and domain adaptation-based model by exploiting shared knowledge from normal samples. To capture glaucoma-related features, we utilize a Gram matrix to encode style information and the domain adaptation strategy to encode domain information, followed by narrowing the style and domain gaps between normal and glaucoma samples by contrastive and adversarial learning, respectively. To validate the efficacy of our proposed model, we conducted experiments utilizing two public datasets to mimic various common scenarios. The results demonstrate the superior performance of our proposed model across multi-scenarios, showcasing its proficiency in both the segmentation- and glaucoma-related metrics. In summary, our study illustrates a concerted effort to target confirmed glaucoma samples, mitigating the inherent bias issue in most existing models. Moreover, we propose an annotation-efficient strategy that exploits low-cost, normal-labeled fundus samples, mitigating the economic- and labor-related burdens by employing a fully supervised strategy. Simultaneously, our approach demonstrates its adaptability across various scenarios, highlighting its potential utility in both assisting in the monitoring of glaucoma progression and assessing glaucoma prognosis.

BackgroundWe conducted a prospective observational study to elucidate the long-term prognosis and management of chronic obstructive pulmonary disease (COPD) in clinical practice in Japan in the mid-2010s.MethodsThis prospective cohort study included 29 facilities. Data from 427 patients clinically diagnosed with COPD, enrolled between September 2013 and April 2016, were analyzed. Interstitial pneumonia was excluded through a central multidisciplinary discussion. Follow-up data were collected for up to 5 years after patient registration.ResultsAt the time of registration, 53 patients clinically diagnosed with COPD did not have airflow limitation (AFL). In the cohort with AFL (n = 374), 232 patients completed a 5-year follow-up, while 49 patients died during the 1576.6 person-years of observation. The mean age was 71.7 years with an overall 5-year survival rate of 85.4%. Stratified by % forced expiratory volume in one second (FEV1), survival rates were 93.6% in the mild and moderate AFL group, 82.5% in the severe AFL group, and 66.1% in the very severe AFL group. The prognosis of the subpopulation without AFL was poor with a 5-year survival of 81.6%. This subpopulation exhibited respiratory symptoms, low vital capacity and total lung capacity, and emphysematous changes.ConclusionsOur study presents the 5-year survival and real-world clinical practice scenario of a prospective cohort of patients clinically diagnosed with COPD in Japan in the mid-2010s. The survival rates of our cohort were numerically better than the Japanese cohort in the 1990s, regardless of the high median age of this cohort. Overall, 12.4% of the patients in this cohort with no AFL at registration exhibited respiratory symptoms and distinct spirometric patterns, and had a poor prognosis.

Nursing students’ perceptions and satisfaction with a self-learning methodology in simulated environments: A mixed-methods study

This study aimed to evaluate the long-term results of Japan Maternal Emergency Life-Saving (J-MELS) simulation training on obstetric healthcare providers, over a 12-month follow-up period. A total of 273 trainees from 17 J-MELS Basic courses conducted between August 2021 and October 2023 were included. The trainees' responses to the pre- and post-tests, questionnaires, and self-reports on the usefulness of the J-MELS scenarios in actual clinical settings at 1, 6, and 12 months after the training were analyzed. Multivariate logistic regression analysis was also conducted to identify the factors influencing knowledge retention. We found an overall improvement in clinical knowledge acquisition after J-MELS training and a significant retention of this improvement at least until 12 months later. However, these scores gradually declined over. Trainees reported increased usefulness of J-MELS scenarios in actual clinical practice at 1, 6, and 12 months after training, particularly in managing obstetric emergencies such as atonic postpartum hemorrhage. Knowledge retention was influenced by several specific factors, such as years of clinical experience, affiliated institutions, qualifications, and especially pre-test scores. Our longitudinal follow-up study demonstrated, for the first time, the long-term results of J-MELS simulation training using post-tests and self-report data. Our findings provide valuable insight into the impact of J-MELS simulation training on maternal emergency care. By elucidating the factors influencing knowledge retention and practical utility, the findings offer actionable recommendations for optimizing training strategies and improving maternal outcomes in actual clinical practice.

The rising prevalence of cancer in India over the last few decades has led to a significant increase in health-seeking behavior among cancer patients toward Ayurveda. These patients incorporate Ayurvedic treatment into their cancer care for the following benefits – Patients with ongoing conventional care, patients expecting for mitigation of conventional care adverse effects, patients willing for standalone Ayurveda care for cancer, patients willing for prevention of recurrence, healthy persons having a strong family history of cancer, patients on palliative care, left out cases of cancer with no conventional care option. Most of the time, patients and their family members have less correct, less realistic information about the role, and scope of Ayurveda in this domain. Lack of authentic information and tall claims make the picture hazier and more confusing for patients. This also creates and increases confusion and/or skeptical approach in the minds of Oncologists, which proves a hurdle in the execution of an integrative approach in cancer care. The article discusses the role and scope of classical Ayurveda and contemporary clinical practice scenarios in Ayurveda for cancer. This will put forward a realistic and transparent picture in front of the scientific community to accelerate the action of integration. However, the need of scientific communication for better patient education about Ayurveda is discussed.

Identification of hypoxaemia and hypercapnia is essential for the diagnosis and treatment of acute respiratory failure. While arterial blood gas (ABG) analysis is standard for PO2 and PCO2 measurement, venous blood gas (VBG) analysis is increasingly used as an alternative. Previous systematic reviews established that VBG reporting of PO2 and PCO2 is less accurate, but the impacts on clinical management and patient outcomes are unknown. This study aimed to systematically review available evidence of the clinical impacts of using ABGs or VBGs and examine the arteriovenous difference in blood gas parameters. A comprehensive search of the MEDLINE, Embase and Cochrane Library databases since inception was conducted. Included studies were prospective or cross-sectional studies comparing peripheral ABG to peripheral VBG in adult non-critical care inpatients presenting with respiratory symptoms. Of 15 119 articles screened, 15 were included. No studies were found that examined clinical impacts resulting from using VBG compared to ABG. Included studies focused on the agreement between ABG and VBG measurements of pH, PO2, PCO2 and HCO3 -. Due to the heterogeneity of the included studies, qualitative evidence synthesis was performed. While the arteriovenous difference in pH and HCO3 - was generally predictable, the difference in PO2 and PCO2 was more significant and less predictable. Our study reinforces the notion that VBG is not comparable to ABG for physiological measurements. However, a key revelation from our research is the significant lack of data regarding the clinical implications of using VBG instead of ABG, a common scenario in clinical practice. This highlights a critical knowledge gap.