Effectiveness of varying alternating rapid maxillary expansions and constrictions (Alt-RAMEC) durations on maxillary protraction in noncleft Class III malocclusion: A systematic review and meta-analysis.

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is common despite the equivocal evidence regarding its benefits. This study aimed to evaluate the impact of pre-PCI viability or ischemia assessment on left ventricular (LV) function, ischemic burden, symptoms, and major adverse cardiovascular events in CTO patients. A systematic search of PubMed/MEDLINE, EMBASE, CENTRAL, Web of Science Core Collection, ClinicalTrials.eu, and ClinicalTrials.gov was conducted. Studies assessing viability and/or ischemia before PCI with follow-up data were included. Quality was assessed using Cochrane Risk of Bias 2.0 and ROBINS-I tools. Meta-analyses were conducted for quantitative outcomes and narrative synthesis for heterogeneous data. A total of 21 studies (3 randomized, 18 observational) were included; notably, among the randomized trials, only one required the presence of viability or ischemia as an inclusion criterion. Twenty-one studies were included in this review. Cardiac magnetic resonance was the most used imaging modality, followed by positron emission tomography. Successful PCI was associated with improved LV ejection fraction (MD: 3.97%; 95% CI: 1.51% to 6.42%) but no significant change in LV volumes. Regional segmental wall thickness increased in dysfunctional viable segments (MD: 16.70%; 95% CI: 11.15% to 22.26%), but not in non-viable segments. Successful CTO-PCI improved hyperaemic myocardial blood flow (MBF) (MD: 1.03 mL/min/g; 95% CI: 0.94 mL/min/g to 1.13 mL/min/g), rest MBF (MD: 0.10 mL/min/g; 95% CI: 0.06 mL/min/g to 0.14 mL/min/g), and coronary flow reserve (MD: 1.16; 95% CI: 1.03 to 1.30). The extent of ischemia reduction was associated with improved long-term prognosis and symptom relief. Pre-PCI viability and ischemia assessment may help identify patients more likely to achieve better functional recovery and symptom relief after successful CTO recanalization. These findings support its role in patient selection and highlight the need for further randomized studies to confirm prognostic value. The review protocol was registered in PROSPERO (ID: CRD42023426858).

IntroductionRandomised controlled trials (RCTs) are central to generating high-quality evidence in the surgical field but face unique methodological and practical challenges, including recruitment, follow-up, blinding and ensuring patient-centred outcomes. Patient and public involvement (PPI) has emerged as a promising strategy to enhance the relevance, quality and impact of surgical research by actively involving patients throughout the whole research process. Despite growing recognition of its value, the integration and reporting of PPI in surgical RCTs remain inconsistent, and no systematic evaluation has yet addressed its application within general and abdominal surgery.Methods and analysisRCTs in general and abdominal surgery published since 2014 will be identified through systematic searches of the databases MEDLINE, Web of Science and CENTRAL. This systematic review and primary (meta-epidemiological) statistical analysis will assess the reporting prevalence, implementation extent and quality of PPI over time. The Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2)-SF checklist and Cochrane Risk of Bias V.2.0 tool will be used to evaluate PPI reporting and study quality. To enable a comparison between studies reporting PPI and those that do not, propensity score matching will be performed to identify non-PPI studies with similar population and design characteristics. Subsequently, regression analyses will be employed to investigate potential associations between PPI reporting and various trial characteristics, including patient recruitment and retention, outcome selection and methodological quality. The Patient Advisory Board of the Study Centre of the German Society of Surgery is actively engaged in all phases of the systematic review.Ethics and disseminationThis systematic review does not require ethical approval. Results will be published in an international peer-reviewed scientific journal, as well as distributed in a lay format to the patient community and to the broader public.PROSPERO registration numberCRD42024524426.

Systematic review: The impact of virtual reality interventions on stress and anxiety in intensive care units.

Unravelling the miscellaneous effects of exercise interventions on activities of daily living in frail older adults: A systematic review and meta-analysis.

ABSTRACTBackground and AimsMedication adherence is the extent to which a patient's behavior corresponds with the prescriber's recommendations for taking medications. Non‐adherence is particularly high in patients with hypertension, leading to poor blood pressure control, increased cardiovascular risk, and increased burden on the healthcare system. A multitude of techniques and interventions to measure and improve medication adherence have been evaluated with mixed results. This protocol outlines a systematic review and meta‐analysis of randomized controlled trials evaluating interventions aimed at improving medication adherence in people with hypertension. There will be a focus on investigating intervention impact on the duration of medication adherence, persistence, analysis of subjective versus objective medication adherence measurement techniques, the impact of patient demographics on intervention effectiveness, and the use of the Behavior Change Taxonomy to categorize behavior change interventions and facilitate their evaluation.MethodsThis protocol was developed using the PRISMA‐P checklist and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024614468). A comprehensive literature search was conducted using Medline (Ovid), CINAHL and Embase electronic databases for articles published from inception to November 27th, 2024. In addition, CENTRAL was searched for articles published up to the end of 2024. Fixed and/or random‐effects meta‐analysis will be used as appropriate, according to between study heterogeneity, and the risk of bias of included studies will be assessed using the Cochrane risk of bias tool.ResultsThe results and findings of this review will be reported in accordance with PRISMA guidelines and published in a peer‐reviewed journal.ConclusionThe findings of this review will evaluate the evidence for interventions designed to improve medication adherence in people with hypertension. The results will provide evidence on which adherence interventions, or components of complex interventions, are effective and how they impact blood pressure control. Recommendations will be made for further research, including the design of interventions and methodology for medication adherence measurement.

Obesity is a multifactorial health condition arising from lifestyle imbalances and impaired metabolic regulation, often accompanied by gut microbial dysbiosis. Modulating the gut microbiota through probiotics has therefore gained attention as a therapeutic approach, with lactic acid bacteria such as Lactobacillus plantarum commonly used to help restore microbial balance. This study aimed to evaluate the effectiveness of Lactobacillus plantarum in improving body mass index (BMI) and lipid profiles in obese patients. A comprehensive literature search following PRISMA 2020 guidelines was conducted across PubMed, ScienceDirect, and Web of Science, and eligible studies were assessed using the Cochrane Risk of Bias 2.0 Tool. Data extraction captured key study characteristics, and a meta-analysis was performed using R Studio. The results demonstrated a significant reduction in BMI in the Lactobacillus plantarum group compared with controls (MD = –0.43; 95% CI: –0.65 to –0.21). Total cholesterol (MD = –6.76; 95% CI: –9.80 to –3.73) and LDL cholesterol (MD = –6.43; 95% CI: –8.88 to –3.98) also decreased significantly following the intervention. However, no meaningful improvements were observed for triglyceride or HDL cholesterol levels. In summary, Lactobacillus plantarum appears to be effective in reducing BMI, total cholesterol, and LDL cholesterol in obese individuals, although its influence on other lipid parameters remains limited. Therefore, selecting an appropriate probiotic strain should involve consideration of the desired metabolic outcomes, as well as formulation, dosage, and patient lifestyle.

ObjectiveThis study conducted a thorough review and meta-analysis to examine how respiratory muscle training (RMT) affects lung function recovery in individuals with spinal cord injury (SCI).MethodsWe conducted a systematic review of Randomized Controlled Trials (RCTs) examining the effects of RMT on lung function in patients with SCI. The search included databases such as PubMed, Embase, The Cochrane Library, Scopus, and Web of Science up to October 2025. The experimental group received RMT as the main intervention, while the control group received either no treatment, a placebo, or conventional rehabilitation. Outcome measures included Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), Peak Expiratory Flow (PEF), Minute Ventilation Volume (MVV), Total Lung Capacity (TLC), Inspiratory Capacity (IC), and Vital Capacity (VC). Two reviewers independently screened, extracted data, and assessed bias. Meta-analysis was conducted using RevMan 5.3 software, and the quality of included studies was evaluated using the Cochrane bias risk assessment tool and the Physical Therapy Evidence Database scale. The reporting of this study followed the PRISMA guidelines and was registered with PROSPERO (ID: CRD42024627736).ResultsIn this meta-analysis, 25 RCTs were included, comprising a total of 679 patients. The meta-analysis showed that compared with conventional rehabilitation, respiratory muscle training significantly improved FEV1 (p < 0.0001), FVC (p = 0.0001), MIP (p < 0.00001), MEP (p = 0.0004), PEF (p < 0.00001), MVV (p < 0.0001), TLC (p = 0.05), VC (p = 0.04), and their differences were statistically significant. However, IC (p = 0.40) was not statistically significant. Subgroup analyses showed that resistive training and surface electromyography biofeedback training were effective for improving FEV1 and FVC, while threshold training significantly improved MVV.ConclusionThis meta-analysis provides strong evidence that RMT is an effective intervention for enhancing respiratory muscle strength and key parameters of pulmonary function in individuals with SCI. Further research with robust methodologies and extensive sample sizes is needed to validate this finding.

Ethnopharmacological Significance Pediatric allergic rhinitis (AR) is often treated with conventional Western medical therapy (CWMT), but such regimens can cause adverse effects. Evidence suggests that Chinese patent medicines (CPMs) combined with CWMT may improve symptom control and immunological markers, yet no PRISMA-compliant network meta-analysis (NMA) has systematically compared available CPMs. Objective This study aims to conduct an NMA of randomised controlled trials (RCTs) comparing the efficacy and safety of CPMs plus CWMT in pediatric AR. Methods We conducted a PRISMA-guided NMA of randomized controlled trials evaluating CPMs plus CWMT versus CWMT alone for pediatric allergic rhinitis. Eight databases were searched through May 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and evidence certainty was graded using the Confidence in Network Meta-Analysis (CINeMA) framework. Continuous outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs), while binary outcomes were summarized as odds ratios (ORs) or risk ratios (RRs) with corresponding 95% CIs. Analyses were performed in StataMP 18, and treatment hierarchies were ranked using the surface under the cumulative ranking curve (SUCRA) method. Results A total of 49 RCTs involving 5,062 participants and 13 CPMs were included. Compared with CWMT alone, the combination of CPMs and CWMT significantly improved the Total Nasal Symptom Score (TNSS). Tongqiao Biyan Granules (TBG) achieved the greatest improvements across nasal obstruction (SMD = −1.79, 95% CI: −2.84 to −0.74; SUCRA 72.3%), sneezing (SMD = −2.09, 95% CI: −3.27 to −0.91; SUCRA 78.8%), and rhinorrhea (SMD = −1.88, 95% CI: −3.20 to −0.56; SUCRA 78.2%), indicating consistent superiority over other regimens, and Sanfeng Tongqiao Dropping Pills (STDP) being most effective for nasal pruritus (SMD = −1.57; SUCRA 81.9%). For overall efficacy, all CPM combinations outperformed CWMT, with Cang’er Zibi Yan Pills (CBP) achieving the highest improvement (RR = 1.25, 95% CI: 1.06–1.49; SUCRA 77.2%). Although seven CPMs showed a trend toward reduced serum IgE, none reached statistical significance; Xinqin Granules (XG) ranked highest (SUCRA 76.9%). Adverse events were generally mild and less frequent with combination therapy, with Yuping Feng Granules (YG) showing the lowest risk (OR = 0.33, 95% CI: 0.19–0.55 SUCRA 79.5%). Recurrence analysis (18 trials, 1,511 participants) indicated that most CPM combinations lowered relapse risk, with Huaiqi Huang Granules (HG) performing best (OR = 0.24, 95% CI: 0.06–0.92; SUCRA 84.8%). Sensitivity and meta-regression analyses confirmed the robustness of these findings, and all significant TNSS improvements exceeded the minimal clinically important difference (MCID = 0.55), indicating clinically meaningful symptom relief. Conclusion Combining CPMs with CWMT may offer superior efficacy and safety for pediatric AR. These findings support CPMs as an adjunct to standard therapy, though large, high-quality RCTs are warranted for confirmation. Systematic Review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251080593 .

Pulpotomy is increasingly considered a viable treatment for permanent teeth with carious or traumatic pulp exposure, particularly when preserving pulp vitality is desired. Materials such as Calcium Hydroxide (CH), Mineral Trioxide Aggregate (MTA), Biodentine, and iRoot BP Plus have distinct properties. Although many studies report favorable outcomes, direct comparisons between these materials in permanent teeth remain limited, and evidence on their relative long-term performance is inconclusive. This systematic review aimed to evaluate and compare the clinical and radiographic outcomes of CH, MTA, Biodentine, and iRoot BP Plus in permanent teeth, providing evidence to guide material selection in clinical practice. A comprehensive search of Cochrane, PubMed, ScienceDirect, Google Scholar, and Sage Journals was conducted for studies published from 2000 up to mid 2025 using keywords such as Pulpotomy, Vital Pulp Treatment (VPT), Calcium Hydroxide (CH), MTA, Biodentine, and iRoot BP Plus. The review followed PRISMA 2020 guidelines and the PICOS framework. The quality of randomized controlled trials was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, while cohort and case reports were evaluated using the JBI checklist. A total of 1,543 studies were initially identified, and 22 met the inclusion criteria, with follow-up periods ranging from 6 to 45.6 months. Risk of bias assessments indicated sufficient quality for data extraction. MTA demonstrated consistently high success rates (80%-100%), with several studies reporting complete clinical and radiographic success. iRoot BP Plus also showed excellent outcomes (84.6%-100%), with near perfect results in multiple studies. Biodentine achieved success rates from 70.7% to 100%, with most studies above 90%. CH showed more variable performance (37.5%-99.8%), though some trials reported outcomes comparable to MTA. MTA and iRoot BP Plus demonstrated superior clinical and radiographic success, with Biodentine as a strong alternative. Although CH showed lower success rates, its long history of use supports its continued relevance. These findings should be interpreted cautiously due to study heterogeneity, the limited number of high-quality trials, and short follow-up in some cases. Further well-designed randomized controlled trials with long-term follow-up are needed to confirm these results and guide material selection for pulpotomy in permanent teeth.

Background:Gallbladder retrieval site in laparoscopic cholecystectomy (LC) may influence postoperative outcomes, yet there is limited consensus on the optimal port for extraction. This systematic review and meta-analysis aimed to compare the umbilical port (UP) versus epigastric/subxiphoid port (EP/SP) in terms of clinical efficacy and safety.Methods:This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Google Scholar, and the Cochrane Library was performed through June 2025. Only randomized controlled trials from Pakistan comparing EP and UP for LC were included. Outcomes assessed included postoperative pain at multiple intervals, retrieval time, port-site infection, and hospital stay. Data were synthesized using Review Manager (RevMan) 5.4.1 with random-effects models, and heterogeneity was assessed via I² statistics. Risk of bias was evaluated using Cochrane risk of bias (RoB 2.0).Results:Nine randomized controlled trials involving 1338 patients (672 EP, 666 UP) were analyzed. UP retrieval was associated with significantly lower postoperative pain at 1, 6, 24, and 48 hours. Retrieval time was shorter in the UP group (mean difference: –1.34 minutes; 95% confidence interval: –2.40 to –0.28; P = .01). Hospital stay was also reduced with UP (mean difference: –0.73 days; 95% confidence interval: –1.31 to –0.16; P = .01). Port-site infection rates showed no significant difference (risk ratio = 1.23; P = .90). Sensitivity analyses supported the robustness of key findings.Conclusion:UP retrieval in LC offers favorable early postoperative outcomes, including reduced pain and shorter hospital stay, compared to the subxiphoid port. These results support UP as a potentially preferred approach.

Background:Peri-implant disease is an inflammatory condition that affects implant stability and quality of life. As nonsurgical treatments show limited efficacy, probiotics have been explored for their anti-inflammatory effects. This systematic review evaluated the efficacy, safety, and health-related quality of life outcomes of peri-implant diseases.Methods:Databases were searched for randomized controlled trials (RCTs) and non-randomized studies (November 2024). The outcomes included bleeding on probing (BoP), probing depth, plaque index, and biomarkers. The protocol was registered with International Prospective Register of Systematic Reviews (CRD42024617103). The RoB in RCTs was assessed using the Cochrane Risk of Bias 2.0 tool, and non-RCTs using the RoB In Non-randomized Studies of Interventions tool. Evidence certainty was graded using the Grading of Recommendations, Assessment framework.Results:Fourteen studies were included, and 10 RCTs (n = 391) were meta-analyzed. For peri-implant mucositis, probiotics reduced BoP at 3 months (mean difference [MD] −1.45; P = .002) and 6 months (MD −9.44; P = .0003) and improved plaque index at 3 months (MD −0.99; P = .001). No effects on probing depth or peri-implantitis were observed. Tumor necrosis factor-alpha levels improved, while interleukin levels remained unchanged. Microbial analysis revealed no major changes. Subgroup analyses showed greater effects in placebo-controlled versus active comparator studies. Health-related quality of life and long-term safety were not assessed. Evidence certainty ranged from moderate to very low.Conclusion:Probiotics may provide modest short-term benefits for peri-implant mucositis by reducing BoP and plaque accumulation. Current evidence is insufficient to support its use in peri-implantitis or to establish long-term safety and patient-centered outcomes. Further high-quality long-term trials are required.

Introduction: Cervical cancer is the fourth most common cancer in women globally, etiologically linked to persistent high-risk human papillomavirus (HPV) infection (World Health Organization, 2024a; World Health Organization, 2024b). High-grade cervical intraepithelial neoplasia (CIN), specifically CIN2 and CIN3, are the direct, histologically confirmed precursor lesions (Cleveland Clinic, 2023). This systematic review synthesizes the evidence from randomized controlled trials (RCTs) and real-world observational studies on the effectiveness of prophylactic HPV vaccination in reducing the incidence of CIN2 and CIN3 (CIN2+). Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, and the Cochrane Library was conducted (Ghebrekidan et al., 2024; Khalil et al., 2023). Studies were included if they were RCTs or observational (cohort, case-control) studies assessing the efficacy or effectiveness of prophylactic HPV vaccination (bivalent, quadrivalent, or nonavalent) on histologically confirmed CIN2+ outcomes in females. Methodological quality was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs (Sterne et al., 2019; Cochrane, 2024) and the Newcastle-Ottawa Scale (NOS) for observational studies (Wells et al., 2024; Ohri, 2024). Results: This synthesis includes 17 high-quality studies. Foundational RCTs (e.g., FUTURE, PATRICIA) demonstrated near-perfect efficacy (98-100%) against vaccine-type HPV 16/18-related CIN2+ in per-protocol (HPV-naïve) populations (FUTURE II Study Group, 2007; Paavonen et al., 2009; Kjaer et al., 2018). A high-certainty Cochrane review confirmed a 63% reduction in any CIN2+ (irrespective of HPV type) in hrHPV-negative young women (Risk Ratio 0.37, 95% CI 0.25-0.55) (Arbyn et al., 2018). Recent, large-scale real-world effectiveness (RWE) studies from national registries report profound, significant reductions in high-grade lesions. In England, cohorts vaccinated at age 12-13 showed an 87% reduction in invasive cervical cancer and a 97% reduction in CIN3 (Falcaro et al., 2021). In Sweden, vaccination before age 17 was associated with an 88% reduction in invasive cervical cancer (Lei et al., 2020), and in Scotland, an 86% reduction in CIN3+ was observed in the 12-13 age cohort (Palmer et al., 2019). Effectiveness is strongly dependent on vaccination age (Hariri et al., 2023; Herweijer et al., 2016). Furthermore, significant evidence demonstrates high effectiveness (74-87% reduction) in preventing the recurrence of high-grade lesions when used as an adjuvant to surgical conization (Dvořák et al., 2024; Ghelardi et al., 2021). Discussion: The evidence is overwhelming and consistent. The near-100% efficacy observed in controlled trial settings has translated directly into profound population-level effectiveness in countries with high, sustained vaccine uptake (Ghebrekidan et al., 2024; Drolet et al., 2019). The dependency of effectiveness on age confirms the vaccine's prophylactic mechanism, underscoring the criticality of pre-adolescent vaccination. Conclusion: Prophylactic HPV vaccination provides a significant, robust, and long-lasting reduction in the incidence of high-grade cervical precancer (CIN2/3). High-coverage national programs are demonstrating the potential to "almost eliminate" (Falcaro et al., 2021) cervical cancer in vaccinated generations, representing a major public health triumph.

There is currently no evidence-based method to identify the forces that may drive someone to attempt suicide. To examine whether cognitive behavior therapy (CBT) interventions that incorporate a narrative assessment are associated with a greater reduction in suicide attempts than comparable interventions without this component. Studies were identified through version 25.0.1 of the Metapsy Suicide Prevention Database, which includes randomized clinical trials published up to April 2025 retrieved through PubMed, Embase, Web of Science, Scopus, and Cochrane Central, including unpublished studies and references from relevant articles. Included studies were randomized clinical trials of CBT interventions reporting suicide attempts as an outcome. Studies using waiting list controls, reporting only suicidal ideation, or lacking information on the type of assessment used were excluded. Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted using 3-level models with robust variance estimation. Relative risks (RRs) were pooled using the Mantel-Haenszel method. Analyses followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were pooled using a random-effects model. The primary outcome was the incidence of suicide attempts. Interventions were grouped by presence or absence of a narrative assessment component. Twenty-three studies with 3262 participants met inclusion criteria. CBT interventions including a narrative assessment were associated with a significantly reduced risk of suicide attempt compared with controls (RR, 0.68; 95% CI, 0.53-0.87; 1764 participants across 14 studies), whereas CBT interventions without this component were not associated with risk of suicide attempt (RR, 1.17; 95% CI, 0.63-2.20; 1498 participants across 9 studies). Subgroup comparison indicated a significant difference between groups (Q1 = 7.27; P = .007; I2 = 86%). Studies without a narrative assessment had significantly younger participants, a lower event rate, and slightly higher risk of bias. In this systematic review and meta-analysis, CBT interventions including a narrative assessment were associated with a reduced risk of suicide attempt, while CBT without this component did not have an association with risk of suicide attempt. Age differences between study populations may partly explain this finding, as interventions in younger populations often show smaller and more inconsistent effect sizes. These results suggest that a narrative assessment may be a simple and effective way to capture the forces that lead to suicide attempts and to direct interventions toward their prevention. Causal conclusions require direct head-to-head trials.

Comparative efficacy of different mind-body exercise modalities in low back pain: Systematic review and network meta‑analysis.

Poor sleep duration and quality in middle age is associated with higher dementia risk in late adulthood. The aim of this review was to (i) identify the effectiveness of behaviour change techniques (BCT)-based therapies in improving both sleep and cognition simultaneously; and (ii) determine the specific aspects of BCTs that were most effective for improving sleep and cognition in mid-life adults. Electronic databases (MEDLINE, EMBASE, PsycINFO) were searched. Inclusion criteria were randomised controlled trials (RCTs), adults aged between 45 and 64 years, behavioural/cognitive interventions targeting sleep quality and duration, and measured outcome on cognitive function. A narrative synthesis and risk of bias (Cochrane Risk of Bias) and study quality (GRADE) was conducted, with BCTs mapped to the BCT Taxonomy V1. 6013 records were reviewed and 6 RCTs (N = 969 participants) reporting both online and face to face behavioural interventions for sleep were found. Interventions were mostly focused on meditation (e.g., yoga training (2/6, 33.3%) or meditation exercises (2/6, 33.3%)). Overall, 28 out of a possible 93 BCTs (30.1%) were identified as targeting change in sleep behaviour to improve cognition (range: 7–22, mean: 14.7). BCT categories commonly used were goal setting, shaping knowledge, natural consequences, comparison of behaviour, repetition/substitution, comparison of outcomes, regulation and antecedents. These BCTs were also linked to positive outcomes for cognition and sleep quality. Identification of BCTs may provide a helpful understanding on the content used in interventional trials and be used to inform more effective structured lifestyle intervention strategies. There is unexplored potential for using currently untested BCTs in future interventions targeting improved sleep and cognition for middle-aged adults.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24009-4.

ObjectiveTo compare the effectiveness of manual cleaning, alkaline multi-enzyme immersion with ultrasonic cleaning, and automatic reprocessing machines in decontaminating laparoscopes through a systematic review and meta-analysis of randomised controlled trials.MethodsA comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI and Wanfang databases from inception to February 2025. Randomised controlled trials comparing different cleaning and disinfection methods for laparoscopes were included. The primary outcome was the qualified rate of decontamination, defined as meeting predetermined thresholds for each detection method (visual cleanliness, protein <6.4 μg/cm², ATP <200 RLU, negative occult blood). Heterogeneity was assessed using I² statistics, with subgroup analyses by detection method and intervention type. Risk of bias was evaluated using the Cochrane risk of bias tool.ResultsEleven randomised controlled trials involving 4,661 cases were included. Meta-analysis showed that alkaline multi-enzyme immersion with ultrasonic cleaning improved qualified decontamination rates compared with manual cleaning alone when assessed by visual inspection (risk ratio [RR] = 1.07, 95% CI: 1.02–1.13, P < 0.01) and occult blood test (RR = 1.12, 95% CI: 1.02–1.23, P < 0.05). The 7% improvement in first-pass cleaning qualification translates to potentially preventing contamination in approximately 70 additional instruments per 1,000 processed. Automatic reprocessing machines showed similar improvements (RR = 1.08, 95% CI: 1.01–1.16, P < 0.05). Low heterogeneity (I² < 25%) was observed across most outcomes.ConclusionThe evidence suggests that combined cleaning methods provide modest but clinically meaningful improvements over manual cleaning alone, though certainty is limited by methodological constraints and geographic concentration of studies. Healthcare facilities should consider implementing enhanced protocols while weighing resource availability, training requirements, and local infection prevention priorities.

This systematic review aims to determine whether exercise timing influences different health indicators. The search, conducted until May 2025 across PubMed, Web of Science, EBSCO, China National Knowledge Infrastructure, and Wanfang databases, reviewed 2,937 articles. This review included randomized controlled trials in English that explored exercise timing for various populations, excluding unspecified exercise timing, animal studies, and low-quality articles. A total of 43 studies with 3,543 participants were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and study characteristics and results were tabulated. Current evidence suggests that exercise timing may differentially impact health dimensions: afternoon exercise may improve metabolism in metabolic disorders; postdinner exercise might enhance blood glucose control for type 2 diabetes; premeal exercise could reduce appetite for overweight and obese individuals; evening exercise may improve sleep quality for sleep disorders but may negatively affect early chronotypes; morning exercise may enhance athlete performance, while afternoon exercise may promote the recovery of ordinary individuals; and morning exercise should be approached cautiously in cardiovascular risk groups. However, contradictions in some dimensions highlight the need for further rigorous research to solidify implications for exercise prescriptions. The study protocol was prospectively registered on PROSPERO (ID: CRD42024595984).

With the development of comfortable medical care, the application of intravenous anesthesia in painless gastroscopy is becoming increasingly widespread. However, anesthetic drugs may have adverse effects on postoperative cognitive function, and the risk of postoperative cognitive dysfunction (POCD) is particularly worthy of attention in the elderly population. Our aim is to evaluate the effect of intravenous anesthesia on postoperative cognitive function (POCF) in patients undergoing painless gastroscopy, with a focus on identifying potential risks of POCD and guiding clinical anesthesia practices. Analyzing randomized controlled trials (RCTs) published in English that assessed the impact of intravenous anesthesia on POCF in patients over 60 years old undergoing elective gastrointestinal endoscopy. The literature search spanned databases including PubMed、Embase、Web of Science、Scopus、Cochrane, and Clinical Key. Study inclusion and exclusion criteria were rigorously defined, and the Cochrane bias risk assessment tool was utilized to evaluate study quality. Meta-analyses were performed using RevMan 5.3, with heterogeneity assessed via I-square statistics. From a total of 432 articles identified, 7 studies involving 219 patients met the inclusion criteria. The meta-analysis revealed no significant difference in the incidence rates of POCD on Day 1 and Day 3 postoperatively between patients undergoing intravenous versus inhalation anesthesia. However, on Day 7, the incidence of POCD was significantly lower in the intravenous anesthesia group, with a combined Odds Ratio (OR) of 0.96 (95% Confidence Interval (CI): 0.73-1.26, I^2 = 34%, n = 7, P < 0.00001). Furthermore, plasma levels of S-100β protein, a marker for neural injury, were significantly lower in the intravenous anesthesia group, with a Mean Difference (MD) of 0.34 (95% CI: 0.23-0.48, I^2 = 0%, n = 5, P < 0.00001). Intravenous anesthesia for painless gastroscopy appears to be associated with a lower incidence of POCD on Day 7 postoperatively, suggesting a potentially reduced risk of early postoperative cognitive decline compared to inhalation anesthesia. The findings indicate that intravenous anesthesia may be preferable in minimizing the risk of POCD, particularly in older adults undergoing painless gastroscopy. However, further high-quality, large-scale RCTs are warranted to validate these results and explore the effects across different patient demographics.

Epilepsy affects millions of patients worldwide, and approximately one-third of patients are resistant to antiepileptic drugs. Dietary therapies, such as ketogenic diet (KD), modified Atkins diet (MAD), and low glycemic index treatment, have shown potential in seizure control. This review aims to evaluate the effectiveness and safety of these dietary interventions in reducing seizure frequency and improving related outcomes in individuals with drug-resistant epilepsy. A comprehensive search of PubMed, Scopus, the Cochrane Library, and Web of Science was conducted up to December 2024 and updated in May 2025. Eligible studies were randomized controlled trials and prospective cohort studies evaluating KDs in patients with drug-resistant epilepsy. The primary outcomes included seizure reduction (≥ 50%, ≥ 90%, or complete cessation), whereas the secondary outcomes included cognitive function, quality of life, and adverse events. The risk of bias was assessed via the Cochrane Risk of Bias 2 tool. Meta-analyses were performed via R (version 4.3.2), with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Fixed- or random-effects models were applied on the basis of heterogeneity levels. Dietary interventions significantly increased ≥ 50% seizure reduction [odds ratio (OR) = 3.46, 95% CI = 1.83-6.56] compared with standard care, with stronger effects in pediatric patients (OR = 10.93 vs. 2.54 in adults, P = 0.007). MAD outperformed standard care (OR = 4.04), whereas KD did not (OR = 1.83). For a ≥ 90% reduction, KD had greater efficacy (OR = 6.23) than MAD did (OR = 1.98). No significant difference was found for complete seizure resolution (OR = 1.19). Adverse events varied: constipation was most common with MAD (30.97%), whereas KD had higher rates of respiratory infections (42.77%, P < 0.0001 vs. MAD) and diarrhea (13.75% vs. 8.11%, P = 0.0017). Heterogeneity was substantial in most analyses (I2 > 75%). KDs and MADs are effective in reducing seizures in patients with drug-resistant epilepsy, especially in children. However, claims of seizure freedom remain uncertain. Further high-quality trials are needed to compare diets and assess long-term safety.