Effects of anodal transcranial direct current stimulation on athletic performance among elite athletes: A systematic review and meta-analysis.

Patient-Directed Discharge Among Hospitalized Persons With Opioid Use Disorder in the Fentanyl Era: A Scoping Review.

Understanding the epidemiological trends and economic impact of dengue in Indonesia: A systematic literature review.

Artificial intelligence literacy in higher education and implications for nursing education: A scoping review.

Clinical Efficiency of Lasers in Endodontic Treatment of Primary Endodontic Cases: An Umbrella Review of Systematic Reviews.

Chemotherapy (CT) remains the standard first-line treatment for advanced triple-negative breast cancer (aTNBC), despite the emergence of innovative therapies, including targeted therapies (TT) and immune checkpoint inhibitors (ICI). Studies have shown that the treatment strategies for aTNBC vary widely, with inconsistent efficacy acrossdifferent treatment modalities. A comprehensive search was carried out in electronic databases, such as PubMed and Embase, for systematic reviews and randomized clinical trials (RCTs) that investigated the efficacy of TT, ICI, and CT to treat aTNBC until June 2025. Seventeen published meta-analyses and 52 RCTs reporting the prognosis of the disease treated with TT, ICI, and CT in aTNBC patients were analyzed. It showed that in terms of prolonging PFS, both the TT group and the ICI group were superior to the CT group [ICI: HR = 0.81 (0.69, 0.94); TT: HR = 0.68 (0.62, 0.74)]. In terms of OS, the TT group was superior to the CT group [HR = 0.77 (0.68, 0.88)]. In the subgroup analysis of TT, compared with CT alone, both sacituzumab govitecan (SG) monotherapy and trilaciclib combined with chemotherapy (TRI_CT) significantly improved the time of PFS [SG: HR = 0.41 (0.30, 0.56); TRI_CT: HR = 0.62 (0.46, 0.86)] and OS [SG: HR = 0.48 (0.33, 0.70); TRI_CT: HR = 0.41 (0.28, 0.59)]. This umbrella review supports SG monotherapy and TRI_CT as the first choice for patients with aTNBC. Additionally, the review was rated as high-quality evidence using AMSTAR 2, the credibility classification standard, and GRADE rating. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and is registered with PROSPERO: CRD420251034666.

Hypertriglyceridemia is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). We aimed to evaluate the efficacy and safety of apolipoprotein C-III (ApoC-III) inhibitors in patients with hypertriglyceridemia. Electronic databases were systematically searched for randomised controlled trials (RCTs) comparing ApoC-III inhibitors (Volanesorsen, Olezarsen and Plozasiran) with placebo. A frequentist network meta-analysis was performed. Continuous outcomes were presented as mean differences (MDs), and dichotomous outcomes as risk ratios (RRs), both with 95% confidence intervals (CIs). A total of 15 RCTs involving 3934 patients were included. All ApoC-III inhibitors demonstrated significant reductions in TG, except for Volanesorsen 100 mg Q1W and Olezarsen 10 mg Q4W. Olezarsen 80 mg administered every 4 weeks had the highest SUCRA ranking for TG reduction (MD: -63.26; 95% CI: -70.04 to -56.47; p < 0.01). Moreover, ApoC-III inhibitors were associated with a significant reduction in the incidence of pancreatitis (HR: 0.16, 95% CI: 0.07-0.33, p < 0.01). None of the agents significantly increased the risk of serious adverse events. ApoC-III inhibitors significantly improved triglyceride levels and other lipid parameters and, most importantly, substantially reduced the risk of acute pancreatitis. Future trials are needed to evaluate their effects on cardiovascular outcomes.

To map current evidence on artificial intelligence (AI)-enhanced robotic systems for dental implant placement, focusing on system autonomy, accuracy, and clinical applicability. This mixed-method scoping review followed PRISMA-ScR guidelines and included studies published up to August 2025. Five electronic databases were systematically searched (PubMed, Scopus, Web of Science, Embase, Cochrane Library), supplemented by grey literature search, to identify English-language studies assessing robotic-assisted dental implant placement in terms of accuracy, time efficiency, or clinical feasibility. Two reviewers independently performed study selection, data extraction, and quality appraisal. Quantitative data were pooled descriptively using random-effects models with subgroup analyses, while remaining findings were synthesized narratively. A parallel search identified commercially available robotic and dynamic navigation systems, including their regulatory status, validation level, and human-robot interaction features. The systematic search identified 27 studies evaluating robotic-assisted dental implant placement met the inclusion criteria. Methodological quality was generally high, with 92.6% of studies scoring ≥ 8/10 on the Mixed Methods Appraisal Tool (MMAT). Robotic systems demonstrated high placement accuracy, with a mean coronal deviation of 0.45 mm, apical deviation of 0.50 mm, and angular deviation of 0.80° However, statistical heterogeneity was high across outcomes (I² > 97%). Subgroup analyses indicated that fully autonomous robotic systems achieved the lowest deviation values. Implant placement in the mandible showed greater accuracy compared with maxillary and zygomatic sites. When compared with dynamic navigation systems, robotic-assisted approaches demonstrated comparable linear deviations but superior angular precision. Limited evidence suggested potential improvements in procedural efficiency, particularly in multi-implant cases. Robotic systems show strong technical performance, but current evidence is dominated by in vitro and single-center studies with limited long-term clinical data. Future multicenter trials with standardized outcomes and long-term follow-up are needed to confirm clinical benefits. Robotic systems offer high accuracy and reproducibility in dental implant placement, potentially improving efficiency and reducing variability in complex cases. However, clinical adoption should be guided by further multicenter trials with long-term outcomes.

Dietary modification is a crucial component of chronic kidney disease (CKD) management, but the complexity of renal diets leads to significant adherence challenges. Understanding the patient's perspective is vital for developing effective, patient-centred interventions that improve adherence and health outcomes. This scoping review aimed to map the available evidence on the reported preferences of patients with CKD regarding nutrition-related health outcomes, and to identify the perceived barriers and facilitators that hinder or support the achievement of these outcomes. Studies were included if they involved adult patients with CKD and explored their perspectives on nutrition-related outcomes, barriers, or facilitators to dietary management. Qualitative, quantitative, and mixed-methods studies published in English were eligible. A systematic search was conducted in June 2025 across four electronic databases (MEDLINE, CINAHL, Embase, and Cochrane Database of Systematic Reviews), supplemented by hand-searching reference lists of included articles. Data were extracted independently using a custom data extraction tool. The identified barriers and facilitators were thematically mapped and categorised according to the World Health Organization Multidimensional Adherence Model (WHO-MAM). Four studies met the inclusion criteria. A primary finding was the lack of evidence directly addressing patients' preferred nutrition-related health outcomes. However, preferences could be inferred; patients value reassurance, emotional support, and receiving practical, individualised, and culturally relevant advice. Perceived barriers included: (A) unhelpful, paternalistic communication from healthcare teams; (B) patient factors like feeling overwhelmed and confused; (C) socioeconomic factors such as conflicting cultural norms and social pressures; and (D) therapy-related factors like generic, non-culturally specific advice. Key facilitators included: (A) helpful, empathetic, and collaborative communication styles; (B) patient factors like self-monitoring and psychosocial support; (C) socioeconomic factors such as leveraging cultural health beliefs; and (D) therapy-related factors like health literacy-sensitive materials and dietitian support. There is a significant gap in the literature regarding the nutrition-related health outcomes that CKD patients prioritise. The findings highlight that the patient-healthcare provider relationship is a pivotal factor influencing adherence. Clinical practice should shift towards a more patient-centred, collaborative, and culturally sensitive model of care. Future research should use qualitative methods to directly investigate patient preferences to inform the co-design of effective dietary interventions.

People living with amyotrophic lateral sclerosis (ALS) are at high risk of malnutrition, making it essential to monitor their nutritional status through measurements of body composition and energy expenditure. However, validity of equations, as alternatives to reference standards for assessing these parameters in ALS, is unclear. This systematic review evaluates criterion validity of equations to estimate body composition and energy expenditure in ALS. Four electronic databases (EMBASE, MEDLINE, CINAHL and Cochrane) were systematically searched from inception until July 7th, 2025. Studies were included if criterion validity of an instrument or method for estimating body composition or energy expenditure was examined in people diagnosed with ALS. Methodological quality was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias checklist. Criterion validity was rated as sufficient (+), indeterminate (?) or insufficient (-) based on COSMIN criteria for good measurement properties. Results were qualitatively summarised. Twelve studies were included: five evaluated the criterion validity of equations to estimate body composition using Bioelectrical Impedance Analysis (BIA) or anthropometry, and seven to estimate resting or total daily energy expenditure. No equation was rated as sufficient for criterion validity across studies. Equations to estimate body composition and energy expenditure should be applied with caution, as no equation exhibited high criterion validity in ALS. ALS-specific equations require further validation, and ideally, new equations tailored to the unique physiological characteristics of ALS should be developed. CRD42024573509.

Count data time series, characterized by non-negative integer values, frequently arise across diverse domains, including finance, public health, economics, epidemiology, and environmental sciences. Such series often exhibit characteristics such as equidispersion, overdispersion, underdispersion, and zero-inflation/deflation. Failure to appropriately account for these features can result in biased parameter estimates and misleading statistical inference. This review presents a comprehensive overview of recent methodological developments in integer-valued autoregressive (INAR) models, with particular emphasis on thinning operators, estimation methods, and model extensions. A systematic literature search was conducted using electronic databases, including Scopus and Google Scholar, to identify relevant studies published between 2010 and 2024. Recent research has primarily focused on the development of novel thinning operators and flexible innovation distributions aimed at constructing unified modeling frameworks capable of accommodating multiple characteristics of count data simultaneously. This review highlights prevailing research trends, identifies existing methodological gaps, and outlines promising directions for future research in count data time series modeling.

Physiotherapy plays a vital role in the care and development of children with Down syndrome (CDS), especially in addressing related health issues. Understanding caregivers' perspectives on physiotherapy for CDS is essential for enhancing service delivery. This scoping review aims to synthesize research on parental experiences and expectations concerning physiotherapy for CDS. Scoping review methodology follows the recommendations of Arksey and O'Malley and the steps described by the Joanna Briggs Institute. A comprehensive search strategy was employed across four electronic databases: PubMed, Scopus, Web of Science and CINAHL, as well as relevant grey literature sources. Out of the 97 studies screened, five met the inclusion criteria and were included in the review. Parents widely viewed physiotherapy as essential for their child's development, reporting benefits in motor skills, confidence and independence. However, they also faced challenges such as limited access, emotional strain and service dissatisfaction. This review enhances our understanding of the experiences and expectations of parents concerning physiotherapy for children with Down syndrome. It identifies important areas where future research and clinical practice can improve developmental outcomes and the quality of life for CDS.

A review of plant-derived products regulating amyloid beta-degrading enzymes in Alzheimer's disease.

Sleep health of children and adolescents in foster and kinship care: A systematic review.

Acute blood pressure responses and safety considerations in heat therapy interventions: A narrative review.

Efficacy of Rhizoma Drynariae (Drynaria roosii Nakaike) extracts in treating osteoporosis in rat models: A systematic review and meta-analysis.

Emergence delirium (ED) is a common complication in pediatric anesthesia. Although intranasal dexmedetomidine (DEX) is widely used, its application is constrained by a slow onset, residual risk of ED in some patients, and risks such as bradycardia and hypotension. Esketamine (ESK), an NMDA receptor antagonist, may provide a faster onset and reduce these side effects. This study compared the efficacy and safety of intranasal DEX-ESK combination versus DEX alone as premedication for anesthesia induction in pediatric patients undergoing surgery. Electronic databases (PubMed, Web of Science, Scopus, CINAHL, and Embase) were systematically searched for randomized controlled trials (RCTs). The primary outcomes included the ED incidence and the onset of sedation. Secondary outcomes included mask acceptance score, FLACC pain score, post-anesthesia care unit (PACU) length of stay, and adverse events. A random-effects model generated pooled effect estimates-risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. Prediction intervals were also reported to reflect the expected range of effects in future similar studies. Trial Sequential Analysis was performed. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Five RCTs encompassing 466 pediatric patients were included in the quantitative synthesis. The DEX-ESK combination was associated with a reduction in ED incidence (RR = 0.58; 95% CI: 0.35-0.97; p = 0.04) and a shorter time to sedation onset (MD = -3.95 min; 95% CI: -4.77 to -3.14; p < 0.01). Secondary analyses demonstrated improved mask acceptance (MD = -0.77; 95% CI: -1.27 to -0.27; p < 0.01), reduced FLACC pain scores (MD = -0.36; 95% CI: -0.70 to -0.02; p = 0.04), and shorter PACU length of stay (MD = -1.83 min; 95% CI: -2.75 to -0.91; p < 0.01). Adverse event incidence did not differ significantly between groups. The intranasal DEX-ESK combination was associated with improved outcomes compared with DEX monotherapy for pediatric premedication including reductions in ED incidence, a modest acceleration in sedation onset, improved mask acceptance, and slightly shorter PACU length of stay, without an increased risk of adverse events. This combination may represent a feasible and safe premedication option for pediatric patients. PROSPERO: CRD420251236740.

Defining varus thrust assessment and measurement: A scoping review.

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic pre-cancerous condition that precedes plasma cell dyscrasias, including multiple myeloma (MM). Current clinical guidelines report that MGUS's rate of malignant progression to haematological malignancy (HM) is ~1% per year; however, reported rates have varied widely. To address this discrepancy, a systematic review was conducted, investigating MGUS's rate of malignant progression to HM and MM alone. Four electronic databases were searched from inception to 28 March 2024 for articles reporting these outcomes; articles were summarised using meta-analysis and narrative synthesis. Findings were incorporated from n = 46 studies, published between 1991 and 2024 and conducted across n = 17 countries. Median follow-up ranged from 1.3 to 34.2 years and sample sizes ranged from n = 63 to 17,963. In random-effects meta-analysis, n = 13 studies reported on MGUS progression to HM and n = 12 reported on progression to MM. The overall estimates of malignant progression events were 12 per 1000 person-years to HM, equivalent to 1.2% per year (95% CI: 1.0%-1.5%) and 8 per 1000 person-years to MM or 0.8% per year (95% CI: 0.7%-1.1%), with substantial heterogeneity between studies (I2: 96.7% and 95.8%, respectively). Progression rates varied widely in narrative synthesis; at 10 years, studies reported annual MGUS progression rates of 6.6%-33.6% to HM and 7.0%-28.5% to MM. While progression rates aligned with clinical guidelines overall, studies' varied findings present opportunities for further research, exploring the impact of world region, follow-up duration, and study methods. Considering this, caution should be taken when informing clinicians and patients about the risk of progression from MGUS to MM.

PurposeTo describe the utilization of an on-call critical care pharmacist to bridge gaps in clinical coverage for subspecialized critically ill populations.MethodsIn October 2022, a 24/7 on-call team of medical and cardiac ICU pharmacists was established to field questions regarding patients with mechanical circulatory support and pulmonary hypertension. On-call pharmacists were available via centralized telephone number Monday through Friday from 4:00 p.m. to 8:00 a.m., and at all hours on weekends. Information characterizing calls received was collected in an electronic database. A review of all database entries through March 2025 was conducted and descriptive statistics were used to quantify calls received, time spent, multidisciplinary team member engagement, and types of interventions.ResultsOn-call pharmacists received 207 calls and documented 218 interventions. Calls were most often received between the hours of 4:00 p.m. and 8:00 a.m., and the median time spent per call was 10 minutes (IQR 5-20 minutes). On-call critical care pharmacists received the most calls for ECMO patients (38.2%), followed by pulmonary hypertension (26.1%) and Impella® patients (20.8%). The majority of inquiries were from pharmacists (35.7%), followed by advanced practice providers (33.3%) and physicians (21.3%). Anticoagulation and hemostasis was the most commonly cited intervention category (56.4%).ConclusionIn the absence of an onsite critical care pharmacist, a 24/7 on-call critical care pharmacist was utilized by members of the multidisciplinary team to bridge gaps in clinical coverage. Further research is needed to determine the pharmacoeconomic and clinical impacts of on-call critical care pharmacists when onsite resources are unavailable.