Global Clinical Practice Research Articles

Background: Polygenic risk scores (PRS) offer promising avenues for stratifying myocardial infarction (MI) risk and informing precision prevention. However, most PRS are derived from European-ancestry datasets, raising concerns about predictive validity and clinical equity across ancestrally diverse populations. Goals/Aims: To evaluate the predictive performance, calibration, and clinical utility of MI-related PRS across global ancestries, and to identify strategies that enhance transethnic applicability. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase and Scopus were searched through March 2025 for studies reporting ancestry-stratified PRS performance for MI. Primary outcomes included area under the curve (AUC), odds ratio (OR) per standard deviation of PRS, observed-to-expected event ratios (O/E), and reclassification metrics (net reclassification improvement [NRI], integrated discrimination improvement [IDI]). Random-effects models were used for pooled estimates, with subgroup analyses by ancestry (European, African, South Asian, East Asian, Hispanic/Latino, admixed) and PRS construction method. Meta-regression, heterogeneity (I2), and risk-of-bias assessments were applied. Publication bias was evaluated via funnel plots and Egger’s test. Results: Forty-six studies encompassing 1.32 million individuals across six ancestral groups were included. In European cohorts, pooled PRS AUC was 0.74 (95% CI: 0.72–0.76), compared to 0.63 (95% CI: 0.60–0.66) in African and 0.66 (95% CI: 0.64–0.68) in South Asian populations (p < 0.001 for heterogeneity). Calibration was poorer in non-European groups (O/E >1.4), indicating systemic overestimation of risk. While PRS improved net reclassification in European cohorts (NRI: +12.1%), clinical utility was limited in African ancestry (NRI: +2.3%). Meta-regression revealed that ancestry-specific allele frequency adjustment and inclusion of multi-ancestry training datasets significantly improved PRS performance (p < 0.01). Conclusion: Current PRS for MI demonstrate reduced accuracy and suboptimal calibration in non-European populations, undermining clinical utility and exacerbating genomic health disparities. These findings highlight the urgent need for globally inclusive genomic data and ancestry-aware PRS optimization. Implementation of strategies is critical for equitable risk prediction tools and for aligning precision cardiology with global clinical practice.

The Data Innovation, Program Implementation, and Community Action (DIPICA) Observatory for Surgical, Anesthesia, and Obstetric (SAO) Care in India convened in December 2024 in New Delhi. This two-day program brought together experts from global surgery, public health, health policy, and clinical practice to address planned challenges in SAO care, focusing on data-driven approaches, sustainable financing, and workforce development. The discussions emphasized leveraging data to strengthen SAO care systems by creating practical data products for localized planning and community engagement. Participants advocated for dynamic observatories to support data-driven research and policy implementation, making SAO care more accessible and efficient. Sustainable financing emerged as a key focus, with experts discussing innovative approaches that move beyond conventional models. Community-based solutions, decentralized funding, and performance-based models were discussed as strategies to optimize resource allocation. Establishing partnerships involving government, private, and community sectors was highlighted as crucial for achieving financial sustainability, particularly in underserved areas. Workforce development discussions addressed competency-based training and task-sharing initiatives to reduce disparities. The attendees agreed on the need for structured training to enhance surgical skills, especially for general practitioners in rural areas. Regulatory policies on task-sharing and task-shifting were considered essential to maintaining care quality while expanding access. Improving trauma care and emergency response through targeted training and rural workforce retention also remained key priorities. Advocacy efforts focused on integrating SAO care into national health priorities through data-driven communication and public engagement. The observatory aims to sustain progress through collaborative research, advocacy, and policy dialogues to ensure equitable, accessible, and high-quality SAO care across India.

Evolving treatment strategies for resectable gastric cancer: Bridging Asia-West disparities toward personalized and integrated therapy.

With the advent of flow cytometry and dedicated fluorescent dyes in the 1980s, automated reticulocyte enumeration has effectively superseded conventional manual microscopy, dramatically boosting throughput and precision while, through metrics including the immature reticulocyte fraction (IRF) and reticulocyte production index (RPI), delivering previously unattainable diagnostic resolution for anemia phenotyping, longitudinal tracking of marrow erythropoiesis, and evaluation of functional iron deficiency. Yet appreciable heterogeneity in analytical principles, reagent chemistry, and calibration frameworks persists across platforms, constraining result comparability and uniform interpretation across systems. The International Council for Standardization in Haematology (ICSH) is advancing commutable reference materials built on stable cell lines or synthetic microspheres, together with globally harmonized reference intervals, to achieve interoperable performance among instruments. Concurrently, the capital expense and servicing requirements of high-end fully automated analyzers continue to be a major impediment to clinical access to automated reticulocyte testing. This narrative review focuses on the "standardization and clinical accessibility of automated reticulocyte counting," systematically elaborating the core technical principles and characteristics of mainstream instruments, analyzing advances and challenges in standardization, and envisioning its application prospects in global clinical practice.

BackgroundPremature birth poses a major challenge in global obstetric clinical practice. The relationship between preterm infants and behavioral problems in school-aged children remains debatable, and the mediating role of sleep-disordered breathing (SDB) in this connection has not been investigated. This study aimed to address these gaps through a large-scale cross-sectional survey.MethodsWe recruited 18,138 children aged 6–10 from schools. Data on demographics, prematurity, SDB, and childhood behavioral problems were collected. The Paediatric Sleep Questionnaire (PSQ), a validated screening tool, assessed SDB symptoms, and the Conners’ Parent Rating Scale (CPRS) evaluated behavioral problems. Path analysis with bootstrap methods was used for statistical analysis.ResultsAmong 18,138 participants, 8% (n = 1,450) were premature. After adjusting for age, gender, BMI z-score, maternal age, and maternal education level, prematurity showed a positive association with total PSQ score (B = 0.411, p < 0.01). Higher total PSQ scores were significantly associated with all six CPRS dimensions (all p < 0.05). While prematurity was not directly associated with Conduct, Psychosomatic, Impulsive-hyperactive, or Hyperactivity scores in CPRS (all p > 0.05), it demonstrated significant associations with Learning problems (β = 0.063, p = 0.005) and Anxiety scores (β = 0.076, p = 0.003). Mediation analysis showed PSQ accounted for a large proportion of associations between prematurity and Conduct, Psychosomatic, Impulsive – hyperactive, and Hyperactivity problems (95% Bootstrap CI excluded 0).ConclusionPremature infants may exhibit behavioral problems significantly associated with SDB, though our cross-sectional design precludes causal inference and parent-reported SDB severity may bias true associations. Future studies should utilize longitudinal cohorts to explore whether SDB is involved in the relationship between prematurity and behavioral problems (eg, anxiety). Additionally, they should conduct pilot randomized controlled trials of SDB interventions in preterm infants to assess neurodevelopmental benefits. Final conclusions require subsequent causal validation.

To assess geographically global clinical practice guidelines (CPGs) for diabetic macular oedema (DMO) management. A systematic literature review (SLR) of CPGs for DMO management was conducted using Embase and MEDLINE databases, Guideline Central, Health Technology Assessment bodies, professional ophthalmology associations, and backwards citation tracking. CPGs published between January 2010-October 2023 were included and independently assessed by four reviewers and one adjudicator using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. CPGs were qualitatively assessed for anatomical measurement (optical coherence tomography [OCT]) and visual acuity (VA) recommendations. PROSPERO identification: CRD42023473223. 14/147 identified CPGs were included. Overall AGREE II scores were 49-91 (mean [SD] = 67 [11]). Strongest domains were Scope and Purpose (85 [10.9]), Clarity of Presentation (87 [18.7]), and Editorial Independence (91 [13.7]). Stakeholder Involvement (57 [8.3]), Applicability (54 [19.4]), and Rigor of Development (41 [19.0]) scored lowest. 13/14 CPGs were "Recommended" or "Recommended with Modifications". All CPGs recommended OCT for initial diagnosis. 3/14 CPGs did not recommend VA or considered VA optional. For initial disease management, 11/14 CPGs recommended OCT. One considered OCT optional. VA was recommended by 9/14 CPGs for initial management. All CPGs recommended using VA and OCT for disease monitoring while on anti-vascular endothelial growth factor therapy. 12/14 CPGs recommended using OCT to measure anti-VEGF response to adjust treatment interval. CPGs were aligned regarding the importance of OCT in DMO management. More rigorous methods, applicability in resource-constrained systems, and patient perspectives will improve CPG trustworthiness and transparency.

Primary target volume delineation for radiotherapy in nasopharyngeal carcinoma: CSTRO, CACA, CSCO, HNCIG, ESTRO, and ASTRO guidelines and contouring atlas.

Serum uric acid and its metabolism-a vital factor in the inflammatory transformation of cancer.

Primary mitochondrial myopathies (PMMs), a group of genetic mitochondrial oxidative phosphorylation disorders, primarily affect skeletal muscle function. No approved treatments for PMM exist, and patient information is limited. The international RePOWER registry (NCT03048617) assessed genotypic and phenotypic relationships in PMM and identified patients for MMPOWER-3 (elamipretide Phase 3 study). RePOWER enrolled screened and ambulatory patients aged 16-80 years. With signs and/or symptoms of PMM (N = 376; 60.4% female; mean [SD] age 42.6 [14.4] years; ~75% with an mtDNA variant and ~25% with an nDNA variant). Baseline information, current symptoms, qualityoflife, and functional assessments (6-Minute Walk Test [6MWT], Triple-Timed Up-and-Go [3TUG] Test, and 5-Times Sit-to-Stand Test [5XSST]) were captured. Accredited laboratory and genetic testing methods were available to most patients. The majority of enrolled PMM patients presented with progressive external ophthalmoplegia and fatigue. US patients were observed to use more medical interventions. Compared to non-US patients, US patients did not perform as well on the 6MWT (mean 364.6 vs. 375.2 m) and 5XSST (mean 21.6 vs. 18.6 s); US patients performed better on the 3TUG test (mean 40.2 vs. 45.0 s). The RePOWER registry provided data on patients with genetically confirmed PMM, thereby improving our understanding of PMM diagnosis and treatment and the differences in global mitochondrial clinical practice.

Introduction: Patients with complement 3 glomerulopathy (C3G) have poor clinical outcomes, although new targeted therapies have very recently been approved. Here, we describe the burden and management of C3G in global clinical practice. Methods: Retrospective analysis of data obtained from a cross-sectional survey (Adelphi Real World C3G Disease Specific Programme™) of nephrologists actively managing C3G (N = 195) and their patients (N = 385) in France, Germany, Italy, Spain, the UK (EU5), the USA, China, and Japan (July 2022–April 2023). Information on patient demographics, clinical characteristics, diagnosis journey, treatment patterns, dialysis and kidney transplant information, and patient-reported outcomes was collected from nephrologist-completed patient record forms (PRFs) and patient self-completion forms (PSCFs). Results were reported using descriptive statistics. Results: Records for 385 patients with C3G were completed by 129 nephrologists. Most patients had moderate to severe disease at the time of diagnosis (85.1%), based on individual nephrologist assessment. At the time of PRF completion, 83.4% of patients were receiving pharmacological treatment, which included angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (70.4%) and corticosteroids (48.6%). In patients receiving treatment, proteinuria remained the most common nephrologist-reported sign of C3G (66.0%), irrespective of treatment duration; of patients with available data, 68.9% had proteinuria ≥1 g/day. At the time of PRF completion, 8.3% of patients were on dialysis, 41.6% of patients were considered eligible for a kidney transplant, and 6.5% were transplant recipients. Patients experienced anxiety/depression (73.7%), pain/discomfort (65.3%), fatigue (90.7%), and problems doing usual activities (62.7%) at the time of PSCF completion. Conclusion: Despite most patients receiving current guideline-recommended standard of care, the burden of C3G remains high worldwide, demonstrating the need for more effective treatment options. In addition, most patients presented with advanced disease by the time of diagnosis, warranting a need to address significant diagnostic delays to facilitate earlier therapeutic intervention.

Rapid sequence intubation in emergency settings may involve opioid pretreatment to blunt hemodynamic responses during laryngoscopy and intubation; however, opioids may lead to postintubation hypotension, increasing morbidity and mortality. Global clinical practice varies significantly, reflecting uncertainty about opioids' benefits and risks. Our goal was to evaluate the association between opioid pretreatment and hemodynamic instability, focusing on postintubation hypotension in adult patients undergoing emergency intubation. We performed a systematic review of randomized controlled trials and observational studies comparing opioid administration vs. no opioids before adult emergency intubations. Searches included Cochrane, Embase, Medline, Scopus, and Web of Science databases until November 2024. Elective intubations were excluded. Eight (6708 patients) studies met criteria. The primary outcome was postintubation hypotension, variably defined across studies. Secondary outcomes included hypoxemia, first-attempt success, cardiac arrest, and vasopressor use. Independent reviewers conducted data extraction, risk-of-bias assessments, and certainty evaluation. Results were qualitatively synthesized. Among 6708 (2757 opioids and 3951 controls) patients, postintubation hypotension incidence varied widely (risk differences: -12.5% favoring opioids to +13.2% favoring controls). The single low-risk randomized study reported opioids increased hypotension (risk difference: 13%, odds ratio: 2.15, 95% confidence interval: 1.22-3.78). Observational studies yielded inconsistent results. Secondary outcomes showed no consistent differences. Evidence certainty was very low because of risk of bias, inconsistency, and imprecision. Current evidence regarding opioid pretreatment effect on postintubation hypotension risk during emergency intubation is limited and conflicting.

лукиан самосаткийThe search and application of genetic prognostic and predictive biomarkers in colorectal cancer (CRC) are aimed at identifying the characteristics of colorectal tumors for choosing a therapy strategy. The review is devoted to summarizing the achievements in scientific and clinical research on this topic.Aim. Based on genetic and epigenetic changes in CRC to analyze and summarize the world practice of using them as prognostic and predictive biomarkers of CRC to assess the patient’s prognosis and response to therapy.The analysis of modern literature data published in leading peer-reviewed journals in the Russian and international databases of scientific citation RSCI (Russian Science Citation Index), Medline and PubMed is carried out. The main phenotypes of the CRC pathogenesis are considered, as well as their possible functional intersections during the development of the disease. Both biomarkers already used in global clinical practice and potential promising biomarkers, including gene expression, are analyzed to identify subgroups of patients with high cancer risk at early stages of CRC. As a new approach from the perspective of personalized medicine, a set of tumor derivatives in biological media detected by liquid biopsy: circulating tumor cells, circulating DNA, microRNAs, and long non-coding RNAs is considered as biomarkers. It is noted that the joint use of biomarkers makes it possible to improve the prognosis and selection of therapeutic effects. A review of the literature confirms that modern methods of genetic analysis make a significant contribution to understanding the molecular mechanisms of CRC progression and resistance to antitumor therapy, thereby facilitating the selection of the most appropriate treatment strategy. To assess the potential of individual CRC biomarkers or biomarker panels, large-scale standardized studies and verification of these biomarkers in prospective international programs are necessary.

Pneumonia remains a leading cause of respiratory morbidity and mortality, underscoring the need for rapid and accurate diagnosis to enable timely treatment and prevent complications. This study introduces PELM (Pneumonia Ensemble Learning Model), a novel deep learning framework for automated pneumonia detection using chest X-ray (CXR) images. The model integrates four high-performing architectures—InceptionV3, VGG16, ResNet50, and Vision Transformer (ViT)—via feature-level concatenation to exploit complementary feature representations. A curated, large-scale dataset comprising 50,000 PA-view CXR images was assembled from NIH ChestX-ray14, CheXpert, PadChest, and Kaggle CXR Pneumonia datasets, including both pneumonia and non-pneumonia cases. To ensure fair benchmarking, all models were trained and evaluated under identical preprocessing and hyperparameter settings. PELM achieved outstanding performance, with 96% accuracy, 99% precision, 91% recall, 95% F1-score, 91% specificity, and an AUC of 0.91—surpassing individual model baselines and previously published methods. Additionally, comparative experiments were conducted using tabular clinical data from over 10,000 patients, enabling a direct evaluation of image-based and structured-data-based classification pipelines. These results demonstrate that ensemble learning with hybrid architectures significantly enhances diagnostic accuracy and generalization. The proposed approach is computationally efficient, clinically scalable, and particularly well-suited for deployment in low-resource healthcare settings, where radiologist access may be limited. PELM represents a promising advancement toward reliable, interpretable, and accessible AI-assisted pneumonia screening in global clinical practice.

Abstract BackgroundSickle cell disease (SCD) is a widespread inherited condition that has increased in global prevalence by 41% since 2000. Despite advancements in understanding the pathophysiology and clinical management of SCD, limited evidence exists regarding the economic implications of interventions for managing the disease during pregnancy.AimThe World Health Organization is developing its first global clinical practice guidelines for the management of SCD during pregnancy. This systematic review aims to evaluate the cost‐effectiveness of interventions for the screening and management of SCD during pregnancy to inform guideline development.MethodsWe searched MEDLINE, Embase, CINAHL, PsycINFO, Global Index Medicus, NHS Economic Evaluation Database, and EconLit for articles published from inception to December 4, 2024, using key terms related to pregnancy, SCD, and economic evaluation. We included full economic evaluations on any interventions for the detection, treatment, and/or management of SCD during pregnancy. Data on the study characteristics, intervention, comparator, and key economic and health outcomes were extracted. Results were reported narratively, with conversions of costs to 2024 US dollars where applicable. The methodological quality of the included studies was assessed using the Consensus on Health Economic Criteria (CHEC) extended checklist.ResultsThree studies published between 1999 and 2010 were included, all of which focused on screening strategies as interventions. No evaluations of other SCD management strategies were identified. There was considerable variability and limitations in economic evaluation methodologies, hindering direct comparisons of cost‐effectiveness. Studies that assessed universal compared to selective screening strategies found that selective screening was more cost‐effective; however, universal screening may be a viable option in high‐prevalence contexts. One study that examined primary and secondary screening strategies reported that the cost per pregnancy for offering sickle cell trait screening was highest for primary care with parallel testing ($41) (i.e., test offered to mothers and fathers at the same time), followed by primary care with sequential testing ($37) (i.e., test offered to mothers, followed by father if mother identified as a carrier), and secondary care with sequential testing ($29).ConclusionsThere is a significant gap in the economic evidence for interventions for SCD during pregnancy, particularly in low‐resource settings. This gap underscores the urgent need for more high‐quality economic evaluation studies to inform equitable, evidence‐based global guidelines for SCD screening and management during pregnancy.

This study aims to describe the prevalence of previous solid tumor and prior systemic cancer therapy in patients newly diagnosed with active tuberculosis (TB) in a low-Tuberculosis-incidence region. A retrospective multicenter study was conducted from 2018 to 2023 across two tertiary hospitals in southeastern Spain, covering a population of approximately 341,000 inhabitants. Patients with culture-confirmed TB were identified through electronic health records. Demographic data, cancer history, systemic cancer therapy, and comorbidities were analyzed to assess any association between active TB and previous solid tumors. Among 87 patients diagnosed with active TB (incidence rate: 5.1 per 100,000 inhabitants per year), 64.4% were male, with a median age of 48years (range: 0-85). Only four patients (4.6%) had a history of solid tumor, none of whom had received systemic cancer therapy or radiotherapy prior to active TB diagnosis. Statistical analysis showed no significant difference between TB patients with a history of cancer and the general population, and there were no significant associations between gender, country of origin, or systemic cancer therapy. In this low-incidence TB region, previous medical history of solid tumor among active TB patients is marginal. Solid tumor history does not behave as a strong risk factor for active TB development. In this region, routine latent TB screening in solid cancer patients is not supported by scientific evidence. Routine TB screening may lead to unnecessary interventions and increase healthcare costs. Further research in different epidemiological settings is recommended to validate these findings and inform global clinical practice guidelines.

Introduction: Variability in clinical practice for pharmacological thromboprophylaxis in superficial endovenous interventions may reflect inconsistencies and ambiguities present in clinical practice guidelines (CPGs) for this patient cohort. Conflicting recommendations not only complicate clinical decision-making but can also negatively impact patient outcomes and impose unnecessary costs on healthcare providers. This study aimed to assess the quality of these guidelines using the Appraisal of Guidelines for REsearch &amp; Evaluation II (AGREE II) instrument, highlighting strengths, weaknesses and areas for improvement. Methods: A systematic search of Ovid Medline, Embase and grey literature was conducted to identify CPGs addressing pharmacological thromboprophylaxis in superficial endovenous interventions. Four independent assessors evaluated each guideline using the AGREE II tool across six domains: Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability and Editorial Independence. Inter-reviewer reliability was calculated using the intraclass correlation coefficient (ICC) and a Pearson correlation analysis assessed associations among the domains. Results: Ten guidelines published between 2014 and 2024 met the eligibility criteria. Among these, four (40%) were classified as high quality, specifically those from the National Institute for Health and Care Excellence (NICE), European Society for Vascular Surgery (ESVS), Scottish Intercollegiate Guidelines Network (SIGN) and the joint American Venous Forum (AVF), American Vein and Lymphatic Society (AVLS) and Society for Vascular Surgery (SVS). The remaining six guidelines were rated as low quality, with the Royal Society of Medicine (RSM) guideline scoring the lowest. Notable variability was observed in the scores, particularly within the Rigour of Development and Applicability domains, with the Applicability domain achieving the lowest mean score (33.4±26.0%). ICC values indicated good inter-reviewer reliability (ICC=0.81), with excellent agreement observed in the Stakeholder Involvement and Rigour of Development domains. Strong correlations between the Scope and Purpose, Stakeholder Involvement and Rigour of Development domains suggest that these aspects of guideline quality are interrelated. Conclusions: The assessed guidelines for pharmacological thromboprophylaxis in superficial endovenous interventions exhibit considerable inconsistencies and a reliance on low-quality evidence, which limits their applicability in clinical practice. Targeted improvements in the Rigour of Development and Applicability domains could enhance the clarity, quality and practical utility of these guidelines. Future research could focus on evaluating the impact of guideline quality on clinical outcomes and explore clinicians’ perspectives on guideline inconsistencies to better understand their influence on decision-making in this area.

Background/ObjectivesTo assess geographically global clinical practice guidelines (CPGs) for neovascular age-related macular degeneration (nAMD) management.MethodsA systematic literature review (SLR) of CPGs for nAMD management was conducted using Embase and MEDLINE databases, Guideline Central, Health Technology Assessment bodies, professional ophthalmology associations, and backwards citation tracking. CPGs published between January 2010–October 2023 were included and independently assessed by four reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). CPGs were qualitatively assessed for anatomical measurements (optical coherence tomography [OCT] and visual acuity [VA]). PROSPERO identification is CRD42023473223.ResultsNine of 147 identified global CPGs were included in the SLR for diagnosis, treatment, and disease monitoring for nAMD. Overall AGREE II scores were 62–95 (mean [standard deviation] score 75 [10.6]). Strongest domains were Scope and Purpose (86.6 [11.0]), Clarity of Presentation (84.3 [13.0]), and Editorial Independence (89.1 [15.4]); Stakeholder Involvement (63.4 [16.6]), Applicability (73.0 [12.6]), and Rigor of Development (55.4 [25.9]) were lowest. 4/9 CPGs were “Recommended” by reviewers, and 5/9 were “Recommended with Modifications”. All CPGs recommended OCT for initial diagnosis. 2/9 CPGs did not mention VA. For managing pharmacological interventions, 4/9 CPGs recommended using VA, and three recommended OCT. Eight CPGs recommended using either VA or OCT for disease monitoring while on anti-vascular endothelial growth factor (VEGF) treatment. 6/9 CPGs recommended screening for VA and 7/9 CPGs recommended using OCT to change anti-VEGF intervals.ConclusionCPG methods, recommendations on applicability in resource-constrained systems, and patient advocacy/perspectives will improve CPG trustworthiness and transparency.

Low back pain (LBP) is the most common and incapacitating musculoskeletal disorder globally. The use of non-pharmacological interventions for the management of LBP is recommended by global clinical practice guidelines. However, existing guidelines often exhibit poor quality, as evidenced by inadequate systematic reviews of evidence. This necessitates further reviews tailored to the specific context of different countries. This review searched the CINAHL, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and Wanfang databases from their inception to May 14, 2024. After data extraction by two independent researchers, a total of 57 randomized control trials (RCTs) were included. The Bayesian network meta-analysis results demonstrated that: (1) non-pharmacological therapies generally exhibited superior efficacy over pharmaceuticals in improving functional disability and overall efficacy; (2) pharmaceuticals, both alone and in combination with non-pharmacological therapies, were generally more effective than most non-pharmacological therapies in reducing pain intensity. High heterogeneity was observed, which could be explained by LBP subtypes in the analysis of functional disability. While heterogeneity had a limited impact on the confidence of results for pain intensity and functional disability, it significantly influenced the assessment of overall efficacy with major concerns of imprecision. The high volume of studies with a high risk of overall bias necessitates cautious interpretation of these findings. Chinese LBP patients may benefit most from non-pharmacological interventions, particularly those rooted in Traditional Chinese Medicine, for improving disability. For pain intensity reduction, pharmaceuticals andmulti-componenttherapies incorporating pharmaceuticals may be more effective.

Vectorcardiography (VCG) is an electrophysiological investigation technique, giving supplementary information about the electrical activation of the heart, compared to traditional 12-lead electrocardiography (ECG). Whereas the 12-lead ECG has found its way into global clinical cardiology practice in numerous cardiac pathophysiological instances, VCG has not. In an investigation of the electrical activation of the heart in cardiac resynchronization therapy (CRT), in order to understand the baseline pathology in potentially eligible patients, and to understand and optimize CRT-derived paced activation of the heart in the therapy's recipients, all of these aspects are essential to the success of the therapy. Due to a consistently present group of non-responders in CRT, VCG has gained interest as a potential improvement in this field. This review comprehensively summarizes the contemporary evidence for the additional value of VCG in CRT, as well as current deficiencies in evidence, to support its implementation in global practice in addition to, or as a substitution for, traditional 12-lead ECG.

1924-2024: First centennial of EEG.