A majority of adolescents do not meet the recommended levels of physical activity, while reported levels of mental health problems are increasing, and socioeconomic disparities in academic performance are widening. Many schools are implementing physical activity in different forms, but there is inconclusive evidence on what types of interventions improve mental health, cognitive functions, and academic performance and how to implement such interventions. There is a critical need for integrated, feasible, and equitable interventions. The objective of this study is to develop an effective multi-component school-based intervention that will target both physical activity and homework support during an extended school day and evaluate its effects on mental health, cognitive function and academic performance. The study is designed as a cluster-randomised controlled trial with 54 schools and approximately 2,700 students in grade 8 (age 14-15). The intervention includes three weekly 60-minute sessions: (1) Different types of physical activities (2), Homework support with short activity breaks, and (3) Walking and listening to audiobooks. This study will evaluate both outcome effects and implementation process. The primary outcome is anxiety, assessed using the Spence Children's Anxiety Scale (SCAS-S). Secondary outcomes include physical activity, sedentary time and behaviours measured by accelerometry and questionnaire, cognitive functions assessed by a computer-based test battery, mental health and sleep with questionnaires, and academic performance by grades. Process evaluation will include fidelity, dose, feasibility, acceptability and context, using structured documentation, interviews, focus groups, and observations. The effectiveness of outcomes between groups will be assessed using mixed-effects regression analysis, adjusting for relevant covariates. Process data will be analysed using descriptive statistics and content, and thematic analysis. This study addresses key knowledge gaps in school-based health promotion by integrating physical activity and homework support within the school structure. The results will yield insights into both effectiveness and implementation, informing future policy and practice in schools to promote health and facilitate students' learning. The intervention targets youth in diverse socioeconomic contexts and is expected to contribute to reducing health and education inequalities. The trial was retrospectively registered on April 27, 2021. ISRCTN78666212.

This randomized controlled study aimed to examine the effects of a six-week Differential Learning (DL)-based adaptation of the FIFA 11+ Kids warm-up program on selected physical performance outcomes, including agility, sprint speed, and jump performance in youth male basketball players (mean age = 13.2 ± 0.8 years). A pre-post test design was used, with twenty participants randomly assigned to either a basketball-adjusted FIFA 11+ Kids (BB-adjusted FIFA 11+ Kids) group or a DL-based warm-up group. Bayesian repeated-measures ANOVAs, along with Bayesian independent- and paired-samples t-tests, were conducted to evaluate between- and within-group changes. Between-group analyses showed inconclusive evidence for differences in sprint (BF 10 = 0.41), agility without the basketball (BF 10 = 0.55), agility with the basketball (BF 10 = 0.54), and jump performance (BF 10 = 0.40). Bayesian evidence indicated comparable pre-to-post improvements in both groups across all performance measures. These results suggest that a short-term DL-based warm-up results in comparable performance outcomes to the basketball-adjusted version FIFA 11+ Kids program. Future research should investigate whether extending DL-based approaches beyond an acute warm-up context, such as implementing them across training periods longer than six weeks and including retention testing, affects performance outcomes in youth athletes. In addition, examining different levels and types of variability (e.g., geometric versus dynamic noise) may help clarify context-dependent effects of DL-based warm-ups.

ABSTRACT Engaging adolescents with health topics on social media is notoriously challenging. A common strategy is message personalization, yet most efforts focus on personalizing what is said rather than how it is expressed. This is a missed opportunity, as youth-relevant health communication requires attention to both style and content. Digital communication environments enable such adaptation by making users’ linguistic patterns visible and available for personalization. Yet little is known about how adolescents respond to health messages written in a similar linguistic style, or how such similarity is best operationalized. Addressing these gaps, this preregistered study tests whether adolescents prefer social media health messages that are more similar to their linguistic style and identifies which linguistic categories are most effective in eliciting positive responses. Using WhatsApp conversations donated by 191 Dutch adolescents (aged 13–15), we derived linguistic profiles and created Instagram-style health messages varying in linguistic similarity. Participants then evaluated 22 message pairs, each pair manipulating one linguistic category. Multilevel Bayesian analyses yielded inconclusive evidence for effects of linguistic similarity on message preference or personalization, and moderate evidence against effects on perceived effectiveness. Our findings point to potential trade-offs between experimental transparency and similarity strength, yielding important insights for refining future operationalizations. At the same time, adolescents consistently preferred positive and simple-worded messages, which gives general stylistic guidance for more engaging health communication on social media. Further, we discuss implications for AI-based style matching, including the use of algorithmic approaches and large language models.

Quality participation of physical activity matters for quality of life and subjective wellbeing in people with disabilities.

BackgroundThis study investigates the association between the frequency of daily use of technology and working memory (WM) cognitive function in older adults, considering variables such as digital competencies, frequency of technology use, educational level, and age. Previous research shows mixed results; some indicate benefits (Pochintesta et al., 2021; Valdivieso Ortega et al., 2021), while others find inconclusive evidence (Montejo et al., 2022). Declining WM, commonly associated with aging (Stern, 2021) and significantly affected by neurodegenerative diseases such as Alzheimer's (Calero & Navarro, 2022), manifests as a reduced capacity to process and store information, leading to difficulties in daily life. This research used a reverse sentence WM test, increasing in difficulty, based on Baddeley's model, which defines WM as retaining and manipulating verbal information via the phonological loop, central executive, and episodic buffer. (Baddeley & Hitch, 1974; Baddeley, 2000).MethodThe sample consisted of 66 individuals aged over 60, predominantly women (90.9%), from the University Program for Older Learners (PUAM) at the National University of Mar del Plata and community centers of Mar del Plata city. The average age was 69.4 years, with an average educational level of 5 (tertiary or incomplete universitary education) (Pascual et al., 1993). Participants completed a reverse sentence WM test, the Digital Competencies Questionnaire (DigComp, 2022, IKANOS), and a frequency test for everyday technology use.ResultA Kendall´s Tau correlation model was applied due to data non‐normality (Shapiro‐Wilk test, p < 0.05). Significant positive correlations were found between WM and digital competencies (p < .001), frequency of technology use (p < .01), and educational level (p < 0.01), and showed a negative significant correlation with age (p < .05).ConclusionFindings suggest that older adults with higher WM performance also have higher educational levels, supporting education as a protective factor in aging. Higher WM scores were associated with greater digital competencies and more frequent use of everyday technology, contributing to independence and autonomy. However, despite this, older participants showed lower WM scores, consistent with age‐related cognitive decline. These results highlight the importance of promoting technology access among older adults to enhance digital skills and maintain cognitive function.

This study aims to extract the inclusive soteriological formulation of Aswaja from the text Jauharah al-Tawhid and the tradition of syarh, assess its implications for the design of intra-Islamic dialogue, and develop operational tools in the form of SOPs, checklists, rubrics, and facilitation protocols that are publicly accountable. The study uses a two-track qualitative approach. The text track is carried out through a close hermeneutic reading of ibarat-syarh by mapping usul/furu and the status of dalil (qat’i/zanni). The application track involves interviews and FGDs with facilitators, kiai, and community activists. Data were analyzed using Reflexive Thematic Analysis, supplemented by source-method-researcher triangulation, member-checking, audit trail, and a Delphi-based consensus test. The research findings formulate five principles of Aswaja's inclusive soteriology: firmness in proposals (qathi), openness in furu (zanni), rejection of takfir (contempt) against sinners, tawaqquf (religious tolerance) in the face of inconclusive evidence, and recognition of the udhr bil-jahl (the evil-doer) and ahl al-fatrah (the people of fatrah) as soteriological variables. These principles are mapped into dialogue SOPs in the form of issue classification, freezing of khilafiyyat (the wrong-doer), reason-giving procedures, tawaqquf (the wrong-doer), restorative language, the udzr bil-jahl protocol, and official clarification channels. The findings can be applied in the Religious Moderation program, the framework for Islamic intra-faith dialogue, the design of community-based conflict prevention policies, curriculum development in Islamic universities, and mediator training. These results are useful for Islamic boarding schools (pesantren), government institutions, interfaith organizations, and community facilitators in promoting tolerance and reducing sectarian tensions. This research introduces a two-track Delphi-based model that weaves classical texts into a community policy framework, as an example of "hermeneutics that yields policy." Its contribution lies in combining normative theology with practical instruments of facilitation, offering transferable design principles for building tolerance and religious dialogue in a structured manner.

The existing literature on bank mergers reveals mixed and inconclusive evidence on merger ‎outcomes, particularly in developing economies. This study examines the impact of the 2020 ‎merger of Indian Public Sector Banks (PSBs), which remained largely underexplored. The ‎study employs a quantitative design with causal-comparative elements, utilising eight years (2016–2024). It applies the "Profit = Spread – Burden" framework to explore the drivers ‎of bank profitability after the mergers. CAMEL-based key performance ratios are also analysed using paired and independent-samples t-tests, and a difference-in-differences regression is employed to isolate merger effects. Findings indicate improved profitability primarily due to ‎increased spreads, alongside gains in capital adequacy and asset quality. Employee productivity rose without significant downsizing, though rising intermediation costs highlight operational challenges. A significant decline in the cost of funds (CF) highlights stronger bargaining power ‎and an improved ability of merged banks to mobilise funds at lower costs. Compared to non-‎merged banks, merger benefits appear moderate, questioning guaranteed scale efficiencies. ‎Thus, with a multi-layered analytical approach, this study provides insights into merger ‎outcomes for policymakers in evaluating the effectiveness of mergers as a reform tool, ‎especially in the Indian banking context.

BackgroundA common magnitude system—consistently involving the right intraparietal sulcus (IPS)—has been proposed to support the representation of space, time and numerosity. While shared mechanisms are acknowledged, domain-specific contributions have also been suggested. Among these, the role of the right precuneus remains debated, with inconclusive evidence regarding its involvement in spatial and temporal processing. Translating this question into the language domain and within a grounded cognition framework, we investigated the causal contribution of the IPS and precuneus to the processing of spatial and temporal concepts (e.g., circuit, eternity) using a state-dependent Transcranial Magnetic Stimulation (TMS) priming paradigm. Twenty healthy participants received stimulation over the IPS and precuneus, and a sham stimulation over the control site (vertex).ResultsResults showed that stimulation of the IPS abolished the priming effect observed under the sham control condition for both spatial and temporal concepts, whereas stimulation of the precuneus selectively disrupted priming for temporal concepts only.ConclusionsThese findings support the role of the right IPS as a key area for magnitude processing in language, while also highlighting a more specific contribution of the precuneus—particularly its ventral portion—to temporal concepts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12993-025-00315-9.

With shifting perceptions about the therapeutic potential of cannabis and evolving regulatory frameworks, global prescribing of medicinal cannabis is increasing. While some emerging evidence supports its use for conditions like multiple sclerosis and epilepsy, its efficacy and safety profile for the treatment of mental health conditions remains controversial and under-explored. Previous reviews found inconclusive evidence due to heterogeneity in study design and quality. Accordingly, this review was designed as a scoping review, consistent with established methodological frameworks to map and characterise all available randomised controlled trial (RCT) evidence in this emerging and heterogeneous field. It specifically sought to synthesise the highest-quality trial evidence to date, addressing the question: How effective is medicinal cannabis in treatingmental health conditions, as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and how safe and tolerable is it, as assessed through adverse events and treatment withdrawals? A scoping review was conducted comprising RCTs investigating medicinal cannabis for mental health conditions. Eligible studies were required to meet predefined inclusion criteria based on population, intervention, comparator, outcomes, and study design (PICOS framework). PubMed, Web of Science, and PsycINFO databases were searched, supplemented by citation tracking and Google Scholar, for studies published between 1980 and 2024. The search identified 8061 studies, with 28 RCTs meeting inclusion criteria across 12 DSM-5 mental health conditions. Indications most frequently studied were schizophrenia (n = 5), cannabis use disorder (n = 4), cocaine use disorder (n = 4), post-traumatic stress disorder (n = 3), anxiety disorders (n = 3), and opioid use disorder (n = 2); there were two trials in autism spectrum disorder and single trials in depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, tobacco use disorder, and Tourette syndrome. Sample sizes ranged from 6 to 150 participants (median = 42), and follow-up durations from 1 day to 13 weeks (median = 6 weeks). Interventions included purified cannabidiol (CBD; single doses of 300-800 mg and daily regimens up to 1000 mg/day), nabiximols or other tetrahydrocannabinol (THC)/CBD oromucosal sprays (up to 113 mg THC/105 mg CBD per day), and smoked or vaporised cannabis flower of varying THC/CBD content. Findings showed substantial heterogeneity and variable quality, with some short-term benefits reported (notably in cannabis use disorder, autism spectrum disorder, and schizophrenia), but no trial demonstrated long-term efficacy. Despite growing interest, substantial heterogeneity limits current evidence for medicinal cannabis in mental health. This review highlights key gaps, underscoring the need for robust, well-powered RCTs with extended follow-up to clarify its role in the management of mental ill health.

Melatonin is multifaceted neurohormone secreted by pineal gland during darkness which is regulated by a small region present in hypothalamus i.e. Suprachiasmatic nucleus (SCN). Although melatonin primarily regulates the sleep and wake cycles, its effects are not limited to sleep. It also contributes to a number of physiological processes, including hormone regulation, metabolism, reproduction and body temperature regulation. Research has consistently highlighted the potential of melatonin to support reproductive health by enhancing testosterone synthesis, promoting gametogenesis, and improving both sperm quality and motility. Moreover, it has been found that melatonin improves fertilization rate and oocyte quality, making it a valuable adjunct in fertility treatments for both men and women. Beyond its role in reproductive function, melatonin also possesses potent anti-apoptotic, antioxidant, anti-inflammatory and properties. These effects help safeguard reproductive cells from the harmful impacts of oxidative stress and DNA damage, further underscoring melatonin's importance in maintaining optimal fertility and overall reproductive health. Despite its potential benefits, melatonin utility in reproductive health remains controversial due to inconclusive evidence, unclear mechanism and scattered information. Additionally, the supplementation of dosage and duration of melatonin in infertility and reproductive health needs exploration. In this review, we have tried to summarize the findings from various clinical and pre-clinical studies demonstrating the therapeutic potential of melatonin in male and female fertility and reproductive health. Aim of this review is to provide a deep knowledge on the current status of melatonin's potential therapeutic effects on reproductive health with emphasis on the molecular mechanism and future directions in melatonin's utility in reproductive health.

Association between blood cholesterol profile and risk of lung cancer: A meta-analysis of prospective cohort studies.

This systemic review bridges any gaps in current literature and knowledge regarding the efficacy of neuroimaging modalities in the prediction of the conversion of MCI (mild cognitive impairment) to AD (Alzheimer's disease) dementia, and provides a recommendation for the best neuroimaging METHOD: A comprehensive literature review was performed using SCOPUS, Google Scholar, and PubMed with the combination of any of the following keywords: "neuroimaging," "MCI to AD," "conversion," "prediction," "MRI," "FDG-PET," "SPECT," "EEG," and Research Rabbit was used to discover relevant literature based on previously searched papers. Paper exclusion criteria included: those without a specific mention of MCI-AD conversion in their titles, ones that discussed the conversion of MCI to any other form of dementia besides AD dementia, papers with inconclusive evidence of efficacy, papers that did not use neuroimaging methods, and any papers that mentioned "MCI due to AD." Additionally, papers were only considered if they were published between the years of 2000 to 2024. A total of 89 papers were reviewed for this review paper, and 27 papers were excluded from the final review due to meeting one or more of the exclusion criteria. There were 6 total papers for EEG studies, 16 papers for SPECT, 31 for MRI studies, and 7 for FDG-PET. In a clinical setting, there may be limited resources and funding available for such predictive methods, so while the usage of SPECT or FDG-PET may be effective methods in the prediction of MCI-AD conversion in laboratory settings, they require resources that most clinics do not have and utilize radioactive tracers. While EEG is a promising up-and-coming methodology, more research needs to be done on its efficacy in a clinical setting. Based on the current evidence available, MRI (specifically sMRI and DTI) has the highest predictive ability of MCI-AD conversion in a clinical setting.

Impact of Statins on Mortality and Cardiovascular Outcomes in Dialysis Patients With Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-Analysis.

The international popularity of cannabis and the shifting legal landscape have propelled conversationsaround its medical and recreational use to the forefront of public discussion. Clinicians face increased questions from patients, though there is a lack of clear medical consensus on several conditions for which cannabis is commonly used. As of 2025, key indications for cannabis and cannabinoid use are nausea and vomiting induced by chemotherapy, loss of appetite due to HIV/AIDS, Dravet syndrome, Lennox-Gastaut syndrome, seizures associated with tuberous sclerosis, and multiple sclerosis spasticity. We reviewed current evidence for cannabis and cannabinoid treatment of chronic noncancer pain, insomnia, and psychiatric and neurologic disorders. We also considered current inconclusive evidence for cannabis to treat opioid use disorder and neurological disorders. Risks associated with cannabis and cannabinoid use include addiction, decreased neurocognitive function (particularly in adolescents) cannabinoid hyperemesis syndrome, psychosis, perinatal complications, cardiovascular and pulmonary disorders, as well as physical injury risks, such as falls and motor vehicle accidents. As public and clinical interest in cannabis grows, clinicians must evaluate potential harms alongside benefits relevant to the medical condition for which cannabis is being considered. Anecdotal experiences and commercial claims, whether positive or negative, and however compelling, must be eschewed in favor of research findings and facts to guide clinical decision‑making.

Evidence around pressure injuries in palliative care settings is limited and fragmented. To synthesize systematic review evidence regarding prevalence, risk factors, prevention and treatment of pressure injuries in non-acute care settings, and evaluate implications for specialist palliative care. A rapid overview of reviews following the Cochrane guidance for overviews. We searched four databases (MEDLINE, Cochrane Database of Systematic Reviews, JBI EBM Reviews, and CINAHL) from inception to October 2024. We included systematic reviews on adult patients in inpatient Palliative Care Units or settings likely involving end-of-life care. Seventeen systematic reviews incorporating 149 unique studies (n = 5,856,293) were included. Thirteen of the reviews were high quality. Only one low-quality review specifically addressed palliative care, focusing on prevalence and risk factors. Interventions were categorized into nutritional, physical (e.g. repositioning, tilt strategies), topical/dressing-based, electrical stimulation and organizational approaches. Frequent repositioning and certain nutritional interventions may reduce incidence or surface area of pressure ulcers; however, certainty remains very low. Frequent repositioning, specific tilt strategies and specific nutritional interventions may help reduce the incidence of pressure injuries and decrease injury surface area; however certainty is very low. Other interventions have limited and inconclusive evidence and were rated low to very low certainty according to GRADE criteria due to poor trial design and population and setting variations. The evidence base remains weak and largely indirect, offering insufficient guidance for clinical practice in palliative care. High-quality, targeted research is needed to inform effective pressure injury prevention and management in this population.

Through a quasi-experimental research design, we show that incorporating self-care reminders in an online sociology course correlates with greater student engagement. Online learning has received enhanced attention since it became the primary learning modality during COVID-19 shutdowns. Despite inconclusive evidence about the efficacy of online learning, students report feelings of isolation and disconnection they attribute to reduced learning in online courses. To enhance learning, online teachers are encouraged to cultivate emotional connections with students, although some report that performing such emotional labor is detrimental to their own mental health. Through a quasi-experimental research design conducted in six online asynchronous courses over three semesters between 2020 and 2022, this study shows incorporating self-care reminders in an online sociology class correlates with higher student engagement that is not emotionally draining for teachers. We suggest incorporating self-care reminders in online sociology courses to improve student engagement without demanding excessive emotional labor from sociology teachers.

Eye disorders significantly impair quality of life, productivity, and overall well-being. With the increasing interest in integrative medicine, yoga has been explored as a potential adjunct therapy for ocular conditions. This systematic review aimed to examine the efficacy of yoga-based interventions in managing glaucoma, refractive errors, dry eye disease, and visual strain. A comprehensive literature search of MEDLINE/PubMed (January 2000 to April 2025) identified experimental studies that evaluated the effects of yoga on eye disorders. Fourteen eligible studies were included. The risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools, and the PRISMA guideline was followed. The strong evidence supports meditation and pranayama as effective adjuncts in reducing intraocular pressure in glaucoma, potentially via stress modulation and autonomic regulation. Limited and inconclusive evidence has been found regarding the effects of yoga on myopia and dry eye disease. Methodological limitations, such as small sample sizes, short intervention durations, and subjective outcome measures, were commonly observed. Yoga is a promising adjunct therapy for glaucoma management. However, more rigorous, long-term, randomized trials with standardized protocols and objective outcomes are needed to validate its role across diverse ocular conditions. eye health, eye disorders, glaucoma, myopia, dry eye disease, yoga, meditation, pranayama, systematic review.

Abstract INTRODUCTION Due to inconclusive evidence, the role and timing of cavity boost radiotherapy (CBRT) following resection of metastases varies in practice globally. Better patient stratification is urgently needed to identify those that might benefit, but limited predictive models exist. This study aims to explore factors associated with improved outcomes in this patient cohort, to inform a clinically useful predictive algorithm. METHODS Patients (n=163, M:64, F:99): histologically confirmed brain metastases undergoing resection at a UK Brain Tumour Centre of Excellence from 2016-21. Data collected: primary site, staging, total intracranial metastases, steroid treatment, KPS, surgery, overall survival (OS), local recurrence. Statistical analysis: Restricted Mean Survival Times (RMST), following Inverse Probability of Treatment Weightage (IPTW) confounder adjustment; Univariate and Multivariate Piecewise Cox Proportional Hazards models to identify significant risk factors, with Leave-One-Out Cross-Validation (LOOCV), Likelihood Ratio Test (LRT) and time-dependent Area Under the Curve (AUC) performed as validation. RESULTS 50 (31%) patients received CBRT (fractionated=31, single-fraction-SRS=19). CBRT demonstrated significant cumulative OS gains from 1 year [RMST: 2.31, 95%CI:-3.30 - -1.40, p=0.002] to 4.6 years [RMST: 6.33, 95%CI:-13.33 - -0.38, p=0.049]. CBRT had the most significant protective effect on OS in the high-risk mortality group (OS&amp;lt;7months) [HR: 0.14, Bootstrapped 95%CI: 0.04-0.39, p=0.0003] compared to moderate-risk (7months&amp;lt;OS&amp;lt;45months) and low-risk (OS&amp;gt;45months) groups. Per 10-point increase in postoperative KPS, mortality risk decreased by 19% [HR: 0.98, Bootstrapped 95%CI: 0.97-0.99, p=0.009]. Multivariate modelling was statistically significant overall (LRT χ²=95.5, p&amp;lt;0.0001), with good predictive power (LOOCV C-index: 0.70, 95%CI: 0.64–0.75) across 1-5 years respectively (time-dependent AUCs: 0.711, 0.715, 0.710, 0.638, 0.611). CONCLUSION Based on a large, multivariate dataset, with long-term follow-up, we identified postoperative KPS with early, upfront CBRT as being key to conferring significant and sustained benefits to patients. These data informed a risk-adapted predictive model that can be used in the management of this patient cohort.

The social support criterion is a significant factor used by US transplant centres to determine whether someone is eligible to be placed on the transplant list. Although intended to fairly allocate donor organs, it exacerbates inequities to transplant accessibility by unfairly excluding one-fifth of individuals seeking transplant listing. Ethical concerns regarding this criterion have been widely discussed, particularly due to bias in assessing the adequacy of support and inconclusive evidence that a strong social network improves transplant outcomes. However, luck egalitarianism-the view that injustices resulting from circumstances beyond one's control are unjust-has not been applied in this context. Inadequate social support is a circumstance shaped by uncontrollable factors such as mental health conditions, familial dynamics, geographic isolation and socioeconomic status. Thus, excluding candidates on this basis reinforces structural inequities.This paper begins by examining practices within the transplant system, particularly in the case of alcohol-related end stage liver disease, through luck egalitarian reasoning, and argues that this perspective helps to ethically evaluate the social support criterion. After establishing its relevance, the concept of luck egalitarianism is then applied to critique the use of the social support criterion, drawing on Organ Procurement and Transplantation Network guidelines and principles. Finally, this paper addresses the objection that removing this criterion would necessitate the elimination of all other non-voluntary criteria, specifically poor medical status and financial instability. Ultimately, the social support criterion is unjust as it penalises individuals for circumstances outside of their control without sufficient utilitarian justification for doing so.

BackgroundRobotic-assisted mitral valve surgery (RAMVS) has emerged as an alternative to conventional minimally invasive mitral valve surgery (MIMVS). However, previous studies have been limited by small sample sizes, heterogeneous techniques and reliance on unmatched or indirectly compared cohorts, resulting in inconclusive evidence. This meta-analysis focuses exclusively on propensity-matched studies to provide a more robust comparison of RAMVS and MIMVS.MethodsA comprehensive literature search was performed to identify propensity-matched studies comparing RAMVS and MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup analyses, including mitral valve repair only, non-isolated mitral valve surgery and MIMVS via right minithoracotomy, were conducted to explore heterogeneity.ResultsEight studies comprising 3352 patients were included, with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a shorter hospital stay (MD -1.8 days; 95% CI -3.0 to -0.5; p = 0.006) but significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI 0.8-42.9; p = 0.04), and higher odds of conversion to sternotomy (OR 2.9; 95% CI 1.6-5.4; p = 0.0007) and re-exploration for bleeding (OR 1.86; 95% CI 1.1-3.2; p = 0.02). Intensive care unit stay, operative time and postoperative complications were comparable. All subgroup analyses consistently showed higher conversion rates with RAMVS.ConclusionThe RAMVS offers potential recovery benefits but at the cost of greater intraoperative complexity. Careful patient selection and technical expertise are essential to maximise outcomes.