Metagenomic next-generation sequencing in pediatric infectious disease diagnosis: A comprehensive systematic literature review and meta-analysis.

Perianal fistulising Crohn's disease (pfCD) is a heterogeneous phenotype of Crohn's disease with marked variability in anatomical complexity, symptomatology, and disease trajectory. This often creates uncertainty in the optimal approach to management, particularly the surgical aspects of when to perform examination under anaesthesia (EUA) and when to insert or remove setons. We conducted a systematic review following PRISMA guidelines. Multiple databases were searched from inception through December 2025. Eligible publications included clinical guidelines on pfCD and/or rectovaginal fistulas that reported indications for EUA, seton insertion, and/or seton removal. We stratified recommendations by fistula complexity, the presence of abscesses, and clinical symptoms. Risk of bias was assessed using the AGREE II Instrument. Twenty-four guidelines met inclusion criteria. EUA (and often seton placement) was universally recommended for perianal abscesses and frequently for symptomatic complex pfCD. For asymptomatic complex or symptomatic simple fistulas, recommendations were variable and often conditional on the presence of proctitis or plans for biologic therapy. In contrast, EUA and setons were not broadly endorsed for asymptomatic simple fistulas. Recommendations for seton removal varied widely, ranging from predefined intervals after anti-TNF therapy initiation to individualised criteria based on clinical or radiologic response. Most guidelines did not consider symptom type/severity, prior surgery, suitability for surgical closure, and asymptomatic abscesses detected by imaging. Substantial heterogeneity and limitations exist across guidelines on the surgical management of pfCD. This underscores the need for international consensus informed by multidisciplinary expertise to standardise care in this complex population.

While antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) is increasingly recognized, cases presenting with initial gastrointestinal symptoms remain underexplored. This study aimed to analyze the clinical characteristics of AAV patients with gastrointestinal onset. Seven AAV patients meeting ACR/EULAR criteria, who presented with gastrointestinal symptoms between January 2017 and 2024, were retrospectively identified. A literature review was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, and Wanfang. In total, 23 patients were included in the study. Among the 23 AAV patients with gastrointestinal symptoms, 15 (65.2%) were male, with a median age of 54 years (range: 18-79). Common clinical manifestations included hematochezia (56.5%), weight loss (43.5%), and purpura (34.8%). Eight (34.8%) had superficial gastritis, and seven (30.4%) had colonic ulcers, as identified by gastrointestinal endoscopy. Laboratory findings revealed elevated D-dimer levels and anemia in most patients, with impaired renal function and a median hemoglobin level of 105 g/L. Anti-PR3 immunoglobulin G (IgG) and antimyeloperoxidase IgG antibodies were positive in 83.3 and 80% of cases, respectively. Abdominal computed tomography (CT) revealed wall thickening in 39.1% of patients, and chest CT identified interstitial lung disease in 73.9% of patients. Nine patients (39.1%) were initially misdiagnosed, with five (55.6% of those nine) misdiagnosed as having inflammatory bowel disease. Most patients responded well to glucocorticoid and immunosuppressive therapy, with 39.1% receiving a combination of glucocorticoids and cyclophosphamide. Gastrointestinal symptoms in AAV are rare, and misdiagnosis remains a concern. Early detection requires assessing gastrointestinal, pulmonary, and renal involvement.

Combining network pharmacology and multi-omics reveals the role of Shengdihuang-Huangqi herb pair in alleviating type 2 diabetes mellitus.

This systematic review evaluated the antibacterial efficacy of the GentleWave system compared with other endodontic irrigation systems. A comprehensive literature search was conducted across multiple databases (PubMed, MEDLINE, Web of Science, Scopus). The eligibility criteria were formulated using the PICOS framework, focusing on the antibacterial efficacy of the GentleWave system compared to other irrigation methods. A total of 2327 articles were screened, with five meeting the selection criteria for inclusion. Four studies were conducted in vitro, one in ex vivo, and various tooth types were tested. A bias assessment was conducted using the QUIN tool. Four studies had a low risk of bias, with one study scoring medium risk. All concluded that the GentleWave system significantly reduced microbial counts. Emerging evidence suggests that GentleWave may provide superior antibacterial efficacy in root canal therapy, making it a compelling option. However, further research is needed to confirm its benefits and promote broader adoption.

Unveiling the genus Taraxacum: From folk medicine to chemodiversity-driven pharmacological and toxicological outcomes-A systematic review.

Progress in research on the hepatoprotective effects of C-21 steroidal glycosides from Baishouwu.

Calycosin ameliorates high-altitude pulmonary edema by regulating macrophage polarization through the PPAR-γ/NF-κB pathway: a comprehensive analysis of network pharmacology, molecular docking, and experimental validation.

Fertility and obstetric outcomes after fertility-sparing treatment for early-stage endometrial cancer and atypical hyperplasia: a systematic review and meta-analysis.

Systematic multi-component profiling of Xiangju Rupining Capsule via online comprehensive two-dimensional liquid chromatography-quadrupole time-of-flight mass spectrometry coupled with stepwise acquisition workflow and multivariate data mining.

Non-pharmacotherapy for craving in methamphetamine use disorder: A systematic review and network meta-analysis of randomised controlled trials.

Secondary stroke prevention focuses on managing vascular risk factors such as hypertension, hyperglycemia, and dyslipidemia. However, the impact of exercise training regimens (ETR) on these factors post-stroke remains unclear. We conducted a network meta-analysis (NMA) to compare the effects of different ETR on vascular risk factors and adverse events in patients following stroke or transient ischemic attacks (TIA). We performed a systematic review following PRISMA criteria, searching multiple databases until March 2024. The outcomes of interest included systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), fasting blood glucose (FBG), and body mass index (BMI). A Bayesian network meta-analysis approach was used to estimate mean differences (MD) and 95% credible intervals (CrI). We analyzed 20 randomized clinical trials involving 1653 patients. Moderate intensity continuous training (MICT) and comprehensive training program (CTP) showed the greatest effects on SBP and DBP. Resistance training (RT) was most effective for improving lipid profiles. ETR had no significant effect on post-stroke FBG and BMI. For secondary stroke prevention, MICT and CTP may be beneficial for managing hypertension, while RT could be the primary strategy for improving lipid profiles.Trial Registration: CRD42024554934.

In the United States, colorectal cancer is the third most prevalent non-skin cancer, causing 8% of cancer-related deaths. The most effective way to decrease cancer morbidity and mortality is cancer screening. However, individuals who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) are less likely to utilize cancer screening services compared to the general population. To understand the barriers to effective colorectal cancer screening in the LGBTQ+ population and recommend solutions, we conducted a critical review of the literature using multiple databases until March 2024 using search strings like "colorectal cancer", "screening", "LGBTQ+", "healthcare equity" and "barriers". We addressed the barriers at various levels, including patient, provider, institution, health insurance, healthcare policies, and data and population surveys. Our analysis indicates that the key contributing factors are social stigma, lack of provider awareness, and insufficient culturally competent care. We also recommend potential solutions such as provider training, increasing awareness and accessibility of screening services, and incorporating patient-centered care models. To achieve equitable access to colorectal cancer screening for the LGBTQ+ population, a holistic strategy involving healthcare professionals, lawmakers, and researchers is required. By identifying the challenges and solutions, this minireview aims to promote healthcare equity and better health outcomes for the LGBTQ+ population. Recommendations for future studies are also given to improve healthcare provision for the LGBTQ+ community.

Red cell distribution width (RDW) measures the red blood cell size variation. Elevated RDW has been associated with various adverse health outcomes, including cardiovascular diseases. To analyze current evidence on the prognostic significance of high RDW in patients with heart failure (HF). A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, and Google Scholar, up to May 2024. Studies were included if they investigated the relationship between RDW levels and outcomes in HF patients. Compared to those in the lowest quartile. The primary outcome was all-cause mortality. Compared to those in the lowest quartile. Heterogeneity was assessed using the I 2 statistic, we assessed the impact of individual studies on the overall estimate using a leave-one-out sensitivity analysis and publication bias was evaluated through a contour-enhanced funnel plot and Luis Furuya-Kanamori (LFK) index. Seven studies, including a total of 11460 HF patients, were analyzed. The participants' mean age varied between 60 years and 80 years, with 6562 (57.26%) in the lower quartile. Patients in the highest quartile of RDW (> 15.21%) had a significantly increased risk of all-cause mortality, with an odds ratio of 1.84 (95%CI: 1.31-2.57, P < 0.001), compared to those in the lowest quartile (RDW: 14.1%-15.20%). There was significant variability in the included studies' results (I 2 = 93%, P < 0.01), as well as potential publication bias suggested by the high LFK index (8.47). Sensitivity analysis reinforced the robustness of these findings, showing that the results were not unduly influenced by any single study. This meta-analysis confirms that high RDW is a robust predictor of adverse outcomes in patients with HF, highlighting its potential utility as a simple, cost-effective biomarker for risk stratification. Future research should focus on elucidating the mechanisms underlying this association and exploring the potential benefits of RDW-guided therapeutic strategies in HF management.

Meta-topolin riboside (mTR) has shown superior effects over benzyladenine (BA) in promoting root and shoot development in passion fruit tissue culture, yet its underlying mechanisms remain unclear. Understanding the metabolic differences between mTR and BA treatments can inform optimized propagation strategies for high-quality planting material in this economically important crop. Nodal buds of Passiflora edulis "Tainung No. 1" were cultured on BA- or mTR-supplemented medium, then analyzed using ultra-high-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) in SWATH acquisition mode. Metabolite features were extracted, statistically filtered (VIP > 1, FC > 1.5 or < 0.667, p < 0.05), identified via multiple databases, and subjected to enrichment and pathway analysis. SWATH-MS detected 2823 ions in positive and 1637 in negative mode, with 21 significant metabolites identified in each mode. mTR treatment upregulated metabolites linked to root development (e.g., 5,10-methylenetetrahydrofolate, daidzin, and hesperidin) and stem elongation (amygdalin), while BA treatment had higher levels of kinetin, gibberellin A4, and lignans. Pathway analysis highlighted folate metabolism as significantly enriched in mTR samples. mTR treatment altered phytohormone, flavonoid and phenolic profiles in ways that likely promote rooting, shoot elongation and oxidative stress resilience, explaining its superior growth performance over BA. These insights can guide refined cytokinin use in micropropagation and broader applications in horticultural biotechnology.

Adolescent idiopathic scoliosis (AIS) affects physical and psychosocial health, with treatments including surgery, bracing, and observation. However, the long-term effects on health-related quality of life (HRQoL) are still uncertain. The aim of the present study was to evaluate the long-term HRQoL outcomes in untreated AIS patients compared to those undergoing surgical or brace interventions through systematic review and meta-analysis. A systematic search was conducted across multiple databases (PubMed, Scopus, WoS, and Medline). Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) tool, and evidence certainty was evaluated using the GRADE system. The primary outcomes of the meta-analysis were measured using SRS-22r and SF-12 scales for the assessment of HRQoL, evaluating domains including function, mental health, pain, self-image, and satisfaction after a minimum ten-year follow-up period. Eight studies published between 2010 and 2023 that assessed HRQoL after a follow-up period of ten years or more were included in the systematic review. Six studies were included in the meta-analysis. The observation group showed better outcomes in functional (MD 0.43, 95% CI 0.01-0.84) and mental health domains (MD 0.12, 95% CI 0.03-0.20) compared to the surgical group. No significant differences were found in pain, self-image, and satisfaction domains. Comparison between observation and brace groups showed equivalence across all domains. Evidence certainty ranged from moderate to low. Long-term HRQoL in AIS shows no clear benefit of surgery or bracing over observation, which may offer equal or better mental and functional outcomes. This supports personalized care. Further high-quality research is needed to strengthen the evidence base.

Purpose This research formulates an integrative framework bridging established strategic theories and artificial intelligence (AI) adoption in Ibero-American small and medium-sized enterprises (SMEs), addressing how resource-constrained organizations navigate digital transformation challenges. Design/methodology/approach Employing a structured narrative literature review following Torraco (2016) and Juntunen and Lehenkari (2021), this study synthesizes 72 articles from multiple databases (2015–2024). The analysis integrates resource-based view (RBV), dynamic capabilities theory and institutional theory through thematic synthesis and systematic coding procedures. Findings Four interrelated drivers enable SMEs to overcome resource constraints: strategic synchronization, leadership commitment, technology sensing and institutional bridging. These drivers result from iterative thematic synthesis, demonstrating how organizational antecedents interact with contextual moderators through implementation processes to generate performance outcomes. Originality/value The framework extends strategic management theories to emerging market contexts, offering eight testable propositions linking capability development to AI-driven performance. For practitioners, findings highlight how SME leaders can align AI initiatives with strategic capability growth to improve competitiveness despite resource limitations.

Advancements in cochlear implant (CI) and hearing aid (HA) technology enabled the combining of acoustic and electric stimulation for bimodal hearing and electro-acoustic stimulation (EAS) among listeners with hearing loss. While some users experience benefits such as enhanced speech or music perception and improved localization, others face interference between CI and HA, potentially leading to HA discontinuation. Our study aims to explore the underlying causes of interference, map existing evidence, and identify potential research gaps. The insights gained on interference will help foresee and mitigate such scenarios, improving speech and music perception in bimodal and EAS users. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines, and it was registered on protocols.io (access online at dx.doi.org/10.17504/protocols.io.dm6gp37xdvzp/v2). Inclusion criteria were peer-reviewed articles written in English and published between 2000 and May 2024, and articles reported adverse performance outcomes with combined CI and HA use in adults or children compared to CI or HA alone. Relevant articles were searched using specific key words and Boolean operators across multiple databases. The final scoping review included 15 articles published across 13 scientific journals. These articles originated from nine countries and underwent narrative analysis to extract insights on interference in combined CI and HA use. The study offers valuable insights into the prevalence, causes, and assessment of interference in the combined use of CI and HA. Our review suggests that bimodal interference is individualized or listener-specific, with various factors affecting the utility of bimodal and EAS. Thus, a mixed-methods approach should be implemented in the future to gain a more comprehensive understanding of interference. Customized strategies can also be explored and applied to reduce interference through HA programming, CI mapping, counseling, and training to enhance the benefits for bimodal and EAS users.

Gymnodiptychus pachycheilus, a specialized schizothoracinae fish, exhibits remarkable morphological regression, such as near-complete scale loss, making it an important model for understanding the genomic basis of adaptation and phylogeny in this lineage. Here, we assembled a high-quality chromosome-level reference genome of G. pachycheilus by Illumina short reads, PacBio HiFi long reads, and Hi-C technologies. The final genome assembly spans 1.83 Gb, with 95.52% of the sequences anchored onto 25 pseudochromosomes, a contig N50 of 71.36 Mb, and a BUSCO completeness of 98.40%. Repetitive sequences accounted for 47.75% of this genome. We predicted 48,952 protein-coding genes, of which 92.51% were functionally annotated using multiple public databases, together with diverse classes of non-coding RNAs. This genome assembly represents the first high-quality reference for G. pachycheilus and provides a valuable resource for exploring genome evolution, rediploidization processes, and adaptive mechanisms of schizothoracinae fishes on the Qinghai-Tibet Plateau.

Neoadjuvant chemoimmunotherapy has high rates of pathologic response and improved prognosis among solid tumors. Its role in head and neck squamous cell carcinoma (HNSCC) remains understudied. To summarize the efficacy associated with neoadjuvant chemoimmunotherapy regimens in HNSCC and to compare the efficacy associated with neoadjuvant chemoimmunotherapy vs immunotherapy alone in locoregionally advanced resectable HNSCC prior to definitive surgery. A librarian-led systematic review was conducted using multiple electronic databases, including Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, following Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Databases were queried from inception to October 2024. Inclusion criteria included prospective interventional trials that have completed accrual, with results published in English. Only trials of resectable, treatment-naive HNSCC were included. Exclusion criteria included lack of reporting on pathologic response or Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 response. Two investigators independently conducted title, abstract, and full-text reviews per PRISMA guidelines. Primary outcomes extracted were major pathologic response (MPR) and complete pathologic response (CPR) at surgery and complete response (CR) on imaging by RECIST 1.1. Secondary outcomes included 1-year overall survival (OS) and toxic effects. A meta-analysis was performed using a binary random-effects model to determine the pooled proportion of primary outcomes in the immunotherapy and chemoimmunotherapy groups. Heterogeneity was reported as I2. A total of 751 patients (502 [77%] male; age range, 27-87 years) across 23 studies were included in the meta-analysis, including 357 patients (47%) who underwent chemoimmunotherapy, 102 patients (14%) who underwent dual-agent immunotherapy, and 292 patients (39%) who underwent single-agent immunotherapy. Pooled rates of MPR plus CPR were 66% (95% CI, 58%-73%; I2 = 0.59) for chemoimmunotherapy, 18% (95% CI, 6%-29%; I2 = 0.65) for dual-agent immunotherapy, and 6% (95% CI, 3%-9%; I2 < 0.01) for single-agent immunotherapy. Across all groups, 1-year OS rates ranged from 88% to 96% for single-agent immunotherapy, 88% to 96% for dual-agent immunotherapy, and 88% to 100% for chemoimmunotherapy. Grade 3 to 5 adverse events were reported in 61 of 210 patients (29%), 2 of 67 patients (3.0%), and 36 of 210 patients (17%) among the reporting studies in the single-agent immunotherapy, dual-agent immunotherapy, and chemoimmunotherapy groups, respectively. These findings suggest that neoadjuvant chemoimmunotherapy regimens were associated with higher pathologic and radiographic response rates compared with immunotherapy alone in locoregionally advanced HNSCC. These results call for phase 3 trials comparing these neoadjuvant regimens head to head.