Clinical guidelines rely heavily on expert opinions and institution protocols to provide recommendations for administration of systemic antibiotic prophylaxis for open extremity fractures to prevent fracture-related infections. The purpose of this study was to determine evidence-based (1) durations; (2) types; (3) dosing regimens of systemic perioperative antibiotic prophylaxis following Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity open fractures, and isolated lower extremity open fractures to prevent fracture-related infections. Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and the GRADE approach were implemented to structure and synthesize this study. Five databases (PubMed, Cochrane Library, Web of Science, Scopus, CINAHL) were systematically and independently searched for randomized controlled trials (RCTs) meeting eligibility criteria. Included patients had open extremity fractures and were treated with prophylactic systemic antibiotics administered perioperatively (preoperative, intraoperative, postoperative). Meta-analyses were done of the data. Twenty-one (n = 21) RCTs met eligibility criteria (Gustilo-Anderson type I = 6, Gustilo-Anderson type II = 4, Gustilo-Anderson type I/II = 12, Gustilo-Anderson type III = 4, Gustilo-Anderson type I/II/III = 21). Summary tables were generated to provide evidence-based durations and types of systemic antibiotic prophylaxis after Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity (hand) open fractures, and isolated lower extremity open fractures. Although data were derived primarily from older studies, we summarized the strongest available evidence from RCTs for antibiotic prophylaxis following Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity open fractures, and isolated lower extremity open fractures.

To compare the one-year clinical efficacy and cost-effectiveness of single vision lenses (SVL), Myopia-control spectacle lenses (MCSL), Orthokeratology (Ortho-K), and Repeated Low-Level Red-Light (RLRL) therapy in children within a real-world setting. This retrospective observational cohort study analyzed data from 206 myopic children aged 8-14 years, who had already received one of four myopia control interventions: SVL (n = 50), MCSL (n = 60), Ortho-K (n = 44), or RLRL (n = 52). The primary outcomes were the change in axial length (AL) and spherical equivalent refraction (SER) after one year of intervention. The secondary outcome was the Incremental Cost-Effectiveness Ratio (ICER), calculated as the additional cost per 0.1mm of AL elongation saved compared to the SVL group. All active interventions significantly outperformed SVL in controlling AL elongation (SVL mean: 0.42mm/year). RLRL exhibited the greatest efficacy (mean AL change: 0.06mm; 86.0% relative to SVL), with 31% of participants showing axial shortening. Ortho-K (0.18mm; 57.5% efficacy) and MCSL (0.23mm; 45.2% efficacy) also demonstrated substantial benefits. Mean annual direct medical costs were $140.93 (SVL), $429.44 (MCSL), $1,108.08 (Ortho-K), and $806.29 (RLRL). ICER analysis identified MCSL as the most cost-effective active intervention ($151.69 per 0.1mm AL saved), followed by RLRL ($184.13), while Ortho-K yielded the highest ICER ($400.42). In this one-year study, RLRL therapy was observed to have the highest efficacy. However, the finding of axial shortening warrants validation in long-term randomized controlled trials (RCTs) to elucidate its mechanism and long-term safety. MCSL spectacle lenses were identified as the most cost-effective option, representing a well-balanced profile of efficacy and economic feasibility. Ortho-K, while a highly effective intervention, was associated with a greater financial burden.

Abstract Purpose of Review The purpose of this manuscript is to provide an overview of plaque modification technologies available to the interventionalist treating peripheral arterial disease. Recent Findings Conventional balloon angioplasty continues to be an often-used resource. However, more specialized balloons, including drug-coated, cutting and scoring balloons, play a key role in vessel preparation. Though not demonstrated in the literature, their theoretical benefit includes improved drug delivery and uniform vessel dilation. Atherectomy comes in many forms as multiple randomized control trials have demonstrated its superiority to conventional angioplasty. Intravascular lithotripsy has taken a foothold in the treatment of severe calcific disease with trials to support their effectiveness. Summary Multiple plaque modification modalities are available in the vascular surgeon’s arsenal. A thorough understanding of their mechanism of action is paramount to tailoring their use to various lesion types.

The aim of this study is to review literature on the relationship between physical activity (PA) and idiopathic pulmonary fibrosis (IPF), specifically investigating the effect of PA on IPF outcomes reported in RCTs, the relationship between PA and IPF outcomes over time in longitudinal cohort studies and the lived experience of PA among people with IPF in qualitative studies. Following the PRISMA checklist, a structured search strategy was developed by two reviewers and applied to six databases up to June 2024.Grey literature was excluded. Randomised control trials, longitudinal studies and qualitative research papers were included. Screening was completed independently by two reviewers, followed by manual screening. Data extraction was completed manually using extraction tables. Of 4,092 articles retrieved, fourteen were included: five randomised control trials and one follow-up study; five longitudinal and three qualitative studies. PA significantly improved QOL in four trials that analysed this outcome, with two studies reporting a p-value of < 0.001 and two others reporting p-values of < 0.04 and < 0.01. Longitudinal studies demonstrated low device-measured PA and high self-reported sedentary time correlated with poorer morbidity and mortality. Lower aerobic fitness measured using 6MWT correlated with higher mortality.Qualitative research identified progressing disease and respiratory symptoms as barriers, while social support and telehealth facilitated PA engagement. Short-term improvements are observed in physical capacity and QOL by incorporating PA in IPF management. Aerobic testing and PA correlate well with morbidity and mortality outcomes. Positive patient perspective on PA further supports PA prescription in IPF.

Objective To evaluate the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in relieving postoperative pain and reducing the incidence of postoperative nausea and vomiting (PONV) in patients undergoing cancer surgery. Methods A systematic search was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, and Wanfang databases to identify randomized controlled trials (RCTs) published between January 2015 and May 2025. Postoperative pain scores at different time points, assessed using the visual analog scale (VAS) or numerical rating scale (NRS), as well as the incidence of PONV, postoperative nausea (PON), and postoperative vomiting (POV), were extracted. Subgroup analyses were performed according to the timing of TEAS intervention and pain assessment methods. The risk of bias was evaluated using the Cochrane Risk of Bias (RoB) tool, and the meta-analysis was conducted using RevMan 5.4 software. Results A total of 16 randomized controlled trials involving 2,017 postoperative cancer patients were included (1,125 in the TEAS group and 892 in the control group). Meta-analysis of 13 studies showed that TEAS significantly reduced postoperative pain scores (SMD = −1.19, 95% CI: −1.42 to −0.95, p &amp;lt; 0.00001). Eleven studies indicated that TEAS decreased the incidence of PONV (RR = 0.47.95% CI:0.37~0.61, P &amp;lt;0.00001). Four studies were included in the meta-analysis of postoperative nausea, showing a significant reduction in incidence in the TEAS group compared to controls (RR = 0.33, 95% CI: 0.22 to 0.49, p &amp;lt; 0.00001). Another four studies showed a downward trend in postoperative vomiting but without statistical significance (RR = 0.69, 95% CI: 0.44 to 1.09, p = 0.11). Conclusion TEAS appears to be an effective adjunctive intervention for alleviating postoperative pain and nausea in patients undergoing cancer surgery, showing clear clinical advantages. Further high-quality, large-scale, and multicenter studies are warranted to confirm its long-term efficacy and to promote the standardization of TEAS protocols for broader clinical application. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038890

This systematic review and meta-analysis aimed to assess the clinical outcomes of biologic therapies, which include platelet-rich plasma and cell-based therapies (e.g., adipose-derived mesenchymal stem cells), on pain, physical function, and disease progression in patients with knee osteoarthritis (OA), focusing on studies with a follow-up of at least 12 months. We searched for randomized controlled trials (RCTs) posted at some stage in January 2000-May 2025. Eligible research protected the ones in adults with Kellgren-Lawrence grades I-III OA who underwent at least 12 months of follow-up. The bias risk was assessed, and the evidence certainty was evaluated. Random-effects models were used for pooled analyses. Fourteen RCTs were included. Compared with control treatments, biologic therapies significantly reduced pain and improved physical function. Potential structural benefits, including cartilage thickness preservation and favourable biochemical changes, were noted. However, substantial heterogeneity in study design and intervention protocols, along with potential publication bias, reduced the certainty of evidence to a very low level. Biologic therapies may be associated with improvements in pain and physical function at ≥12 months of follow-up, with preliminary indications of structural benefit. Nevertheless, high-quality multicenter RCTs with extended follow-up are warranted.

Relying on a single primary endpoint in randomized controlled trials (RCTs) is often infeasible, for example due to rare or heterogeneous events. Regulatory guidance therefore allows multiple endpoints, but different analytical strategies address different scientific questions and null hypotheses, even when applied to the same set of variables. We explored three approaches to consider multiple endpoints in the primary analysis of RCTs, as stated in the FDA and EMA guidelines on multiplicity: (i) a composite endpoint (CE), (ii) multiple testing and multiplicity correction (MTMC), and (iii) a hierarchical non-parametric procedure, called generalized pairwise comparisons (GPC). Using clinical trial simulations, we compared these strategies' power in two-arm RCTs perform when testing strategy-specific hypotheses across a range of scenarios reflecting endpoint prioritization, correlation between endpoints, and opposing treatment effects. When testing time-to-event endpoints, global testing strategies (CE and GPC) generally achieved higher power than MTMC. However, we also demonstrate that global procedures may yield statistically significant results even when treatment effects are heterogeneous across endpoints, underscoring the importance of careful interpretation and component-wise assessment. As trials increasingly use multiple endpoints, understanding the trade-off between statistical efficiency and interpretability, and provide practical guidance for choosing endpoint definitions and primary analysis strategies in future trials.

Type2 diabetes mellitus (T2DM) necessitates long-term pharmacological management, with drug safety now a pivotal factor in therapy selection. Sodium‒glucose cotransporter2 inhibitors (SGLT2is) and dipeptidyl peptidase4 inhibitors (DPP4is) are widely prescribed oral antidiabetic agents; however, their comparative safety profiles remain under debate. A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was performed up to June 2, 2025. Forty-two randomized controlled trials (RCTs) that compared SGLT2is with DPP4is in adults with T2DM were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Review Manager (RevMan) 5.3. Heterogeneity was assessed with I2, and publication bias with funnel plots and Egger's test. SGLT2is were associated with a higher overall risk of total adverse events (AEs) (RR1.05, 95%CI 1.01-1.08). Infection-related risks included increased genital infections (RR5.31, 95%CI 3.93-7.18) and urinary tract infections (UTIs) (RR1.45, 95%CI 1.25-1.70), with no difference in upper respiratory tract infections (URTIs) (RR0.78, 95%CI 0.61-1.02). For organ injury, a non-significant trend toward renal injury was noted (RR1.83, 95%CI 0.92-3.67), with no difference in liver injury (RR0.64, 95%CI 0.28-1.46) or fracture (RR0.83, 95%CI 0.25-2.70). Severe outcomes-including hypoglycemia (RR1.07, 95%CI 0.88-1.29), mortality (RR1.48, 95%CI 0.59-3.71), diabetic ketoacidosis (DKA) (RR2.99, 95%CI 0.31-28.45), and major adverse cardiovascular events (MACEs) (RR1.21, 95%CI 0.35-4.19)-did not differ. Hypersensitivity risk was also comparable (RR1.25, 95%CI 0.65-2.42). SGLT2is have an overall favorable safety profile but increase the risks of genitourinary infections and transient renal impairment. Risk stratification and monitoring are essential for high-risk individuals, for whom DPP4is may be safer. These findings provide robust RCT-based evidence to inform individualized treatment and guideline updates. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. The protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251115623).

Background Severe mental illness (SMI) is associated with high cardiovascular disease (CVD) risk. Important contributors are poor diet quality, physical inactivity, and metabolic side effects of antipsychotic medication entailing significant weight gain. Evidence implies that dietary counseling delivered by clinical dietitians leads to greater improvements in diet quality, weight management, and cardiometabolic health than counseling delivered by non-specialist health personnel, especially when combined with increased physical activity. However, randomized controlled trials (RCTs) testing clinical dietitian-led nutrition counseling integrated with structured exercise across diverse treatment modalities in psychiatric care remain scarce. Objective The Norwegian Mental Illness Heart Health (NORMI-Heart) study will evaluate the efficacy and applicability of a 6-month lifestyle program, combining individualized, clinical dietitian-led nutrition counseling focused on weight reduction and improved dietary quality, and moderate-to-vigorous exercise training, on CVD risk in adults with SMI in Oslo, Norway. Methods This parallel-group RCT will recruit 70 overweight adults with SMI. Participants will be randomized to a 6-month diet and lifestyle intervention, or control. The intervention is individualized and includes monthly one-to-one sessions with a clinical dietitian focusing on heart-healthy eating and weight reduction, monthly supervised group exercise, and support to follow an individual exercise program. Control participants will receive treatment as usual (TAU). The NORMI-Heart Trial aims to evaluate the effect of the intervention on estimated CVD risk. Expected outcomes This trial aims to provide evidence on the effectiveness, feasibility, and real-world applicability of clinical dietitian-led nutrition counseling combined with structured exercise for reducing CVD risk in individuals with SMI. Findings may strengthen the scientific and policy rationale for integrating clinical dietitians as a standard part of multidisciplinary mental health care. Results will also inform scalable, integrated lifestyle care models in mental health services. Trial registration ClinicalTrials.gov Identifier: [NCT07085923].

Cannabidiol (CBD) has gained significant attention for its potential therapeutic benefits, but its safety profile in healthy populations remains underexplored. This systematic review and meta-analysis aim to evaluate the safety of CBD compared to placebo in healthy adults. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov identified four randomized controlled trials (RCTs) involving 269 healthy adults. The primary outcome was headache, with secondary outcomes including fatigue, abdominal pain, diarrhea, upper respiratory tract infection (URTI), and dizziness. The results revealed that CBD use was associated with a significantly higher risk of diarrhea (RR = 5.85; 95% CI = 1.14–30.02; P = 0.03). While there was a trend toward increased abdominal pain and headache, these results were not statistically significant. Fatigue, dizziness, and URTI showed no significant differences between the CBD and placebo groups. These findings suggest that while CBD appears safe for short-term use in healthy adults, gastrointestinal side effects, particularly diarrhea, should be monitored. Further large-scale studies with longer follow-up periods are warranted to confirm these results and explore long-term safety.

The healthcare sector is rapidly evolving with the integration of Artificial Intelligence (AI). As AI technologies shift from rule-based expert systems to deep learning architectures, AI-based chatbots have emerged as innovative solutions to persistent challenges in the health domain. Given the growing concerns about their effectiveness and ethical implications, as well as the demand to optimise their potential in facilitating health outcomes, this study conducts a systematic review of existing research on AI-based chatbots, focusing on their applications and evaluation. A total of 348 articles, collected from eight databases—PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IEEE, the ACM Digital Library, Scopus, and Web of Science - 20 of which were analysed. This review identifies four main research areas concerning AI-based chatbots: text quality, clinical efficacy, user engagement, and safety. It also highlights the lack of randomised controlled trials (RCTs) and the limited use of theoretical frameworks in evaluating their performance. Future research directions and practical solutions are discussed.

Background and Objectives: Gingival recession (GR) is a recognized periodontal condition that can expose the tooth root, imposing aesthetic, functional, and hypersensitivity concerns. We conducted this study to investigate xenogenic soft tissue substitutes as potential alternatives to the gold standard connective tissue graft (CTG) for the treatment of multiple GR. Materials and Methods: This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted until October 2025 for randomized controlled trials (RCTs) comparing connective tissue graft (CTG) to xenogeneic substitutes (XCM or P-XADM) for treating multiple gingival recessions. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB 2 tool, 2019 version. Data were pooled using a random-effects model to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) for primary (mean root coverage, MRC; complete root coverage, CRC) and secondary outcomes (clinical attachment level, CAL; keratinized tissue width, KTW; gingival thickness, GT; probing depth, PD). Results: Sixteen RCTs (632 patients, 1878 recessions) were included. At 6 and 12 months, CTG demonstrated a significantly greater MRC than both XCM (MD −13.4% and −11.05%) and P-XADM (MD −11.63% at 12 months). CTG was also superior to XCM in achieving CRC at 6 months (RR = 0.71, 95% CI [0.62 to 0.82]). For secondary outcomes, CTG showed superior gains in CAL and KTW at 12 months compared with both xenogeneic materials. GT was significantly greater in the CTG than in the XCM group in 12 months. No significant differences were found in PD at all time points. Conclusions: CTG continues to have superior clinical outcomes in the treatment of multiple GR. However, xenogenic materials are a promising alternative, particularly when patient comfort and satisfaction are prioritized. Future well-designed trials with larger sample sizes and standardized outcomes are needed to validate their clinical benefits and long-term stability.

Abstract Background We conducted a systematic review and meta‐analysis to examine the effects of mindfulness‐based interventions (MBIs) on emotion regulation (ER) and emotion dysregulation (ED) in people with any mental health condition. Methods Following a pre‐registered protocol (PROSPERO CRD42024618605), we searched multiple databases (Web of Science, PsycINFO, Embase, and PubMed) on 04/07/2025. We identified randomised‐controlled trials (RCTs) in which the effects of MBIs on ER or ED were measured in people with mental health conditions established by an adequately trained healthcare professional according to the Diagnostic and Statistical Manual of Mental Disorders (from third to fifth editions) or equivalent diagnosis as per the International Classification of Diseases (ninth or 10th revisions). Pooled effect sizes (Hedge's g ) were estimated using random‐effect meta‐analyses. Study quality was assessed using the Cochrane Risk of Bias Tool 2 . Results We identified 19 RCTs, with 16 in the meta‐analyses (988 participants in total; 50.71% randomised to MBIs). We found that MBIs significantly improved cognitive reappraisal ( k = 6, g = 0.65, 95% CI = 0.33, 0.98) and reduced overall ED ( k = 9; g = −0.54; CI = −0.71, −0.36). Significant reductions in ED domains concerning goal‐directedness, impulsivity, and accessing ER strategies were found. Effects for expressive suppression were nonsignificant ( k = 6; g = −0.25; CI = −0.94, 0.45) with significant heterogeneity. Study quality significantly moderated both ER outcomes, though not overall ED. Conclusion MBIs show potential for improving cognitive reappraisal and reducing ED across diagnoses. However, limited evidence for younger people and self‐report measurements warrant cautious interpretation. Trial Registration NIHR PROSPERO 2024 CRD42024618605. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024618605 .

Objective This systematic review, including a meta-analysis, aimed to investigate the efficacy and safety of direct oral anticoagulants (DOACs) in preventing and resolving radial artery occlusion (RAO) following transradial artery access. Methods We synthesized evidence from randomized controlled trials (RCTs) identified in PubMed, CENTRAL, Scopus, and Web of Science up to May 2025. Using Stata MP v. 17, we employed a fixed-effects model to report dichotomous outcomes, presenting relative risk ratio (RR) with a 95% confidence interval (CI). Trial sequential analysis (TSA) was conducted to investigate the robustness and reliability of the cumulative evidence. Results Four RCTs with 970 participants were included. DOACs significantly decreased the incidence of RAO [RR: 0.49, 95% (0.31, 0.79), p &amp;lt; 0.001]. However, in terms of RAO resolution, there were no differences between groups [RR: 1.22, 95% CI (0.80, 1.88), p = 0.36]. Moreover, there were no differences between groups regarding the incidence of hematoma [RR: 0.56, 95% (0.12, 2.61), p = 0.46], minor bleeding [RR: 1.55, 95% (0.72, 3.32), p = 0.26], and major bleeding [RR: 2.41, 95% (0.48, 12.25), p = 0.36]. There were no incidences of arteriovenous fistula, pseudoaneurysm, or compartment syndrome throughout the trials. Conclusion DOACs significantly prevented the incidence of RAO, although TSA indicates that this finding is not yet conclusive. No significant differences were found between groups regarding RAO resolution or the incidence of hematoma, minor bleeding, or major bleeding. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251063999.

Conventional Therapy vs HMA or LDAC ± Venetoclax in Older Adults With AML: Systematic Review and Meta-analysis.

Triple-negative breast cancer (TNBC), an aggressive subtype lacking oestrogen and progesterone receptors and amplification of HER2 receptors, accounts for 12% to 17% of breast cancers. Adjuvant and neoadjuvant chemotherapy improve survival; however, 30% to 40% of early-stage TNBC cases progress to metastatic disease. Recent evidence suggests that combining immune checkpoint inhibitors (PD-1/PD-L1 inhibitors) with chemotherapy may improve pathological complete response and event-free survival. To assess the benefits and harms of immune checkpoint inhibitors (PD-1 or PD-L1 inhibitors) plus chemotherapy compared with chemotherapy for people with early TNBC. We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, the WHO ICTRP, and ClinicalTrials.gov up to 6 November 2024. We also searched the reference lists of identified relevant trials or reviews for potentially eligible studies. Randomised controlled trials (RCTs) comparing PD-1 or PD-L1 inhibitors plus chemotherapy with chemotherapy alone in participants with early TNBC. Pairs of review authors independently identified studies for inclusion and performed data extraction and risk of bias assessment. Outcomes were pathological complete response, event-free survival (EFS), overall survival (OS), health-related quality of life (HRQoL), and overall rates of any adverse events and serious adverse events (SAEs). We calculated hazard ratios (HRs) for time-to-event data, risk ratios (RRs), odds ratios (ORs), or risk differences (RDs) for dichotomous outcomes, and mean differences (MDs) for continuous outcomes with corresponding 95% confidence intervals (CIs). We performed random-effects meta-analyses to summarise the evidence and evaluated the certainty of evidence using the GRADE approach. We included seven RCTs with a total of 4341 participants. Two trials investigated PD-1 inhibitors (i.e. pembrolizumab), and five investigated PD-L1 inhibitors (i.e. durvalumab, atezolizumab) in the intervention group. Six studies used neoadjuvant chemotherapy (NACT), and one study used adjuvant chemotherapy (ACT) in the control group. The studies cover a five-year follow-up period. Two studies were at low risk of bias for all reported outcomes. The main limitation of the other trials was lack of blinding. PD-1 or PD-L1 inhibitors plus chemotherapy versus chemotherapy alone beforebreast cancer surgery PD-1 or PD-L1 inhibitors plus chemotherapy probably increase pathological complete response rate (RR 1.47, 95% CI 1.15 to 1.86; 6 studies, 1564 participants; moderate-certainty evidence); improve EFS (HR 0.64, 95% CI 0.52 to 0.79; 4 studies, 1789 participants; high-certainty evidence); and probably improve OS (HR 0.56, 95% CI 0.34 to 0.93; 3 studies, 1681 participants; moderate-certainty evidence) compared with chemotherapy alone. There may be little or no difference between PD-1 or PD-L1 inhibitors plus chemotherapy and chemotherapy alone in HRQoL (MD -1.49, 95% CI -3.88 to 0.91; 2 studies, 1395 participants; low-certainty evidence). PD-1 or PD-L1 inhibitors plus chemotherapy probably have little or no effect on any adverse events (OR 0.26, 95% CI 0.05 to 1.24; 3 studies, 1781 participants; moderate-certainty evidence) and treatment-related deaths (RD 0.2%, 95% CI -0.4% to 0.8%; 4 studies, 1761 participants; moderate-certainty evidence) compared with chemotherapy alone. PD-1 or PD-L1 inhibitors plus chemotherapy probably increase immune-related SAEs (OR 1.75, 95% CI 1.15 to 2.67; 5 studies, 2016 participants; moderate-certainty evidence) compared with chemotherapy alone. PD-1 or PD-L1 inhibitors plus chemotherapy versus chemotherapy alone afterbreast cancer surgery There may be little or no difference between PD-1 or PD-L1 inhibitors plus chemotherapy and chemotherapy alone in EFS (HR 1.11, 95% CI 0.87 to 1.42; 1 study, 2199 participants; low-certainty evidence), OS (HR 1.23, 95% CI 0.87 to 1.73; 1 study, 2199 participants; low-certainty evidence), HRQoL (MD -1.02, 95% CI -2.71 to 0.67; 1 study, 2168 participants; low-certainty evidence), any adverse events (OR 3.38, 95% CI 0.93 to 12.33; 1 study, 2177 participants; low-certainty evidence), and treatment-related deaths (RD -0.1%, 95% CI -0.4% to 0.2%; 1 study, 2177 participants; low-certainty evidence). PD-1 or PD-L1 inhibitors plus chemotherapy probably increase immune-related SAEs (OR 1.81, 95% CI 1.47 to 2.24; 1 study, 2177 participants; moderate-certainty evidence) compared to chemotherapy alone. Combining PD-1 or PD-L1 inhibitors with chemotherapy compared to chemotherapy alone before breast cancer surgery improves pathological response, EFS, and OS in early TNBC. In contrast, the combination of PD-1/PD-L1 inhibitors with chemotherapy after breast cancer surgery may have little to no effect on EFS and OS in early-stage TNBC when compared with chemotherapy alone. The addition of PD-1 or PD-L1 inhibitors probably increases immune-related SAEs.

To systematically evaluate the impact of virtual reality (VR) technology on pediatric patients during venous access in the emergency departments (EDs). Randomized controlled trials (RCTs) investigating the effects of VR technology on pediatric patients during venous access in the EDs were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search period spanning from inception to July 2025. Data analysis was performed using RevMan 5.2 software. A total of 8 RCTs involving 629 pediatric patients in the EDs were included. The analysis revealed that the VR technology group showed significantly better outcomes in pain scores compared with the control group (SMD=-0.73, 95% CI=-1.42 to -0.04, P=0.04). However, no significant differences were observed between the 2 groups in fear scores (SMD=-0.94, 95% CI=-2.13 to 0.26, P=0.12) or first-attempt success rate (OR=1.01, 95% CI=0.60-1.72, P=0.96). VR technology may help alleviate pain in pediatric patients during venous access in the EDs, but no significant improvements were found in reducing fear or increasing the first-attempt success rate.

Background Chronic obstructive pulmonary disease (COPD) remains the leading cause of illness and death. Traditional Chinese mind-body exercises (TCMBEs), such as Tai Chi, Baduanjin, Liuzijue, and Yijin Jing, have emerged as additional treatment options for pulmonary rehabilitation (PR). This meta-analysis sought to find out the extent to which TCMBEs affect lung function, exercise capacity, and health-related quality of life (HRQoL) in patients with COPD. Methods Five international databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were examined until October 2025. Twenty-two randomized controlled trials (RCTs) with 1,871 individuals fulfilled the qualifying criteria. Outcomes included forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), the FEV 1 /FVC ratio, percent predicted FEV 1 (FEV 1 % predicted), six-min walk distance (6MWD), and patient-reported measures such as the St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Data were synthesized using a random-effects model, with subgroup analyses conducted according to exercise type. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Results Compared with usual care or conventional PR, TCMBEs significantly improved FEV 1 ( MD = 0.20 L; 95% CI 0.09–0.30), FVC ( MD = 0.22 L; 95% CI 0.06–0.38), FEV 1 /FVC (MD = 3.42 %; 95% CI 2.54–4.29), FEV 1 % predicted ( MD = 4.98 %; 95% CI 2.53–7.42), and 6MWD ( MD = 42.05 m; 95% CI 29.06–55.05; p &amp;lt; 0.01). Quality-of-life scores improved significantly, as reflected by reductions in SGRQ (−13.76 points), CAT (−2.62 points), and mMRC (−0.50 points). Subgroup analyses revealed that Liuzijue and Yijinjing produced the greatest gains in pulmonary function, while Tai Chi yielded the most pronounced improvement in functional endurance. No serious adverse events were reported across the included studies. Conclusions TCMBEs are effective and safe adjuncts for COPD rehabilitation. By focusing on controlled breathing, gentle movement, and mindful awareness, these practices can enhance lung function, improve exercise capacity, and support psychological well being. Incorporating approaches such as Liuzijue, Tai Chi, and Yijinjing into structured PR programs may provide a sustainable and cost-effective way to promote functional recovery and improve overall quality of life in people with COPD.

Objective The meta-analysis aimed to systematically assess the influence of traditional mind–body exercise (TMBE), including taichi, baduanjin, wuqinxi, and yoga, on cognitive functioning and related cognitive decline for patients with neurodegenerative diseases (NDDs) or Prodromal Cognitive Decline. Methods Randomized controlled trials (RCTs) were published until October 19, 2025, as determined by searching PubMed, Cochrane Library, Web of Science, and Embase. The study population included adults with AD and PD, including those at prodromal stages, such as MCI and SCD. The interventions were a TMBE group and a control group. The primary outcome was overall cognitive functioning score, which was measured using the MMSE or MoCA, and secondary outcomes included executive function, memory, attention and language. Data were analyzed using random effects models and quality assessed with the Cochrane Risk of Bias Tool. Results Twenty-one RCTs were included, with the total sample size varying according to outcome metrics. TMBE showed significant improvement in overall cognitive functioning (MMSE: MD = 0.65, 95% CI: 0.20 to 1.09, p = 0.004; MoCA: MD = 0.87, 95% CI: 0.46 to 1.29, p = 0.001). Significant differences were seen in executive function (e.g., digit reversal: MD = 0.24, 95% CI: 0.05 to 0.44, p = 0.013; TMT-B: MD = −1.18, 95% CI: −1.70 to −0.67, p &amp;lt; 0.001), verbal fluency (MD = 0.36, 95% CI: 0.14–0.57, p = 0.001), and significant benefits were also observed in specific subgroups with respect to long-term delayed recall (e.g., mild dementia: MD = 1.35, 95% CI: 0.81–1.88, p &amp;lt; 0.001). Attention improvement effects were generally positive but varied by assessment tool. Moderate to high heterogeneity existed for some of the outcome indicators, but this tended to be resolved after sensitivity analyses. The degree of publication bias was low. Conclusion TMBE has demonstrated the ability to contribute to improvement of overall and specific cognitive functions in individuals diagnosed with NDDs or Prodromal Cognitive Decline. These trainings offer a promising non-pharmacological intervention strategy that is safe, reliable, and multi-targeted to improve cognitive impairment in this population. Systematic review registration PROSPERO – International prospective register of systematic reviews Unique identifier: CRD420251106629, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251106629 .

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID share clinical features including persistent fatigue, post-exertional malaise (PEM), and gastrointestinal (GI) dysfunction. Growing evidence implicates brain-gut axis dysregulation, characterized by dysbiosis, neuroinflammation within the central nervous system (CNS), increased intestinal permeability, and microbial translocation in their pathophysiology. However, therapeutic strategies targeting these pathways remain poorly defined. We report a case of post-COVID ME/CFS successfully treated with electroacupuncture (EA)-based deep peroneal nerve stimulation which was employed to potentiate the vagal reflex. Fatigue trajectories were assessed using the Multidimensional Fatigue Inventory over 12 weeks. Based on the case, a systematic review of randomized controlled trials (RCTs) evaluating brain-gut axis-modulating interventions in ME/CFS or Long COVID was conducted. The patient exhibited a significant reduction in total fatigue, with early improvements in motivation and mental fatigue, and delayed improvement in physical fatigue following transient systemic symptom flares. Across included RCTs (n = 8, 790 participants), four investigated gut microbiome-modulating therapies and four employed nerve stimulation. Synbiotic and herbal interventions demonstrated benefits for fatigue or PEM, accompanied by alterations in specific bacterial populations or CNS metabolisms. Regarding nerve stimulation, transcranial direct current stimulation (tDCS) combined with exercise program improved fatigue, whereas standalone tDCS, auricular or peripheral TENS showed limited efficacy. Brain-gut axis-based interventions may alleviate fatigue in ME/CFS and Long COVID by potentially modulating neuroinflammation, restoring microbiome balance, and improving epithelial barrier function. EA-based vagal stimulation represents a feasible option for patients with severe or treatment-resistant symptoms. Larger mechanistic studies and rigorously designed RCTs are needed to establish therapeutic targets and optimize intervention strategies.