Degenerative ocular disorders, glaucoma, cataracts and age-related macular degeneration, are major contributors to global blindness and visual impairment. Other conditions, such as limbal stem cell deficiency, dry eye disease and retinitis pigmentosa, lead to significant ocular distress and progressive vision loss, profoundly affecting patients’ quality of life. Conventional therapies primarily focus on symptom management and slowing disease progression, offering limited potential for tissue restoration. In recent years, stem cell therapy and regenerative medicine have emerged as promising strategies to address these limitations. Mesenchymal Stem Cells (MSCs) induced Pluripotent Stem Cells (iPSCs) and other progenitor cells have demonstrated the capacity to differentiate into ocular-specific cell types, modulate inflammation, secrete neurotrophic factors and promote tissue repair. Preclinical studies and early clinical trials have shown encouraging results in corneal regeneration, retinal repair and optic nerve protection, highlighting the translational potential of these therapies. Despite these advances, challenges remain, including optimizing cell sourcing, delivery methods, immune compatibility and long-term safety. This review provides a comprehensive overview of current stem cell-based approaches in ophthalmology, discussing underlying mechanisms, preclinical and clinical evidence and future directions for regenerative interventions aimed at restoring visual function. Stem cell therapy offers a transformative approach with the potential to shift ophthalmic care from palliative management to true tissue regeneration, offering hope for patients with previously untreatable ocular disorders.

This review aims to understand nurses' and midwives' perceptions, experiences, and behaviors related to sleep. The importance of sleep for nurses and midwives has received growing attention due to its significant impact on health, patient safety, and workforce sustainability. Nurses and midwives face unique challenges in achieving quality sleep due to a multitude of workplace factors. Given the multifactorial aspects of sleep, there is a need for targeted interventions that take into account nurses' and midwives' experiences, perceptions, and behaviors related to sleep. This review will consider primary qualitative or mixed methods studies that examine nurses' and/or midwives' perceptions, experiences, and behaviors concerning sleep. The target population includes licensed nurses and/or midwives working across all health care settings. Only studies published in English will be included, but no restrictions will be applied based on the publication date or country of origin. A systematic meta-aggregative review will be conducted following JBI methodology for systematic reviews of qualitative evidence, and results will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases such as MEDLINE, Embase, PsycINFO, CINAHL, and Scopus will be searched. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Qualitative Studies, and data will be analyzed using the meta-aggregation approach. OSF https://osf.io/f32um/overview.

This narrative review critically examines the potential association between paracetamol (acetaminophen) use during pregnancy and autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. Paracetamol remains the most widely used analgesic-antipyretic agent during pregnancy, used by approximately 60% of pregnant women. It is considered the first-line therapeutic option because non-steroidal anti-inflammatory drugs, particularly when used after 20 weeks of gestation, have been associated with adverse neonatal outcomes, including fetal renal dysfunction, oligohydramnios, and, rarely, neonatal renal failure, while their third-trimester use has also been linked to premature closure of the ductus arteriosus. In this context, unsubstantiated risk claims surrounding paracetamol create an important dilemma for clinicians and patients in clinical decision-making.The review evaluated large birth cohorts, sibling-controlled analyses, and meta-analyses from the literature, with a predominant focus on large-scale studies from Scandinavian countries (Norway, Denmark, Sweden). While several studies have reported small-to-moderate increases in risk between prenatal paracetamol exposure and ASD and ADHD, these associations lose significance in some sibling-controlled analyses, which are methodologically more rigorous.Current evidence suffers from substantial methodological limitations, including unmeasured confounding factors (particularly genetic susceptibility, familial characteristics, and maternal illnesses), validation problems in outcome measures, the absence of a demonstrable dose-response relationship, and confounding by indication. Furthermore, no valid, reproducible animal model specific to ASD exists.In conclusion, the available data do not support a causal relationship between paracetamol use during pregnancy and ASD or ADHD in offspring, and the reported associations remain questionable. Exaggerating unproven risks regarding medication use in pregnancy may unnecessarily amplify public concerns, discourage pregnant patients from receiving necessary treatment, and disrupt the balance between benefits and risks. Therefore, risk assessments should be conducted using an objective, evidence-based, cautious, and balanced approach.

At least a quarter of acute stroke and myocardial infarction (MI) survivors experience subsequent major depressive disorder, which adversely impacts adherence to secondary prevention strategies and is associated with a reduced quality of life and increased risk of recurrence of cardiovascular event and mortality. To provide a comprehensive review of evidence from randomised controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions to help mitigate depression after non-fatal stroke or MI. PubMed database was searched on 17th April 2025 for all trials evaluating the efficacy of interventions to help treat depression amongst those with recent stroke or MI and have reported effects on depressive symptoms (as a primary outcome) using validated tools. Studies were included if RCT design and if intervention duration were 4 weeks or longer, compared against routine care/no active treatment, and published since 1st January 2000. Risk of bias was assessed using Cochrane Risk of Bias tool. 53 RCTs were included. 44 studies were in post-stroke patients, and 9 were in post-MI patients. 16 evaluated pharmacological and 37 evaluated non-pharmacological (sub-divided into 8 types) interventions. The findings suggest that some selective serotonin reuptake inhibitors (escitalopram) and serotonin-norepinephrine reuptake inhibitors (duloxetine, milnacipran) are effective in reducing severity of depression amongst stroke survivors. Non-pharmacological interventions such as psychological interventions (e.g. behavioural therapies), device-based stimulation (vagus nerve, transcranial), and some physical activity/exercise interventions appear efficacious in those with recent stroke but there is a substantial evidence gap for the efficacy of these interventions amongst MI survivors. A holistic, multidisciplinary, and tailored approach encompassing pharmacological treatments together with non-pharmacological interventions (psychological therapy, device-based stimulation, and physical activity/exercise) is beneficial in reducing depression severity or risk amongst those with recent stroke, but there is a lack evidence for the long-term efficacy amongst those with recent MI.

Artificial intelligence and robotic surgery in emergency gastrointestinal procedures: a review of current evidence and future directions.

Cardiac telerehabilitation has become a promising alternative to traditional programmes for preventing acute coronary syndrome (ACS) in the secondary phase. However, current implementations are still reactive and standardised, lacking personalisation and flexibility in clinical settings. By integrating artificial intelligence (AI), it may be possible to overcome these limitations and provide intelligent, scalable, and patient-centred care. Methods: We conducted a structured literature review across PubMed, Scopus, the Cochrane Library, and Web of Science, targeting English-language studies published from January 2015 to May 2025. Inclusion criteria included adult populations with a history of ACS or high cardiovascular risk, assessing interventions based on AI, telerehabilitation, or their combination. Studies are needed to report clinical, functional, behavioural, or technological outcomes. A thematic narrative synthesis was utilised. Results: AI-enhanced telerehabilitation demonstrates potential advantages over conventional digital care in selected domains, including adaptive risk prediction, personalised exercise modulation, and adherence support. Several systems report real-time adjustment of exercise protocols, early dropout detection, and predictive analytics for rehospitalisation. AI integration may also contribute to personalised behavioural feedback and psychosocial monitoring. Nevertheless, the overall level of evidence remains preliminary and heterogeneous, with most AI-based interventions evaluated in pilot, feasibility, or modelling studies rather than large-scale randomized trials. Conclusions: The integration of AI into telerehabilitation represents a promising evolution in post-ACS care, shifting from predominantly reactive monitoring toward more adaptive and data-driven support models. While early-phase studies suggest feasibility and potential clinical benefit, robust multicentre randomized controlled trials and cost-effectiveness analyses are required before definitive conclusions regarding superiority or widespread implementation can be drawn.

Devastating or nearly invariably fatal infections caused by free-living amoebae (FLA), including Acanthamoeba keratitis (AK), granulomatous amoebic encephalitis (GAE), and primary amoebic meningoencephalitis (PAM), remain a significant public health concern, driven by increasing case numbers, geographic expansion, and the lack of approved, effective, and safe treatments. Despite decades of research, no new drugs have been successfully approved, highlighting the severe limitations of de novo drug development for these infections, particularly for GAE and PAM, largely due to the challenges of conducting clinical trials for these rare and rapidly lethal diseases. In this context, drug repurposing represents a cost-effective and promising strategy to accelerate therapeutic advances and overcome key bottlenecks of conventional drug development. Accordingly, we conducted a systematic review of in vitro studies and animal models of AK, GAE, and PAM reported in indexed databases to identify promising drug repurposing candidates against FLA infections. After screening 23,624 records, 112 studies were included in the analysis. Overall, 2726 drugs and drug combinations, spanning 865 pharmacological classes and approved for 565 therapeutic indications, were assessed for their repurposing potential. Among these, 166 compounds showed substantial trophocidal activity (≥IC50) at potentially translatable concentrations (≤10 µM), including six with additional cysticidal activity. In vitro, four compounds were active against Balamuthia mandrillaris, 44 against Acanthamoeba spp. (three cysticidal), and 115 against Naegleria spp. (three cysticidal). In in vivo studies, sulfadiazine and rifampicin were effective as preventive or early monotherapies for GAE. For AK, the combination of polyhexamethylene biguanide, neomycin, and atropine, as well as voriconazole and nitazoxanide monotherapies, showed the greatest promise. In PAM, azithromycin alone or in combination with amphotericin B emerged as the most promising therapeutic options. Further studies are required to advance the clinical translatability of these findings. To the best of our knowledge, this work provides the first comprehensive and integrated synthesis of repurposable drug candidates against FLA infections.

Minimally invasive surgery has emerged as a promising approach to the management of advanced-stage epithelial ovarian cancer, particularly in the setting of interval debulking surgery following neoadjuvant chemotherapy. Although primary cytoreduction has traditionally been performed via laparotomy, growing evidence supports the use of neoadjuvant chemotherapy to reduce surgical morbidity without compromising survival, creating new opportunities for minimally invasive surgery. Retrospective and prospective studies consistently report perioperative advantages with minimally invasive surgery, including less blood loss, shorter hospital stay, faster recovery, and earlier resumption of chemotherapy, when applied in carefully selected patients. Importantly, these benefits have yet to be supported by definitive data on long-term oncologic outcomes, underscoring the need for high-quality randomized trials of minimally invasive surgery, which are ongoing. Patient selection remains central to the safe application of minimally invasive surgery. Candidates are typically characterized by favorable response to chemotherapy, limited residual disease, and absence of extensive upper abdominal involvement, with pre-operative assessment supported by imaging, measurement biomarkers such as CA-125, and diagnostic laparoscopy. Despite encouraging feasibility data, adherence to oncologic principles and readiness to convert to laparotomy remain essential safeguards. Parallel technologic advances are expanding the scope of minimally invasive surgery. For example, robotic platforms improve dexterity and ergonomics, whereas intra-operative fluorescence imaging, ultrasound, and augmented-reality navigation offer new ways to identify residual disease and guide cytoreduction. Computational tools, including predictive models, artificial intelligence, and radiomic/pathomic integration, are emerging to refine triage and surgical planning. These innovations, although largely investigational, illustrate the potential of multi-modal integration to enhance both the precision and safety of minimally invasive surgery. Looking forward, the future of minimally invasive surgery will depend on maturation of evidence from randomized trials, broader incorporation of patient-centered outcomes, and integration with precision oncology and adjunct therapies. Minimally invasive surgery holds significant promise to reduce the morbidity of and improve recovery from advanced epithelial ovarian cancer, but its widespread adoption must await confirmation of oncologic equivalence to the open approach.

Objectives: The aim of this systematic review was to evaluate the current evidence on photon-counting detector computed tomography (PCCT) in hepatocellular carcinoma (HCC) imaging. Methods: A systematic literature search was performed in PubMed and Scopus, and five articles were finally included. Results: Four studies focused on the optimization of acquisition and reconstruction parameters such as slice thickness, kernels, virtual monoenergetic imaging (VMI), and quantum iterative reconstruction (QIR), with 50 keV reconstructions consistently associated with improved lesion conspicuity. QIR demonstrated significant noise reduction compared with filtered back projection, enhancing overall image quality, while one proof-of-concept study investigated dual-contrast PCCT, showing feasibility for simultaneous arterial and portal-phase acquisition. According to QUADAS-2, most studies presented a low or unclear risk of bias, with only one study rated at high risk for patient selection. Conclusions: In conclusion, PCCT shows promising technical advances and potential for improved HCC detection and characterization. Current evidence remains preliminary and focused on image quality rather than clinical outcomes; PCCT applications in routine practice are still largely unexplored.

The 2025 European Resuscitation Council (ERC) cardiac arrest guidelines mark a substantial evolution in modern resuscitation practice. Grounded in the most recent evidence reviews from the International Liaison Committee on Resuscitation (ILCOR), the guidelines move beyond isolated technical updates and adopt a broader, system-oriented perspective on cardiac arrest care. This approach integrates prevention strategies, early identification, high-quality resuscitation, structured post-resuscitation management, and long-term recovery within an updated concept of the chain of survival. In Basic Life Support, the algorithms have been streamlined to improve accessibility and increase bystander participation, with early cardiopulmonary resuscitation (CPR) and defibrillation now presented as a combined, immediate response. Within Advanced Life Support, the guidelines prioritize maintaining uninterrupted chest compressions, accelerating rhythm analysis and defibrillation, and considering defibrillation pad repositioning in cases of refractory ventricular fibrillation. Greater emphasis is also placed on physiology-guided CPR whereas novel concepts such as CPR-induced consciousness are introduced. Post-resuscitation care is further strengthened, with recommendations supporting timely coronary angiography when appropriate, thorough investigation of the underlying cause of arrest, active temperature management with rigorous prevention of fever, and the use of multimodal approaches for neurological prognostication. Overall, the 2025 ERC guidelines underscore that successful resuscitation depends on coordinated systems, timely action, and continuous training, aiming to improve both survival and long-term outcomes after cardiac arrest.

Self-medication with psychedelics: a scoping review and narrative synthesis of review-level evidence.

Despite the emphasised benefits of exclusive breastfeeding (EBF) among pregnant and breastfeeding mothers being recognised globally, its practice is still low among developing countries, including Tanzania. Several barriers to EBF in Tanzania have been detailed but lack a comprehensive approach. This study provides comprehensive evidence of the barriers to EBF, drawing from existing studies in Tanzania. This review was conducted using search queries in several databases, including PubMed, Cochrane, Scopus and Web of Science. The review included qualitative, quantitative and mixed methods studies written in English addressing EBF in Tanzania. The critical appraisal skills programme checklist was used to assess the quality of studies while thematic analysis was used to analyse the data for each identified study. Twenty-three studies (23) from 10 regions met inclusion criteria, including eight qualitative studies, nine cross-sectional studies, four mixed methods approaches, and two quantitative studies. All the studies reported maternal, infant and social-environmental to EBF practices in Tanzania. Though this review has shown evidence of barriers to EBF, further research is needed, especially on factors influencing EBF practices in Tanzania.

To provide evidence-based recommendations for the evaluation and diagnosis of endometriosis. Reproductive-aged adults and adolescents with symptoms suggestive of endometriosis. This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology and one specialist in reproductive endocrinology and infertility appointed by the American College of Obstetricians & Gynecologists' (ACOG) Committee on Clinical Practice Guidelines-Gynecology. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. The National Institute for Health and Care Excellence (NICE) evidence review on endometriosis diagnosis and management served as the evidence base for many of the clinical considerations. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. This Clinical Practice Guideline includes recommendations on the clinical, imaging, and surgical evaluation and diagnosis of endometriosis. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation cannot be made because of inadequate or nonexistent evidence. The recommendations included in this guideline also apply to adolescents unless otherwise specified and are based on review of the limited available evidence, extrapolated data from adult populations, and expert consensus.

ABSTRACT Background/Importance Selective nerve root blocks (SNRBs) are frequently used in clinical algorithms for managing chronic radicular pain. However, their prognostic value in identifying patients likely to benefit from pulsed radiofrequency (PRF) treatment remains uncertain. Objective This systematic review evaluates whether a positive response to an SNRB predicts improved clinical outcomes following PRF in patients with chronic radicular pain. Evidence Review A systematic search was conducted in PubMed, Embase, and Cochrane databases, along with reference lists of relevant articles. Eligible studies included patients with chronic radicular pain and assessed the prognostic role of SNRBs administered prior to PRF. Risk of bias was assessed using the ROBINS‐I V2 tool. Results Only one prospective observational study met inclusion criteria. In patients with chronic lumbosacral radicular pain, a positive SNRB response was associated with a higher likelihood of treatment success at 6‐week follow‐up (odds ratio: 3.26; 95% CI: 0.97–11.00; p = 0.06). Multivariate analysis identified limited baseline disability, age > 55 years, and a positive SNRB response as predictors of success at 6 months, with an area under the receiver operating characteristic curve of 0.73. Conclusions This review identified a lack of published studies—aside from one prospective observational study—examining the prognostic value of SNRBs in the context of PRF for chronic radicular pain. The findings underscore not only a lack of high‐quality evidence but a broader gap in the literature. Further robust research is warranted to clarify the clinical utility of SNRBs in guiding PRF treatment decisions.

The best evidence on programmed weaning from mechanical ventilation in neurocritical care patients should be gathered, evaluated, and integrated to provide an evidence basis for determining the optimal weaning program for these patients. According to the '6S' pyramid model of evidence-based practice resources, Chinese and international guideline websites, websites of relevant professional societies, and Chinese and English databases were systematically searched. The databases were searched from the time of establishment to October 2024. Literature screening was subsequently performed according to the inclusion and exclusion criteria. Two researchers independently evaluated the literature quality and extracted and summarised the evidence. A total of 21 publications were included, including 3 guidelines, 5 expert consensus papers, 1 evidence summary, and 12 systematic reviews. A total of 29 pieces of best evidence in the following 5 aspects were summarised: preweaning preparation and screening, a weaning protocol, extubation assessment, extubation preparation and procedure, and postextubation management. This study summarises the best evidence for the programmed weaning of neurocritical care patients from mechanical ventilation and provides a basis for clinical medical personnel to standardise this weaning process. Evidence-based application of these strategies should be implemented to verify their clinical efficacy and safety in practice. Successful weaning is key in the management of neurocritical care patients receiving mechanical ventilation. The establishment of a localised extubation protocol guided by a multidisciplinary team can significantly reduce the extubation failure rate, the duration of mechanical ventilation and the incidence of related complications. However, evidence-based application is needed to verify the efficacy and safety of these strategies in clinical practice. This evidence review adhered to the evidence review report guidelines formulated by the Evidence-Based Nursing Center of Fudan University. These guidelines cover aspects such as problem establishment, literature search, literature screening, literature evaluation, evidence summary and classification, as well as the formulation of practical suggestions. This evidence summary followed the evidence summary reporting specifications of the Fudan University Center for Evidence-Based Nursing (http://ebn.nursing.fudan.edu.cn) with registration number ES20244849. This study was based on the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing; the registered name is 'Summary of the best evidence for weaning from mechanical ventilation in neurocritical care patients'; the registration number is ES20231823.

Real-world outcomes of vosoritide in achondroplasia: A systematic review and meta-analysis of multinational clinical evidence.

Responses of African food systems to climate change: A systematic review of concepts, methods, and evidence

Effectiveness of Telerehabilitation After Total Knee Arthroplasty: An Umbrella Review.

Exploring the personal impact of cluttering: A scoping review of current evidence.

A0278 Gender disparities in academic authorship, leadership, and compensation in urology: A systematic review of quantitative evidence