Infants with critical congenital heart disease (CHD) are at increased risk of brain injury and neurodevelopmental impairments, with variable rates of ischemic brain injury reported across studies. In this systematic review and meta-analysis, we aimed to understand the overall prevalence of ischemic brain injury and associated risk factors in infants with critical CHD. A systematic review and meta-analysis was performed using a prespecified protocol registered on PROSPERO (CRD42021268352). Primary, original research in English reporting the prevalence of ischemic brain injury in neonates with critical CHD was included. Case reports and series were excluded. The search was conducted based on all article titles and abstracts published in MEDLINE, Embase, and Cochrane from inception to 2024. The Newcastle-Ottawa Scale for Cohort Studies and the revised Cochrane risk-of-bias tool for randomized trials were used to assess risk of bias. Random-effects restricted maximum likelihood models were used to calculate pooled prevalence rates. Funnel plots and Egger tests were used to assess publication bias. We explored associations with year of study, age at surgery, and female sex proportion using meta-regression analyses. We identified 31 studies that reported the prevalence of ischemic brain injury in neonates with CHD. The pooled cumulative prevalence of ischemic brain injury among neonates with CHD was 68.5% (95% CI 62.7%-73.8%), with low between-study heterogeneity (I2 = 3.0%, Qp value = 0.4). The pooled cumulative prevalence of preoperative ischemic brain injury was 34.7% (95% CI 28.4%-41.5%), with moderate between-study heterogeneity (I2 = 43.4%, Qp value = 0.05), and that of new postoperative ischemic brain injury was 46.5% (95% CI 34.8%-58.5%), with substantial between-study heterogeneity (I2 = 69.1%, Qp value = 0.004). Age at surgery and female sex proportion were associated with cumulative white matter injury and preoperative arterial ischemic stroke, respectively. The prevalence of ischemic brain injury in neonates with CHD is high and depends on brain injury type and timing. Identifying ischemic injuries in this population is important for counseling families about expected neurodevelopmental outcomes and beginning early neurodevelopmental surveillance and interventions. Significant heterogeneity exists in the literature; to improve outcomes, further research is warranted to determine modifiable risk factors and neuroprotective strategies.

Methotrexate (MTX) remains the first-line pharmacotherapy for rheumatoid arthritis (RA), yet gastrointestinal (GI) adverse events (AEs) are frequently reported. This systematic review and meta-analysis aimed to estimate the prevalence of GI AEs among RA patients treated with MTX. A comprehensive search of PubMed, Scopus, and Cochrane databases was conducted, including observational and interventional studies reporting GI AEs in adult RA patients receiving MTX. Risk of bias was assessed using the Newcastle-Ottawa Scale, JBI Critical Appraisal Tool, and Cochrane RoB 2 as appropriate. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-seven studies involving 19,986 participants were included. Nausea and abdominal pain were the most frequently reported AEs, with pooled prevalence of 24.3% (95% CI: 16.7-34.0) and 19.6% (95% CI: 13.9-26.9), respectively. Substantial heterogeneity was observed across studies and persisted after stratification by MTX route or study design. Nine studies reported discontinuation due to GI AEs, with rates ranging from 1.7% to 23.4% and a pooled prevalence of 8.5% (95% CI: 5.0-14.3). Gastrointestinal AEs affect approximately one-fifth of RA patients receiving MTX, with nausea and abdominal pain being the most common symptoms. GI events leading to treatment discontinuation were relatively uncommon. Clinician awareness and timely management of GI AEs are important to prevent nonadherence and optimize MTX therapy.

The integration of large language models (LLMs) such as ChatGPT into radiology has introduced new possibilities for structured reporting. While these models are designed to improve the clarity, accuracy, and efficiency of radiology workflows, their diagnostic performance and clinical reliability are still not well established. We aimed to systematically review the diagnostic accuracy, sensitivity, specificity, and clinical utility of ChatGPT and related LLMs in generating structured radiology reports. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Register of Systematic Reviews (CRD42025639804). PubMed and Google Scholar were searched for retrospective diagnostic accuracy studies involving ChatGPT or similar LLMs applied to structured radiology reporting. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A narrative synthesis summarized performance metrics across imaging modalities and artificial intelligence model types. Due to the variability in methodologies and outcome reporting, a meta-analysis was not conducted. Twenty-eight out of the 1428 studies were included in this review, which were published between 2023 and 2024. GPT-4 consistently outperformed earlier models, achieving up to 99% accuracy in liver magnetic resonance imaging and 94% in brain magnetic resonance imaging interpretation. GPT-4o showed higher sensitivity in chest imaging (75%) with a specificity of 95%. Other domain-specific models also demonstrated high performance, including augmented transformer assisted radiology intelligence (98% accuracy) and Vicuna (96% accuracy). However, variability in diagnostic capability was observed, with models like GPT-4V underperforming in musculoskeletal and gastrointestinal imaging. The overall risk of bias according to the Quality Assessment of Diagnostic Accuracy Studies 2 tool was moderate, with common issues in patient selection and index test standardization. ChatGPT and similar LLMs show promising accuracy and applicability in structured radiology reporting, particularly for chest, brain, and liver imaging. However, their performance remains inconsistent across modalities, and further prospective studies with standardized protocols are needed before routine clinical adoption.

Introduction: The acute effects of aerobic exercise with blood flow restriction (AE+BFR) on systolic, diastolic, and mean blood pressure remain scarce and inconsistent in the literature. Objective: To systematically review the acute effects of AE+BFR on systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) in adults and older adults. Methods: Searches were conducted in October 2025 in PubMed, EMBASE, Cochrane Library, LILACS, Scopus, and gray literature. Randomized controlled trials comparing the acute effects of a single session of AE+BFR with conventional aerobic exercise (AE-C) on blood pressure were included. Two independent reviewers performed study selection, data extraction, and assessment of risk of bias (RoB 2) and certainty of evidence (GRADE). Results: Eight studies, totaling 130 participants, were included. The qualitative synthesis indicated that seven studies found no differences in SBP, DBP, or MBP after AE+BFR compared with AE-C. One study reported an increase in DBP immediately after AE+BFR (79.23 ± 10.56 vs. 69.69 ± 8.79 mmHg; p = 0.001). All studies showed some concerns regarding risk of bias, and the certainty of evidence was rated as very low for all three outcomes. Conclusions: Most studies indicate that AE+BFR does not acutely change SBP, DBP, or MBP compared with conventional aerobic exercise. However, the small number of studies, heterogeneity of protocols, and very low certainty of evidence suggest that the findings should be interpreted with caution.

In recent years, forest bathing has gained popularity worldwide due to its many positive effects on health. In the face of increasing urbanization and limited access to natural forests, digital forest bathing is a promising alternative. Digital forest bathing could also be an option for people with restricted mobility, which could be a way to make the health-promoting effects of forests more accessible. This systematic review examines the current state of research on digital forest bathing, considers the associated effects, and highlights the technical possibilities and thereby consolidates the currently limited evidence base in this emerging field. For literature identification, the databases APA, PsycInfo, PubMed, PubPsych, Scopus, and Google Scholar were searched. A total of four studies were included. The results indicate that digital forest bathing could have positive effects on relaxation and well-being that could be comparable to real-life forest bathing, and summarize how interventions were technically implemented across the included studies. As there are still a few studies on digital forest bathing, the implementation of the research varies greatly, and some studies have risks of bias; the results presented here should be interpreted with caution. In addition to a critical examination of the study designs and quality, suggestions for further research in this area are given, and key methodological constraints relevant for interpreting early effects are outlined.

Surgical site infections (SSIs) account for up to 20% of healthcare-associated infections and significantly increase morbidity, mortality, and healthcare costs. Preoperative decolonization strategies-targeting nasal and/or skin colonization-are variably recommended across surgical disciplines. While benefits have been reported in elective arthroplasty, their efficacy in trauma surgery remains unclear. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for systematic reviews and Meta-Analyses. The study protocol was registered in PROSPERO (CRD420250642382). MEDLINE, Cochrane Library, ClinicalTrials.gov, and Google Deep Research were searched up to 26 February 2025. Eligible studies reported on patients undergoing elective lower extremity joint arthroplasty or fracture surgery and compared nasal, skin, or combined decolonization protocols to standard care. Primary outcome was the incidence of SSIs. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies. Nineteen studies (n = 64,796 patients) met inclusion criteria. Of those, five were RCTs and 14 were observational, retrospective or pre-post studies. 17 focused on elective arthroplasty; two addressed fracture surgery. Among orthopedic patients, nasal decolonization reduced SSIs with an OR of 0.65 (95% CI, 0.34-1.22), skin decolonization with an OR of 0.43 (95% CI, 0.29-0.64), and combined strategies with an OR of 0.48 (95% CI, 0.33-0.69). Trauma surgery data were limited and heterogeneous (I² = 81%); the pooled OR for combined decolonization was 0.59 (95% CI, 0.08-4.32), but with conflicting individual study results. Nasal and skin decolonization protocols seem to reduce the incidence of SSIs in elective hip and knee arthroplasty. Thereby, skin, nasal and combined decolonization strategies may be used. However, current evidence in fracture surgery remains insufficient and inconsistent. High-quality randomized trials are urgently needed to evaluate decolonization efficacy in lower extremity trauma surgery.

Homeopathy is used by some veterinary practitioners as a complementary approach for treatment and prophylaxis in a range of animal species. The clinical evidence base is contested and heterogeneous. This systematic review synthesizes randomized and non-randomized clinical trials, systematic reviews and key policy statements assessing the clinical use, efficacy, safety, welfare implications, and regulatory context of veterinary homeopathy. Methods: A systematic search and synthesis were performed across published systematic reviews, randomized controlled trials (RCTs), controlled clinical trials (CCTs), and institutional position statements concerning homeopathy in animals. Data were extracted on species, indication, study design, risk of bias, outcomes, and main conclusions. Evidence quality and clinical implications were evaluated. High-quality systematic reviews found a limited number of RCTs with heterogeneous quality and endpoints; meta-analysis suggests only very limited evidence of effects beyond placebo in animals, with small, low-quality trials responsible for most positive findings. A small number of trials reported outcomes favoring homeopathy for specific indications like prophylaxis of post-weaning diarrhea in pigs and some mastitis studies, but methodological limitations and risk of bias substantially limit confidence. Broad reviews of complementary and alternative veterinary medicine and evidence syntheses similarly conclude that clear, reproducible evidence for routine clinical effectiveness is lacking. Institutional position statements (RCVS, BVA, AVMA) emphasize evidence-based use and caution where animal welfare could be compromised. Current clinical evidence does not provide robust support for routine substitution of conventional proven therapies with homeopathy in veterinary medicine. Homeopathy may be considered as a complementary option where used alongside conventional treatment, provided informed consent, rigorous monitoring, and safeguards for animal welfare. High-quality, adequately powered randomized trials with transparent reporting are needed for firmer conclusions.

Introduction: Resting-state EEG (rsEEG) is a scalable window onto trait-like “executive readiness,” but findings have been fragmented by task impurity on the executive-function (EF) side and heterogeneous EEG pipelines. This review synthesizes rsEEG features that reliably track EF in healthy samples across development and aging and evaluates moderators such as cognitive reserve. Materials and methods: Following PRISMA 2020, we defined PECOS-based eligibility (human participants; eyes-closed/eyes-open rsEEG; spectral, aperiodic, connectivity, topology, microstate, and LRTC features; behavioral EF outcomes) and searched MEDLINE/PubMed, Embase, PsycINFO, Web of Science, Scopus, and IEEE Xplore from inception to 30 August 2025. Two reviewers were screened/double-extracted; the risk of bias in non-randomized studies was assessed using the ROBINS-I tool. Sixty-three studies met criteria (plus citation tracking), spanning from childhood to old age. Results: Across domains, tempo, noise, and wiring jointly explained EF differences. Faster individual/peak alpha frequency (IAF/PAF) related most consistently to manipulation-heavy working may and interference control/vigilance in aging; alpha power was less informative once periodic and aperiodic components were separated. Aperiodic 1/f parameters (slope/offset) indexed domain-general efficiency (processing speed, executive composites) with education-dependent sign flips in later life. Connectivity/topology outperformed local power: efficient, small-world-like alpha networks predicted faster, more consistent decisions and higher WM accuracy, whereas globally heightened alpha/gamma synchrony—and rigid high-beta organization—were behaviorally sluggish. Within-frontal beta/gamma coherence supported span maintenance/sequencing, but excessive fronto-posterior theta coherence selectively undermined WM manipulation/updating. A higher frontal theta/beta ratio forecasts riskier, less adaptive choices and poorer reversal learning for decision policy. Age and reserve consistently moderated effects (e.g., child frontal theta supportive for WM; older-adult slow power often detrimental; stronger EO ↔ EC connectivity modulation and faster alpha with higher reserve). Boundary conditions were common: low-load tasks and homogeneous young samples usually yielded nulls. Conclusions: RsEEG does not diagnose EF independently; single-band metrics or simple ratios lack specificity and can be confounded by age/reserve. Instead, a multi-feature signature—faster alpha pace, steeper 1/f slope with appropriate offset, efficient/flexible alpha-band topology with limited global over-synchrony (especially avoiding long-range theta lock), and supportive within-frontal fast-band coherence—best captures individual differences in executive speed, interference control, stability, and WM manipulation. For reproducible applications, recordings should include ≥5–6 min eyes-closed (plus eyes-open), ≥32 channels, vigilant artifact/drowsiness control, periodic–aperiodic decomposition, lag-insensitive connectivity, and graph metrics; analyses must separate speed from accuracy and distinguish WM maintenance vs. manipulation. Clinical translation should prioritize stratification and monitoring (not diagnosis), interpreted through the lenses of development, aging, and cognitive reserve.

Zinc deficiency is prevalent in people with chronic kidney disease (CKD) and has significant clinical implications. Previous systematic reviews have only evaluated the impact of zinc supplementation on a limited range of biochemical outcomes in people receiving hemodialysis. In this analysis we sought to evaluate the impact of zinc supplementation on all outcomes in adults with CKD, including kidney replacement therapies. We conducted a systematic search across Cochrane, MEDLINE, CINAHL, PubMed, Scopus, and Google Scholar to identify randomized controlled trials assessing any outcomes in adults with CKD. Three authors independently assessed trial eligibility, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. We identified 41 studies, with 23 included in meta-analyses. In total, 176 outcomes were reported, of which 11 were meta-analyzed. Zinc supplementation resulted in a significant increase in body weight (weighted mean difference [WMD], 2.52 kg; 95% CI, 1.58-3.45; P < .00001), serum zinc (WMD, 24.96 µg/dL; 95% CI, 20.43-29.50; P < .00001), high density lipoprotein cholesterol (HDL-C; WMD, 8.05 mg/dL; 95% CI, 0.22-15.88; P = .04), albumin (WMD, 0.38 g/dL; 95% CI, 0.07-0.69; P = .02), and dietary energy intake (WMD, 271.80 kcal; 95% CI, 172.70-370.90; P < .00001). No significant difference was observed in body mass index, total cholesterol, triglycerides, creatinine, and dietary protein and zinc intakes. Qualitative synthesis suggests that zinc supplementation may improve gastrointestinal symptoms, intensity of pruritus, quality of life, and quality of sleep. In patients with CKD, znc supplementation is associated with increases in body weight, serum zinc, high-density lipoprotein-cholesterol (HDL-C), albumin, and dietary energy intake. The current body of evidence is of low quality, highlighting the need for further high-quality research to substantiate these findings and for the translation of findings into clinical practice. PROSPERO registration no. CRD42024574253.

Surgical site infections (SSIs) particularly periprosthetic joint infection (PJI, a deep/organ-space infection) remain devastating after total hip arthroplasty (THA). Because routine systemic perioperative antibiotics are standard of care, we focused on the added value of intrawound (local) prophylaxis. We evaluated whether intrawound antibiotics, used in addition to standard systemic prophylaxis, reduce infection after THA and explored effects across surgery type (primary vs. revision). We searched PubMed, Cochrane Library, ScienceDirect, EMBASE, CNKI, VIP, Wanfang, and CBM (January 2010 to final search) for cohort studies comparing intrawound antibiotic prophylaxis + standard systemic prophylaxis versus standard systemic prophylaxis alone. We systematically searched studies published since 2010 to include the most recent and relevant data, ensuring that the research included reflects modern surgical techniques, standardized reporting, and advancements in the use of intrawound antibiotics. Two reviewers independently screened, extracted data, and assessed risk of bias; meta-analysis used RevMan 5.3. Eight cohort studies (n = 16,939) met criteria. Heterogeneity for PJI was low (Chi² = 7.57, df = 7, P = 0.37; I² = 8%). Intrawound prophylaxis plus systemic prophylaxis was associated with lower PJI risk than systemic prophylaxis alone (OR = 0.42, 95% CI: 0.30-0.58, P < 0.00001). Subgroup analysis showed consistent benefit in both primary and revision THA (OR = 0.30, 95% CI: 0.20-0.47, P < 0.00001; I² = 0%). Superficial incisional SSI (skin/subcutaneous) showed no significant difference (OR = 0.41, 95% CI: 0.10-1.66, P = 0.92), and adverse events did not differ significantly (OR = 0.89, 95% CI: 0.45-1.78, P = 0.75). Funnel plots suggested possible publication bias. There is limited evidence, with a possible risk of publication bias, suggesting that intrawound (local) antibiotic prophylaxis, when added to standard systemic antibiotics, may be associated with reduced postoperative PJI after THA across primary and revision procedures. Evidence for superficial SSI and safety remains limited by few contributing studies. Standardized, head-to-head randomized trials are needed to define optimal regimens (agent, dose, timing) and long-term safety (including antimicrobial resistance).

This systematic review evaluates the accuracy, reliability, and clinical utility of jaw motion tracking (JMT) systems compared to traditional occlusal assessment methods, providing an overview of current evidence supporting their integration in dental practice. The review followed PRISMA guidelines (PROSPERO Registration: CRD42024567619). A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library (January 2005- December 2025) using predefined keywords related to JMT systems and digital occlusal analysis. Studies were included if they assessed JMT device performance in clinical, experimental, or in vitro settings, comparing them to conventional mechanical articulators or manual occlusal techniques. The QUADAS-2 tool evaluated study quality, focusing on bias, patient selection, and applicability concerns. Twenty studies met inclusion criteria, ranging from single-patient case studies to larger clinical trials. Optical tracking systems demonstrated higher precision and accuracy in recording mandibular movements compared to traditional methods. JMT systems showed potential in reducing chair time and improving prosthetic outcomes. The risk of bias was high, mainly due to small sample sizes and the lack of long-term evaluations. Digital JMT technologies improve occlusal assessment and treatment planning, particularly in prosthodontics and TMJ diagnostics. However, further research is needed to standardize protocols, validate these systems across diverse populations, and ensure clinical applicability. Despite the potential benefits, methodological inconsistencies highlight the need for more rigorously designed studies.

This systematic review aims to assess whether studies that followed the 2016 and updated 2024 European Association of Urology (EAU) Renal Cell Carcinoma (RCC) guidelines for CT during follow-up after tumor ablation (TA) yield different oncological outcomes compared to studies that performed more frequent imaging. A literature search of relevant search engines was performed up to June 6th, 2025. Studies that reported follow-up schedules of patients after TA for cT1 RCC were included. Studies utilizing more CT scans than recommended by the 2016 and 2024 EAU guidelines were compared with those adhering to the guidelines. Data on recurrences and survival were analyzed. Thirty-seven studies met the inclusion criteria, involving patients with cT1 RCC treated with TA. The mean 5-year overall survival rate was 82.9%. The pooled recurrence rate was 7.7% in studies that performed more imaging than recommended by the 2016 EAU guideline, compared with 12.3% in studies that adhered to the guideline (p = 0.19). All studies performed more imaging than recommended by the updated 2024 guidelines. Risk of bias was moderate to high in most studies. The majority of included studies conducted more frequent imaging than advised by the 2016 EAU guidelines, with all studies exceeding the 2024 EAU guidelines. The studies included in our systematic review revealed similar oncological outcomes after TA, among studies that followed the 2016 EAU guidelines and those that performed more frequent imaging, suggesting that more frequent imaging than the 2016 EAU guidelines may not lead to a survival benefit. Question Does more frequent follow-up CT imaging after tumor ablation for localized renal cell carcinoma improve oncological outcomes compared to European Association of Urology guideline recommendations? Findings 89% of studies performed more frequent CT scans than the 2016 guidelines; recurrence was 7.7% with extra scans versus 12.3% with guideline adherence. Clinical relevance Current intensive imaging protocols may not improve patient outcomes, supporting potential reduction in follow-up imaging frequency to minimize radiation exposure and healthcare costs while maintaining adequate oncological surveillance.

Objectives: To evaluate the efficacy of resin infiltrants (RIs) in controlling non-cavitated occlusal carious lesions (NCOCLs) in primary and permanent teeth. Methods: This systematic review followed PRISMA guidelines. Randomized clinical trials (RCTs) and in vitro/ex vivo studies comparing RI with placebo or other materials were included. Searches were conducted in five databases and gray literature up to December 2025. Risk of bias was assessed using the RoB 2.0 tool for RCT and an adapted instrument for in vitro/ex vivo studies. Certainty of evidence was evaluated using the GRADE tool, and data were synthesized qualitatively. Results: Eight studies were included, of which only two were RCTs, and six were in vitro and ex vivo studies. RCTs showed reduced caries progression in infiltrant-treated groups compared with controls, with efficacy comparable to conventional sealants. In vitro studies demonstrated improved resin penetration and sealing ability with optimized protocols. Risk of bias ranged from low to moderate. Certainty of clinical evidence was low, primarily due to the limited number of RCTs and methodological limitations. Conclusions: RIs may be effective in managing NCOCLs, with performance comparable to conventional preventive approaches. However, the limited number of clinical trials and short follow-up periods reduce the strength of the evidence. Long-term clinical studies are needed to confirm the sustained effectiveness and durability of RIs.

Arteriovenous fistulas (AVFs) remain the preferred vascular access for haemodialysis globally. Malaysia has a rapidly rising burden of end-stage renal disease (ESRD), but reported AVF outcomes vary across institutions, and no national synthesis has previously been performed. This review aimed to evaluate AVF outcomes in Malaysia, consolidate available evidence, and provide baseline reference values to guide future access planning and research. A systematic search of PubMed, Scopus, Web of Science, Google Scholar and Malaysian databases was conducted from inception to June 2025. Eligible studies reported outcomes of native AVFs in Malaysian populations. The primary outcome was 12-month primary patency. Secondary outcomes included primary failure (early thrombosis or non-maturation), maturation at ~6 weeks, complications and predictors of outcome. Random-effects meta-analysis was used. Risk of bias was assessed using RoB 2 and ROBINS-I. Twelve studies (n = 1426 patients) were included: two randomized trials and ten observational cohorts. The pooled 12-month primary patency rate was 73.5% (95% CI, 62.4%-84.6%; I2 = 93%, considerable heterogeneity). The pooled primary failure rate was 19.3% (95% CI, 14.1%-24.5%; I2 = 69% - substantial heterogeneity), and pooled early maturation was 84.2% (95% CI, 78.1%-90.4%; I2 = 73%, substantial heterogeneity). Upper-arm AVFs demonstrated consistently higher maturation than forearm sites. Diabetes, small vessel calibre and central venous catheter dependence were the most common predictors of poor outcome. Intraoperative heparin significantly reduced early thrombosis (RR 0.36; 95% CI, 0.13-0.99), whereas fish oil and aspirin had no measurable benefit. Complication profiles resembled international reports, dominated by stenosis and thrombosis. Malaysian AVF outcomes demonstrate favourable early maturation and acceptable 12-month patency, consistent with international experience despite a high comorbidity burden. These data provide the first consolidated national benchmark for vascular access outcomes in Malaysia and highlight priorities for future multicentre collaboration, surveillance strategies and standardized reporting.

Background: Women’s rugby sevens is rapidly expanding, yet injury patterns remain poorly understood, limiting prevention strategies. This systematic review aimed to describe injury incidence, severity, burden, and risk factors across competitive levels. Methods: Original studies on senior or U19 women’s rugby sevens reporting ≥ 2 epidemiological variables were included; studies on men, mixed samples without disaggregation, 15-a-side rugby, other sports, or players below U19 were excluded. Searches were conducted in PubMed, Google Scholar, ScienceDirect, SpringerLink, and Scielo (last searched September 2024), supplemented by gray literature and hand searching. Risk of bias was assessed with ROBINS-I, and study quality was assessed with STROBE. Results were tabulated and synthesized narratively due to heterogeneity. Results: Fifteen studies were included. Injury incidence ranged from 40.5 to 153.6 per 1000 match h at the elite level and 26.5–46.3 at the community level. Severity was higher in elite players (45.6–124 days) than in community players (29.6–58.4 days). Lower-limb joint/ligament injuries predominated, contact (especially tackling) was the main mechanism, and injuries often occurred in the second half. Conclusions: Evidence was limited by small samples, inconsistent reporting, and a moderate risk of bias. Injuries are frequent and severe, especially in elite players, highlighting the need for targeted prevention and improved surveillance.

Ex vivo human tooth culture models preserve the native dentine–pulp complex and offer a translational platform to study pulp-capping biomaterials. This systematic review aimed to synthesize the evidence on histological pulp tissue responses to calcium silicate-based cement (CSCs) used for direct pulp capping in human tooth culture models. The review followed PRISMA 2020 guidance. Eligible studies were ex vivo whole human tooth culture models with direct pulp exposure treated with commercial or experimental CSCs and reporting histological outcomes. Risk of bias was assessed using the QUIN tool. Thirteen studies were included. Most used immature human third molars (from 15- to 19-year-old patients) and culture periods up to 28 days, with a minority extending observation to 45–90 days. Across hydraulic CSCs, Biodentine was the most frequently evaluated material, followed by ProRoot MTA and several experimental hydraulic and resin-modified formulations. Overall, hydraulic CSCs were consistently associated with biocompatible pulp responses and a pro-mineralization pattern characterized by periexposure mineralized foci/osteodentin-like tissue; where assessed, immunohistochemistry supported odontoblast-like differentiation. In contrast, the resin-modified CSC TheraCal LC and other experimental resin-modified CSCs showed more heterogeneous findings, with reports of absent, delayed, or less prominent mineralization compared with reference hydraulic CSCs. In intact human tooth culture models, hydraulic CSCs show reproducible biocompatibility and early mineralization features consistent with reparative dentinogenesis, whereas resin-modified CSCs demonstrate more variable histological performance.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin important for neuronal survival and synaptic plasticity that also plays a role in metabolic regulation (energy homeostasis and appetite control). Lower circulating BDNF levels have been associated with obesity, metabolic risk factors, and poorer cognitive and mental health outcomes, whereas higher levels are linked to more favorable profiles. In this study we sought to systematically evaluate the effects of dietary weight-loss interventions on circulating BDNF levels in adults with overweight or obesity. A comprehensive literature search of PubMed, Web of Science, Scopus, and Google Scholar was conducted from inception through April 2025 to identify clinical trials investigating dietary weight-loss or calorie-restriction interventions in adults with overweight or obesity that reported data regarding circulating BDNF outcomes. Eligible studies were clinical trials with interventions lasting ≥4 weeks to investigate circulating BDNF concentrations before and after dietary interventions that were conducted in adults (≥18 years old) with baseline overweight or obesity. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Risk of bias was assessed using the Cochrane risk-of-bias tool. Data on study design, participant characteristics, dietary interventions, and BDNF outcomes were extracted and synthesized qualitatively. A summary table of the included studies was generated. Fifteen clinical studies (n = 862 total participants) met inclusion criteria (11 randomized trials and 4 single-arm trials). Diet modalities included continuous calorie restriction (typically 20%-30% caloric deficit), intermittent fasting (eg, alternate-day fasting, time-restricted eating), ketogenic diets (KDs), Mediterranean-type diets, and other weight-loss diets. Duration of interventions ranged from 6 to 26 weeks. Responses to BDNF varied by intervention. In adults with overweight/obesity, weight-loss dietary interventions demonstrated heterogeneous effects on circulating BDNF. We categorized the included studies into 3 groups based on the effects of dietary weight loss on BDNF: increases, no significant change, or decreases. Approximately half of the studies showed no significant effect, while a few interventions showed a decrease. Intermittent fasting regimens and certain dietary patterns (eg, the Mediterranean-DASH [Dietary Approaches to Stop Hypertension] [MIND] diet, and the KD) tend to elevate BDNF levels, whereas continuous calorie restriction often shows no change, and very rapid weight loss may paradoxically reduce BDNF in some cases. These findings suggest that diet-induced weight loss can influence neurotrophic status, potentially modulating brain health. However, results are inconsistent across studies. Overall, interventions involving intermittent calorie restriction, MIND, and/or KD, more frequently reported BDNF increases, whereas continuous calorie restriction produced mixed results.

Chronic hyponatremia is a common electrolyte disturbance associated with adverse outcomes. The optimal rate of correction remains uncertain, with current guidelines emphasizing avoidance of overcorrection. This systematic review and meta-analysis aimed to synthesize the existing evidence on patient and healthcare utilization outcomes associated with overcorrection in adults with chronic hyponatremia. This study followed a pre-registered protocol (PROSPERO CRD42024606516). Medline and EMBASE were searched from inception to May 2024. Eligible studies included original experimental or observational research. Included studies reported outcomes for adult patients with chronic hyponatremia who experienced overcorrection, and those who did not. The outcomes of interest were neurologic complications, acute care utilization (hospital and intensive care unit length of stay, re-admission) and mortality. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman random effects models when data allowed; otherwise, outcomes were synthesized narratively. Forty-three studies were included. Overcorrection of hyponatremia was associated with an increased odds of neurologic complications (OR 4.23, 95% CI 2.93 - 6.11, I2 = 0%) but lower odds of mortality (OR of 0.67, 95% CI 0.47 - 0.97, I2 = 82.3%). In sensitivity analyses restricted to studies at low risk of bias, the association between overcorrection and neurologic complications was no longer statistically significant (OR 3.22, 95% CI 0.40-25.83, I2 = 25.4%). Given the observational nature of included studies, indirect evidence, and high risk of bias across studies, the certainty of evidence is very low. While sodium overcorrection appears to be associated with increased risk of neurologic complications but lower risk of mortality, the limitations of the current literature warrant cautious application of these findings. Given the potential risks of under- and overcorrection, a reframing of practice to achieve adequate correction, rather than focusing on overcorrection avoidance alone may be warranted.

Background: Neuropathic pain represents a substantial global burden with limited effective therapeutic options. Pulsed Electromagnetic Field (PEMF) therapy has emerged as a potential non-invasive adjuvant, though clinical evidence remains inconsistent. This systematic review and meta-analysis evaluated PEMF efficacy and safety, specifically analyzing the influence of etiology and stimulation parameters. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD420251184151), five databases (Cochrane, PubMed, Scopus, Web of Science, and LILACS) were searched for Randomized Controlled Trials (RCTs) comparing PEMF versus sham. Risk of bias was assessed via Cochrane RoB 2, and heterogeneity was explored through detailed subgroup analyses. Results: Thirteen RCTs met the inclusion criteria (N = 688). While global analysis indicated a statistically significant pain reduction (SMD: −1.01; p = 0.03), it exhibited extreme statistical heterogeneity (I2 = 92.8%) and instability. After adjusting for missing studies using the Trim-and-Fill method, global significance disappeared. However, subgroup analysis resolved this inconsistency, revealing a massive, clinically meaningful effect in Spinal/Radicular pain (SMD: −2.35; 95% CI: −4.42 to −0.29), whereas Peripheral Neuropathy showed no significant reduction (SMD: −0.38; 95% CI: −0.86 to 0.10). Conclusions: The PEMF evidence base for neuropathic pain is currently highly fragmented. Extreme heterogeneity and publication bias render “one-size-fits-all” efficacy estimates invalid and potentially misleading. Instead, our data reveals a critical etiological divergence: PEMF appears highly effective for spinal/radicular pathology, likely due to the mechanical nature of the lesion, but demonstrates limited efficacy for diffuse peripheral neuropathy. Future research must abandon generic protocols in favor of etiology-specific trials, prioritizing high-frequency parameters and rigorous bias control.

Oral leukoplakia (OL) is a common oral potentially malignant disorder in which chronic inflammation and carcinogenic exposures may promote oxidative stress. Saliva is in direct contact with the lesion and represents a non-invasive medium for assessing redox dysregulation. This systematic review and meta-analysis synthesized evidence on salivary oxidative damage markers and antioxidant defenses in OL compared with healthy controls. A PROSPERO-registered systematic review (CRD420251242238) was conducted in accordance with PRISMA and Cochrane guidelines. PubMed, Scopus and Web of Science were searched up to 10 December 2025 for observational studies comparing salivary oxidative stress and/or antioxidant markers in patients with clinically and/or histopathologically confirmed OL and healthy controls. Case–control and cross-sectional studies reporting quantitative data were included. Risk of bias was assessed using a modified Newcastle–Ottawa Scale. When ≥2 datasets were available, standardized mean differences (SMDs) with 95% confidence intervals (CI) were pooled. Meta-analysis showed significantly higher salivary malondialdehyde in OL (SMD = 1.47; 95% CI: 0.55–2.39), indicating enhanced lipid peroxidation. OL was also associated with significantly lower levels of reduced glutathione, vitamins C and E, and uric acid. For 8-hydroxy-2′-deoxyguanosine, a non-significant trend towards higher levels was observed with substantial heterogeneity. Evidence for TBARS, total antioxidant capacity and enzymatic antioxidants was limited. OL is associated with a salivary redox imbalance favoring a pro-oxidant state. High heterogeneity and limited biomarker-specific evidence highlight the need for larger, standardized prospective studies to validate salivary redox markers for OL monitoring and risk stratification.