The primary objective was to analyze the efficacy of EOIPB in reducing use of opioids in postoperative period. Time and need for rescue analgesia, postoperative pain scores and incidence of nausea and vomiting were also evaluated. The review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024622945). Randomized clinical trials that included adults undergoing thoracoabdominal surgery, comparing EOIPB with general anesthesia, multimodal anesthesia, or other regional blocks, were selected. Search was performed on May 2025 in PubMed, Embase, Scopus, and Cochrane Library databases, with no time or language restrictions. Certainty of the evidence was assessed using GRADE system. Fifteen studies involving 899 patients were identified. Results indicated that EOIPB significantly reduced opioid consumption in the first 24 hours postoperatively, compared with standard analgesia (MD = -19.55; 95% CI [-28.50, -10.60]; P < 0.0001, I2 = 72%) and other regional blocks (MD = -13.15; 95% CI [-24.77, -1.52]; P = 0.03, I2 = 95%). Heterogeneity was considered moderate to high among studies, related to differences in samples, anesthetic protocols, and assessment methods. Outcomes associated with postoperative pain have a low to very low quality of evidence according to the GRADE method. The findings support the clinical potential of EOIPB as an effective strategy for postoperative pain control, but without indication for adoption in clinical practice routine, limited to situations of failure of first-line techniques in analgesia, such as epidural anesthesia.

Emergency general surgery (EGS) decisions often occur under time pressure and with reduced patient involvement in comparison to the elective setting. Variation in decision-making in the field of EGS is partly attributable to patient and contextual factors, but clinician factors also likely shape decisions.This scoping review aims to clarify which clinician factors have been investigated in relation to decision-making in adult EGS, which have been identified as influential, and the methods used to measure them. Any studies reporting on individual clinician factors and decision-making in EGS will be eligible. Studies must be only in adult populations (patients aged 18 and over). This review will consider quantitative, qualitative and mixed-methods study designs.This scoping review will be conducted in accordance with the methodology developed by the Joanna Briggs Institute and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This protocol was prospectively registered with the Open Science Framework: https://osf.io/xcqp4. We will search MEDLINE, EMBASE, CINAHL, CDSR and CENTRAL. The search strategy will be adapted for each database, and no time or language restrictions will be applied.Two independent reviewers will screen studies for eligibility and extract data using a purpose-designed data extraction form, with disagreements resolved by a third reviewer. Extracted data will be synthesised using a narrative approach to map key concepts, describe study characteristics and identify gaps in the literature. Ethical approval is not required as this review will use publicly available data. Findings will be disseminated through peer-reviewed publication and conference presentations.

Introduction: Currently, restorative dentistry has been moving toward minimally invasive approaches. Significant advances in materials and adhesive systems have occurred, for which there is still a need to integrate this information. Objective: To summarize the scientific evidence regarding the different types of adhesive systems, emphasizing their evolution and clinical performance. Methods: This integrative review study used the Health Sciences Descriptors (DeCS/MeSH) “Dental Cements,” “Adhesives,” “Dentin,” “Composite Resins,” “Dental Materials,” “Longevity,” and “Tensile Strength,” adapted for the databases PubMed/MEDLINE, SciVerse Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), and grey literature (Google Scholar), aiming to select clinical trials without a time restriction on publication. Results: Of the 431 studies identified, 22 were included in the final sample. Most focused on evaluating adhesive systems applied in composite resin restorations in non-carious cervical lesions (NCCLs), totaling 19 investigations. A smaller number of studies evaluated adhesive systems in restorations classified as I to III or in unspecified cavities. The publication period ranged from 2001 to 2025, with the highest concentration of studies in 2020. The clinical samples showed wide variation, ranging from 90 to 234 NCCLs, with participants distributed into two to five experimental groups. Regarding adhesive systems, there was a predominance of the use of eighth-generation universal adhesives, especially Scotchbond Universal/Single Bond Universal, which were the most frequently investigated. Conclusion : The appropriate choice of the adhesive system, combined with the correct execution of the technique, is decisive for the clinical quality of composite resin restorations.

Precipitation Use Efficiency (PUE) is a key ecological indicator for evaluating how vegetation converts precipitation into biomass or productivity. A thorough analysis of its quantification methods and driving mechanisms is of great significance for improving regional precipitation use efficiency and ensuring agricultural and ecological water security. In this study, we conducted a comprehensive literature search without time restrictions in the Web of Science and China National Knowledge Infrastructure (CNKI) databases, using “Precipitation Use Efficiency” and “PUE” as core keywords. After retrieval, a strict “independent dual-screening plus cross-checking” procedure was adopted with unified inclusion and exclusion criteria to ensure literature quality. Only highly relevant and methodologically rigorous studies were retained, resulting in a final set of 80 eligible publications. Key information was systematically extracted using content analysis, followed by integrated summarization and inductive analysis. This paper systematically illustrates the ecological connotation of PUE, compares diverse quantification and research methods with their applicable conditions, analyzes spatiotemporal differentiation characteristics and multidimensional driving mechanisms, summarizes practical approaches for PUE improvement, and reviews current research limitations. It represents a systematic integration and refinement of the research framework of precipitation use efficiency. The results can provide targeted theoretical support for revealing the driving mechanisms of PUE and promoting the efficient utilization of precipitation resources.

As UNESCO's cultural heritage protection philosophy shifts from monumental architecture to traditional living architecture, the preservation of vernacular architectural heritage has received increasing attention. Nevertheless, it is still in trouble at present. The paper utilizes textual analysis and fieldwork to examine the situation of present vernacular architectural heritage preservation, serious games, and issues and solutions associated with conservation of the vernacular residential cultural heritage buildings. The research confers that preservation of the vernacular architectural heritage is still focused on the heritage itself and there is relatively lack of protection of the collective memories and cultural spirit that is contained within such heritage. The present paper suggests a vision of the serious games incorporating the concept of heritage awareness and cultural experience. The study results indicate that serious games can not only break the time and space restrictions and safeguard the privacy of the residents, but also address the flaws in memory passing and emotional bonding. The research offers a new direction of the ongoing preservation of the vernacular architecture in the digital era and contributes to the innovative methods to the designing of the further cultural serious game narratives.

Adrenal venous sampling (AVS) interpretation distinguishes unilateral from bilateral primary aldosteronism (PA), which determines surgical versus lifelong medical management. Data is scant regarding the effects of mineralocorticoid receptor antagonist (MRA) use on the risk of AVS misclassification. To review the data in the literature about the effect of uninterrupted MRA use on the success of AVS lateralization and postoperative clinical and biochemical outcomes in patients with PA. A systematic search of five different databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library) with no time restrictions was performed to identify relevant studies evaluating patients with PA who underwent AVS while on or off concurrent MRA treatment. Four retrospective cohort studies were included, yielding a total of 1116 participants who underwent AVS. Of these, 147 (13.2%) were performed with concurrent MRA therapy. Rates of successful AVS were higher in patients with ongoing (89.1%) versus discontinued (78.0%) MRA treatment, with continuation of MRAs associated with a higher likelihood of lateralization consistent with unilateral disease (OR = 2.1, 95% CI: 1.4-3.1, I2 = 0%). Clinical (OR = 0.9, 95% CI: 0.1-10.7, I2 = 53%) and biochemical (OR = 0.8, 95% CI: 0.2-3.1, I2 = 47%) success rates were comparable between MRA and non-MRA groups. Concurrent use of MRA treatment did not adversely affect the diagnostic performance of AVS, rates of PA lateralization or postoperative outcomes. These results suggest that discontinuation of MRAs, despite being recommended by society guidelines, may not be necessary, and instead support a patient-centred approach to management of PA. Given the overall low quality of evidence, future prospective studies are needed to address this dilemma.

Salmonella infections remain a persistent global health burden, with rising incidence and substantial mortality. This study estimated the pooled case fatality rate (CFR) of Salmonella infections in low- and middle-income countries (LMICs) and delineated CFRs of typhoidal and non-typhoidal infections across regions and populations to inform targeted interventions. PubMed, Scopus, Web of Science and ScienceDirect were searched for primary studies without language or time restrictions. Eligible studies reported typhoidal or non-typhoidal Salmonella cases and deaths. Random-effects meta-analysis with a 95% CI was conducted in R Studio, alongside subgroup, meta-analyses, heterogeneity (I2, Egger's test) and sensitivity analyses. Study quality was assessed using STROBE and Cochrane RoB 2 tools, following PRISMA guidelines, with registration in the Open Science Framework registries. Of 1914 records, 104 studies from 35 countries were included, mostly from Africa and Asia (86%). Hospitalised patients formed the largest group (56%). Typhoidal cases predominated (70%), with culture as the main diagnostic (79%). Overall, 365 922 Salmonella infections were reported, with a pooled CFR of 5.72%. Non-typhoidal infections had a higher CFR (13.85%) than typhoidal (2.99%). Mortality was greatest in patients with typhoid intestinal perforation (15.29%) and older people (40.91%). Addressing Salmonella mortality disparities requires urgent investment in LMIC diagnostic and surveillance infrastructure.

Sensitivity and specificity of the video head impulse test in the diagnosis of vestibular migraine - A systematic review and meta-analysis.

Medicinal plants in the management of muscle loss and sarcopenia: A narrative review of preclinical and clinical evidence from eight species.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit and one of the most prevalent dermatological conditions globally. Its multifactorial pathogenesis and variable clinical presentation necessitate a multimodal therapeutic approach. While pharmacological interventions remain first-line therapy, cosmetic and dermatologic procedures are increasingly utilized as adjunctive strategies to enhance clinical outcomes. This narrative review synthesizes current evidence on four commonly employed cosmetic modalities in acne management: chemical peels, mechanical peels, light-based therapies, and radiofrequency-assisted microneedling. The aim of this study is to evaluate the role of procedural treatments as adjunctive options in the management of acne vulgaris. A literature search was performed in PubMed, Web of Science, and Scopus with no time restrictions, focusing on patients with acne vulgaris and adjunct cosmetic/procedural interventions. Given the narrative scope, this was a non-comprehensive, non-exhaustive evidence synthesis, with treatment options organized thematically. Overall, these cosmetic procedures can provide meaningful adjunctive benefits when integrated into individualized acne treatment plans. However, variability in study designs, procedural parameters, and outcome measures limits direct comparison across modalities. Further high-quality randomized controlled trials are necessary to establish standardized protocols and to determine long-term safety and efficacy. Procedural treatments can serve as valuable adjuncts in the management of acne vulgaris by enhancing therapeutic outcomes and addressing treatment-resistant cases. However, individualized treatment selection and further high-quality studies are needed to optimize their use and long-term benefits.

Violence and aggressiveness in borderline disorder: A systematic review.

There is a paucity of evidence and reports addressing the Economic Evaluation in Health (EEH) of the implementation of the Nurse Prescribing of Medication (NPM) role. Consequently, there is limited knowledge about the economic costs and the overall impact of NPM on healthcare systems worldwide where it has been implemented. This gap of knowledge limits the ability of other nations to determine whether adopting this initiative would be beneficial. A few countries have published their NPM economic benefits, though available scientific publications have focused on NPM clinical effectiveness, particularly regarding quality and safety in patient care. This review aimed at mapping the current knowledge about the role played by the NPM internationally in terms of EEH in terms of direct and indirect economic benefits for cost minimization, cost-effectiveness, cost-utility, cost-benefit, return on investment and healthcare cost savings. A scoping review of international literature was conducted based on the PRISMA-ScR checklist and the Johanna Briggs Institute Guide to identify scientific evidence and relevant grey literature on the review topic. The search strategy was conducted in four bibliographic databases of Scopus, Web of Science, PubMed (covering Medline) and Google Scholar, with no time restrictions, covering publications up to 30 September 2024. The search was performed in both English and Spanish, selecting relevant publications based on inclusion and exclusion criteria. For research synthesis and data analysis, two summaries were developed: one summarizing the findings from the scientific literature search and the other summarizing the results from the grey literature search. The 26 included studies in this scoping review suggest a positive EEH across various countries where its implementation has led to enhanced efficiency, reduced healthcare costs and improved economic profitability. The actions carried out for decades in those countries represent a significant reduction in direct and indirect costs, also in medical supplies and waiting lists, as well as an increase in the quality of patient care leading to a positive contribution to healthcare systems' sustainability. Improving the conditions and utilization of NPM is essential to maximize nurses' contribution to patient care within healthcare systems. More high-quality research is required to identify and examine economic effectiveness and healthcare cost savings by governments and other healthcare organizations, given that evidence regarding the benefits of the NPM role globally is insufficient.

Impact of pelvic lymph node dissection on oncological outcomes in patients with clinically staged non-muscle-invasive bladder cancer undergoing radical cystectomy: A systematic review.

The optimal anesthetic technique during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) remains uncertain. General anesthesia (GA) provides airway protection and procedural stability, whereas conscious sedation (CS) offers faster workflow and the ability to monitor neurological status. This updated systematic review and meta-analysis (SRMA) aims to summarize and update the existing literature from randomized controlled trials (RCTs) to guide the selection of the most appropriate anesthetic technique during EVT for AIS. We searched the electronic databases of PubMed, ProQuest, and Scopus from their inception to October 17, 2025. No time or language restrictions were applied. Only RCTs were included. The SRMA protocol was registered with PROSPERO (ID: CRD420251170612) on 18th October 2025. Statistical analysis was performed using Review Manager software. Risk of bias (RoB) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were assessed. Of the 348 records screened, ten eligible RCTs were included. GA was associated with a significantly higher rate of successful reperfusion, but there was no difference in 90-day functional independence on modified Rankin scale (mRS) score, or mortality compared with CS. GA increased the risk of hypotension and prolonged the door-to-puncture time, but not other complications or process times. The RoB was low for most included studies. The certainty of evidence for study outcomes was moderate on GRADE. To conclude, GA has superior recanalization rates than CS, but functional outcomes and mortality are similar. Conversely, hypotension occurs more frequently with GA, while CS provides a faster workflow.

The aim of this study was to identify the effects of a hybrid maternal role enhancement program based on Meleis' Transition Theory for working mothers. Using a non-equivalent control group pretest-post-test repeated-measures design, 46 participants were conveniently recruited and assigned to experimental (n = 24) and control (n = 22) groups. Data were collected before intervention (baseline), immediately after intervention (Post-test 1) and 2 weeks after intervention (Post-test 2) using structured questionnaires. The experimental group participated in the hybrid maternal role enhancement program, which included a 1-day offline workshop for both parents and 2 weeks of online support and counselling for mothers. Data were analysed using IBM SPSS Statistics 25.0. The hybrid maternal role enhancement program had significant interaction effects (group × time effect) on parenting efficacy, maternal identity and spousal childcare support. Scores in the experimental group increased from baseline to Post-test 1 and Post-test 2, whereas the scores of those in the control group remained similar or decreased. The nursing-led maternal role enhancement program developed based on the transition theory can be provided for working mothers with severe time and space restrictions as a hybrid program that combines online and offline programs.

Background: Tumor-infiltrating lymphocytes (TILs) are key components of the immune microenvironment in ovarian cancer, influencing disease progression and clinical outcomes. However, the prognostic significance of different TIL subtypes, including CD8+, CD4+, FOXP3+ regulatory T cells, and CD20+ B cells, remains inconsistent across studies. This systematic review aims to synthesize current evidence on the prognostic roles of these immune subtypes, with a focus on their spatial distribution within the tumor microenvironment and associations with overall survival (OS) and progression-free survival (PFS) in ovarian cancer. Methods: A systematic search was conducted using the PRISMA 2020 guideline protocol and was registered under PROSPERO with registration number CRD42025638744. Several databases, including PubMed, Scopus, and Google Scholar, were included to obtain articles, using keywords related to ovarian cancer, TILs, immune subtypes, and prognosis. Studies published in peer-reviewed journals without time restrictions were included. Selection criteria focused on studies that reported the density and localization of TIL subtypes and their association with clinical outcomes.Results: Fifteen studies met the inclusion criteria, involving 7,982 ovarian cancer patients. CD8+ TILs, together with CD20+ B cells and memory T cells, were consistently associated with better clinical outcomes, particularly when localized within intraepithelial regions. CD4+ T cells exhibited diverse prognostic effects depending on their polarization, where FOXP3+ regulatory T cells were linked to poor prognosis due to their immunosuppressive functions. The spatial distribution of TILs was a critical determinant of their prognostic value, with intraepithelial TILs showing stronger anti-tumor activity than stromal TILs. Variability in detection methods, cut-off values, and tissue sampling contributed to inconsistencies across studies.Conclusion: While TILs phenotypes may predict clinical outcome in ovarian cancer patient, their spatial distribution must be taken into consideration to sharpen analysis. To establish a more reliable prognostic marker, methodologies using standardized TIL thresholds should be implemented, hence the need for further studies.

Background: Paraneoplastic limbic encephalitis (PLE) with anti-Ma2 antibodies is a rare immune-mediated disorder associated with testicular cancer, particularly in young males. While neurological manifestations are well documented, hypothalamic-pituitary dysfunctions remain underreported. We present a case of anti-Ma2 PLE associated with testicular cancer together with a systematic review of PLE associated with testicular cancer, selectively restricted to anti-Ma2 positive cases and focusing on hypothalamic-endocrine involvement. Case presentation: We describe a 21-year-old male diagnosed with anti-Ma2 PLE and intratubular germ cell neoplasia of the right testis. He underwent orchifunicolectomy and immunosuppressive therapy with neurological improvement. Four years later, he developed new-onset temporal seizures, decreased libido, and a polyuria-polydipsia syndrome. Dynamic endocrine testing, including a water deprivation test and copeptin measurement, supported a diagnosis of partial central diabetes insipidus (CDI). Methods: A systematic literature review was performed in accordance with PRISMA guidelines. PubMed was searched using predefined keywords without time restriction. Studies reporting PLE associated with testicular tumors in humans with confirmed anti-Ma2 antibody positivity were included. Results: Eleven studies were included, reporting a total of 38 patients with anti-Ma2-associated PLE and testicular cancer. Hypothalamic or diencephalic involvement was described in 16 patients (42.0%), while endocrine manifestations were explicitly reported in four cases. Only two previous reports mentioned CDI, without detailed diagnostic evaluation. Conclusions: This study highlights the importance of recognizing hypothalamic-endocrine manifestations in PLE. In patients presenting with polydipsia and polyuria, CDI should be carefully differentiated from primary polydipsia using dynamic testing. Hypothalamic involvement may emerge years after tumor treatment, warranting long-term endocrine surveillance.

To evaluate the strength and methodological quality of evidence regarding the association between periodontal disease (PD) and chronic obstructive pulmonary disease (COPD) through an umbrella review. A comprehensive search was conducted through April 2025 in PubMed, Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews (SRs), with or without meta-analysis, investigating the association between PD and COPD were included without time or language restrictions. Narrative reviews, primary studies, protocols, and non-systematic reports were excluded. Methodological quality was assessed using AMSTAR-2. The degree of primary study overlap was calculated using the Corrected Covered Area (CCA) index. Due to high overlap (CCA = 14.45%) and clinical heterogeneity, no de novo meta-analysis was performed, and a structured qualitative synthesis was conducted. Of 313 identified records, 12 SRs comprising 145 primary studies were included. Six reviews were rated as high confidence, one as low confidence, and five as critically low confidence according to AMSTAR-2. Most SRs reported a positive association between PD and COPD. However, the magnitude and statistical significance of the association varied according to periodontal parameters, COPD outcomes, and smoking status. Current evidence suggests a likely association between PD and COPD, although the relationship may be influenced by shared risk factors such as smoking and methodological heterogeneity. Integrating periodontal assessment into COPD management may be clinically relevant, but high-quality prospective studies are needed to clarify causal pathways. Open Science Framework (OSF), https://doi.org/10.17605/OSF.IO/YTXB6.

Task shifting and task sharing (TS/S) redistribute responsibilities across cadres to expand access to healthcare, particularly in underserved areas. TS/S addresses workforce shortages and improves the availability of essential surgical procedures. The scope and geographical distribution of surgical TS/S programs are well documented, less is known about how TS/S initiatives are monitored and evaluated, especially with respect to trainee, program, and health systems outcomes. This review describes existing approaches to evaluation within surgical TS/S initiatives. We searched nine electronic databases (MEDLINE [Ovid], Embase [Ovid], CINAHL [EBSCO], Scopus, CABI Digital Library, Clarivate Web of Science, Evidence Aid, Global Index Medicus, and Eldis) on 31 January 2024 and 12 March 2025, using MeSH terms and keywords related to "Task Sharing" AND "Surgery". All patient populations, practice settings, surgical skills, and study designs were eligible. No language or time restrictions were utilized. Publications that did not describe the evaluation of surgical skills, or that focused on skills within a practitioner's typical scope of practice, were excluded. Two reviewers independently screened and extracted data. Risk of bias was assessed with MINORS. Findings were synthesized using inductive content analysis. Results were tabulated and presented graphically. Of 2483 identified records, 1609 unique publications were screened, 452 underwent full-text review, and 228 were included in the review. Most studies reported surgical TS/S in low-income countries (41.7%, 95/228). Obstetric and gynaecological procedures were most commonly taught (61.4%, 140/228). In total, 1753 examples of evaluation metrics were extracted from the 228 included publications. The evaluation metrics were sorted into three themes, including metrics that evaluated TS/S providers (72.6%, 1272/1753), training programs (7.5%, 132/1753), and systems (19.9%, 349/1753). This scoping review comprehensively describes existing evaluation strategies. While evaluation of surgical TS/S initiatives remains heterogeneous, limiting the generalizability of any single approach, we successfully grouped monitoring and evaluation metrics into three key domains: provider, program, and health systems. Future work should focus on proposing a comprehensive but adaptable monitoring and evaluation framework that can be used by surgical TS/S programs across the globe.

Background: There is evidence that person-centred care has positive effects, and the research field is growing fast and is cumbersome to overview. The purpose of this scoping review is to present an overview of the international research literature on person-centred care. Approach: Relevant literature indexed in PubMed, Scopus, PsychINFO, CINAHL and Web of Science was retrieved. Literature searches were developed using index terms and free text words related to person-centred care. A variety of terms such as person-centred, patient-centred, client-centred, woman-centred, child-centred, family-centred and people-centred, including all variations on term endings, were included. No time restriction was used but language was restricted to English. Methods of combined manual and computer-assisted were used for screening. The initial project idea was anchored in the Gothenburg University Centre for Person-Centred Care, the GPCC, steering committee in which a senior patient partner was a member. Two patient representatives/partners were included in the project group. Results: In total, 1 351 publications were included. Theoretical and empirical studies were most prevalent in the sample. For empirical studies the most common setting was hospital care, and the study population was most often health professionals or patients. The most frequently used term was patient-centred, followed by person-centred and family-centred. Research from six continents was included, and several research clusters were revealed. Implications: The review provides an overview of the field as well as includes a discussion about the current barriers in being able to provide such an overview. The review shows for example that literature using a variety of centredness terms is eligible to include in a review on person-centred care. Transparent use of terminology (as well as underlying conceptualisations) in research is critical. This in order to prevent fragmentation of knowledge in future studies attempting towards person-centred care research synthesis, and in turn enabling research-based policy and practice development.