Journal of Clinical Medicine

Background/Objectives: Intermittent claudication (IC) secondary to peripheral artery disease (PAD) causes exertional leg pain and discomfort, which limits functional walking capacity. The clinical efficacy of Ginkgo biloba extract (GBE) as a therapeutic agent for IC is debatable. This systematic review and meta-analysis evaluated the efficacy and safety of GBE compared with a placebo in patients with IC due to PAD. Methods: Databases including PubMed, Embase, the Cochrane Library, and CINAHL were searched until 24 April 2026. Eligible studies included randomized, double-blind, controlled trials (RCTs) comparing placebo. Primary outcome was absolute claudication distance (ACD) at the end of the study. Secondary outcomes were initial claudication distance (ICD), ankle-brachial index (ABI), ankle pressure, and adverse events. Walking outcomes across various treadmill protocols were standardized to estimate caloric expenditure (kcal). A random-effects model was used to pool the effect estimates across trials. Risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). Results: A total of 14 RCTs comprising 893 participants represent the total number randomized were included. GBE was associated with a statistically significant but modest improvement in ACD compared with placebo (mean difference [MD], 3.50 kcal; 95% CI, 0.02 to 6.98; p = 0.049). This benefit was significant in trials with a 24-week duration (MD, 4.67 kcal; 95% CI, 2.26 to 7.08; p < 0.001) but not in 12–16 weeks trials (MD, 1.35 kcal; 95% CI, −2.39 to 5.09; p = 0.48). No significant changes were observed for ICD or resting ABI/ankle pressure. GBE was well tolerated, with an overall adverse event incidence comparable to placebo. Conclusions: In patients with IC due to PAD, GBE therapy improves absolute walking performance, with a significant effect observed in trials evaluating 24 weeks of treatment. Given its favorable safety and tolerability profile, GBE can represent a clinically relevant and well-tolerated therapeutic option to support functional walking capacity, particularly for patients unable to tolerate or use conventional pharmacological agents.

Background/Objectives: Digital guidance of tooth autotransplantation, using cone beam computed tomography (CBCT)-based planning with three-dimensionally (3D) printed donor tooth replicas, surgical guides, navigation or robotics, aims to shorten extra-alveolar time and improve positioning. This systematic review synthesised the clinical, radiographic and operative outcomes of digitally guided autotransplantation and compared them with conventional technique. Methods: Following PRISMA 2020 and PROSPERO registration CRD420261434791, MEDLINE (PubMed and Ovid), Embase, Scopus, Web of Science, CENTRAL and ClinicalTrials.gov were searched from inception to August 2026, with Google Scholar and reference-list screening. Clinical studies of at least five digitally guided transplanted teeth or patients were eligible. Two reviewers independently screened, extracted data and assessed risk of bias (RoB 2, ROBINS-I or the JBI case-series checklist); certainty was rated with GRADE. Results: Twenty-five studies reported in 33 publications (2012–2026; one randomised, eight comparative non-randomised, sixteen single-arm; approximately 1300 patients) were included. All used CBCT- or CT-derived 3D-printed replicas, eleven with printed guides; none used navigation or robotics. In guided arms, survival was 92–100% and success 86–100% at 6 months to 5 years. Extra-alveolar time was under one minute in eleven reports, most donor teeth fitted at the first attempt, and positional deviation from the plan was about 1–2 mm. Compared with the conventional technique, guidance shortened surgical time by 13–15 min in two studies (low certainty) and was associated with higher survival and success and less root resorption in retrospective cohorts at serious risk of bias, whereas the registered controlled trial and a prospective paediatric cohort found no significant clinical difference (very low certainty). Conclusions: Digital guidance improves the operative efficiency and positional control of autotransplantation. Clinical superiority over conventional technique remains unproven; randomised trials with standardised outcomes and follow-up beyond two years are needed.

Central serous chorioretinopathy (CSC) is increasingly understood within the pachychoroid disease spectrum, with choroidal abnormalities playing a central pathogenic role. Nevertheless, the retinal pigment epithelium (RPE) remains critical to outer blood–retinal barrier function and subretinal fluid (SRF) homeostasis, and represents a potentially modifiable therapeutic target. RPE-targeted laser therapies employ biologically distinct approaches, ranging from sublethal RPE modulation with subthreshold micropulse laser and nondamaging retinal laser therapy to selective RPE injury followed by repair with selective retina therapy. We reviewed their laser–tissue interactions, dosimetry, clinical outcomes, and safety in CSC, focusing on how different RPE responses contribute to fluid resolution. Experimental and clinical observations provide a biological basis for considering how sublethal RPE modulation and selective RPE injury followed by repair may contribute to restoration of the RPE barrier and fluid homeostasis through distinct biological responses. Nevertheless, the mechanisms linking these RPE responses to SRF resolution remain incompletely understood. RPE-targeted laser therapies represent both potential therapeutic approaches and a means of gaining mechanistic insight into the contribution of RPE dysfunction to CSC. However, despite their distinct biological rationales, the clinical evidence supporting these modalities remains heterogeneous and insufficient to establish their comparative efficacy. Optimal treatment parameters, patient selection, and the long-term efficacy and safety of repeated treatment remain to be established.