Search Results (1,348)

Objective: To explore healthcare professionals’ beliefs and concerns about doxyPEP by systematically reviewing the literature. Method: A systematic review of three bibliographical databases (CINAHL, EMBASE and MEDLINE) and MedRxiv in August 2024, updated in February 2026 explored healthcare professionals’ beliefs and concerns about doxyPEP. Three researchers independently reviewed full-text manuscripts for eligibility and narratively synthesized data. We used the Joanna Briggs Institute toolkit to assess risk of bias. This review was registered on PROSPERO (ID:CRD42024570646). Results: Eight manuscripts were included in the final review: five cross-sectional studies, two qualitative studies, and one mixed method study from the USA (n = 5), Australia (n = 1), Kenya (n = 1), and the UK (n = 1) published between 2020–2025 and including 1840 healthcare professionals. Healthcare professionals recognised the high burden of bacterial STIs and believed that doxyPEP should be made available to MSM. There was a strong willingness to provide doxyPEP to MSM with the support of national guidelines. Healthcare professionals suggest that implementing doxyPEP would be feasible with educational support, but were concerned about antimicrobial resistance, drug–drug interactions, pill burden, cost, implementation logistics and the effect on clinical service demands. They acknowledged the lack of research and access to doxyPEP for other groups, specifically trans people and cis-gendered women. They also highlighted the need for community involvement in the implementation of doxyPEP. Conclusions: This review highlights that healthcare professionals were willing and ready to provide doxyPEP; however, they have concerns including antimicrobial resistance, the effect on service capacity, and the lack of research on cis-gendered women and trans people. Patients and health professionals need to be involved in the implementation of doxyPEP. Full article

Background: Acute kidney injury (AKI) is a frequent and severe complication after liver transplantation (LT), occurring in 30–60% of cases. It increases mortality, prolongs hospital stay, and increases the risk of chronic kidney disease. Intraoperative, modifiable anesthetic factors play a key preventive role. This systematic review synthesizes the overall prevalence of AKI and examines the evidence linking intraoperative anesthetic management to AKI after LT, emphasizing modifiable factors that may inform future perioperative strategies. Methods: We conducted a systematic, computerized search on PubMed, EMBASE, Cochrane Library, and Scopus from January 2004 to November 16, 2025, following a registered protocol on PROSPERO (ID: CRD420250580749). Randomized controlled trials (RCTs) and cohort studies assessing intraoperative predictors of AKI were considered eligible for inclusion. The primary outcome was the incidence of post-LT AKI. Intraoperative factors associated with post-LT AKI, including intraoperative hypotension, fluid therapy, transfusion strategies, and the use of vasopressors and/or inotropic agents, were also assessed. Results: A total of 50 studies (8 RCTs and 42 cohort studies) involving 22,434 patients were included. The pooled incidence of post-LT AKI from observational studies was 41% (95% CI 36–46%). Across the included studies, intraoperative hemodynamic instability, excessive or unbalanced fluid administration, liberal transfusion practices, and suboptimal use of vasopressors were consistently associated with an increased risk of post-transplant AKI. Conclusions: AKI after LT is mainly influenced by modifiable perioperative factors. Prevention relies on maintaining stable hemodynamics, careful fluid and transfusion management, and avoiding intraoperative hypotension. Prompt and adequate vasopressor support appeared protective. A multimodal, personalized, kidney-protective approach is essential for improving post-transplant outcomes. Full article

Background/Objectives: Interstitial ectopic pregnancy is a rare and potentially life-threatening condition, accounting for 1–6% of ectopic pregnancies. Its location complicates diagnosis and management, and no standardized treatment guidelines exist. Fertility-preserving, minimally invasive approaches have been proposed as alternatives to medical therapy or radical surgery. This systematic review evaluates the safety and effectiveness of hysteroscopic treatment, focusing on uterine preservation and reproductive outcomes. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251249508). Web of Science, Scopus, and PubMed were searched from inception to January 2026. Eligible articles included case reports and case series describing interstitial pregnancies managed hysteroscopically, alone or combined with minimally invasive treatments, without medical therapy. Study quality was assessed using the JBI Checklist. Results: Eight studies comprising 21 patients were included. Mean gestational age at diagnosis was 55 days, and mean β-hCG level was 7981 IU/L (range 1440–32,000 IU/L). Hysteroscopic management was successful in 16 of 21 cases (76%). Five patients required rescue therapy. Reduced residual myometrial thickness was the main factor associated with treatment failure. Mean time to β-hCG normalization was 32 days. Conclusions: Hysteroscopic management is a safe and effective minimally invasive option for clinically stable patients with interstitial ectopic pregnancy. It allows direct visualization, targeted tissue removal, and preservation of uterine integrity and fertility, with limited morbidity. Ultrasound guidance is generally sufficient, reserving laparoscopy for high-risk cases. These findings support hysteroscopy as a fertility-preserving strategy, though larger prospective studies are needed to confirm long-term reproductive outcomes. Full article

Introduction: Lattice Radiation Therapy (LRT) is an evolving spatially fractionated radiation therapy (SFRT) technique that delivers heterogeneous dose distributions to large and radioresistant tumors. The literature highlights LRT’s potential for effective tumor debulking, palliation, and immune modulation. Effective LRT planning is crucial for maximizing tumor control while minimizing toxicity to organs at risk (OARs). The process involves defining the size, spacing, and arrangement of high-dose vortexes within the GTV. Traditionally, this has been a manual and time-consuming process, prone to inter-planner variability in vortex placement. Recent research has focused on developing automated or semi-automated tools to address these challenges, enhancing planning standardization. We aimed to systematically review for the first time the available scientific evidence of automated planning tools of vortexes for Lattice Radiotherapy and to assess the efficacy of such tools for standardizing Lattice Radiotherapy delivery. Methods: A systematic review of available studies in PubMed, Web of Science, and Scopus, including the terms “Lattice radiation therapy and (automated or optimized)”. Only LRT clinical planning reports published in English and with access to the full accepted text were considered eligible. This study was conducted in accordance with the PRISMA guidelines and was registered on the PROSPERO platform (CRD420251108024). Results: A total of 82 articles were found. Twenty articles fulfilled all inclusion criteria. Automated treatment planning tools have significantly improved the efficiency, consistency, and scalability of LRT planning, addressing limitations of manual planning. In conclusion, LRT should be planned to use automated tools to improve wide clinical standardization and implementation. Full article

Background/Objectives: Our goal was to evaluate the effectiveness of tract sealing agents in reducing pneumothorax and chest drainage insertion following CT-guided lung biopsy (CLB), and to assess the certainty of supporting evidence. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines (PROSPERO: CRD42024608747). Four health science databases (ScienceDirect, PubMed, Scopus, and Cochrane Library) were searched up to 13 October 2025. Randomized controlled trials and cohort studies reporting tract sealing after CLB were included. Outcomes were post-procedural pneumothorax and pleural drainage insertion. Both were analyzed as dichotomous variables using random-effects meta-analysis with the Mantel–Haenszel method. Statistical heterogeneity was assessed using the I² statistic. Results were considered statistically significant for p < 0.05. Study quality was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-randomized Studies—of Interventions, Version 2 (ROBINS-I V2) tool for cohort studies. Results: A total of 3328 records were initially retrieved, with 37 studies (13,107 patients, 7161 male and 4526 female) meeting the inclusion criteria. Sealing agents included saline solution, hydrogel plug, gelatin sponge, autologous blood patch, saline + rapid roll-over, hemocoagulase, gelatin sponge + hemocoagulase, and fibrin glue. Meta-analysis demonstrated significant reductions in pneumothorax and drainage insertion with saline solution (pneumothorax: OR = 0.35; 95% CI 0.25–0.48; p < 0.00001; drainage: OR = 0.22, 95% CI 0.11–0.43; p < 0.00001), gelatin sponge (pneumothorax: OR = 0.44, 95% CI 0.37–0.53; p < 0.00001; drainage: OR = 0.40, 95% CI 0.29–0.54; p < 0.00001), autologous blood patch (pneumothorax: OR = 0.50, 95% CI 0.40–0.62; p < 0.00001; drainage: OR = 0.40, 95% CI 0.27–0.59; p < 0.00001), and hydrogel plug (pneumothorax: OR = 0.65, 95% CI 0.50–0.85; p = 0.001; drainage: OR = 0.44, 95% CI 0.25–0.76; p < 0.004). Conclusions: Saline solution, hydrogel plug, gelatin sponge, and autologous blood patch are sealing agents that are effective at lowering the risk of pneumothorax and drainage insertion following CLB. Full article

Background and Objectives: The role of tourniquet use in arthroscopic partial meniscectomy remains debatable. While traditionally adopted to enhance visualization and reduce intraoperative bleeding, concerns were raised regarding its impact on postoperative outcomes and potential adverse effects, such as muscle damage or delayed recovery. This systematic review aimed to evaluate whether the use of a tourniquet offers advantages in terms of surgical efficiency, patient recovery and complication rates in arthroscopic partial meniscectomy. Materials and Methods: A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42025644740). A comprehensive literature search was performed in 5 databases including studies from the past 20 years. Only randomized controlled trials (RCTs) comparing tourniquet-assisted versus non-tourniquet procedures in adolescent and adult patients undergoing isolated arthroscopic partial meniscectomy matched our inclusion criteria and the analysis was performed on those. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Data were synthesized either quantitatively or narratively, depending on the availability of statistical details. Results: Three RCTs with a total of 243 patients met the inclusion criteria. Operative time was shorter in tourniquet-assisted procedures in one study (p = 0.001), though comparable outcomes were achieved in non-tourniquet groups when pharmacological agents such as intra-articular adrenaline were used. No significant differences were observed between groups regarding postoperative pain (p = 0.22, p = 0.43), knee effusion (p = 0.96), range of motion (p = 0.91, p = 0.96), or time to return to functional activities (p = 0.9, p = 0.34, p = 0.23). Muscle damage, assessed by serum creatine phosphokinase CPK levels, did not differ between groups (p = 0.3, p = 0.093, p = 0.079). Intraoperative visibility and surgeon satisfaction rated higher in tourniquet groups (p = 0.002), although this was subjective and reported variably. No major tourniquet-related complications were recorded. Conclusions: The routine use of a tourniquet in arthroscopic partial meniscectomy provides limited intraoperative advantages and does not improve postoperative outcomes. Current evidence supports a selective rather than routine use of tourniquets, especially when pharmacological alternatives are available. Further high-quality studies are needed to define standardized protocols and assess long-term outcomes. Full article

Background: Succinic acid plays a central role in human energy metabolism as a key intermediate of the Krebs cycle that releases energy accumulated as guanosine triphosphate (GTP). Through its conversion via succinate dehydrogenase (SDH), succinate directly links the Krebs cycle to oxidative phosphorylation (OXPHOS), contributing to adenosine triphosphate (ATP) production. Exercise induces pronounced changes in succinate concentrations in skeletal muscle, blood, and saliva, with responses influenced by training status, exercise modality, and intensity. Objective: This systematic review evaluated the effects of succinate-containing supplements or sole-ingredient succinic acid supplementation on exercise performance and post-exercise recovery in healthy trained individuals. Methods: The review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched without date restrictions. Interventional studies assessing succinate-containing supplementation with outcomes related to exercise performance or recovery were included. Methodological quality was evaluated using the Cochrane Risk of Bias 2 tool. This study was registered in advance with the International Prospective Register of Systematic Reviews (PROSPERO, CRD420251237042). Results: Six studies involving 153 participants (mean age: 23 years) met the inclusion criteria. Five of the six included studies were rated as having a high risk of bias, while the only study judged to be at low risk of bias reported no beneficial effects on exercise performance outcomes. Supplementation protocols included daily doses of 300–2040 mg for up to 21 days and a single acute dose of 30 mg/kg, with most interventions administering succinate as part of multi-ingredient formulations rather than as an isolated compound. Three studies reported ergogenic effects in direct performance metrics, including improvements in maximal oxygen uptake, oxygen consumption, anaerobic threshold power, and total work performed. Two additional studies demonstrated favorable physiological adaptations indirectly relevant to exercise performance, including improved acid-base regulation, hematological markers related to oxygen transport, and antioxidant status, although validated performance outcomes were not assessed. Substantial heterogeneity and overall methodological limitations precluded meta-analysis. Conclusions: Current evidence suggests that succinate-containing supplements or sole-ingredient succinic acid supplementation may enhance direct performance outcomes such as aerobic performance, total workload, and indirect physiological markers, e.g., acid-base balance, hematological indicators and antioxidant capacity in healthy trained individuals. However, given that the majority of included studies were at high risk of bias and the only low-risk study reported no ergogenic effects, current evidence does not provide reliable support for performance-enhancing benefits of succinate supplementation. Interpretation is further limited by the predominant use of multi-ingredient formulations, making it difficult to isolate the effects of succinic acid. While biologically plausible mechanisms exist, well-controlled trials using isolated succinic acid are required before conclusions regarding efficacy can be drawn. Full article

Objective: Bacterial vaginosis is a dysbiosis of the vaginal microbiome, typically characterized by a loss of Lactobacillus. Lactobacillus plays a crucial role in vaginal immunity and protection against sexually transmitted infections. Herpes simplex virus 2, the primary cause of genital herpes, impacts 13% of people worldwide. We undertook this systematic review and meta-analysis to examine the risk of herpes simplex virus 2 acquisition in women with bacterial vaginosis. Secondarily, we examined the impact of bacterial vaginosis on herpes simplex virus 2 shedding, reactivation, and symptoms. Data sources: We searched PubMed, EMBASE, Cochrane, Web of Science, Google Scholar, and ClinicalTrials.gov for articles published before 1 July 2023 for microbiome and herpes simplex virus type 2. Studies were limited to human subjects and the English language. An updated search was performed in January 2026. This study was registered on PROSPERO (CRD42023439139). Methods of study selection: Studies on non-pregnant, reproductive-aged cisgender women that diagnosed bacterial vaginosis by Amsel Criteria, Nugent Scoring or used molecular techniques, and those that detected herpes simplex virus 2 by serological assay or PCR testing were included. Our search identified 863 results with four publications eligible for inclusion. For our secondary outcomes, 40 results were identified regarding herpes simplex virus 2 shedding, with two publications eligible for inclusion, which did not meet our threshold for meta-analysis. There were 21 results identified for herpes simplex virus 2 reaction and 115 results for herpes simplex virus 2 symptoms, with no articles being eligible for inclusion. Tabulation, integration, and results: Quality assessment was performed following data extraction using the quality assessment scales from the Joanna Briggs Institute. Results were extracted, and the pooled hazard ratio was calculated with 95% confidence interval. A total of 1906 women were included in this analysis, and 255 acquired herpes simplex virus 2. The pooled unadjusted hazard ratios produced an effect size of 1.91, (95% confidence interval 1.4649–2.4980), and a p-value of <0.0001, while the pooled adjusted hazard ratios produces an effect size of 1.85, (95% confidence interval of 1.3556–2.5162), and a p-value of 0.0001 indicating that bacterial vaginosis is associated with a increased risk of herpes simplex virus 2 acquisition. Conclusions: This systematic review with meta-analysis indicates that bacterial vaginosis is associated with a significantly increased risk (91% unadjusted, 85% adjusted) of herpes simplex virus 2 acquisition, indicating that bacterial vaginosis treatment may reduce herpes simplex virus 2 acquisition. A notable limitation of these findings is the relatively small number of studies eligible for inclusion in this systematic review and meta-analysis. Full article

Background and Objectives: Post-traumatic lower limb injuries are frequently associated with gait impairment, reduced functional independence, and delayed recovery due to weight-bearing restrictions. Dynamic body weight support (DBWS) refers to rehabilitation technologies that provide real-time, adaptive unloading of body weight during functional tasks such as walking, enabling safer and more effective gait training. Although these robotic systems have been extensively investigated in neurological pathologies, there is a lack of evidence regarding their use in post-traumatic lower limb injuries. Therefore, this systematic review aimed to evaluate the clinical effectiveness of robotic systems incorporating DBWS in the rehabilitation of post-traumatic lower limb pathologies. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD420261294273). Seven major databases (PubMed, Scopus, ScienceDirect, Cochrane, Web of Science, Springer, and Wiley) were searched from inception to October 2025. Studies that were considered included patients with recent post-traumatic pathologies in the lower limbs. The methodological quality and risk of bias of the included studies were evaluated using the PEDro scale and the RoB 2 tool. Results: Seven studies involving 265 participants with recent post-traumatic lower limb injuries were included. The rehabilitation systems reviewed enabled early, intensive gait and balance training by reducing lower limb loading and facilitating safe performance of functional walking tasks. However, substantial heterogeneity in intervention protocols and outcome measures limited direct comparisons across studies. Conclusions: The findings of this systematic review suggest that DBWS interventions may enhance gait and balance recovery in individuals with post-traumatic lower limb injuries. Despite the small number of participants included, the available evidence indicates that these technologies can facilitate functional improvements during the early stages of rehabilitation and may represent a valuable adjunct to conventional therapeutic approaches. Nevertheless, further well-designed studies with larger sample sizes, standardized intervention protocols, and long-term follow-up are required to establish optimal clinical implementation strategies and to confirm the durability of treatment effects. Full article

Background: Dental fear and anxiety are highly prevalent in children, resulting in avoidance or incomplete dental treatment; sedation emerges as a possible behavioral management strategy. This umbrella review aimed to provide a structured and critical synthesis of the available knowledge on sedative single-agent efficacy and routes of administration employed for achieving sedation (excluding deep sedation/general anesthesia) during dental procedures in children for behavior management, as well as to evaluate acceptability and satisfaction for child, caregiver, and provider, and to assess the influence of clinical setting and provider. Methods: In line with the PRISMA statement, the protocol was registered on PROSPERO (CRD420251043738), and 18 systematic reviews were included and synthesized qualitatively. Results: Single-agent sedation was safe and effective for managing behavior in children during dental procedures, with midazolam and nitrous oxide being the most studied agents. Different routes of administration showed distinct characteristics in onset, recovery time, adverse effects and cooperation, while agent selection appeared influenced by clinical setting and provider type. However, data on acceptability and satisfaction from children, caregivers, and providers remains limited. Conclusions: Evidence suggests potential effectiveness of selected agents and routes in appropriately monitored settings, but data heterogeneity precludes strong comparative recommendations. Further studies are therefore needed to address the existing gaps in pediatric dental sedation. Full article

Background/Objectives: This systematic review and meta-analysis was designed to examine the efficacy of extracorporeal shock wave therapy (ESWT) and ultrasound therapy in the treatment of upper and lower limb tendinopathies. Methods: The protocol was registered in PROSPERO (CRD420251113976) and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic searches were performed in the PubMed, Embase, EBSCOhost, and Ovid MEDLINE databases up to August 2025, to identify randomized controlled trials (RCTs). Mean differences (MDs) and standardized mean differences (SMDs) were calculated with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and a random-effects model was applied. Risk of bias was evaluated using the Risk of Bias (RoB 2) tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Fourteen RCTs involving 639 patients with tendinopathies were included. All studies were characterized by a high risk of bias. Very low-certainty evidence suggested that ESWT as monotherapy may reduce pain at rest compared with ultrasound therapy in patients with lateral epicondylitis (MD = −1.51; 95% CI: −2.71 to −0.31; p = 0.01), although the effect was highly heterogeneous (I² = 89.8%; p = 0.002). In patients with upper- and lower-limb tendinopathy, ESWT combined with pharmacotherapy resulted in significantly lower pain intensity compared with ultrasound therapy combined with pharmacotherapy (SMD = −0.6; 95% CI: −1.07 to −0.14; p = 0.01). No significant differences in PRTEE (Patient-Rated Tennis Elbow Evaluation) scores were observed between ESWT and ultrasound monotherapy in patients with lateral epicondylitis (MD = −1.06; 95% CI: −11.06 to 8.94; p = 0.83; I² = 75.82%), or between ESWT combined with other conservative treatments and ultrasound combined with other conservative treatments (MD = 0.46; 95% CI: −10.22 to 11.15; p = 0.93; I² = 0%). Conclusions: Very low-certainty evidence suggests that ESWT may be more effective than ultrasound therapy in reducing pain when used as monotherapy in lateral epicondylitis, despite substantial heterogeneity, and when combined with pharmacotherapy in upper- and lower-limb tendinopathies. In terms of function, ESWT appears to provide improvements comparable to those of ultrasound therapy, as assessed by PRTEE scores, in patients with lateral epicondylitis, both as monotherapy and when combined with other conservative treatments. However, significant methodological limitations substantially limit confidence in these findings. Full article

Background: Motivation is widely recognized as a key factor influencing learning and rehabilitation outcomes in children with cerebral palsy (CP). Despite its acknowledged relevance, motivation is rarely assessed systematically in pediatric neurorehabilitation, and there is limited consensus regarding appropriate outcome measures. Objectives: This systematic mapping review aimed to examine how motivation-related constructs are assessed in rehabilitation studies involving children with CP, identifying the instruments used and evaluating the extent to which motivation is explicitly measured across different rehabilitation contexts. Methods: The review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420250651843). PubMed and Scopus were searched for studies published between 2013 and 2025. Eligible studies included rehabilitation interventions for children with CP that incorporated a clearly defined motivation-related outcome. Study quality and risk of bias were assessed using Joanna Briggs Institute tools and the RoB 2 tool. Results: Nine studies met the inclusion criteria, including 109 subjects, comprising randomized controlled trials and case series. Most studies involved children with mild to moderate motor impairment (GMFCS or MACS levels I–II). Motivation was assessed through heterogeneous approaches, including self-efficacy, mastery motivation, participation, adherence, and intrinsic motivation, with data collected from children, parents, therapists, or dyads. Conclusions: Although motivation is frequently cited as a critical component of effective rehabilitation in children with CP, its assessment remains inconsistent and methodologically fragmented. This mapping review, based on a limited and heterogeneous evidence base, highlights the need for standardized, validated, and developmentally appropriate tools to measure motivation-related constructs in pediatric CP rehabilitation. Full article

Background/Objectives: Chronic kidney disease (CKD) affects almost 800 million people worldwide. Cardiovascular disease is the main cause of death in this population. Although physical activity is fundamental to systemic health, the evidence regarding its impact on the clinical outcomes of CKD populations is inconclusive. This protocol outlines the methodology for a systematic review and meta-analysis aimed at evaluating the association between physical activity and intensity and all-cause mortality, cardiovascular mortality, and cardiovascular disease. Methods: This protocol adheres to PRISMA-P and Cochrane Handbook guidelines and has been registered with PROSPERO (CRD420261302904). A systematic search will be conducted in MEDLINE, Scopus, Web of Science and the Cochrane Library until June 2026. Studies estimating the association between physical activity and all-cause mortality, cardiovascular mortality and cardiovascular disease in populations with CKD will be included. Two independent reviewers will perform study selection, data extraction and quality assessment using the Study Quality Assessment Tool from the United States National Institute of Health tool. The certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation tool. Narrative synthesis and random-effects meta-analysis will be conducted to calculate pooled effect estimates. Random-effects meta-analyses will be performed according to the level of physical activity, and meta-regressions will be used to control for the association with major covariates. Ethical approval is not required for this study. Results: The results will provide a comprehensive synthesis of the evidence regarding the use of physical activity as a non-pharmacological intervention to modify CKD progression. Conclusions: The findings will be disseminated through peer-reviewed journals and international conferences. Full article

Background/Objectives: Dichorionic triamniotic (DCTA) triplet pregnancies are associated with increased rates of placenta-specific complications primarily attributed to vascular anastomoses in the monochorionic (MC) pair. Selective fetal reduction to twins (of one of the MC pair) is a complex and not a widely available procedure. Multifetal reduction (MFR) to singleton pregnancy can reduce adverse pregnancy outcomes but is controversial due to medico-legal and socio-ethical issues. The aim of this study is to identify the rate of miscarriage < 24 weeks or preterm birth < 34 weeks following MFR to singleton pregnancy in DCTA triplets and compare the results with expectant management. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the Prospective Register of Systematic Reviews System (ID: CRD42023422585). Results: Overall, from 21 citations of relevance, 6 studies with a total of 548 DCTA triplet pregnancies fulfilled the inclusion/exclusion criteria. In comparison with expectant management (n = 336), meta-analysis demonstrated that MFR to singleton pregnancy (n = 212) was associated with a lower rate (9.4% vs. 48.5%) of preterm birth (RR = 0.19, 95%CI 0.07–0.51), whereas the rate of miscarriage (14.6% vs. 9.2%) did not significantly increase (RR = 1.53, 95%CI 0.91–2.55). Conclusions: In DCTA triplet pregnancies, MFR to singleton pregnancy was associated with a reduced preterm birth rate and not associated with an increased miscarriage rate. Given the fact that the MC pair is reduced only to lower the rate of preterm birth, appropriate counselling and justification are important. In the absence of randomized controlled trials, data from systematic reviews are the best available evidence for counseling on the different management options. Full article

Background: Healthcare supply chains (HSCs) are critical socio-technical systems that ensure the timely delivery of pharmaceuticals, medical devices, and electromedical equipment, yet they face increasing complexity due to regulatory constraints, demand uncertainty, and the growing digitalization of healthcare systems. This study aims to systematically map the HSC literature and identify its main thematic structures and research gaps. Methods: A systematic literature review was conducted following PRISMA guidelines, analyzing 705 peer-reviewed articles retrieved from the Web of Science database (PROSPERO registration: CRD42024605761). Natural language processing techniques were applied to support the analysis, including topic modeling, term frequency–inverse document frequency for keyword relevance, and Keyword in Context analysis for semantic interpretation. Results: The analysis identified six main thematic clusters and revealed a fragmented research landscape, characterized by limited integration across supply chain tiers, uneven attention to technological innovations, and marginal consideration of sustainability and implementation issues. The findings also highlight a gap between conceptual developments and real-world applications. Conclusions: This study provides a data-driven overview of the HSC research domain, highlighting key gaps and opportunities for more integrated, resilient, and efficient supply chain management. Full article