Search Results (35)

Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical outcomes remains poorly understood. We conducted a systematic review and meta-analysis to examine the association between preoperative mental health and outcomes following surgical correction for ASD. Methods: A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was performed from inception to April 2025 to identify studies investigating the relationship between preoperative mental health and postoperative health-related quality of life outcomes or complications. Data was pooled using a restricted maximum likelihood (REML) random-effects model. Heterogeneity was assessed using Cochran’s Q statistic, and between-study variance was reported as τ². Study quality was assessed with the Newcastle–Ottawa Scale, and risk of bias was evaluated using the ROBINS-I tool. Results: Twenty-four studies comprising a total of 248,427 patients met inclusion criteria. In pooled analyses, patients with poor preoperative mental health showed comparable improvements in health-related quality of life measures after surgery (standardized mean difference [SMD] −0.04, 95% CI −0.30 to 0.22; I² = 91.5%, τ² = 0.42) and in pain scores (SMD −0.15, 95% CI −0.42 to 0.11; I² = 71.8%, τ² = 0.09). However, patients with poor mental health had significantly higher odds of postoperative complications (odds ratio [OR] 1.44, 95% CI 1.23 to 1.67; I² = 97.4%, τ² = 0.08). These patients also demonstrated worse preoperative disease severity (SMD –0.94, 95% CI −1.41 to −0.47; I² = 95.5%, τ² = 1.64) and worse postoperative disease severity (SMD –0.34, 95% CI −0.44 to −0.25; I² = 48.9%, τ² = 0.03). Conclusions: While patients with poor preoperative mental health have a greater disease severity both before and after ASD surgery, they appear to experience comparable benefits from surgical intervention compared to those without. Recognizing and managing mental health may be useful in preoperative management of ASD patients. Further prospective studies to further elucidate these associations are necessary. Full article

Introduction: Asthma is a chronic respiratory disease affecting approximately 5 million children in the US, but little is known about whether asthma alters children’s attention and memory functions. Most studies on this topic focus on psychiatric and QoL outcomes rather than cognitive functions, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate the attention deficit and memory function outcomes in children with bronchial asthma. Methods: A systematic search was conducted in PubMed, Web of Science, and Cochrane Library from inception to 28 February 2025 for studies evaluating attention deficit and memory function in children with bronchial asthma. Outcomes of interest included attention deficit and memory function. Statistical analysis was performed with R 4.3.1. Heterogeneity was accessed using the I² statistics and Cochrane Q test. The standardized mean difference (SMD) with restricted maximum-likelihood estimator random-effects method was computed for all outcomes. Results: A total of seven studies were included in the final meta-analysis, comprising 104,975 patients, of whom 10,200 (9.7%) had bronchial asthma (mean age ± 8.98 years, mean 45% females). In the pooled analysis, children with asthma had a worsened attention deficit compared to the healthy group (SMD 0.29; 95% CI [0.07; 0.51]; p = 0.01; I² = 92%). However, no statistically significant difference was found in memory function between groups (SMD −0.24; 95% CI [−1.81; 1.33]; p = 0.77; I² = 96%). Conclusions: Children with asthma showed significantly higher attention deficit scores compared to healthy children. No statistically significant differences were observed in memory function between the groups. These findings may have implications for early cognitive screening in pediatric asthma management. Full article

Background/Objectives: Acne vulgaris is a widespread, chronic inflammatory skin condition that significantly impacts patients’ quality of life. Although oral isotretinoin remains the most effective treatment, recent evidence suggests that H₁-antihistamines such as desloratadine and levocetirizine may enhance acne therapy. This study assesses whether combining H₁-antihistamines to isotretinoin enhances treatment efficacy in acne vulgaris compared to isotretinoin alone. Methods: Our analysis included 10 randomized controlled trials involving 675 patients collectively, predominantly from Asia and the Middle East. Data were extracted by two independent reviewers, with discrepancies resolved by a third. Risk of bias was assessed using the Cochrane RoB 2 tool. Analyses were performed using RevMan 5.4 with random-effects models, and heterogeneity was evaluated via I² and Q tests. Sensitivity analyses were conducted to assess result robustness. Results: Combination therapy with isotretinoin and desloratadine showed a significantly greater reduction in GAGS (Global Acne Grading Scale) score by week 12 (p < 0.00001; MD 2.68, 95% CI 1.60 to 3.75; I² = 0%) while earlier timepoints showed non-significant or borderline results. For inflammatory lesions, significant improvements with desloratadine emerged at weeks 4, 8, and 12 after excluding an influential outlier, with low heterogeneity and consistent direction of effect. Non-inflammatory lesions did not differ significantly at weeks 4 or 8. At week 12, a significant reduction was seen in the desloratadine subgroup (OR 2.61, p = 0.003, I² = 11%) and in overall pooled analysis (OR 2.77, p < 0.0001, I² = 2%). Among side effects, acne flare-ups, pruritus, and cheilitis were significantly reduced in the desloratadine group, as well as in pooled analysis. Xerosis did not consistently differ between groups. Overall, desloratadine improved tolerability and reduced mucocutaneous adverse events more than levocetirizine. Conclusions: Current evidence suggests that combining oral antihistamines with isotretinoin may offer therapeutic benefits in acne management, particularly in enhancing tolerability and potentially improving clinical outcomes, as reflected by significant reductions in GAGS scores and mucocutaneous adverse effects such as cheilitis, pruritus, and acne flare-ups. Full article

Background: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to examine the changes in psychological distress, depression, anxiety levels and internet addiction among medical students throughout their six-year education and to identify the contributing factors. Methods: The study cohort consisted of 282 students who enrolled in the medical faculty in the 2017–2018 academic year. A questionnaire including sociodemographic characteristics, the General Health Questionnaire-12 (GHQ-12), Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and Young Internet Addiction Test (IAT) was administered to the students during the first week of their education. The same questionnaire was readministered at the end of the third and sixth years. Friedman’s variance analysis was used to compare measurement data across the three time points, while Cochran’s Q Test was employed for categorical variables. Results: The median scores of the GHQ-12, BDI, S-Anxiety, and IAT significantly increased from the first to the sixth year (p < 0.05). The prevalence of depressive symptoms, S-Anxiety, and risky internet use significantly increased from the first to the final year, particularly between the third and sixth years. According to logistic regression analysis based on sixth-year data, students whose fathers were university graduates, who had been diagnosed with COVID-19, and who were dissatisfied with their social lives were found to be at increased risk for psychological distress and depression. Students with high parental expectations were found to be at risk of depression and S-anxiety. Those dissatisfied with their occupational choice were at risk for both psychological distress and S-anxiety. Conclusions: It was found that the mental health of medical students deteriorated during their education, especially during the clinical years. Given that these students will be responsible for protecting and improving public health in the future, it is essential to prioritize their own mental well-being. Interventions aimed at preserving the mental health of medical students should be planned. Full article

Objective: Premature placental calcification (PPC) has been implicated in adverse perinatal outcomes, yet its clinical significance remains controversial. This meta-analysis aimed to quantitatively synthesize current data on the association between PPC, defined as grade 3 placental calcification before 36⁺⁶ weeks of gestation and adverse perinatal outcomes. Data Sources: A systematic search was conducted in MEDLINE, Scopus and The Cochrane Library from inception until 11 March 2025, to identify eligible studies. Study Eligibility Criteria: Observational studies including singleton pregnancies with PPC diagnosed via ultrasonography between 28⁺⁰ and 36⁺⁶ weeks of gestation and comparing them with pregnancies with Grannum grade 0, 1, or 2 placentas were considered eligible. Methods: Study quality was assessed using the Newcastle−Ottawa Scale, and the risk of bias was evaluated with the Quality In Prognosis Studies tool. The primary outcomes were small-for-gestational-age (SGA) neonates and preeclampsia. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Meta-analyses were conducted using a random-effects model, with outcomes reported as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CIs). Results: In total, nine cohort studies were included. PPC was associated with an increased risk of SGA (RR, 1.99; 95% CI, 1.46−2.70), preeclampsia (RR, 5.27; 95% CI, 2.24−12.40), fetal growth restriction (RR, 2.31; 95% CI, 1.30−4.09), preterm delivery (RR, 2.11; 95% CI, 1.00−4.45), suspected fetal hypoxia (RR, 1.71; 95% CI, 1.13–2.56), low 5 min Apgar score (RR, 2.28; 95% CI, 1.50−3.44) and neonatal intensive care unit admission (RR, 1.80; 95% CI, 1.02−3.18). No significant associations were found with fetal or neonatal death (RR, 2.75; 95% CI, 0.87−8.71), cesarean delivery (RR, 1.26; 95% CI, 0.90−1.78), gestational diabetes mellitus (RR, 1.17; 95% CI, 0.81−1.70), neonatal resuscitation (RR, 1.04; 95% CI, 0.92−1.16), birthweight (MD, −187.46 g; 95% CI, −413.14 to +38.21), or gestational age at birth (MD, −0.62 weeks; 95% CI, −1.36 to +0.11). A sensitivity analysis excluding high-risk-of-bias studies yielded consistent results. Conclusions: PPC is associated with several adverse perinatal outcomes, including SGA and preeclampsia. While the clinical significance of placental grading has remained limited in recent years, this study has shown that PPC may serve as an early indicator of placental insufficiency, warranting enhanced fetal surveillance and risk assessment in affected pregnancies. Further research is needed to refine its prognostic utility and integration into obstetric practice. Full article

This study aims to assess the prevalence of neuropathic pain in the Moroccan population through a systematic review and meta-analysis using a generalized linear mixed model (GLMM). The PRISMA guidelines for systematic reviews and meta-analysis were followed. All observational prevalence studies, conducted in both the general population and hospital settings in Morocco, published before 1 December 2023, were included, provided that neuropathic pain was identified based on consensus criteria. The databases searched included PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). Data on the sample size, subgroups, sociodemographic and clinical characteristics of participants, as well as the methodology of each study, were extracted. The Joanna Briggs Institute tool for prevalence studies was used to assess the risk of bias. A random-effects generalized linear mixed model was applied for direct data adjustment, using Knapp–Hartung standard error correction. Heterogeneity was explored using Cochran’s Q test, Higgins’ I² statistic, and prediction intervals. Subgroup analysis was performed based on underlying pathology, while meta-regression was conducted according to age and sex ratio. Publication bias was assessed using the Doi plot and LFK test. Sensitivity analysis was performed by stratifying studies based on their risk of bias. The statistical analysis was conducted using R software version 4.3.1 with the meta, metafor, metasens, and robvis packages. A total of 33 publications were identified, of which 17 studies were retained after removing duplicates and applying the eligibility criteria. These studies were published between 2013 and 2023 and included either the general population (one study) or patients with diabetes (seven), obesity (one), rheumatologic conditions (six), Parkinson’s disease (one), or cancer (one). The DN4 score was the most commonly used tool to diagnose neuropathic pain. The risk of bias was rated as low in two studies, moderate in eight, and high in seven. The pooled overall prevalence was 22% (95% CI [14.8; 31.5]) with an I² of 98% (p < 0.01). In subgroup analyses, the prevalence was 19.9% among rheumatology patients, 10.2% in oncology patients, 9.4% in Parkinson’s patients, 26.6% in diabetics, 58.6% in obese individuals, and 10.6% in the general population. Meta-regression by sex indicated significantly lower prevalence in men, and prevalence increased with age but did not reach statistical significance. After stratification based on the risk of bias, the pooled prevalence was 15.4% for the two studies with a low risk of bias. The overall prevalence of neuropathic pain in Morocco is relatively high at 22%, with significant variability across medical specialties. However, this prevalence is likely overestimated. Stronger and higher-quality studies are needed to obtain more accurate estimates. Full article

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Methods: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Results: Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of −4.68 (95% CI: −8.77; −0.59, p = 0.032). However, a high heterogeneity (I² = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusions: Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Full article

Objective: The aim of the NALOPOOL project was to assess the efficacy and safety of naloxegol in patients with cancer pain who exhibited opioid-induced constipation (OIC) and were treated under real-world conditions. Methods: We pooled individual patient data from three multicenter observational studies conducted with naloxegol in patients with cancer who exhibited OIC and were prescribed naloxegol under real-world conditions. Efficacy outcomes were evaluated after 4 weeks of treatment. All analyses were performed via a visit-wise approach. Heterogeneity was assessed via Cochran’s Q-test or Levene’s test. Results: Spontaneous bowel movements (SBM) response (≥3 SBM per week and an increase of ≥1 from baseline; three studies) was reported in 223 of 314 evaluable patients (71%, 95% CI 66–76); clinically relevant improvement in the Patient Assessment of Constipation Quality-of-Life Questionnaire (>0.5 points; three studies) occurred in 179 of 299 evaluable patients (60%, 95% CI 56–74) and in the Patient Assessment of Constipation Symptoms (>0.5 points; two studies) was reported in 131 of 190 evaluable patients (69%, 95% CI 62–76); and clinically relevant improvement in the Bowel Function Index (score ≥ 12 points at the endpoint; two studies;) was reported in 133 of 195 evaluable patients (68%, 95% CI 62–75). No significant heterogeneity was found for any efficacy outcome. The pooled proportion of patients who discontinued the drug owing to adverse reactions was 6.1% (95% CI 3.8% to 8.4%). Conclusions: Our results support the use of naloxegol for the management of OIC in patients with cancer pain who do not respond to laxative treatment. Full article

This article demonstrates the necessity of assessing homogeneity in meta-analyses using the Higgins method. The researchers realize the importance of assessing homogeneity in meta-analytic work. However, a significant issue with the Higgins method has been identified. In this article, we explain the nature of this problem and propose solutions to address it. Our narrative in this article is to point out the problem, analyze it, and present it well. A prerequisite to check the consistency of findings in comparable studies in meta-analyses is that the studies should be homogeneous, not heterogeneous. The Higgins $I^2$ score, a version of the Cochran Q value, is commonly used to assess heterogeneity. The Higgins score is an improvement in the Q value. However, there is a problem with Higgins score statistically. The Higgins score is supposed to follow a Chi-squared distribution, but it does not do so because the Chi-squared distribution becomes invalid once the Q score is less than the degrees of freedom. This problem was recently rectified using an alternative method ($S^2$ score). Using this method, we examined 14 published articles representing 133 datasets and observed that many studies declared homogeneous by the Higgins method were, in fact, heterogeneous. This article urges the research community to be cautious in making inferences using the Higgins method. Full article

Background: Universal community engagement interventions can address childhood obesity. Objectives: This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents. Methods: Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I² statistics and Cochran’s Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively. Results: Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children’s standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = −0.02, 95%CI = [−0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children’s dietary choices and activity levels. Only the meta-analysis on children’s daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = −0.25, 95%CI = [−0.38, −0.13], Z = 3.98, p < 0.0001) at immediate post-intervention. Conclusions: Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement. Full article

Objective: The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. Methods: This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran’s Q-test and Higgins’ I² statistic. Results: Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference (p > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 (p > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr (p > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) (p < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months (p < 0.001). Conclusions: The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up. Full article

Background/Objectives: Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6. Randomized controlled trials (RCTs) have recently become available on EVT effects in people with LVO-related large core stroke (ASPECTS 0–5). Here, we provide an updated meta-analysis of the EVT effect on functional neurological status in people with large-core stroke. Methods: The study followed the PRISMA guidelines. PubMed, EMBASE and Cochrane Central were searched for RCTs comparing EVT vs. best medical treatment (BMT) in large-core LVO stroke. The primary outcome was functional independence at 90 days (modified Rankin Scale; mRS 0–2). The secondary outcomes were symptomatic intracranial hemorrhage (sICH), good functional outcome (mRS 0–3) and excellent functional outcome (mRS 0–1). EVT vs. BMT was compared through random effect meta-analysis. Heterogeneity was assessed with the I² and Q test and risk of bias reported according to the RoB2 tool. Results: Six RCTs were included (n = 1656 patients). All studies had a moderate risk of bias, with blinding bias due to the nature of the intervention, potential allocation bias and incomplete outcome reporting. Functional independence was significantly more frequent in the EVT vs. BMT group (OR = 2.47, 95% CI = 1.52–4.03, p < 0.001). sICH rates (OR = 1.77, 95% CI = 1.01–3.11, p = 0.04) and good functional outcome (OR = 2.20; 95% CI = 1.72–2.81, p < 0.001) were more frequent in the EVT vs. BMT group, while the rates of mRS 0–1 did not differ. Conclusions: In patients with large-core stroke and LVO, EVT plus BMT as compared to BMT alone carries a significant increase in independent ambulation and good functional outcome at 3 months despite the marginal increase in sICH. Full article

Purpose: This study aimed to comprehensively report the epidemiological and clinical features of atypical anorexia nervosa (AAN) in children and adolescents. Methods: In May 2024, a systematic review was performed using Medline, Cochrane Library, ClinicalTrials.gov, and relevant websites. Following PRISMA guidelines, 234 articles were screened for studies on DSM-5-defined AAN. A standardized checklist—the JBI critical appraisal tool—was adopted in assessing methodology, and 13 retained studies passed the screening and critical appraisal process for the final review. The Newcastle–Ottawa Scale was utilized to assess the risk of bias in cohort and case–control studies, ensuring a comprehensive evaluation of methodological quality. Results: AAN prevalence in young age groups is 2.8%, with a cumulative 2.8% incidence over 8 years. Incidence is 366 per 100,000 person-years, and the average episode duration is 11.6 months, with a 71% remission rate. Diagnostic persistence for AAN is less stable than other restrictive feeding and eating disorders (FEDs). AAN individuals exhibit higher EDE-Q scores, more severe distress, and distinct BMI differences compared to those with anorexia nervosa and controls. The diagnostic transition from the DSM-IV to the DSM-5 shows that AAN patients are predominantly female, slightly older, and with higher weight. Conclusions: This study yields concrete insights into the features of AAN in the developmental age, highlighting demographic variations, clinical presentations, and treatment outcomes. Recognizing the unique challenges faced by AAN individuals is vital for tailoring effective interventions and improving overall care within the FED spectrum. Full article

Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient’s morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast’s shape and volume, results in higher satisfaction scores. Full article

Authorship attribution for less-resourced languages like Romanian, characterized by the scarcity of large, annotated datasets and the limited number of available NLP tools, poses unique challenges. This study focuses on a hybrid Transformer combining handcrafted linguistic features, ranging from surface indices like word frequencies to syntax, semantics, and discourse markers, with contextualized embeddings from a Romanian BERT encoder. The methodology involves extracting contextualized representations from a pre-trained Romanian BERT model and concatenating them with linguistic features, selected using the Kruskal–Wallis mean rank, to create a hybrid input vector for a classification layer. We compare this approach with a baseline ensemble of seven machine learning classifiers for authorship attribution employing majority soft voting. We conduct studies on both long texts (full texts) and short texts (paragraphs), with 19 authors and a subset of 10. Our hybrid Transformer outperforms existing methods, achieving an F1 score of 0.87 on the full dataset of the 19-author set (an 11% enhancement) and an F1 score of 0.95 on the 10-author subset (an increase of 10% over previous research studies). We conduct linguistic analysis leveraging textual complexity indices and employ McNemar and Cochran’s Q statistical tests to evaluate the performance evolution across the best three models, while highlighting patterns in misclassifications. Our research contributes to diversifying methodologies for effective authorship attribution in resource-constrained linguistic environments. Furthermore, we publicly release the full dataset and the codebase associated with this study to encourage further exploration and development in this field. Full article