Search Results (207)

Background: A cesarean section (CS) is a method of childbirth involving a surgical cut made in the abdominal and uterine wall to deliver the infant. But while it saves the lives of women and infants, it has been implicated in several immediate and long-term complications and adverse consequences as a result of its ineffective use. This study attempts to address the major public health issue of the inappropriate use of CS by exploring its impact on maternal, neonatal, and child health. More specifically, the study aims to investigate the immediate and long-term health impacts on the mother, including her physical and mental health, as well as the immediate and long-term psychosomatic consequences on the neonate’s, infant’s, and child’s health as a result of the inappropriate use of CS. Methods: A scoping review was conducted spanning from 2015 to 2025 according to the PRISMA criteria and checklist. Searches were performed in PubMed, Scopus, and Google Scholar. The inclusion criteria comprised original articles with clear exposure and outcome written in English, and studies that did not involve reviews of any kind or letters to the editors. Results: The review identified 42 relevant studies. The results showed several immediate and long-term complications of CS in mothers, neonates, infants, and children, while its ineffective use carries equally high risks, such as high levels of morbidity and mortality. Conclusions: This scoping review presents the problems that arise in the immediate and long-term health of mother and child from the improper use of cesarean section and underlines the need for immediate action and measures to be taken by health policy makers. Full article

Background/Objectives: The optimal timing for orthodontic treatment in pediatric patients with malocclusion, particularly Class II discrepancies, remains a topic of ongoing clinical debate. Early treatment during the mixed dentition stage harnesses craniofacial growth potential, whereas later intervention may capitalize on pubertal growth for greater skeletal correction, especially for skeletal and airway improvements. This systematic review aimed to compare the outcomes of early versus late orthodontic treatment to assess their relative effectiveness. Methods: A systematic review was conducted in accordance with PRISMA guidelines, including randomized controlled trials and observational studies published between 2015 and 2025. Eleven studies comparing early and late treatment were analyzed, and the risk of bias was evaluated using standardized assessment tools. Results: Of the eleven studies, eight reported statistically significant improvements favoring early orthodontic intervention. Early treatment was associated with greater enhancement of maxillary and mandibular arch development, improved jaw relationships, and expanded airway dimensions. Studies utilizing headgear or other growth-modifying appliances also showed more favorable eruption patterns and alignment, underscoring the clinical relevance of early-phase management. Conclusions: Early orthodontic treatment can provide meaningful benefits in guiding skeletal growth, improving dental arch form, and enhancing treatment efficiency. These benefits were most consistently supported in skeletal and airway outcome domains. While late treatment may be suitable for some cases, personalized planning remains essential. Further large-scale, standardized longitudinal studies are needed to refine treatment-timing protocols in pediatric orthodontics. Full article

Background/Objectives: The integration of artificial intelligence (AI) into dental diagnostics is rapidly evolving, offering opportunities to improve diagnostic precision, reproducibility, and accessibility of care. This systematic review examined the clinical performance of AI-based diagnostic tools in dentistry compared with traditional methods, with particular attention to radiographic assessment, orthodontic classification, periodontal disease detection, and other relevant specialties. Methods: Comprehensive searches of PubMed, Scopus, and Web of Science were carried out for articles published from January 2015 to June 2025, in accordance with PRISMA guidelines. Only English-language clinical studies investigating AI applications in dental diagnostics were included. Fifteen studies fulfilled the inclusion criteria and underwent quality appraisal and risk-of-bias assessment. Results: Across diverse dental fields, AI systems showed encouraging diagnostic capabilities. Radiographic algorithms enhanced lesion detection and anatomical landmark identification, while machine learning models successfully classified malocclusions and periodontal status. Photographic image analysis demonstrated potential in geriatric and preventive care. However, methodological variability, limited sample sizes, and the absence of external validation constrained generalizability. Study quality ranged from high to moderate, with some reports affected by bias or incomplete data reporting. Conclusions: AI holds considerable promise as an adjunct in dental diagnostics, particularly for imaging-based evaluation and clinical decision support. Broader clinical adoption will require methodological harmonization, rigorous multicenter trials, and validation of AI systems across diverse patient populations. Full article

Background: Stroke leads to lasting disability by disrupting the connectivity of functional brain networks. Although several rehabilitation methods are promising, our full understanding of how these strategies restore network function is still limited. Here, we map how non-invasive brain stimulation (NIBS), brain–computer interface (BCI)/neurofeedback, virtual reality (VR), and robot-assisted therapy restore connectivity within the sensorimotor network (SMN), default mode network (DMN), and salience network, and we contextualize these effects within the known temporal evolution of post-stroke motor network reorganization. Methods: This scoping review adhered to PRISMA guidelines and searched PubMed, Cochrane, and Medline from January 2015 to January 2025 for clinical trials focused on stroke rehabilitation with functional connectivity outcomes. Included studies used conventional therapy, neuromodulation, or feedback-based interventions. Results: Twenty-three studies fulfilled the inclusion criteria, covering interventions like robotic training, transcranial stimulation (tDCS/TMS), brain–computer interfaces, virtual reality, and cognitive training. Motor impairments were linked to disrupted interhemispheric sensorimotor connectivity, while cognitive issues reflected changes in frontoparietal and default mode networks. Combining neuromodulation with feedback-based methods showed better network recovery than standard therapy alone, with clinical improvements closely associated with connectivity alterations. Conclusions: Effective stroke rehabilitation depends on targeting specific disrupted networks through various modalities. Robotic interventions focus on restoring structural motor pathways, feedback-enhanced methods improve temporal synchronization, and cognitive training aims to enhance higher-order network integration. Future research should work toward standardizing connectivity assessment protocols and conducting multicenter trials. This will help develop evidence-based, network-focused rehabilitation guidelines that effectively translate mechanistic insights into personalized clinical treatments. Full article

Background: Chronic total occlusion percutaneous coronary intervention (CTO PCI) is a complex revascularization procedure requiring advanced techniques to ensure procedural success and safety. Hybrid strategies combining antegrade dissection/re-entry (ADR) and retrograde approaches have become increasingly adopted in contemporary practice. Objectives: To systematically review and synthesize evidence comparing outcomes of ADR and retrograde CTO PCI techniques, with pooled estimates of success rates and adverse events. Methods: This review followed PRISMA 2020 guidelines. We searched PubMed, Cochrane CENTRAL, and Google Scholar for studies published between January 2015 and June 2025. Eligible studies included randomized controlled trials and observational studies reporting outcomes of ADR and/or retrograde CTO PCI. Data extraction was performed by two independent reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Cochrane RoB 2.0 tool. A random-effects meta-analysis was conducted for consistently reported outcomes. Results: Twenty studies encompassing over 87,000 CTO PCI procedures were included. Pooled analysis of 16 studies demonstrated a technical success rate of 83.4% and a procedural success rate of 84.6%. The in-hospital major adverse cardiac event (MACE) rate was 3.3%. Hybrid strategies integrating ADR and retrograde approaches yielded the highest success rates (86–91%) with acceptable safety profiles. Use of adjunctive tools such as IVUS, dual arterial access, and re-entry devices was associated with improved outcomes. Discussion: Hybrid CTO PCI techniques are safe, effective, and reproducible across diverse clinical settings. When performed by experienced operators using modern adjuncts, these strategies provide durable benefits and should be considered standard for complex occlusions. Limitations include variation in study quality, heterogeneous procedural definitions, and lack of long-term data in several cohorts. Full article

Artistic gymnastics is one of the most physically demanding sports, characterized by a high incidence of both acute and chronic injuries. Although previous research has primarily focused on biomechanical and training-related factors, the multifactorial etiology of injuries—including molecular and genetic aspects—remains insufficiently explored. This systematic review aimed to synthesize current evidence on the causes, mechanisms, and prevention of injuries in artistic gymnastics, with particular emphasis on biomechanical, molecular, and genetic determinants of injury risk and athletic performance. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in the PROSPERO database (Registration No: CRD420251167521). Electronic databases (PubMed, KoBSON, and Google Scholar) were searched for studies published between 2015 and 2025 using the keywords “gymnastics injuries,” “overuse injuries,” “injury prevention,” “biomechanics,” “IL-6,” “TNF-α,” and “miRNA biomarkers.” Nineteen studies met the inclusion criteria and were analyzed based on injury incidence, localization, mechanisms, and molecular and genetic associations. The majority of injuries were localized in the joints of both upper and lower extremities, particularly during puberty and at higher competitive levels. Repetitive loading, improper technique, and insufficient recovery were identified as the main etiological factors. Molecular biomarkers such as IL-6, TNF-α, and miRNAs (miR-155, miR-146a) were found to play key roles in inflammatory responses, while genetic polymorphisms including ACTN3 R577X, ESR1 rs2234693, and CYP19A1 rs936306 were associated with flexibility, explosive strength, and susceptibility to injury. Injury prevention in artistic gymnastics requires a personalized and multidisciplinary approach that integrates biomechanical, clinical, molecular, and genetic data. Incorporating molecular and genetic profiling into training and rehabilitation programs may enhance early detection of overuse conditions and optimize both health and performance outcomes in gymnasts. Full article

Childhood immunization is one of the most effective public health measures, yet inequities remain in marginalized populations across Asia, where parental adherence is essential to sustaining the Expanded Program on Immunization. This narrative review examines determinants of adherence among under-five children in disadvantaged communities. Following PRISMA guidelines, searches of PubMed, Scopus, and Google Scholar identified studies published between 2015 and 2025, with earlier key works included as relevant. Twenty-one studies from South, Southeast, and East Asia were analyzed. Five domains were associated with adherence: socioeconomic and access factors, where maternal education, household income, and possession of immunization cards were positive predictors, while remote residence was a barrier; trust, cultural beliefs, and social norms, with misinformation and vaccine controversies reducing uptake, and provider trust and supportive norms improving it; migration and mobility, as migrant, stateless, and left-behind children had lower coverage due to weak registration and disrupted caregiving; household and caregiver dynamics, where decision-making by family or community members shaped uptake, while large family size and maternal employment limited adherence; and health system capacity, with inadequate infrastructure and follow-up hindering coverage and integration with maternal–child health services facilitating it. Addressing these intersecting barriers through equity-focused strategies is critical to achieving universal immunization coverage. Full article

Background: Artificial intelligence technologies are increasingly integrated into dental practice, offering potential improvements in diagnostic accuracy, treatment planning, and patient outcomes. However, the extent and quality of evidence supporting these applications remain unclear. Methodology: We conducted a systematic literature search using PubMed, Cochrane Library, Embase, and IEEE Xplore databases from January 2015 to December 2024. Search terms included combinations of “artificial intelligence,” “machine learning,” “deep learning,” “dentistry,” “diagnosis,” and “treatment planning.” Studies evaluating AI systems in clinical or laboratory settings with measurable outcomes were included. Data extraction followed PRISMA guidelines, and methodological quality was assessed using the QUADAS-2 tool. Results: Twenty-three studies met the inclusion criteria. Most focused on diagnostic accuracy (n = 21), with few addressing treatment planning (n = 1) or outcome prediction (n = 1). Reported accuracies ranged from 82–94% for caries detection, 85–92% for periodontal disease assessment, and 88–96% for oral lesion identification. Orthodontic applications achieved 95–98% accuracy in cephalometric landmark identification, while implant planning studies demonstrated up to 96% agreement with expert strategies. Despite promising technical performance, 79% of studies were retrospective and conducted in controlled research settings, with limited external or prospective clinical validation. Risk of bias was highest in patient selection due to frequent use of case–control designs and archived imaging datasets. Conclusions: AI shows significant promise for enhancing dental diagnostics and treatment planning. However, most applications require further clinical validation before routine implementation. The disconnect between laboratory performance and real-world clinical validation represents a critical gap that must be addressed. Current AI systems should be viewed as diagnostic aids rather than replacements for clinical judgment. Practitioners considering AI adoption should understand current limitations and evidence quality, particularly the lack of prospective clinical validation in diverse populations. Full article

Background/Objectives: Pediatric asthma is the most prevalent chronic respiratory condition in children and adolescents worldwide and remains a major contributor to morbidity, school absenteeism, and the use of integrated healthcare services. The main goal of this systematic review is to synthesize the available evidence about the impact of biologic therapies on the quality of life in the pediatric population (children and adolescents) with asthma. Methods: This systematic review followed the PRISMA guidelines. A comprehensive search was performed across PubMed, Scopus, and Web of Science for articles published between 2015 and 2025 in English, Portuguese, or Spanish. Studies were eligible if they included pediatric patients (<18 years) with asthma receiving biologic therapies (e.g., omalizumab, mepolizumab, dupilumab) and reported health-related quality of life (HRQoL) outcomes using validated instruments. Article selection followed PICOS criteria and excluded reviews, case reports, and editorials. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Results: A total of 576 articles were found and screened, and 8 studies were selected. The characteristics of the studies highlighted the involved countries, study design, number of participants, conditions, type of biologic intervention, duration, and follow-up. In addition, the importance of biologic therapies in patients’ HRQoL was presented. All eight included studies reported statistically significant improvements in HRQoL using appropriate scales. Conclusions: The studies reinforced the importance of biologic therapies to improve HRQoL in both patients and families/caregivers. Implications for health promotion, in particular, greater involvement of integrated healthcare comprising health professionals, family, school contexts, and the community, are discussed. Full article

Background: Blood flow restriction is proposed as an effective treatment method due to strength gain, muscle mass and pain reduction. This review aimed to evaluate and determine the effects of blood flow restriction training versus conventional training to optimize the functional recovery process in patients with knee pathologies such as rheumatoid arthritis, anterior cruciate ligament rupture and osteoarthritis. Methods: This is a systematic review study. A literature search of studies published from 2015 to 2025 in English and Spanish was conducted in the Medline (PubMed), Web of Science, Cochrane Library, Scopus and Science Direct databases according to the Priority Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In order to determine the methodological quality and scientific evidence of the studies, the Critical Review Form and Oxford scales were applied. Results: Nine articles with a total sample of 540 subjects were selected. The methodological quality scores ranged from 7 to 12 points, and the studies had a level of evidence of 1b with a grade of recommendation of A. Conclusions: Blood flow restriction training may be an effective alternative to conventional physiotherapy treatment. Funding: This research did not receive any specific grant from funding agencies in the public, commercial or non-profit sectors. Registration: This review was registered on the OSF. Full article

Wetlands, among the most productive ecosystems on Earth, shelter a diversity of species and help maintain ecological balance. However, they are witnessing growing anthropogenic and climatic threats, which underscores the need for regular and long-term monitoring. This study presents a systematic review of 121 peer-reviewed articles published between January 2015 and 30 April 2025 that applied machine learning (ML) and deep learning (DL) for wetland mapping and bird-habitat monitoring. Despite rising interest, applications remain fragmented, especially for avian habitats; only 39 studies considered birds, and fewer explicitly framed wetlands as bird habitats. Following PRISMA 2020 and the SPIDER framework, we compare data sources, classification methods, validation practices, geographic focus, and wetland types. ML is predominant overall, with random forest the most common baseline, while DL (e.g., U-Net and Transformer variants) is underused relative to its broader land cover adoption. Where reported, DL shows a modest but consistent accuracy over ML for complex wetland mapping; this accuracy improves when fusing synthetic aperture radar (SAR) and optical data. Validation still relies mainly on overall accuracy (OA) and Kappa coefficient ($\kappa$), with limited class-wise metrics. Salt marshes and mangroves dominate thematically, and China geographically, whereas peatlands, urban marshes, tundra, and many regions (e.g., Africa and South America) remain underrepresented. Multi-source fusion is beneficial yet not routine; The combination of unmanned aerial vehicles (UAVs) and DL is promising for fine-scale avian micro-habitats but constrained by disturbance and labeling costs. We then conclude with actionable recommendations to enable more robust and scalable monitoring. This review can be considered as the first comparative synthesis of ML/DL methods applied to wetland mapping and bird-habitat monitoring, and highlights the need for more diverse, transferable, and ecologically/socially integrated AI applications in wetland and bird-habitat monitoring. Full article

Background: Prostate cancer is one of the most common malignancies in men and a leading cause of cancer-related mortality. Early detection is essential to ensure curative treatment and favorable outcomes, but traditional diagnostic approaches—such as serum prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and histopathological confirmation following biopsy—are limited by suboptimal accuracy and variability. Multiparametric magnetic resonance imaging (mpMRI) has improved diagnostic performance but remains highly dependent on reader expertise. Artificial intelligence (AI) offers promising opportunities to enhance diagnostic accuracy, reproducibility, and efficiency in prostate cancer detection. Objective: To evaluate the diagnostic accuracy and reporting timeliness of AI-based technologies compared with conventional diagnostic methods in the early detection of prostate cancer. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, and Cochrane Library were searched for studies published between January 2015 and April 2025. Eligible designs included randomized controlled trials, cohort, case–control, and pilot studies applying AI-based technologies to early prostate cancer diagnosis. Data on AUC-ROC, sensitivity, specificity, predictive values, diagnostic odds ratio (DOR), and time-to-reporting were narratively synthesized due to heterogeneity. Risk of bias was assessed using the QUADAS-AI tool. Results: Twenty-three studies involving 23,270 patients were included. AI-based technologies achieved a median AUC-ROC of 0.88 (range 0.70–0.93), with median sensitivity and specificity of 0.86 and 0.83, respectively. Compared with radiologists, AI or AI-assisted readings improved or matched diagnostic accuracy, reduced inter-reader variability, and decreased reporting time by up to 56%. Conclusions: AI-based technologies show strong diagnostic performance in early prostate cancer detection. However, methodological heterogeneity and limited standardization restrict generalizability. Large-scale prospective trials are required to validate clinical integration. Full article

Background and Objectives: Keratoconus (KC) is a progressive corneal ectasia with multifactorial etiology, increasingly studied for potential associations with psychiatric disorders. This systematic review aimed to evaluate recent evidence linking KC with depression and other psychiatric conditions, including psychotic disorders, personality disorders, attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), autism spectrum disorder (ASD), and obsessive–compulsive disorder (OCD). Materials and Methods: Following PRISMA guidelines, PubMed, ScienceDirect and SpringerLink were searched for English-language observational studies published since 2015 that examined psychiatric disorders in adults with keratoconus. We excluded reviews, case reports, pediatric, non-English, and inaccessible articles. Study quality was assessed using the Newcastle–Ottawa Scale and JBI Checklist. Data were narratively summarized and tabulated—without meta-analysis due to heterogeneity. Results: Twelve studies met inclusion criteria, including 41,906 KC patients and 63,267 controls. Eleven studies investigated depression and one ADHD. Findings on depression were mixed: five studies showed higher depressive symptoms among KC patients, while others found no significant association. Most were cross-sectional and of moderate-to-high quality. The single study on ADHD reported a higher prevalence of KC in males, but no evidence of casual association. Evidence on TS, ASD, and OCD was scarce and largely limited to case reports. The review was limited by heterogeneous methodologies, small sample sizes, an absence of longitudinal data, and reliance on self-report or registry data. Conclusions: Current evidence indicates increased psychological burden among some individuals with KC, particularly regarding depressive symptoms, yet casual relationships remain unproven. Male ADHD patients may have an elevated risk of KC, especially in the presence of eye rubbing. Registration: Not registered. Full article

Genetic variability in terrestrial mammals is essential for understanding population and evolutionary dynamics, as well as for establishing effective strategies in conservation biology. This comprehensive review aimed to critically analyze invasive and non-invasive techniques used to assess genetic variability in wild terrestrial mammals. Using the PICO (Population, Intervention, Comparison, Outcome) format and following PRISMA guidelines, a comprehensive literature search was conducted in Web of Science, Scopus and Science Direct databases, including articles published in English from January 2015 to April 2025. Thirty-one experimental studies were selected that met specific criteria related to genetic evaluation using invasive (direct blood or tissue collection) and non-invasive (stool, hair and saliva collection) techniques. The results indicate that invasive techniques provide samples of high genetic quality, albeit with important ethical and animal welfare considerations. In contrast, non-invasive techniques offer less disruptive methods, although they present significant challenges in terms of quantity and purity of DNA obtained, potentially affecting the accuracy and confidence of genetic analysis. Detailed analysis of selected studies showed diverse patterns of heterozygosity and inbreeding coefficients between different taxonomic orders (Carnivora, Artiodactyla, Proboscidea, Primates and Rodentia). In addition, the main anthropogenic threats and current conservation strategies implemented in different species were identified. An overall genetic variability ranging from high to moderate was observed, with large species being more vulnerable to genetic reduction due to changes in habitat and human activities. Rather than a static comparison, our synthesis traces a clear methodological arc from small short tandem repeats (STR, or microsatellites) panels towards SNP-based approaches enabled by next-generation sequencing, including reduced representation (ddRAD), amplicon panels (GT-seq), and hybridisation capture tailored to degraded DNA from hair, faeces, and environmental substrates. Over 2015–2025, study designs shifted from presence/absence and coarse diversity estimates to robust inference of relatedness, assignment, effective population size, and gene flow using hundreds–thousands of SNPs and genotype-likelihood frameworks tolerant of allelic dropout and low coverage. Laboratory practice converged on multi-tube replication, synthetic blocking oligos, and capture-based enrichment; bioinformatics adopted probabilistic genotype calling, error-aware filtering, and replication-based consensus. This review provides a solid basis for optimizing genetic sampling methods, allowing for more ethical and efficient studies. Furthermore, it contributes to strengthening conservation strategies by underlining the importance of adapting the sampling method to the biological and ecological particularities of each species studied. Ultimately, these findings can significantly improve genetic conservation decision-making, benefiting the sustainability and resilience of wild land mammal populations. Full article

Virtual reality (VR) has emerged as a promising tool to support social communication in individuals with autism spectrum disorder (ASD). This study presents a systematic review of 28 empirical studies sourced from ERIC, APA PsycInfo, and Scopus. Articles in English published between 2014 and 2015 were included, with the last search being 10 June 2025, that implemented immersive VR interventions for children, adolescents, and young adults with ASD. Following PRISMA guidelines, we analyzed participant characteristics, intervention features, research designs, and reported outcomes with 91.6% IOA. An analysis of the risk of bias was performed using the RoB 2 framework for randomized trials and ROBINS-I for non-randomized studies. Results from the two assessments showed low to significant bias. However, due to the relative novelty of this field of study, all data was deemed valuable and was therefore included in this review. Results show that immersive VR interventions are generally effective in improving skills such as eye contact, emotion recognition, empathy, and conversational abilities, while also being engaging and well accepted by participants. Nevertheless, most studies were limited by small sample sizes, lack of control groups, and scarce evidence for long-term maintenance or real-world generalization. The findings underscore the potential of immersive VR as an innovative and scalable approach for enhancing social communication in ASD, while highlighting the need for more rigorous and longitudinal research. No funding was obtained for this systematic review. No protocol registration was carried out for this review as it was unfunded and exploratory in nature. Full article