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26 pages, 1191 KB  
Systematic Review
The Use of Multimedia in the Teaching and Learning Process of Higher Education: A Systematic Review
by Evelina Staneviciene and Gintarė Žekienė
Sustainability 2025, 17(19), 8859; https://doi.org/10.3390/su17198859 - 3 Oct 2025
Abstract
The integration of multimedia technologies is transforming teaching and learning in higher education, offering innovative ways to improve student engagement and learning outcomes. Although numerous studies investigate the impact of multimedia, there is still a clear need for a synthesis that brings together [...] Read more.
The integration of multimedia technologies is transforming teaching and learning in higher education, offering innovative ways to improve student engagement and learning outcomes. Although numerous studies investigate the impact of multimedia, there is still a clear need for a synthesis that brings together the latest evidence from a variety of disciplines and contexts. To address this need, this systematic review aims to summarize the empirical evidence and provide a clearer understanding of how multimedia is applied in higher education, to outline how educators can effectively design and the implications for curriculum design. This article focuses on three key research questions: (1) How does the integration of multimedia in higher education classrooms influence student engagement and learning outcomes? (2) How does the use of multimedia affect the development of specific skills? (3) What are the challenges and opportunities to integrate multimedia technologies into higher education? Relevant studies were systematically retrieved and screened from major academic databases, including ScienceDirect, Web of Science, IEEE Xplore, Wiley Online Library, Springer, Taylor & Francis, and Google Scholar. In total, 48 studies were selected from these sources for detailed analysis. The findings showed that multimedia tools enhance student engagement, motivation, and performance when integrated with clear pedagogical strategies. In addition, multimedia helps to develop skills such as creativity, digital literacy, and independent learning. However, challenges such as technical limitations, uneven infrastructure, and the need for ongoing teacher training remain significant difficulties in fully exploiting the benefits in higher education. Addressing these challenges requires coordinated institutional support, investment in professional development, and careful alignment of multimedia tools with pedagogical goals. Full article
(This article belongs to the Special Issue Digital Teaching and Development in Sustainable Higher Education)
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22 pages, 1224 KB  
Article
Beyond Biology: Uncovering Structural and Sociocultural Predictors of Breast Cancer Incidence Worldwide
by Janet Diaz-Martinez, Gustavo A. Hernández-Fuentes, Josuel Delgado-Enciso, Mario A. Alcalá-Pérez, Isaac Jiménez-Calvo, Carmen A. Sánchez-Ramírez, Fabian Rojas-Larios, Alejandrina Rodriguez-Hernandez, Mario Ramírez-Flores, José Guzmán-Esquivel, Karmina Sánchez-Meza, Ana C. Espíritu-Mojarro, Osval A. Montesinos-López and Iván Delgado-Enciso
Curr. Oncol. 2025, 32(10), 553; https://doi.org/10.3390/curroncol32100553 - 2 Oct 2025
Abstract
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from [...] Read more.
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017–2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities—such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure—could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology. Full article
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12 pages, 633 KB  
Article
Increased Susceptibility to Salmonella Infection in Systemic Lupus Erythematosus Compared with Other Systemic Autoimmune Diseases: Insights from a Retrospective Cohort Study from the Largest Health Care System in Taiwan
by Chen-Ying Wei, Han-Hua Yu, Pei-Yi Cheng and Yen-Fu Chen
Life 2025, 15(10), 1522; https://doi.org/10.3390/life15101522 - 26 Sep 2025
Abstract
Systemic lupus erythematosus (SLE) and other systemic autoimmune rheumatic diseases (SARDs) require long-term immunosuppressive therapy, placing patients at increased risk of infection. Salmonella species are particularly concerning due to their invasiveness and potential link to autoimmune activation, notably in SLE. This study aimed [...] Read more.
Systemic lupus erythematosus (SLE) and other systemic autoimmune rheumatic diseases (SARDs) require long-term immunosuppressive therapy, placing patients at increased risk of infection. Salmonella species are particularly concerning due to their invasiveness and potential link to autoimmune activation, notably in SLE. This study aimed to compare the risk of culture-confirmed Salmonella infection between SLE and other SARDs, based on data from the Chang Gung Research Database between 2005 and 2020. After propensity score matching, 3537 patients per group were analyzed. Patients with SLE had a higher incidence of Salmonella infection compared with those with other SARDs (0.54 vs. 0.17 per 1000 person-years), with a significantly greater cumulative incidence (log-rank p < 0.01). The adjusted hazard ratio (HR) for Salmonella infection in SLE was 2.47 (95% confidence interval (CI): 0.95–6.38), and the competing risk model confirmed a significant association (sub-distribution HR 2.58, 95% CI: 1.06–6.29, p = 0.04). Among SLE patients, lymphopenia was the only independent predictor of Salmonella infection (adjusted HR 3.98, 95% CI: 1.83–8.68, p < 0.001). Bloodstream infections were most common (70%), and serogroup D was the predominant strain (80%). These results suggest patients with SLE face higher Salmonella risk than other SARDs, especially those with lymphopenia, underscoring the need for targeted surveillance and preventive strategies. Full article
(This article belongs to the Section Physiology and Pathology)
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13 pages, 1334 KB  
Review
Artificial Intelligence for Myocardial Infarction Detection via Electrocardiogram: A Scoping Review
by Sosana Bdir, Mennatallah Jaber, Osaid Tanbouz, Fathi Milhem, Iyas Sarhan, Mohammad Bdair, Thaer Alhroob, Walaa Abu Alya and Mohammad Qneibi
J. Clin. Med. 2025, 14(19), 6792; https://doi.org/10.3390/jcm14196792 - 25 Sep 2025
Abstract
Background/Objectives: Acute myocardial infarction (MI) is a major cause of death worldwide, and it imposes a heavy burden on health care systems. Although diagnostic methods have improved, detecting the disease early and accurately is still difficult. Recently, AI has demonstrated increasing capability [...] Read more.
Background/Objectives: Acute myocardial infarction (MI) is a major cause of death worldwide, and it imposes a heavy burden on health care systems. Although diagnostic methods have improved, detecting the disease early and accurately is still difficult. Recently, AI has demonstrated increasing capability in improving ECG-based MI detection. From this perspective, this scoping review aimed to systematically map and evaluate AI applications for detecting MI through ECG data. Methods: A systematic search was performed in Ovid MEDLINE, Ovid Embase, Web of Science Core Collection, and Cochrane Central. The search covered publications from 2015 to 9 October 2024; non-English articles were included if a reliable translation was available. Studies that used AI to diagnose MI via ECG were eligible, and studies that used other diagnostic modalities were excluded. The review was performed per the PRISMA extension for scoping reviews (PRISMA-ScR) to ensure transparent and methodological reporting. Of a total of 7189 articles, 220 were selected for inclusion. Data extraction included parameters such as first author, year, country, AI model type, algorithm, ECG data type, accuracy, and AUC to ensure all relevant information was captured. Results: Publications began in 2015 with a peak in 2022. Most studies used 12-lead ECGs; the Physikalisch-Technische Bundesanstalt database and other public and single-center datasets were the most common sources. Convolutional neural networks and support vector machines predominated. While many reports described high apparent performance, these estimates frequently came from relatively small, single-source datasets and validation strategies prone to optimism. Cross-validation was reported in 57% of studies, whereas 36% did not specify their split method, and several noted that accuracy declined under inter-patient or external validation, indicating limited generalizability. Accordingly, headline figures (sometimes ≥99% for accuracy, sensitivity, or specificity) should be interpreted in light of dataset size, case mix, and validation design, with risks of spectrum/selection bias, overfitting, and potential data leakage when patient-level independence is not enforced. Conclusions: AI-based approaches for MI detection using ECGs have grown quickly. Diagnostic performance is limited by dataset and validation issues. Variability in reporting, datasets, and validation strategies have been noted, and standardization is needed. Future work should address clinical integration, explainability, and algorithmic fairness for safe and equitable deployment. Full article
(This article belongs to the Section Cardiology)
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17 pages, 2482 KB  
Article
Hippo Signaling Dysregulation in Breast Cancer: Subtype-Independent Gene and miRNA Signatures
by Katarzyna Król-Jatręga, Elżbieta Mitka-Krysiak, Kacper Boroń, Nikola Zmarzły, Piotr Ossowski, Aleksandra Plata-Babula, Paweł Ordon, Wojciech Kulej, Tomasz Sirek, Julia Gajdeczka, Yuriy Prudnikov, Krzysztof Bereza, Olga Nowotny-Czupryna, Dariusz Boroń and Beniamin Oskar Grabarek
Biomedicines 2025, 13(10), 2342; https://doi.org/10.3390/biomedicines13102342 - 25 Sep 2025
Abstract
Background/Objectives: Breast cancer represents a diverse group of malignancies and continues to rank among the leading causes of cancer-related deaths in women. Altered Hippo pathway signaling has been increasingly recognized as a contributor to tumor growth, therapeutic resistance, and metastatic spread. This [...] Read more.
Background/Objectives: Breast cancer represents a diverse group of malignancies and continues to rank among the leading causes of cancer-related deaths in women. Altered Hippo pathway signaling has been increasingly recognized as a contributor to tumor growth, therapeutic resistance, and metastatic spread. This study aimed to identify miRNAs targeting Hippo pathway-related genes that are consistently dysregulated across all five breast cancer subtypes. Methods: The study cohort included patients representing five breast cancer subtypes: 130 luminal A, 96 HER2-positive luminal B, 100 HER2-negative luminal B, 36 non-luminal HER2-positive, and 43 triple-negative breast cancer (TNBC). Tumor samples were collected during surgery, along with adjacent healthy tissue that served as controls. Expression of Hippo-related genes was analyzed using mRNA microarrays and validated with reverse transcription quantitative polymerase chain reaction (RT-qPCR). Protein levels were assessed via enzyme-linked immunosorbent assay (ELISA), while miRNA expression profiling was performed with miRNA microarrays. Potential mRNA targets were predicted using the miRDB database. Results: We identified consistent downregulation of STK4, RASSF6, and FGF1, alongside overexpression of BIRC5 and SERPINE1. miRNA analysis revealed that STK4 is potentially regulated by miR-522-3p, SERPINE1 by miR-199b-5p and miR-30a-3p, whereas RASSF6, FGF1, and BIRC5 appeared to be predominantly regulated at the transcriptional level. These alterations reflect both the suppression of upstream Hippo activation and activation of downstream oncogenic effectors across all subtypes. Conclusions: Our findings reveal a conserved Hippo dysregulation program in breast cancer, highlighting subtype-independent Hippo-related genes and their miRNA regulators as potential universal biomarkers and therapeutic targets, complementing subtype-specific treatment strategies. Full article
(This article belongs to the Special Issue Advanced Research in Breast Diseases and Histopathology)
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25 pages, 427 KB  
Article
Committee Diversity Effect on Corporate Investment Risk Practices
by Chung-Chieh Li, John Sands, Lyn Daff, Adam G. Arian and Richard Busulwa
J. Risk Financial Manag. 2025, 18(10), 539; https://doi.org/10.3390/jrfm18100539 - 24 Sep 2025
Viewed by 106
Abstract
Background: This study examines how diversifying committees influence corporate investment risk practices, specifically in decision-making and resource allocation strategies. Previously, board diversity was commonly used in studies, but committee diversity was often overlooked, even though committees are delegated with providing recommendations for board [...] Read more.
Background: This study examines how diversifying committees influence corporate investment risk practices, specifically in decision-making and resource allocation strategies. Previously, board diversity was commonly used in studies, but committee diversity was often overlooked, even though committees are delegated with providing recommendations for board decisions. Methods: Using information on committee presence, size, gender representation, and independent and non-executive members, we build a detailed diversity composite index. We capture this information from various sources such as corporate official disclosures, corporate websites, and other relevant disclosures. We combine this data with financial and investment information collected through secondary data, including Bloomberg and Refinitiv databases about companies listed on the ASX 300 in the Australian equity market from 2018 to 2020. Results: Our findings show that diversity plays a much more critical role in enhancing long-term strategic investment decisions than in driving short-term operational gains. Conclusions: Additional investigations have shown that increased diversity enhances corporate resource allocation, generating optimal investment and investment efficiency levels. These findings highlight the strategic importance of diversity as a contributor to good governance and better financial performance. Full article
(This article belongs to the Section Sustainability and Finance)
14 pages, 744 KB  
Systematic Review
Harmful Effects of Prescribed Opioids in Children and Adults: A Systematic Review
by Luíza Siqueira Lima, Nayara de S. da Costa, Maria Eduarda A. Galiciolli, Quelen I. Garlet, João José Joaquim, Cláudia S. Oliveira and Cristiano Matos
Pharmaceuticals 2025, 18(10), 1429; https://doi.org/10.3390/ph18101429 - 24 Sep 2025
Viewed by 174
Abstract
Background: Opioids are commonly used to manage both acute and chronic pain by acting on opioid receptors in the central and peripheral nervous systems. However, concerns about their increasing prescription and misuse have emerged due to adverse effects, toxicity, and the global impact [...] Read more.
Background: Opioids are commonly used to manage both acute and chronic pain by acting on opioid receptors in the central and peripheral nervous systems. However, concerns about their increasing prescription and misuse have emerged due to adverse effects, toxicity, and the global impact of opioid-related harm. Objectives: This systematic review aims to evaluate the harmful (adverse and toxic) effects of prescribed opioids on the pediatric and the general population. Methods: Following PRISMA guidelines, a systematic search was conducted for data from January 2011 to December 2024 across selected electronic databases (PubMed®, SciELO®, Web of Science®, and EMBASE®) using a specific search strategy with Boolean operators. Cross-sectional, cohort, and case–control designs published in English, analyzing and identifying the harmful effects of prescribed opioids in children and the general population, were eligible for inclusion. Three reviewers independently assessed titles and abstracts for eligibility, followed by a full-text review. A referee reviewer resolved discrepancies. Data extraction was performed for qualifying studies. The risk of bias was assessed by the ROBINS-I tool. Results: A total of 3984 papers were collected, with 1697 duplicates and 2062 non-eligible papers removed; resulting in 25 papers (112.825 patients) selected for qualitative analysis. The pediatric group experienced more harmful effects across multiple body systems (nausea and vomiting, hypotension, agitation, drowsiness/lethargy, lethargy, respiratory depression, aspiration pneumonia) compared to the general population (dominant S wave, long QTc interval, right axis deviation, seizure). Conclusions: Despite the data heterogeneity, this study highlights the importance of evaluating the harmful effects of opioids, particularly in pediatric patients, to assess the risk–benefit balance and health risks associated with their use. The lower number of effects in the general population may be attributed to increased pharmacological tolerance and tolerability. Full article
(This article belongs to the Special Issue Pharmacology and Toxicology of Opioids, 2nd Edition)
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25 pages, 1204 KB  
Review
A Clinical Review of the Connections Between Diabetes Mellitus, Periodontal Disease, and Cardiovascular Pathologies
by Otilia Țica, Ioana Romanul, Gabriela Ciavoi, Vlad Alin Pantea, Ioana Scrobota, Lucian Șipoș, Cristian Marius Daina and Ovidiu Țica
Biomedicines 2025, 13(9), 2309; https://doi.org/10.3390/biomedicines13092309 - 20 Sep 2025
Viewed by 248
Abstract
Background: Diabetes mellitus (DM), periodontal disease (PD), and cardiovascular disease (CVD) are highly prevalent global health conditions with overlapping pathophysiological mechanisms. Emerging evidence suggests a bidirectional and synergistic relationship among them, driven by chronic inflammation, immune dysregulation, oxidative stress, and microbial dysbiosis. [...] Read more.
Background: Diabetes mellitus (DM), periodontal disease (PD), and cardiovascular disease (CVD) are highly prevalent global health conditions with overlapping pathophysiological mechanisms. Emerging evidence suggests a bidirectional and synergistic relationship among them, driven by chronic inflammation, immune dysregulation, oxidative stress, and microbial dysbiosis. Objective: This review synthesizes current literature on the interconnectedness of DM, PD, and CVD, emphasizing shared molecular pathways, clinical implications, and opportunities for integrated management. Methods: A systematic review and narrative synthesis of recent clinical trials, observational studies, and multi-omics investigations was conducted to explore the mechanisms linking these three conditions. A structured literature search was performed across PubMed, Scopus, and Web of Science from database inception until 30 June 2025. Key findings were contextualized within systems biology, precision medicine, and real-world clinical strategies. Results: DM exacerbates periodontal inflammation and accelerates tissue destruction via hyperglycemia-induced inflammatory mediators, while periodontitis worsens glycemic control and insulin resistance. Both conditions independently elevate cardiovascular risk, and their co-occurrence significantly amplifies the incidence of adverse cardiovascular events. Shared biomarkers such as Interleukin (IL)-6, Tumor Necrosis Factor (TNF)-α, and CRP, as well as overlapping genetic and epigenetic signatures, underscore a common inflammatory axis. Periodontal therapy has demonstrated modest but meaningful benefits on glycemic control and endothelial function, while cardiometabolic therapies (e.g., statins, Glucagon-Like Peptide (GLP-1) receptor agonists, SGLT2 inhibitors) show potential to improve periodontal outcomes. Probiotics, microbiome-targeted therapies, and AI-based risk models are emerging as future tools. Conclusions: DM, PD, and CVD form a mutually reinforcing triad mediated by systemic inflammation and metabolic dysregulation. Integrated, multidisciplinary care models and precision health strategies are essential to address this inflammatory burden and improve long-term outcomes. Further large-scale interventional trials and mechanistic human studies are needed to establish causal links and optimize combined therapeutic approaches. Full article
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18 pages, 2375 KB  
Systematic Review
Effectiveness of Arm Swing Exercise on Comprehensive Health Outcomes: A Systematic Review and Meta-Analysis
by Phatcharaphon Whaikid and Noppawan Piaseu
Healthcare 2025, 13(18), 2357; https://doi.org/10.3390/healthcare13182357 - 19 Sep 2025
Viewed by 323
Abstract
Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires [...] Read more.
Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires no specialized equipment or professional supervision. However, systematic evidence on its health benefits remains limited. Objective: This systematic review and meta-analysis aimed to assess the effects of ASE on body composition, glycemic control, cardiovascular health, and musculoskeletal outcomes. Methods: A comprehensive systematic search was conducted in four major databases, including PubMed, Embase, Scopus, and the Thai-Journal Citation Index Center, covering studies published from inception to October 2024. Articles published in both English and Thai were included. Two independent reviewers screened and selected eligible randomized controlled trials and quasi-experimental studies. Methodological quality was assessed using the JBI critical appraisal tool, and meta-analyses were performed using Stata software (version 18), presenting mean differences (MD) with 95% confidence intervals (CI). Results: Thirteen studies were included, comprising eight randomized controlled trials and five quasi-experimental studies, with intervention durations ranging from 5 to 24 weeks. The ASE significantly reduced waist circumference (MD = −4.76; 95% CI: −8.36 to −1.17; and p < 0.05), hemoglobin A1C (MD= −0.80%; 95% CI: −1.19 to −0.40; and p < 0.001), fasting blood glucose (MD = −17.62 mg/dL; 95% CI: −25.93 to −9.32; and p < 0.05), and diastolic blood pressure (MD = −9.74 mmHg; 95% CI: −17.84 to −1.65; and p < 0.05). The ASE showed a non-significant reduction in systolic blood pressure (MD = −3.65 mmHg; 95% CI: −10.37 to 3.08; and p = 0.29). Additionally, the ASE significantly increased high-density lipoprotein cholesterol (HDL-C) levels (MD = 6.96 mg/dL; 95% CI: 2.20 to 11.71; and p < 0.05). Conclusions: This study, representing the first systematic review and meta-analysis focusing on ASE, demonstrates that ASE is an effective intervention for improving body composition, glycemic control, and cardiovascular health. Given its simplicity, low cost, and broad applicability, ASE could serve as a practical public health strategy to promote health and prevent chronic diseases across diverse populations. Full article
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21 pages, 926 KB  
Systematic Review
Technical Variations in Lateral Extra-Articular Tenodesis for Anterior Cruciate Ligament Reconstruction: A Systematic Review
by Jan Zabrzyński, Bartosz Turoń, Adam Kwapisz, Achilles Boutsiadis, Maria Zabrzyńska, Maciej Sokołowski, Bartosz Majchrzak, Michalina Adamczyk, Katie Kellett and Gazi Huri
J. Clin. Med. 2025, 14(18), 6510; https://doi.org/10.3390/jcm14186510 - 16 Sep 2025
Viewed by 379
Abstract
Background/Objectives: The aim was to provide a comprehensive, systematic review on the Lateral Extra-articular Tenodesis (LET) methods used in anterior cruciate ligament (ACL) reconstruction in the light of recent data. Methods: To identify all of the essential studies that reported relevant [...] Read more.
Background/Objectives: The aim was to provide a comprehensive, systematic review on the Lateral Extra-articular Tenodesis (LET) methods used in anterior cruciate ligament (ACL) reconstruction in the light of recent data. Methods: To identify all of the essential studies that reported relevant data concerning primary outcomes: indications for surgery, surgical technique, graft type, fixation method, and tibial fixation location, an extensive search of the major and significant electronic databases (PubMed, Cochrane Central, ScienceDirect, Web of Science, Embase) was performed by three independent authors. A systematic investigation was conducted in November 2023, with no limits regarding the year of publication. After the database search, three independent reviewers screened all the papers, which followed strictly the inclusion and exclusion criteria, identifying a title, abstract, and full text concerning LET, surgical technique, femoral attachment, tibial attachment, graft type, fixation method, knee angle during fixation, and graft tension at fixation in ACL reconstruction. A systematic review of the collected literature was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Study quality was assessed using the Cochrane Risk of Bias Tool. Results: Of the 35 papers reviewed, seven surgical techniques of LET differing in the way the procedure was performed were separated. The majority of papers were from Italy (n = 11), USA (n = 3), France (n = 3), and Canada (n = 3). The number of total participants across all studies was 6253. The majority of studies (17 papers) used the Lemaire modified procedure, and 10 papers used the MacIntosh technique modified by the Coker–Arnold approach. Most of the papers mentioned fixation location on the lateral distal part of the femur including six articles referring directly to lateral femoral epicondyle. Most authors (25 papers) defined tibial attachment as Gerdy’s tubercle. The most common graft was the iliotibial band and fixation method was sutures. The types of fixation in the surgical techniques of the collected papers were Sutures, Staples, Anchor, Interference screw, K-wire, Bioabsorbable Screw and Titanium Screw with a serrated polyethylene washer. Conclusions: Despite variability in technique, the Lemaire-modified procedure emerged as the preferred approach for Lateral Extra-articular Tenodesis, suggesting a general consensus around its reliability and reproducibility in clinical practice. The frequent use of the iliotibial band as graft material reflects its accessibility and suitability for reinforcing anterolateral stability. Similarly, the consistent use of sutures and fixation at Gerdy’s tubercle may indicate a favorable balance between technical ease and biomechanical strength. The variability in femoral fixation points—either at the lateral femoral condyle or epicondyle—highlights the ongoing debate or surgeon preference, underscoring the need for further comparative studies to establish optimal fixation strategy. Collectively, these patterns may help guide surgical decision-making, particularly when tailoring procedures to individual patient anatomy or surgical expertise. Full article
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13 pages, 1221 KB  
Systematic Review
Integrating Multimorbidity Assessment into Rheumatology Care: Prognostic Role of the Charlson Comorbidity Index in Systemic Lupus Erythematosus
by Ryuichi Ohta, Yoshinori Ryu, Chiaki Sano and Kunihiro Ichinose
Healthcare 2025, 13(18), 2285; https://doi.org/10.3390/healthcare13182285 - 12 Sep 2025
Viewed by 334
Abstract
Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and premature mortality. As patients with SLE often suffer from multiple comorbid conditions, evaluating the overall health burden is critical for improving risk stratification and long-term outcomes. The Charlson Comorbidity [...] Read more.
Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and premature mortality. As patients with SLE often suffer from multiple comorbid conditions, evaluating the overall health burden is critical for improving risk stratification and long-term outcomes. The Charlson Comorbidity Index (CCI) is a widely used tool for quantifying the burden of comorbidity. This systematic review and meta-analysis aimed to assess the prognostic value of the CCI for all-cause mortality in adult patients with SLE. Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. Three databases (PubMed, Embase, and Web of Science) were searched up to May 2025. Three studies (n = 1175 participants) met the inclusion criteria. Eligible studies included adult SLE populations that evaluated the comorbidity burden using the CCI and reported all-cause mortality. Study characteristics and effect sizes were extracted, and a fixed-effects model (after considering both random- and fixed-effects approaches) was applied to calculate pooled odds ratios (ORs). Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Three observational studies (n = 1175 participants) met the inclusion criteria. All demonstrated a significant association between higher CCI scores and increased all-cause mortality. The pooled OR for mortality in patients with a high comorbidity burden was 3.92 (95% CI: 2.74–5.60), with no observed heterogeneity (I2 = 0%). The risk of bias was moderate to high across all studies. Conclusions: Multimorbidity, as measured by the CCI, is a strong independent predictor of mortality in SLE. Integrating comorbidity assessment into rheumatology care may enhance prognostic evaluation, guide personalized treatment, and support interdisciplinary management strategies for patients with complex disease profiles. Full article
(This article belongs to the Special Issue Innovative Strategies in Rheumatology Care)
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16 pages, 757 KB  
Systematic Review
Targeting Myocardial Mechanics in Children and Adolescents with Obesity and Non-Elevated Blood Pressure: A Meta-Regression Study
by Andrea Faggiano, Elisa Gherbesi, Carla Sala, Stefano Carugo, Guido Grassi, Marijana Tadic and Cesare Cuspidi
Diseases 2025, 13(9), 301; https://doi.org/10.3390/diseases13090301 - 11 Sep 2025
Viewed by 301
Abstract
Background/Objectives: Although global longitudinal strain (GLS) appears more sensitive than the ejection fraction in uncovering subtle left ventricular (LV) dysfunction, evidence of impaired LV mechanics in children/adolescents with obesity, independent of comorbidities, remains limited. The aim of the present study was to provide [...] Read more.
Background/Objectives: Although global longitudinal strain (GLS) appears more sensitive than the ejection fraction in uncovering subtle left ventricular (LV) dysfunction, evidence of impaired LV mechanics in children/adolescents with obesity, independent of comorbidities, remains limited. The aim of the present study was to provide new information on clinical and echocardiographic correlates associated with LV mechanics in normotensive children/adolescents with obesity and without comorbidities. Methods: The Pub-Med, Ovid MEDLINE, Ovid EMBASE, and Cochrane databases were searched to identify eligible studies from inception up to 31 March 2025. Studies reporting data on LV mechanics (i.e., GLS, global circumferential strain [GCS]) in children/adolescents with obesity were included. Meta-regression analyses between GLS, GCS, and several clinical, laboratory, and echocardiographic parameters were performed using a random-effect model. Results: Twenty-seven studies including 1398 normotensive children/adolescents with obesity (mean age 12.6 ± 1.8 years) were considered. There was a significant inverse relationship between GLS and body mass index (BMI) (coefficient = −0.33 ± 0.11, p = 0.003) and fat mass (coefficient = −0.19 ± 0.07, p = 0.005); this was not the case for GCS. Notably, both GLS and GCS were unrelated to several clinical/laboratory variables such as blood pressure, metabolic parameters, LV mass, and LV diastolic function indices. Conclusions: Our findings suggest that increasing BMI and fat mass are the only key factors associated with reduced longitudinal myocardial deformation in pediatric obesity. GLS, unlike GCS, can be regarded as an early marker of subclinical organ damage in this setting and should be assessed to optimize cardiovascular prevention strategies in children/adolescents with obesity regardless of hypertension or comorbidities. Full article
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10 pages, 286 KB  
Systematic Review
Effects of the Prescription of Physical Exercises Mediated by Mobile Applications on the Health of Older Adults: A Systematic Review
by Débora Vanessa Santos Dias Costa, Evellin Pereira Dourado, Mayara Bocchi Fernandes, Eduardo Vignoto Fernandes and David Michel de Oliveira
Geriatrics 2025, 10(5), 122; https://doi.org/10.3390/geriatrics10050122 - 10 Sep 2025
Viewed by 350
Abstract
Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness [...] Read more.
Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness of prescribing physical exercise via mobile apps for older people. This study aimed to analyze the effects of prescribing PE through MAs on the health of older adults. Materials and Methods: This systematic review included studies with older people (≥60 years) that used MAs to prescribe PE, published between 2014 and 2024, in Portuguese or English. The search strategy used the descriptors “older adults,” “physical exercise,” “mobile applications,” and “health,” combined with Boolean operators. The screening followed previously defined eligibility criteria regarding population, intervention, outcomes, and study design. Two independent reviewers extracted data, mediated by a third party in case of disagreement; they screened and extracted data from the PubMed and VHL/Medline databases from 2004 to 2024. Risk of bias was assessed according to levels of evidence, and the results were categorized. Results: Of the 2298 publications initially identified, 7 studies were eligible for this review, totaling 748 participants, predominantly female. The studies included prospective and observational clinical trials with older people suffering from Parkinson’s disease, cardiovascular disease, sarcopenia, and breast cancer. The findings showed favorable effects on adherence to the program (6 studies; n = 654), an increase in PE (5 studies; n = 502), and improvements in functional capacity (4 studies; n = 389), perceived quality of life (5 studies; n = 481), and muscle strength (3 studies; n = 298). Conclusions: The prescription of MA-mediated PE showed positive effects on the health of older people, indicating its viability as a complementary strategy in clinical practice or public health. Full article
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10 pages, 492 KB  
Protocol
Gamification Strategies in Undergraduate Nursing Education: A Systematic Review Protocol
by Raffaele Antonio Elia, Maria Colangelo, Valentina Cerrone, Donato Pace and Vincenzo Andretta
Nurs. Rep. 2025, 15(9), 331; https://doi.org/10.3390/nursrep15090331 - 9 Sep 2025
Viewed by 445
Abstract
Background/Objectives: In recent years, the use of gamification has been growing in health education. In undergraduate nursing programs, it aims to enhance motivation, engagement, knowledge retention, and professional competencies. However, the evidence often combining nursing students with other disciplines or focusing on specific [...] Read more.
Background/Objectives: In recent years, the use of gamification has been growing in health education. In undergraduate nursing programs, it aims to enhance motivation, engagement, knowledge retention, and professional competencies. However, the evidence often combining nursing students with other disciplines or focusing on specific tools rather than the broader concept. This systematic review will synthesize the impact of gamification strategies on educational outcomes in undergraduate nursing education. Methods: This protocol was written according to PRISMA-P guidelines and is registered in PROSPERO (CRD420251117719). Eligible studies will include randomized controlled trials, quasi-experimental, and observational designs involving undergraduate nursing students exposed to gamification interventions in classroom, online, or clinical training settings. Comparators may include traditional lecture-based instruction or other non-gamified methods. We will search the PubMed, CINAHL, PsycINFO, Web of Science, Scopus, and Google Scholar databases, covering January 2010 to July 2025, without language restrictions. Two reviewers will independently screen studies, extract data, and assess risk of bias using Cochrane RoB-2, ROBINS-I, and JBI Critical Appraisal Tools. Where possible, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a comprehensive synthesis of gamification’s effectiveness in undergraduate nursing education, identifying the most effective strategies and the contexts in which they perform best. Full article
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20 pages, 837 KB  
Systematic Review
Implementation of Evidence-Based Psychological Treatments to Address Depressive Disorders: A Systematic Review
by Rosa Lorente-Català, Amanda Díaz-García, Irene Jaén, Margalida Gili, Fermín Mayoral, Javier García-Campayo, Yolanda López-Del-Hoyo, Adoración Castro, María M. Hurtado, Caroline H. M. Planting and Azucena García-Palacios
J. Clin. Med. 2025, 14(17), 6347; https://doi.org/10.3390/jcm14176347 - 8 Sep 2025
Viewed by 1463
Abstract
Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more [...] Read more.
Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more extensive use of EBPPs. However, despite these practices being essential to the mental health system, EBPPs are poorly applied in clinical settings. This situation has led to the development of Implementation Research (IR), a scientific field that aims to address the challenge of translation and identify the factors involved in the implementation process. Several implementation studies have been carried out in the field of health. However, the evidence from implementation studies of psychological treatments addressing depression has not yet been summarized. The aim of this study is to conduct a systematic review to assess implementation studies that use EBPPs to address depression. Methods: A systematic review was conducted following the PRISMA guidelines, including implementation studies that applied EBPPs to address depressive disorders. The following databases were used: PubMed, Embase, APA PsycInfo, Cochrane Central, Scopus, and Web of Science. Two independent reviewers revised the studies to determine whether the eligibility criteria were met. Results: A total of 8797 studies were identified through database searches. After removing duplicates, a total of 3757 studies were screened based on titles and abstracts. Finally, 127 full-text articles were reviewed, yielding 31 studies that satisfied the inclusion criteria. Conclusions: This review offers valuable insights into the current state of IR in the implementation of EBPPs for treating depressive disorders. It underlines the necessity for a standardized nomenclature for study designs within the realm of IR and emphasizes the potential of hybrid efficacy–implementation studies to help close the gap between research and clinical practice. Despite the challenges encountered, this review points to a positive outlook for the use of IR in clinical psychology. A gradual adoption of IR is likely to strengthen its role in psychology and support the development of more effective strategies for implementing evidence-based interventions in clinical settings. Full article
(This article belongs to the Section Mental Health)
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