Search Results (6,419)

Background/Objectives: Acute health impacts and longer-term sequelae of sport-related concussion (SRC) are recognized concerns in football (soccer), warranting investigation of interventions to reduce the incidence. The purpose of this study was to identify, synthesize and evaluate interventions used in preventing sport-related concussion (SRC) in adult soccer players. Methods: Five databases (MEDLINE, CINAHL, Embase, SPORTDiscus, PsycINFO) were searched on 6 September 2024 and updated on 17 December 2025 for concussion prevention intervention studies involving adult footballers. Study quality was assessed with the Modified Downs and Black Checklist. A narrative synthesis of all included studies followed Synthesis Without Meta-Analysis (SWiM) guidelines. Results: From 3463 records, five studies met inclusion criteria: three reported rule changes and two reported head-neck training interventions. The low volume of studies discovered were non-randomized and rated fair or poor on quality assessment. Whilst these interventions were grounded in sound and well-reasoned mechanisms to mitigate SRC risks, none reported statistically significant directional effects. This, combined with high heterogeneity, prevented data pooling and no firm conclusions could be drawn about the effectiveness of any intervention. Conclusions: Sparce, preliminary, heterogeneous evidence represents research to reduce SRC in adult soccer players, and this is limited to investigating rule changes and head-neck training and interventions. A larger volume of primary research is needed to determine meaningful practice recommendations of these and other conceivable interventions. Full article

Background: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder worldwide. Management strategies include lifestyle modification, pharmacologic therapy, and surgical interventions. Diaphragmatic breathing exercises have been proposed as a non-pharmacological treatment aimed at improving lower esophageal sphincter function and reducing reflux episodes. Methods: A systematic search of PubMed/MEDLINE, Scopus, ScienceDirect, Google Scholar, and ClinicalTrials.gov was conducted from database inception to 10 March 2026 to identify randomized controlled trials evaluating diaphragmatic breathing in patients with GERD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses were performed to estimate pooled mean differences for symptom scores and quality-of-life outcomes. Results: Ten randomized controlled trials including 476 patients were analyzed (mean age: 39.9 ± 11.3 years). Diaphragmatic breathing interventions were performed in 229 participants, with an average duration of 20.36 min per session over approximately 5.1 weeks. Meta-analysis demonstrated a modest improvement in GERD symptom scores favoring diaphragmatic breathing (SMD −0.74; 95% CI −1.36 to −0.12; p = 0.019), with substantial heterogeneity (I² = 79.7%). Subgroup analyses comparing breathing with medication and sham breathing controls produced similar trends. Quality-of-life outcomes did not demonstrate statistically significant improvement (MD −2.35; 95% CI −6.35 to 1.65; p = 0.25) and showed considerable heterogeneity (I² = 85.3%). Risk-of-bias assessment revealed “some concerns” in several studies, primarily related to randomization procedures and outcome reporting. Conclusions: Although pooled results demonstrated a statistically significant reduction in GERD symptom scores favoring diaphragmatic breathing, this finding must be interpreted with considerable caution given the substantial heterogeneity observed. The current evidence remains limited by methodological heterogeneity, and inconsistent outcome assessment is insufficient to support definitive clinical recommendations, and the observed benefit may not be generalizable across patient populations or clinical settings. Larger standardized randomized trials are required to determine the clinical role of diaphragmatic breathing in GERD management. Full article

Photodynamic therapy (PDT) is a minimally invasive treatment choice whose clinical success in dermatology relies on the interaction between a photosensitizer, light of an appropriate wavelength, and tissue oxygen, leading to reactive oxygen species generation and selective cytotoxicity. This narrative review summarizes contemporary mechanisms and clinical evidence supporting PDT across neoplastic, inflammatory, infectious, and esthetic indications. A comprehensive literature search included randomized trials when available, systematic reviews, meta-analyses, and guideline and consensus documents, complemented by mechanistic and translational studies relevant to clinical outcomes. In premalignant and neoplastic disease, strongest evidence supports field-directed PDT for actinic keratosis and high efficacy in Bowen’s disease, with favorable cosmetic outcomes and acceptable recurrence patterns. PDT plays a more selective role in basal cell carcinoma, particularly superficial and selected nodular lesions, while its routine use as monotherapy in squamous cell carcinoma remains limited by higher recurrence. Beyond oncology, PDT shows expanding utility in acne via sebomodulatory and immunomodulatory effects, and in infectious dermatoses through broad antimicrobial activity and biofilm disruption with low resistance potential. Cosmetic applications, including photorejuvenation, benefit from protocol tailoring and combination strategies that enhance penetration and remodeling. Overall, PDT is evolving into an adaptable therapeutic framework best positioned within mechanism-oriented, multimodal algorithms. Full article

Background: Medial-compartment knee osteoarthritis (KOA) carries substantial disability and long-term cost. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are key joint-preserving or joint-replacing options for selected patients, but their comparative economic ranking remains uncertain. Methods: This critical narrative review synthesized comparative economic evidence on HTO versus UKA for isolated medial-compartment KOA. PubMed and Web of Science were searched as primary sources for English-language studies published from 1 January 2000 to 15 January 2026, while Google Scholar and citation tracking were used supplementarily to identify potentially missed records. Eligible studies were direct economic evaluations or comparative cost/resource studies with clear decision relevance to the HTO–UKA choice. Burden and cost-of-illness studies were used for contextual framing only and were not included in the core comparative synthesis. Results: The direct evidence base was small and methodologically heterogeneous and was dominated by decision-analytic models that differed in perspective, time horizon, utility metric, and assumptions regarding reoperation, revision, and conversion to total knee arthroplasty (TKA). These structural differences largely explain why a U.S. lifetime societal model favored HTO, a UK age-stratified 10-year model produced age-dependent findings, and a recent Canadian public-payer model favored UKA. Observational studies suggest that UKA episode costs can fall substantially in outpatient or ambulatory pathways, whereas HTO costs may rise when reoperations and technique-specific resource use are explicitly captured. Conclusions: Current evidence does not support a context-free economic ranking of HTO and UKA. Because the available studies are heterogeneous and incremental utility differences are often small, the findings should be interpreted cautiously and as scenario-dependent rather than definitive. Future comparative analyses should use contemporary pathway data, transparent and standardized costing, and explicit downstream event definitions for both procedures. Full article

Background: Edible and medicinal mushrooms have attracted growing attention as functional foods due to their rich content of bioactive compounds and their potential to modulate host physiology through microbiota-mediated mechanisms. Methods: This narrative review was conducted through a comprehensive literature search across major scientific databases, including PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar, selecting studies focused on mushroom-derived compounds, gut microbiota, short-chain fatty acids (SCFAs), and the gut–brain axis (GBA). Results: Current evidence indicates that mushroom-derived polysaccharides, particularly β-glucans, along with polyphenols, trehalose, and chitin, resist digestion and are fermented by intestinal microorganisms, promoting SCFA production. These metabolites contribute to intestinal barrier integrity, immune regulation, and metabolic homeostasis and may also influence neuroinflammation and neurotransmitter pathways via the GBA. However, significant variability in mushroom preparations and the limited availability of well-designed human clinical trials remain important limitations. Conclusions: Edible and medicinal mushrooms represent a promising source of novel prebiotic compounds with potential systemic health benefits, although further standardized studies and robust clinical trials are needed to confirm their efficacy and mechanisms of action. Full article

Obesity and depression in childhood and adolescence represent major public health concerns, yet the nature and direction of their association remain incompletely understood. In the present study, we conducted a systematic review and stratified meta-analysis of epidemiological studies examining the relationship between obesity and depression in youth populations. A total of 945 records were identified through database searches, of which 18 studies met the inclusion criteria for the review. To ensure greater conceptual consistency, quantitative synthesis was restricted to studies examining categorical obesity (typically defined as body mass index (BMI) ≥ 95th percentile) and binary depression outcomes, which formed the longitudinal and cross-sectional meta-analytic cores, analyzed separately. Our longitudinal meta-analysis (k = 4; N = 5581) indicated that obesity was associated with an increased likelihood of subsequent depression (OR = 2.05, 95% CI: 1.40–2.99), whereas the cross-sectional meta-analysis (k = 6; N = 20,278) showed a weaker and non-significant association (OR = 1.40, 95% CI: 0.98–2.00) with moderate heterogeneity. Additional studies that could not be pooled due to differences in exposure or outcome definitions were integrated through narrative synthesis and showed mixed and generally less consistent patterns, broadly supporting the distinction between longitudinal and cross-sectional evidence. Overall, our findings suggest that obesity during childhood and adolescence is associated with an increased likelihood of subsequent depression, while concurrent associations appear more heterogeneous and more difficult to interpret. By distinguishing between study designs and prioritizing comparable effect estimates, this study provides a more transparent synthesis of the current evidence on the relationship between obesity and depression in youth. Full article

Background: Agentic artificial intelligence (AI) systems, characterized by autonomous goal-directed behavior, multi-step reasoning, task decomposition, and tool use, are increasingly proposed for healthcare applications. However, their autonomy raises concerns regarding transparency, accountability, and human oversight. While explainable AI (XAI) has been widely studied in traditional predictive models, less is known about how explainability is implemented within agentic architectures. Objective: To map the emerging literature on explainable agentic AI (XAAI) in healthcare and characterize the types, scope, and forms of explainability used in these systems. Methods: A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Embase, IEEE Xplore, and ACM Digital Library were searched through November 2025. Eligible studies described healthcare-related agentic AI systems incorporating explicit explainability mechanisms. Data were extracted on system architecture, explainability type (intrinsic, post hoc, hybrid), explanation scope (local, global), explanation form, and reported clinical outcomes. Results: Nine studies met the inclusion criteria. All systems demonstrated core agentic features, including autonomy, task decomposition, and tool integration, often within multi-agent frameworks. Explainability was predominantly intrinsic and workflow-native, typically delivered through textual reasoning traces and example-based grounding in retrieved clinical evidence. Feature-based and global explanations were comparatively rare and largely confined to hybrid architectures. Across domains including radiology, neurology, psychiatry, and biomedical research, XAAI systems were reported to improve performance and interpretability relative to baseline models in the included studies. However, these findings were derived from heterogeneous, predominantly experimental or retrospective studies, and structured human-in-the-loop oversight was infrequently described. Conclusions: Current XAAI systems appear to emphasize process transparency and evidence grounding rather than mechanistic model-level attribution. The available evidence remains limited and heterogeneous, and findings should be interpreted as early trends rather than established characteristics. Further progress will require standardized evaluation frameworks, clearer reporting of oversight mechanisms, and validation in real-world clinical settings to support safe and trustworthy integration of agentic AI into healthcare practice. Full article

Surrogate-assisted evolutionary algorithms have become the mainstream approach for solving expensive constrained multi-objective optimization problems (ECMOPs). However, existing methods suffer from blind search issues, and their selection strategies fail to adapt to changes in evolutionary stages. To overcome these limitations, this paper proposes a Multi-directional Guided Dual-mode Kriging-assisted Competitive Particle Swarm Optimization (MGD-KCSO) algorithm. MGD-KCSO integrates three synergistic strategies: a multi-directional guided solution strategy that constructs four complementary search paths based on non-dominated solutions to effectively enhance convergence and diversity; a dual-population data selection strategy that separates unconstrained and constrained populations to perform objective-oriented and constraint-oriented optimization, respectively; and an adaptive infill sampling strategy that dynamically switches sampling modes by monitoring the change rate of the objective function of the ideal point. If this rate exceeds a predefined threshold, the algorithm executes unconstrained sampling to accelerate convergence; otherwise, it switches to constrained sampling to prioritize the exploration of feasible boundaries. To verify the effectiveness of MGD-KCSO, comprehensive experiments were conducted on 33 benchmark problems and two real-world engineering design problems (pressure vessel and disc brake design). MGD-KCSO was compared against eight classic algorithms and three state-of-the-art methods published in the past two years. Experimental results evaluated by inverted generational distance (IGD) and hypervolume (HV) metrics demonstrate that MGD-KCSO outperforms the comparative algorithms on most test instances, achieving superior performance in terms of convergence, diversity, and practical applicability. Full article

To accomplish underwater search missions of the target with stochastic motion, path planning is required prior to autonomous underwater vehicle (AUV) operations. Genetic algorithms (GAs) are a classical approach for target search path planning; however, when applied to moving underwater targets, they often rely on oversimplified motion models and lack flexible mutation direction control, resulting in suboptimal search paths and reduced detection performance. To address these limitations, this paper proposes a GA-based path planning method incorporating a target-position-controlled mutation strategy. First, a Markov process combined with a grid-based approach is used to model stochastic target motion and derive the spatial probability distribution of target positions. Second, based on the target distribution grid, the influence of random fluctuations on sonar signals is simulated to construct a probabilistic detection model. Finally, the target distribution and detection probability model are integrated into the proposed GA to generate an optimal AUV search path. Simulation results show that the proposed method effectively improves path planning for moving targets under stochastic conditions, increasing the target cumulative detection probability from 0.33 to 0.48. Full article

Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40–55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials. Full article

Multi-robot collaboration and marine robotics constitute key research directions in intelligent autonomous systems. In this context, multi-ROV cooperative operations are increasingly deployed for sunken ship search missions. A central technical challenge in such applications is to ensure efficient, non-redundant coverage while maintaining accurate formation tracking. This scenario confronts two principal difficulties. First, overlapping operational regions among multiple ROVs tend to produce both redundant coverage and search blind zones. Second, trajectory tracking accuracy is significantly degraded by the combined effects of hydrodynamic disturbances and inherent actuator constraints in ROVs. To address these challenges, an improved dynamic window approach (DWA), incorporating a search distance penalty mechanism, is proposed for multi-ROV trajectory planning. Concurrently, a cascaded tracking control architecture is constructed, wherein a model predictive kinematic controller generates constrained velocity references, while an adaptive sliding mode dynamic controller augmented with an extended state observer provides robust disturbance rejection. Collaborative search is conducted using a three-ROV leader–follower formation. Simulation results indicate that regional search coverage is effectively improved and areas of repeated detection are significantly reduced by the proposed planning algorithm. Real-time trajectory tracking is achieved by the designed controller under two typical extreme strong disturbance conditions, namely, time-varying disturbances and abrupt disturbances, on the premise of satisfying thruster thrust constraints. The proposed scheme enables all three ROVs to successfully complete the tracking task under time-varying disturbances while reducing the frequency of thrust saturation events by up to seven times. In contrast, under the conventional MPC–ASMC controller, one ROV deviates from the formation and fails to complete the tracking task. Under abrupt disturbances, the proposed approach reduces the trajectory tracking error by up to six times and decreases the frequency of thrust saturation events by up to four times. Full article

Retinal ganglion cell (RGC) degeneration underlies glaucomatous optic neuropathy and remains a leading cause of irreversible vision loss worldwide. Although elevated intraocular pressure (IOP) is the primary modifiable risk factor, RGC death reflects converging mechanisms including mechanical stress, vascular insufficiency, metabolic dysfunction, and neuroinflammation. We conducted a PRISMA-guided systematic review with PICOS-defined eligibility criteria, searching PubMed, Cochrane Library, ScienceDirect, Scopus, Google Scholar, and ProQuest for studies through January 2026 on RGC degeneration and neuroprotective or regenerative therapies in glaucoma. Included studies supported OCT-based structural assessment and imaging biomarkers as essential tools for early detection, risk stratification, and monitoring of progression and treatment response. Continued RGC loss despite IOP control in many patients highlights the need for mechanism-based interventions; neuroprotective strategies targeting excitotoxicity, oxidative stress, mitochondrial dysfunction, and neurotrophic insufficiency are emerging, while stem cell and gene-based regenerative therapies remain under active investigation. Integrating molecular insights with advanced imaging and biomarker-guided endpoints may enable earlier, more individualized intervention and help explain progression despite adequate pressure control. Full article

Alcohol use disorder is associated with substantial neurologic and systemic morbidity, but its relationship with audiovestibular dysfunction has not been clearly synthesized. This systematic review summarized human primary clinical evidence on auditory and vestibular manifestations, diagnostic findings, treatment, and prognosis in alcohol use disorder. PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect were searched from inception to 4 February 2026; the review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261301021). Because study designs, clinical contexts, and outcome measures were highly heterogeneous, a structured qualitative synthesis was performed. Twelve human primary clinical studies were included. The available evidence supported objective auditory dysfunction, most commonly sensorineural hearing impairment with frequent high-frequency involvement. Vestibular involvement was also reported, but the evidence was smaller and less phenotypically specific, consisting mainly of syndromic reports, broad peripheral/central classifications, and historical nystagmographic findings. Direct treatment evidence was very limited; improvement after thiamine replacement was reported in alcohol-related Wernicke-spectrum presentations, but no established disease-specific therapy was identified. Overall, current human clinical evidence supports heightened clinical awareness but not disease-specific screening algorithms or targeted therapeutic recommendations. Better prospective studies using contemporary phenotype-based audiovestibular assessment are needed. Full article

Complex psychosis is a clinically relevant rehabilitation construct rather than a formal diagnostic category and refers to psychotic illness associated with treatment-resistant symptoms, functional impairment, and additional cognitive, psychiatric, neurodevelopmental, or physical health complexity. In this clinician-oriented narrative review, we synthesised current evidence on rehabilitation interventions for adults with complex psychosis, integrating direct evidence from specialist rehabilitation settings with indirect evidence from schizophrenia-spectrum studies when clinically informative. We searched major clinical databases, prioritised guidelines, systematic reviews, meta-analyses, and controlled studies, and organised the synthesis by functional domain and pathway relevance. Evidence was strongest for cognitive remediation, particularly when combined with broader psychiatric rehabilitation or vocational support, for family interventions in relapse prevention, and for individual placement and support in competitive employment. Social–cognitive and metacognitive interventions appear clinically valuable, although transfer to real-world functioning is more variable. Community-based rehabilitation, supported accommodation, illness self-management, and ecological adaptation strategies remain central to functional recovery when embedded within multidisciplinary pathways. Digital and virtual interventions are promising adjuncts, but their efficacy remains heterogeneous and implementation challenges include engagement, privacy, and service integration. Overall, rehabilitation in complex psychosis is most convincing when it is personalised, measurement-based, and delivered through integrated service models linking assessment, intervention selection, supported living, and recovery-oriented care. Full article

Background: The impact of overweight and adipocyte size on the development of type 2 diabetes mellitus (T2DM) remains unclear. Aim: We studied (1) the relationship between the state of adipocytes and/or overweight/obesity, the development of T2DM and its clinical and laboratory features; and (2) weight loss effect on glycemic level, endogenous hyperinsulinism (HI), insulin resistance (IR), and T2DM. Methods: We designed a systematic review by searching Web of Science, EBSCO, Scopus/ Science-Direct, Google Scholar, PubMed, Cochrane, and Wolter Kluwer for articles published in 26 years (2000–2026). The study was based on a systematic review of 3853 articles published worldwide. Results: In total, 142 full-text articles were assessed for eligibility. As overweight increases, the size of adipose tissue, adipocytes, and cell radius increase. The increase in cell size overloads intracellular transport and internal organs. The development of IR is a conformational change in cellular receptors caused by an excessive increase in cell size. The increase in cell size with overweight gradually leads to hyperglycemia and HI with the development of IR and T2DM. Any targeted intentional weight loss in patients with T2DM improves metabolic and cardiovascular health, reduces blood pressure and blood sugar, and decreases HI, IR, and T2DM. Conclusions: IR is a protective response of cells that prevents oversaturation and overflow. Overweight is an independent risk factor for the development of HI, IR, and T2DM. Targeted weight loss leads to the cure of HI, IR and T2DM. Full article