Search Results (2,258)

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Conventional needle-based vaccination may cause tissue injury and increase the risk of cross-contamination between animals. This study evaluated the immunological effects of delivering an inactivated porcine circovirus type 2 (PCV2) vaccine using a needle-free jet injection system compared with needle injection in pigs. Immune responses were assessed using enzyme-linked immunosorbent assay (ELISA) for PCV2-specific antibody levels on days 7, 14, and 28 post-vaccination. Cellular architecture at injection sites and differential gene expression were analyzed using immunohistochemistry and transcriptome sequencing. Results showed that pigs receiving needle-free vaccination at 0.50 mL and 0.75 mL injection volumes exhibited higher PCV2-specific antibody responses than pigs receiving 1.0 mL needle injection. Needle-free vaccination also preserved dermal collagen fiber architecture, altered antigen-presenting cell distribution, and was associated with distinct activation of immune-related pathways, particularly those involved in leukocyte migration and cytokine-cytokine receptor interactions. These findings indicate that needle-free vaccination was associated with distinct PCV2-specific antibody responses and local immune microenvironment changes, supporting its potential as an alternative vaccine delivery strategy for swine PCV2 vaccination. Full article

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions. Full article

Background: Fragility fractures of the pelvis (FFP) are increasingly encountered in older adults, yet early deterioration is difficult to anticipate because fracture instability interacts with frailty and systemic vulnerability. We developed and validated an admission-based multimodal framework to predict 90-day treatment failure (TF90) before definitive management. Methods: This multicentre retrospective prediction study included 1684 consecutive patients aged ≥65 years with FFP treated at five tertiary hospitals. TF90 was defined as persistent fracture-related pain or immobility, delayed conversion to operative stabilisation, secondary displacement, FFP-related unplanned readmission, revision or unplanned reoperation, or all-cause mortality within 90 days. Only predictors available within 24 h of admission and before the definitive treatment decision were eligible, including CT-defined fracture morphology, frailty, clinical characteristics and routine laboratory biomarkers; DXA and specialised bone metabolism measurements were evaluated separately in an extended model. Four prespecified models were developed in 985 patients, temporally validated in 520 patients and evaluated in a completely held-out Centre E internal–external validation cohort of 179 patients, with additional leave-one-centre-out internal–external cross-validation. Results: TF90 occurred in 307 patients (18.2%) and increased from 8.1% in FFP I to 37.1% in FFP IV. Higher risk was associated with advanced age, greater frailty, impaired prefracture mobility, bilateral posterior ring injury, greater displacement, systemic inflammation, hypoalbuminaemia and renal dysfunction. In temporal validation, AUROCs were 0.732 for the simple logistic model, 0.763 for the core logistic model, 0.759 for the core random forest and 0.755 for the extended random forest. Neither greater algorithmic complexity nor specialised skeletal measurements provided reproducible incremental value. A development-derived high-risk stratum had a TF90 incidence of 32.2% and contained 70.0% of all events. At the fixed threshold of 0.209, sensitivity was 71.3%, specificity 70.0% and negative predictive value 93.1%. Conclusions: Pretreatment integration of pelvic ring mechanics, frailty and routinely available systemic biomarkers enables clinically relevant enrichment of older patients at risk of TF90. The model is best positioned to support intensified surveillance and structured reassessment rather than determine operative treatment. Independent prospective external validation, recalibration and clinical impact evaluation are required before routine implementation. Full article

Background and Objectives: Topical diclofenac is recommended over oral non-steroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis, particularly in older adults and those with comorbidities, on the assumption that low systemic absorption limits renal effects. Whether this presumed safety extends to patients already at increased risk of kidney injury has not been systematically evaluated. This review assessed the evidence on renal outcomes of topical diclofenac in adults. Materials and Methods: We conducted a systematic review (PROSPERO CRD420261393454) of studies reporting renal outcomes after topical diclofenac exposure. PubMed, Embase, Web of Science, and Scopus were searched from inception to 19 April 2026. Studies were stratified a priori into increased-renal-risk and general populations and synthesised separately, without pooling. Risk of bias was assessed with RoB 2, ROBINS-I, and JBI tools, certainty with GRADE, and synthesis followed the SWiM framework. Results: Eighteen studies, contributing data from more than 500,000 participants, were included; 14 underwent primary risk-of-bias appraisal (three at low, three at serious or high risk). In general populations, topical diclofenac produced little to no change in serum creatinine or creatinine clearance and smaller renal effects than oral diclofenac, providing high-certainty evidence of a favourable profile. In increased-renal-risk populations, one adjusted cohort reported higher acute kidney injury (AKI) risk among topical NSAID users, although exposure was predominantly to non-diclofenac agents; within the same cohort, topical NSAIDs carried lower risk than systemic NSAIDs. No study evaluated early renal injury biomarkers; certainty was moderate owing to indirectness. Conclusions: Relative to oral diclofenac, topical diclofenac shows a favourable renal safety profile, with high-certainty evidence in general populations. In adults at increased renal risk, moderate-certainty evidence derived from predominantly non-diclofenac exposure over short observation windows cannot exclude a modest excess of any-stage AKI; renal risk therefore appears reduced rather than absent. Diclofenac-specific studies in chronic kidney disease using sensitive biomarkers and longer follow-up are needed. Full article

Glioblastoma (GBM) recurs predominantly from infiltrative disease that persists beyond the contrast-enhancing tumor (CET). This structured narrative review aims to define the invasive margin and peritumoral brain zone (PBZ) as a spatially organized molecular ecosystem, summarize the approaches used to interrogate this compartment, and evaluate how malignant-cell plasticity, host niches, and treatment-induced remodeling contribute to minimal residual disease and recurrence. A structured literature search of PubMed/MEDLINE, Scopus, and Web of Science identified the clinical, translational, preclinical, and review literature available through July 2026; evidence was synthesized qualitatively, with priority given to human tissue studies and single-cell or spatially resolved analyses. Across studies, the margin differs from both tumor core and normal brain and contains heterogeneous malignant states interacting with neural, vascular, immune, hypoxic, and extracellular-matrix-supported niches. Surgery, radiotherapy, and systemic treatment further reshape these interactions through inflammation, vascular injury, senescence, hypoxia, and fibrosis. The main translational challenge is therefore not simply to control the CET, but to identify biologically high-risk non-enhancing tissue and demonstrate that therapy reaches and modifies it. We propose three priorities: image-registered characterization of residual compartments, regional measurement of drug exposure and target engagement, and integration of local margin control with distributed and niche-directed treatment. Prospective validation is required before spatial PBZ biomarkers can guide routine care. Full article

Objective: This multicenter, prospective, single-arm study evaluated the safety and preliminary clinical performance of a flowable porcine urinary bladder matrix (UBM) particulate for managing tunneling and undermining features in complex wounds. These features are associated with delayed healing, chronic inflammation, and infection risk. Flowable UBM enables targeted delivery into wound tunnels and cavities. Method: Twenty-five subjects from 3 United States (U.S.) sites were enrolled, with 21 meeting protocol criteria for analysis (15 with undermining and 6 with tunneling wounds). Participants received flowable UBM applied directly to tunneling or undermining areas, along with additional UBM particulate or sheet forms applied to the wound surface. The primary endpoint was the percentage reduction in tunneling volume or undermining depth at 12 weeks, with secondary assessment of reduction in overall wound volume. Safety was evaluated through evaluation of device-related adverse events. Results: At 12 weeks, 90.5% of wounds demonstrated positive response, with mean ± standard deviation and median reduction in tunneling or undermining dimensions of 84.6 ± 29.3% and 100.0%, respectively. Complete resolution of these features occurred in 52.4% of wounds (53.3% in undermining and 50.0% in tunneling wounds) with higher closure rates in non-pressure wounds compared to pressure injuries. No device-related adverse events were reported. Conclusions: Overall, flowable UBM was well tolerated and associated with favorable clinical trajectories demonstrated by reduction in tunneling and undermining dimensions; however, comparative effectiveness cannot be inferred from this limited single-arm pilot study. Further controlled studies are needed to confirm comparative effectiveness and optimize clinical use. Full article

Stroke remains one of the leading causes of death and long-term neurological disability worldwide, while currently available therapeutic strategies are limited by narrow treatment windows and incomplete neuroprotection. In this context, plant-derived polyphenols have attracted increasing attention as potential adjunctive agents because of their multimodal biological activity. This review focuses on resveratrol and curcumin, two of the most extensively investigated polyphenols, and evaluates their potential role in the prevention and treatment of ischaemic and haemorrhagic stroke. Evidence from in vitro studies, animal models, and early clinical trials indicates that both compounds may attenuate key mechanisms involved in stroke-related brain injury, including oxidative stress, neuroinflammation, mitochondrial dysfunction, apoptosis, autophagy dysregulation, blood–brain barrier disruption, and microglial activation. Emerging evidence further suggests that interactions with the gut microbiota and modulation of the gut–brain axis may contribute to their biological effects by influencing intestinal barrier integrity, microbial metabolite production, systemic inflammation, and vascular risk. Preclinical studies show that resveratrol and curcumin can reduce infarct volume, limit cerebral oedema, preserve neuronal viability, promote angiogenesis and neurogenesis, and improve neurological and cognitive outcomes. Their beneficial effects have been reported both when administered before stroke onset and after cerebral injury, suggesting potential relevance for both prevention and post-stroke therapy. However, interpretation of these findings requires consideration of the translational limitations of experimental stroke models, which do not fully reproduce the heterogeneity, comorbidities, age profile, and variable reperfusion patterns characteristic of human stroke. Although commonly used models such as middle cerebral artery occlusion provide important mechanistic and therapeutic insights, preclinical efficacy should therefore not be regarded as a direct predictor of clinical benefit. Resveratrol and curcumin may also complement established and emerging treatment strategies, including thrombolysis, endovascular interventions, antihypertensive therapy, and stem cell-based approaches. Nevertheless, their clinical translation remains limited by poor solubility, low bioavailability, rapid metabolism, and insufficient clinical evidence. Novel formulations, including nanoparticles, exosome-based delivery systems, and structurally modified analogues, may help overcome these barriers by improving brain targeting and therapeutic efficacy. Overall, resveratrol and curcumin represent promising but still investigational candidates for adjunctive stroke therapy, requiring further well-designed clinical trials to define their optimal dosing, timing, safety, and clinical value. Full article

Background: Acute kidney injury (AKI) is a common complication following cardiac surgery and is associated with increased morbidity and mortality. Contemporary national estimates of its clinical and economic burden in the United States remain limited. Methods: We conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS) for 2022–2023. Adult hospitalizations undergoing coronary artery bypass grafting (CABG), valve surgery, or combined CABG and valve surgery were identified using ICD-10-PCS codes. Hospitalizations with end-stage kidney disease were excluded. The primary exposure was AKI. Outcomes included in-hospital mortality, length of stay (LOS), non-home discharge, and hospitalization cost. Survey-weighted multivariable regression models were used to evaluate the independent association between AKI and study outcomes. Results: The final cohort included 133,801 hospitalizations, representing an estimated 669,005 cardiac surgery hospitalizations nationally. AKI occurred in 123,240 weighted hospitalizations (18.4%). Compared with hospitalizations without AKI, those with AKI had higher unadjusted mortality (7.21% vs. 0.71%), longer LOS (14.4 vs. 6.3 days), greater rates of non-home discharge (68.1% vs. 41.2%), and higher hospitalization costs ($97,452 vs. $56,253). After adjustment for demographic, socioeconomic, clinical, and procedural characteristics, AKI remained independently associated with in-hospital mortality (adjusted odds ratio [aOR] 9.91, 95% confidence interval [CI] 8.95–11.00), non-home discharge (aOR 2.52, 95% CI 2.42–2.63), prolonged LOS (adjusted rate ratio [aRR] 1.88, 95% CI 1.85–1.91), and increased hospitalization costs (cost ratio 1.59, 95% CI 1.56–1.61). AKI was associated with an adjusted incremental cost of $33,497 per hospitalization, corresponding to an estimated national attributable cost burden of $4.13 billion during the study period. Conclusions: AKI complicates nearly one in five cardiac surgery hospitalizations in the United States and is associated with substantially increased mortality, healthcare utilization, and hospitalization costs. These findings highlight the significant clinical and economic burden of cardiac surgery–associated AKI and support continued efforts to improve prevention, risk stratification, and perioperative management. Full article

Background and Objectives: Severe traumatic limb injuries, particularly those involving extensive soft tissue damage, present significant challenges in clinical management. Thus, we aimed to critically assess the effectiveness of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for severe traumatic limb injuries. Materials and Methods: For this systematic review and meta-analysis, we conducted a systematic search of MEDLINE/PubMed, Embase, and the Cochrane Library for studies published up to 7 March 2026. We included studies evaluating the effectiveness of adjunctive HBOT in patients with severe limb injuries. The prespecified primary outcome was complete wound healing, while secondary outcomes included time to wound healing, wound necrosis, length of hospital stay (LOS), and wound infection. Risk of bias was assessed using the ROBINS-I tool for observational studies and the Cochrane RoB 2.0 for randomized controlled trials (RCTs). Results: Seven studies (three RCTs and four observational) were included. A high risk of bias was identified in two RCTs, and a serious risk of bias was noted across all four observational studies. Complete wound healing was reported in one randomized trial and favored HBOT, but the certainty of evidence was very low. The time to wound healing did not differ between the HBOT and control groups (MD, −1.44; 95% CI, −6.70 to 3.82, I² = 0%). The LOS did not differ between the HBOT and control groups (MD, −3.39; 95% CI, −14.74 to 7.79, I² = 94%). However, wound infection rates were lower in the HBOT group compared to the control group (OR, 0.31; 95% CI, 0.22–0.45, I² = 20%). Similarly, wound necrosis rates were reduced in the HBOT group (OR, 0.23; 95% CI, 0.12–0.45, I² = 41%). Conclusions: Evidence is insufficient to determine whether HBOT improves complete wound healing. Although HBOT may reduce wound infection and necrosis, the certainty of evidence was low to very low. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Tendinopathies represent a major clinical challenge. Vasculature, neuromuscular junctions, low cellularity, and slow extracellular matrix (ECM) turnover restrict endogenous repair and predispose injured tendons to fibrosis, mechanical weakness, and reinjury. Current therapeutic strategies including rehabilitation protocols, anti-inflammatory medications, platelet-rich plasma (PRP) injections, and surgical repair primarily address symptoms or structural deficits without correcting the underlying biological limitations of tendon healing. Cell-based therapies have emerged as a promising regenerative approach aimed at restoring tissue homeostasis through modulation of angiogenesis, collagen synthesis, immune responses, and tenogenic differentiation. Mesenchymal stem cells (MSCs), adipose-derived stem cells (ADSCs), tendon-derived stem cells (TDSCs), induced pluripotent stem cells (iPSCs), differentiated tenocytes, and extracellular vesicle (EV)-based products have demonstrated the ability to enhance vascularization, promote type I collagen remodeling, suppress excessive inflammation, and stimulate tenocyte lineage commitment. These effects are mediated through paracrine signaling, growth factor secretion, and activation of key pathways, including HIF-1α, TGF-β/SMAD, NF-κB, and PI3K/Akt signaling. Despite promising preclinical data, significant translational challenges remain, including limited cell survival at the injury site, variability in cell sources and dosing, immunogenicity, risk of misdifferentiation, and lack of standardization across clinical protocols. Emerging strategies such as genetic modification, hypoxic preconditioning, scaffold-based delivery systems, and extracellular vesicle engineering aim to enhance therapeutic efficacy and reproducibility. This review synthesizes current evidence on cell-based tendon repair, critically evaluates mechanistic insights, clinical trials, and translational barriers, and outlines future directions toward biologically informed regenerative therapies. Full article

Repeated sit-to-stand practice is an important rehabilitation strategy for individuals with trunk and lower limb impairments; however, its implementation is often limited by fall risk, patient fatigue, and the physical burden on assisting staff. This prospective single-center feasibility study evaluated the safety and feasibility of sit-to-stand training using Qolo, a motor-free, gas-spring-assisted sit-to-stand training device, in 40 clinically selected individuals with trunk and lower limb impairments. All sessions were performed under physiatrist supervision. The primary feasibility endpoint was completion of at least three intervention sessions using Qolo. A total of 181 sessions were conducted, and in this clinically selected, supervised cohort, 36 participants achieved the primary endpoint, yielding a feasibility rate of 90.0% (95% confidence interval, 76.9–96.0%). The median number of sessions was 4 per participant, with 48 sit-to-stand repetitions per session and 134 repetitions per participant. Participant-reported fatigue was descriptively higher after training, whereas perceived fatigue among primary assisting staff remained low. No intervention-related adverse events, falls, or skin injuries were observed in this supervised feasibility study. Thirteen device-related problems were recorded, most of which involved the Qolo–tablet connection rather than the assistive mechanism, indicating important usability and reliability issues for further refinement. These findings support the early feasibility of Qolo-assisted sit-to-stand training in this small, clinically selected, supervised, heterogeneous cohort. Further controlled studies are warranted to evaluate clinical effectiveness, sustained adherence, staff workload, device reliability, and safety under routine clinical use. Full article

Background/Objectives: Cytomegalovirus (CMV) reactivation is a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Letermovir is used to prevent infections, but it is not available in many countries. Ganciclovir and valganciclovir carry a risk of bone marrow suppression. Foscarnet is frequently used as a bone marrow-sparing alternative; however, its clinical utility is constrained by nephrotoxicity. In this study, we aimed to evaluate the efficacy and renal safety of foscarnet and to identify factors associated with acute kidney injury (AKI) occurring during foscarnet treatment. Methods: This real-world, retrospective, single-center cohort study included 40 adult allo-HCT recipients treated with foscarnet for CMV reactivation between May 2022 and February 2025. Results: CMV polymerase chain reaction (PCR) negativity was achieved in 90% of patients, with a median time to PCR negativity of 10 (4–28) days. AKI occurred in 42.5% of patients, and 12.5% required hemodialysis. Foscarnet treatment was associated with a significant increase in serum creatinine levels and significant reductions in potassium, calcium, and magnesium concentrations (p < 0.05 for all). In univariable logistic regression analysis, myeloablative conditioning was associated with higher odds of AKI (OR 10.29, 95% CI 1.15–91.63; p = 0.037), while male sex showed numerically higher odds that did not reach conventional statistical significance (OR 4.28, 95% CI 0.96–19.01; p = 0.056). Conclusions: Among allo-HCT recipients treated with foscarnet, virological clearance was frequently observed, while AKI and electrolyte disturbances were common. These findings suggest that close renal and electrolyte monitoring may be warranted. However, given the retrospective, single-center design, small sample size, and absence of a comparator group, the findings should be interpreted cautiously and confirmed in larger prospective comparative studies. Full article

Introduction: Exercise programmes effectively prevent sports injuries and enhance neuromuscular parameters, but their impact on futsal performance remains understudied. Objective: The primary objective was to evaluate the effects of exercise-based programmes on injury outcomes in futsal players. The secondary objective was to assess their effects on physical and neuromuscular outcomes potentially associated with injury risk. Material and Methods: A search was carried out in PubMed, Scopus, SPORTDiscus, Web of Science, and PEDro databases. The methodological quality of the included studies was assessed using the PEDro scale, risk of bias using the RoB 2 tool, and certainty of evidence using the GRADE approach. A meta-analysis was performed using the Hedges’ g adjustment. Results: Fifteen reports corresponding to 12 unique studies and 405 randomized participants met the eligibility criteria. Two studies assessed direct injury outcomes. One reported significantly lower exposure-adjusted injury rates following the FIFA 11+ programme, whereas the other reported fewer injury events without a statistically significant between-group difference. Owing to differences in injury definitions and denominators, these findings were synthesized narratively. Random-effects meta-analyses showed significant effects favouring exercise-based programmes for muscle power (Hedges’ g = 0.616; 95% CI, 0.131 to 1.101; p = 0.013), muscle strength (g = 1.972; 95% CI, 0.214 to 3.731; p = 0.028), and flexibility (g = 0.569; 95% CI, 0.029 to 1.108; p = 0.039). The certainty of evidence was very low for injury outcomes and muscle strength and low for muscle power and flexibility. Conclusions: Exercise-based programmes may improve several physical and neuromuscular outcomes in futsal players. However, direct evidence regarding injury prevention is limited to two studies, and improvements in performance-related or biomechanical outcomes should not be interpreted as confirmation of a reduction in injury incidence. Full article