Search Results (1,967)

Background: The anterior cerebral artery (ACA), a critical component of the cerebral arterial circle, exhibits substantial morphological variability. While previous studies have explored ACA morphology using cadaveric and imaging methods, a comprehensive meta-analysis incorporating the latest evidence is lacking. Methods: Following current guidelines, a systematic review and meta-analysis were performed across four major databases, supplemented by the gray literature and targeted journal searches. Ninety-nine studies, encompassing 85,316 patients, met the inclusion criteria. Statistical analyses were conducted using R, applying random effects models to estimate pooled prevalence and morphometric parameters. Results: The pooled prevalence of typical ACA morphology was 93.75%, whereas variants were noted in 6.25% of cases. The predominant variation identified was the accessory ACA (aACA) (1.99%), followed by unilateral absence of the A1 segment (1.78%), with the latter being more frequently recognized in imaging studies (p < 0.0001). Rare variants encompassed azygos ACA (azACA) (0.22%), fenestrated ACA (fACA) (0.02%), and bihemispheric ACA (bACA) (0.02%). The mean diameter and length of the A1 segment were measured at 2.10 mm and 14.24 mm, respectively. Hypoplasia of the A1 segment (<1 mm diameter) was recorded in 3.15% of cases. The influences of imaging modality, laterality, and population distribution on prevalence estimates were minimal. No significant publication bias was detected. Conclusions: Although infrequent, variants of the ACA possess significant clinical importance attributable to their correlation with aneurysm formation and the impairment of collateral circulation. The aACA and the absence of the A1 segment emerged as the most common variations. This meta-analysis presents an updated and high-quality synthesis of ACA morphology, serving as a valuable reference for clinicians and anatomists. Full article

Background: This meta-analysis aimed to evaluate the dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) compared with conventional rapid palatal expansion (CRPE) in growing patients (≤16 years). Methods: A systematic and comprehensive literature search was carried out independently by two reviewers using both MeSH terms and free-text keywords across PubMed, the Cochrane Library, and Embase, with studies published through February 2025 included. The risk of bias was assessed using the Cochrane ROB 2.0 tool. The GRADE system was employed to determine evidence quality. Results: Of the 462 initially screened articles, 6 met the inclusion criteria and were selected for quantitative synthesis. Most studies had a low risk of bias with some concerns in reporting. The pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% confidence interval (CI), 0.54 to 1.42; p < 0.01). The test for overall effect was significant (p < 0.01), but no significant differences were found between the subgroups. The pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p < 0.01). The test for overall effect was significant (p < 0.01), and there were substantial differences between the subgroups. The supporting evidence ranged in certainty from moderate to low. Conclusions: MARPE was more effective than CRPE in minimizing the buccal tipping and buccal bone loss of the maxillary first premolars and first molars. However, to further confirm these outcomes and guide evidence-based clinical practice, well-designed randomized controlled trials with long-term follow-up are necessary. Full article

Background: Anastomotic leak (AL) is a serious complication after gastrectomy. It is associated with prolonged hospital stay, greater expenses, and increased risk for 90-day mortality. Currently, there is no consensus regarding the effect of AL on OS in patients with GC undergoing gastrectomy. This study was designed to investigate the effect of AL on long-term survival after gastrectomy for gastric cancer. Methods: PubMed, Embase, Scopus, Google Scholar, and Cochrane Library were queried during the search process. The literature search started in January 2025 and was updated in May 2025. The studies analyzed the impact of AL on long-term survival, with the primary outcome being long-term overall survival. Pooled effect size measures included restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CIs). Results: Ten studies (11,862 patients) were included. Overall, 338 (2.9%) patients experienced AL. The RMSTD analysis indicates that at 12, 24, 36, 48, and 60 months, patients with AL tend to live 1.1, 3.1, 5.2, 8.1, and 10.6 months shorter, respectively, compared to those who did not develop AL. All results were statistically significant with p < 0.0001. The time-dependent HRs analysis for AL versus no AL shows a higher mortality hazard in patients with AL at 12 (HR 1.32, 95% CI 1.11–1.58), 24 (HR 1.61, 95% CI 1.34–1.92), 36 (HR 1.55, 95% CI 1.27–1.91), 48 months (HR 1.22, 95% CI 0.98–1.53), and 60 months (HR 0.79, 95% CI 0.59–1.10). Conclusions: This research appears to indicate a clinical impact of AL on long-term OS after gastrectomy. Patients experiencing AL appear to have an increased risk of mortality within the initial four years of follow-up. Full article

Accurate rainfall quantile estimation is critical for urban flood management, particularly given the escalating climate change impacts. This study comprehensively compared at-site frequency analysis and regional frequency analysis for sub-hourly rainfall quantile estimation, using data from 27 sites across Seoul. The analysis focused on Seoul’s disaster prevention framework (30-year and 100-year return periods). Employing L-moment statistics and Monte Carlo simulations, the rainfall quantiles were estimated, the methodological performance was evaluated, and Seoul’s current disaster prevention standards were assessed. The analysis revealed significant spatio-temporal variability in Seoul’s precipitation, causing considerable uncertainty in individual site estimates. A performance evaluation, including the relative root mean square error and confidence interval, consistently showed regional frequency analysis superiority over at-site frequency analysis. While at-site frequency analysis demonstrated better performance only for short return periods (e.g., 2 years), regional frequency analysis exhibited a substantially lower relative root mean square error and significantly narrower confidence intervals for larger return periods (e.g., 10, 30, 100 years). This methodology reduced the average 95% confidence interval width by a factor of approximately 2.7 (26.98 mm versus 73.99 mm). This enhanced reliability stems from the information-pooling capabilities of regional frequency analysis, mitigating uncertainties due to limited record lengths and localized variabilities. Critically, regionally derived 100-year rainfall estimates consistently exceeded Seoul’s 100 mm disaster prevention threshold across most areas, suggesting that the current infrastructure may be substantially under-designed. The use of minute-scale data underscored its necessity for urban hydrological modeling, highlighting the inadequacy of conventional daily rainfall analyses. Full article

Background: Epidemiological studies have reported an inverse association between smoking and Parkinson’s disease (PD) risk, prompting interest in nicotine as a potential therapeutic agent. The present meta-analysis evaluated the efficacy of nicotine therapy in improving motor symptoms and activities of daily living in patients with PD. Methods: PubMed, Embase, and Cochrane Library were systematically searched to identify randomized controlled trials (RCTs) assessing nicotine therapy in PD. Clinical RCTs administering interventions extending beyond 1 week and reporting motor or nonmotor outcomes were included. Random-effects models were used to analyze short-term (<6 months) and long-term (≥6 months) outcomes by using standardized mean differences (SMDs). Results: This meta-analysis included five RCTs (346 participants). Nicotine therapy led to no significant improvement in motor outcomes in the short term (pooled SMD: −0.452, 95% confidence interval: −1.612 to 0.708) or long term (pooled SMD: 0.174, 95% confidence interval: −0.438 to 0.787). Considerable interstudy heterogeneity was noted. Furthermore, short-term nicotine therapy resulted in no significant improvement in daily functioning, cognition, or quality of life. Conclusions: This meta-analysis revealed a lack of compelling evidence suggesting that nicotine-based therapies improve motor or nonmotor outcomes in PD. The findings highlight a disconnect between epidemiological associations and clinical efficacy. Given the prodromal nature of PD pathology and the challenges of early diagnosis, future preventive strategies should be implemented before symptom onset in high-risk individuals identified using advanced biomarker panels. Full article

Low-altitude drones, which are unimpeded by traffic congestion or urban terrain, have become a critical asset in emergency rescue missions. To address the current lack of emergency rescue data, UAV aerial videos were collected to create an experimental dataset for action classification and localization annotation. A total of 5082 keyframes were labeled with 1–5 targets each, and 14,412 instances of data were prepared (including flight altitude and camera angles) for action classification and position annotation. To mitigate the challenges posed by high-resolution drone footage with excessive redundant information, we propose the SlowFast-Traffic (SF-T) framework, a spatio-temporal sequence-based algorithm for recognizing traffic accident rescue actions. For more efficient extraction of target–background correlation features, we introduce the Actor-Centric Relation Network (ACRN) module, which employs temporal max pooling to enhance the time-dimensional features of static backgrounds, significantly reducing redundancy-induced interference. Additionally, smaller ROI feature map outputs are adopted to boost computational speed. To tackle class imbalance in incident samples, we integrate a Class-Balanced Focal Loss (CB-Focal Loss) function, effectively resolving rare-action recognition in specific rescue scenarios. We replace the original Faster R-CNN with YOLOX-s to improve the target detection rate. On our proposed dataset, the SF-T model achieves a mean average precision (mAP) of 83.9%, which is 8.5% higher than that of the standard SlowFast architecture while maintaining a processing speed of 34.9 tasks/s. Both accuracy-related metrics and computational efficiency are substantially improved. The proposed method demonstrates strong robustness and real-time analysis capabilities for modern traffic rescue action recognition. Full article

Background: MRI-based radiomics has emerged as a promising approach to enhance the non-invasive, presurgical assessment of lymph node staging in rectal cancer (RC). However, its clinical implementation remains limited due to methodological variability in published studies. We conducted a systematic review and meta-analysis to synthesize the diagnostic performance of MRI-based radiomics models for predicting pathological nodal status (pN) in RC. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published until 31 December 2024. Eligible studies applied MRI-based radiomics for pN prediction in RC patients. We excluded other imaging sources and models combining radiomics and other data (e.g., clinical). All models with available outcome metrics were included in data analysis. Data extraction and quality assessment (QUADAS-2) were performed independently by two reviewers. Random-effects meta-analyses including hierarchical summary receiver operating characteristic (HSROC) and restricted maximum likelihood estimator (REML) analyses were conducted to pool sensitivity, specificity, area under the curve (AUC), and diagnostic odds ratios (DORs). Sensitivity analyses and publication bias evaluation were also performed. Results: Sixteen studies (n = 3157 patients) were included. The HSROC showed pooled sensitivity, specificity, and AUC values of 0.68 (95% CI, 0.63–0.72), 0.73 (95% CI, 0.68–0.78), and 0.70 (95% CI, 0.65–0.75), respectively. The mean pooled AUC and DOR obtained by REML were 0.78 (95% CI, 0.75–0.80) and 6.03 (95% CI, 4.65–7.82). Funnel plot asymmetry and Egger’s test (p = 0.025) indicated potential publication bias. Conclusions: Overall, MRI-based radiomics models demonstrated moderate accuracy in predicting pN status in RC, with some studies reporting outstanding results. However, heterogeneity in relevant methodological approaches such as the source of MRI sequences or machine learning methods applied along with possible publication bias call for further standardization and preclude their translation to clinical practice. Full article

Background: The central variant of posterior reversible encephalopathy syndrome (cvPRES) is an atypical subtype of PRES. Although no unifying definitions exists, it is most often characterized by vasogenic edema involving “central” structures, such as the brainstem, subcortical nuclei, and spinal cord, with relative sparing of the parieto-occipital lobes. Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was pre-registered on PROSPERO [CRD42023483806]. Both the Joanna Briggs Institute and New-Castle Ottawa scale were used for case reports and cohort studies, respectively. The meta-analysis was completed using R-Studio and its associated “metafor” package. Results: A comprehensive search in four databases yielded 70 case reports/series (n = 100) and 12 cohort studies. The meta-analysis revealed a pooled incidence rate of 13% (95% CI: 9–18%) for cvPRES amongst included cohort studies on PRES. Significant heterogeneity was observed (I² = 71% and a τ² = 0.2046). The average age of affected individuals was 40.9 years, with a slightly higher prevalence in males (54%). The most common etiological factor was hypertension (72%). Fifty percent had an SBP >200 mmHg at presentation and a mean arterial pressure (MAP) of 217.6 ± 40.82. Imaging revealed an increased T₂ signal involving the brain stem (88%), most often in the pons (62/88; 70.45%), and 18/100 (18%) cases of PRES with spinal cord involvement (PRES-SCI). Management primarily involved blood pressure reduction, with adjunctive therapies for underlying causes such as anti-seizure medications or hemodialysis. The MAP between isolated PRES-SCI and cvPRES without spinal cord involvement did not show significant differences (p = 0.5205). Favorable outcomes were observed in most cases, with a mortality rate of only 2%. Conclusions: cvPRES is most often associated with higher blood pressure compared to prior studies with typical PRES. The pons is most often involved. Despite the severity of blood pressure and critical brain stem involvement, those with cvPRES have favorable functional outcomes and a lower mortality rate than typical PRES, likely attributable to reversible vasogenic edema without significant neuronal dysfunction. Full article

Poor sleep quality and insomnia are increasingly linked to chronic inflammation and obesity-related metabolic dysfunction. Aerobic exercise is a promising non-pharmacological approach for enhancing sleep quality and reducing systemic inflammation; Therefore, we aim to systematically evaluate and quantify the effects of aerobic exercise interventions on subjective sleep quality, insomnia severity, and circulating markers (IL-6 and TNF-α) in adults. A systematic search was conducted in institutional databases (UNAM, UACJ) and PubMed to identify randomized controlled trials (RCTs) examining the effects of exercise on sleep and inflammation. Risk of bias was assessed using the Cochrane RoB2 tool. Meta-analyses were performed using RevMan 5.4 with random-effects models to estimate pooled mean differences (MD) and standardized mean differences (SMD), with 95% confidence intervals. Anaerobic protocols were excluded from the meta-analysis due to the insufficient availability of data. : Eleven RCTs met the inclusion criteria. Aerobic exercise showed a significant pooled effect on sleep outcomes (MD = −2.51; 95% CI: −4.80 to −0.23; p = 0.03). However, subgroup analyses for Pittsburgh Sleep Quality Index (PSQI) (MD = −2.27; p = 0.15) and Insomnia Severity Index (ISI) (MD = −2.98; p = 0.16) were not statistically significant. Two studies on IL-6 reported a non-significant reduction (SMD = −0.17; p = 0.66), with moderate heterogeneity. TNF-α results were also non-significant (SMD = 0.60; p = 0.29) with substantial variability. Our results showed that aerobic exercise may modestly improve sleep outcomes; however, current evidence does not support its effectiveness in reducing levels of IL-6 or TNF-α. Further well-controlled trials are needed to clarify its immunometabolic effects, particularly in populations with obesity or metabolic disorders. Full article

This study investigates the implementation and impact of the Guided Personalised Learning (GPL) model, a structured pedagogical framework designed to operationalise personalised and student-centred learning in STEM higher education. The GPL model integrates three interconnected components: a three-dimensional knowledge and skill grid, Interactive Learning Progress Assessments (ILPA), and an adaptive learning resource pool. These components were embedded into two undergraduate engineering modules, Network Engineering and Software Engineering, at a UK university. A mixed-method evaluation, centred on student attainment data across two academic years, revealed statistically significant improvements among students who engaged with GPL, particularly those who completed ILPA activities. Participation was associated with higher mean grades, increased proportions of high achievers, and reduced failure rates. These findings demonstrate the GPL model’s effectiveness in supporting learner autonomy, formative assessment, and targeted feedback, while offering a scalable strategy for integrating personalised learning into mainstream STEM curricula. Full article

Introduction: Unruptured intracranial aneurysms (UIAs) can induce psychological stress, leading to anxiety, depression, and impaired quality of life (QoL). Most studies on this topic are limited by small sample sizes, cross-sectional designs, and a focus on treated rather than untreated cases, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate mental health and QoL outcomes in patients with untreated UIAs. Methods: A systematic search was conducted up to 30 November 2024 using PubMed, Scopus, and Cochrane Central for studies comparing patients with untreated UIAs to a control group. The outcomes of interest included anxiety, depression, and QoL. Statistical analysis was performed using RevMan 5.1.7 and R 4.3.1. Heterogeneity was assessed using I² statistics and the Cochrane Q test. Risk ratios (RR) and standardized mean differences (SMD) were computed using a frequentist random-effects model. Results: We included five studies with 417,152 patients, of whom 85,668 (20.53%) had untreated UIAs. In the pooled analysis, patients with untreated UIAs had significantly higher anxiety levels (SMD 0.66; 95% CI [0.16; 1.17]; p = 0.01; I² = 76%) and lower QoL (SMD −0.82; 95% CI [−1.12; −0.53]; p = 0.01; I² = 56%) compared to the control group However, no statistically significant differences were found in depression (RR 0.94; 95% CI [0.52; 1.72]; p = 0.84; I² = 88%) between groups. Conclusions: This meta-analysis indicates a potential association between untreated UIAs and increased anxiety levels and reduced QoL. Regarding depression, no significant differences were observed between groups. Full article

Background/Objectives: Hospitalized peripartum patients who later decompensate and require an upgrade to the intensive care unit (ICU) may have an increased risk for poor outcomes. Most of the literature regarding the need for ICU involves Modified Early Warning Scores in already hospitalized patients or the evaluation of specific comorbid conditions or diagnoses. This systematic review and meta-analysis aimed to assess the differences in clinical scores at admission among adult peripartum patients to identify the later need for ICU. Methods: We systematically searched Ovid-Medline, PubMed, EMBASE, Web of Science and Google Scholar for randomized and observational studies of adult patients ≥18 years of age who were ≥20 weeks pregnant or up to 40 days post-partum, were admitted to the wards from the emergency department and later required critical care services. The primary outcome was the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included other clinical scores, the hospital length of stay (HLOS) and mortality. The Newcastle–Ottawa Scale was utilized to grade quality. Descriptive analyses were performed to report demographic data, with means (±standard deviation [SD]) for continuous data and percentages for categorical data. Random-effects meta-analyses were performed for all outcomes when at least two studies reported a common outcome. Results: Seven studies met the criteria, with a total of 1813 peripartum patients. The mean age was 27.2 (±2.36). Patients with ICU upgrades were associated with larger differences in mean SOFA scores. The pooled difference in means was 2.76 (95% CI 1.07–4.46, p < 0.001). There were statistically significant increases in Sepsis in Obstetrics Scores, APACHE II scores, and HLOS in ICU upgrade patients. There was a non-significantly increased risk of mortality in ICU upgrade patients. There was high overall heterogeneity between patient characteristics and management in our included studies. Conclusions: This systematic review and meta-analysis demonstrated higher SOFA or other physiologic scores in ICU upgrade patients compared to those who remained on the wards. ICU upgrade patients were also associated with a longer HLOS and higher mortality compared with control patients. Full article

Lane detection is a key technology in automatic driving environment perception, and its accuracy directly affects vehicle positioning, path planning, and driving safety. In this study, an enhanced real-time model for lane detection based on an improved DeepLabV3+ architecture is proposed to address the challenges posed by complex dynamic backgrounds and blurred road boundaries in suburban road scenarios. To address the lack of feature correlation in the traditional Atrous Spatial Pyramid Pooling (ASPP) module of the DeepLabV3+ model, we propose an improved LC-DenseASPP module. First, inspired by DenseASPP, the number of dilated convolution layers is reduced from six to three by adopting a dense connection to enhance feature reuse, significantly reducing computational complexity. Second, the convolutional block attention module (CBAM) attention mechanism is embedded after the LC-DenseASPP dilated convolution operation. This effectively improves the model’s ability to focus on key features through the adaptive refinement of channel and spatial attention features. Finally, an image-pooling operation is introduced in the last layer of the LC-DenseASPP to further enhance the ability to capture global context information. DySample is introduced to replace bilinear upsampling in the decoder, ensuring model performance while reducing computational resource consumption. The experimental results show that the model achieves a good balance between segmentation accuracy and computational efficiency, with a mean intersection over union (mIoU) of 95.48% and an inference speed of 128 frames per second (FPS). Additionally, a new lane-detection dataset, SubLane, is constructed to fill the gap in the research field of lane detection in suburban road scenarios. Full article

Background: Sarcopenia significantly affects the health and quality of life in older adults. Exercise combined with nutritional interventions is widely recognized as an effective strategy for improving sarcopenia outcomes. However, current studies rarely focus on differential effects across subpopulations with distinct demographic and health characteristics. This study aimed to explore the effects of combined exercise and nutrition interventions on sarcopenia-related outcomes, considering the variations in population characteristics. Methods: A systematic search was conducted across PubMed, Embase, the Web of Science, and Cochrane Library, covering the literature published between January 2010 and March 2025. Only randomized controlled trials (RCTs) evaluating combined exercise and nutritional interventions for sarcopenia were included. The primary outcomes were handgrip strength (HS), the skeletal muscle mass index (SMI), gait speed (GS), and the five-times sit-to-stand test (5STS). The mean differences (MD) with 95% confidence intervals (CIs) were calculated. Random-effects models were used for the meta-analysis and subgroup comparisons. Results: Fifteen RCTs involving 1258 participants in the intervention group and 1233 in the control group were included. Exercise combined with nutritional interventions significantly improved sarcopenia-related outcomes. HS improved with a pooled MD of 1.77 kg (95% CI: 0.51 to 3.03, p = 0.006); SMI increased by 0.22 kg/m² (95% CI: 0.09 to 0.35, p = 0.0007); GS improved by 0.09 m/s (95% CI: 0.04 to 0.14, p = 0.0002); and 5STS performance improved with a time reduction of −1.38 s (95% CI: −2.47 to −0.28, p = 0.01). Subgroup analyses indicated that the intervention effects varied according to age, BMI, and living environment. Conclusions: Exercise combined with nutrition is effective in improving key outcomes associated with sarcopenia in older adults. The magnitude of these effects differed across population subgroups, underscoring the importance of tailoring interventions to specific demographic and health profiles. Full article

Youth unemployment remains a pressing issue in many emerging economies, where educational disparities and demographic pressures interact in complex ways. This study investigates the links between higher-education enrolment, demographic structure and youth unemployment in eight developing countries from 2009 to 2023. Panel cointegration techniques—Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS)—are applied to estimate the long-run effects of gross tertiary-school enrolment on youth unemployment while controlling for GDP growth and youth-cohort size. Robustness is confirmed through complementary estimations with pooled-mean-group ARDL and system-GMM panels, which deliver consistent coefficient signs and significance levels. Results show a significant negative elasticity between enrolment and youth unemployment, indicating that wider access to higher education helps lower joblessness among young people. Youth-population growth exerts an opposite, positive effect, while GDP growth reduces unemployment but less uniformly across regions. The evidence points to an integrated policy mix—expanding tertiary (especially vocational and technical) education, managing demographic pressure and maintaining macro-economic stability—to improve youth-employment outcomes in emerging economies. Full article