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Search Results (2,155)

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Keywords = non-randomized controlled trial

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19 pages, 1659 KB  
Article
The Stapler Dilemma in VATS Wedge Resection: Are Sutures a Viable Alternative?
by Mithat Fazlioglu, Argun Kıs, Gokhan Ozturk and Nevin Fazlioglu
J. Clin. Med. 2025, 14(20), 7356; https://doi.org/10.3390/jcm14207356 - 17 Oct 2025
Abstract
Background: This single-center, retrospective, non-randomized observational study aims to explore the outcomes of video-assisted thoracoscopic surgery (VATS) wedge resection using the traditional clamp-and-suture technique versus staplers, with a focus on cost-effectiveness, operative time, and short-term postoperative outcomes. Methods: Data from 59 patients who [...] Read more.
Background: This single-center, retrospective, non-randomized observational study aims to explore the outcomes of video-assisted thoracoscopic surgery (VATS) wedge resection using the traditional clamp-and-suture technique versus staplers, with a focus on cost-effectiveness, operative time, and short-term postoperative outcomes. Methods: Data from 59 patients who underwent VATS wedge resection between 2018 and 2024 were retrospectively analyzed. Patients were divided into the stapler group (S-group, n = 27) and the clamp-and-suture group (C-group, n = 32). Technique selection was made intraoperatively by the surgeon based on lesion characteristics. Co-primary outcomes were total hospitalization cost and air leak duration > 2 days. Secondary outcomes included drainage time, complications, and hospital stay. The researchers conducted multivariable regression and sensitivity analyses to handle selection bias and confounding variables. Statistical analyses were performed with a significance level of p < 0.05. This study was approved by the Tekirdağ University Faculty of Medicine Ethics Committee (Approval No: 2024.22.02.06). Results: The C-group lesions showed proximity to the pleural surface at 5 mm compared to 8 mm (p = 0.048), indicating significant selection bias. Operation time was longer in the C-group (70 vs. 60 min, p = 0.115). Air leak duration and drainage time were similar between groups (p = 0.872, p = 0.176). Complication rates classified by Clavien–Dindo scale and hospital stay were comparable. The C-group showed reduced hospitalization expenses ($191.6 vs. $371.7) after adjusting for lesion characteristics and confounders while the clinical results between groups remained equivalent (adjusted OR for air leak: 0.68, 95% CI: 0.13–3.51, p = 0.645). The cost advantages persisted through sensitivity analysis which tested for selection bias effects. Conclusions: The clamp-and-suture method appears to offer a potentially cost-effective alternative to staplers for carefully selected peripheral lesions in VATS wedge resection, particularly in resource-limited settings. The preliminary results need to be treated as speculative because the study uses a non-randomized retrospective design with limited data from a small number of patients treated by one surgeon and shows evidence of selection bias. The obtained results do not qualify as practice-changing recommendations. The validation of these findings requires prospective randomized controlled trials with predetermined selection criteria and extended follow-up periods to establish clinical recommendations. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current Practice and Future Directions: 2nd Edition)
16 pages, 2015 KB  
Article
Flapless Immediate Implants: Soft Tissue Alterations Following a Trimodal Approach with or Without Modifying Osseous and Mucosal Compartments in the Esthetic Zone: A Non-Randomized Clinical Trial with Historical Control Group
by Gustavo Cabello, María Rioboo, Daniel Torres-Lagares and Javier Fábrega
Dent. J. 2025, 13(10), 478; https://doi.org/10.3390/dj13100478 - 17 Oct 2025
Abstract
Objective: This study aimed to compare two protocols for immediate implants with fixed provisional restoration, no grafting (trimodal approach = TA) versus grafting in both the osseous gap and peri-implant mucosa (a trimodal approach with modification of the bony and mucosal compartments = [...] Read more.
Objective: This study aimed to compare two protocols for immediate implants with fixed provisional restoration, no grafting (trimodal approach = TA) versus grafting in both the osseous gap and peri-implant mucosa (a trimodal approach with modification of the bony and mucosal compartments = TAOM), by measuring soft tissue changes over time. The periodontal phenotype was noted to investigate the relationship between its thickness and the clinical outcomes. Methods: Thirty-one patients met the inclusion criteria (15 in the TA group and 16 in the TAOM group). The TA group was a historical control group. Measurements were taken using a digital caliper at T0 and 3, 6, and 12 months following the procedure (T3), (T6), and (T12), respectively, from reference points marked in a dental-supported stent. The periodontal phenotype was determined using an analogical caliper. Results: T12: Vertical midfacial change was −0.17 ± 0.37 in the TAOM group and 0.54 ± 0.33 in the TA group, respectively. Statistical significance (p = 0.0001) was found. Papilla vertical change in the TAOM group was −0.16 ± 0.45 mesially and 0.00 ± 0.44 distally. In the TA group, it was 0.55 ± 0.82 mesially and 0.86 ± 0.95 distally. Statistical significance (p = 0.0001) was also found. Conclusions: There were differences in soft tissue change between the two groups, and changes were related to the periodontal phenotype. Studies with more extended follow-up periods are needed to assess the long-term evolution of both protocols. Full article
29 pages, 1001 KB  
Systematic Review
Safety of Roxadustat in Chronic Kidney Disease Patients: An Updated Systematic Review and Meta-Analysis
by Patricia Martínez-Miguel, Encarnación Fernández-Antón, Diego Rodríguez-Puyol, Francisco J. de Abajo and Susana López Ongil
Pharmaceuticals 2025, 18(10), 1566; https://doi.org/10.3390/ph18101566 - 17 Oct 2025
Abstract
Background/Objectives: Roxadustat is a new treatment for the anemia of chronic kidney disease (CKD) that has comparable efficacy to erythropoietic-stimulating agents (ESAs), with the advantage of oral administration and increased iron bioavailability. It appears to be a safe treatment in terms of the [...] Read more.
Background/Objectives: Roxadustat is a new treatment for the anemia of chronic kidney disease (CKD) that has comparable efficacy to erythropoietic-stimulating agents (ESAs), with the advantage of oral administration and increased iron bioavailability. It appears to be a safe treatment in terms of the development of major adverse cardiovascular events (MACEs); however, its long-term safety has not been fully evaluated. In this meta-analysis we evaluate its safety in dialysis-dependent (DD) and non-dialysis-dependent (NDD) CKD patients, considering the comparator used and treatment duration. Methods: The safety of Roxadustat was assessed based on the incidence of serious (SAEs) and non-serious adverse events (AEs). A random-effects method was used to estimate the odds ratios (ORs) and their 95% CIs. Results: Fifteen different randomized controlled clinical trials were included, with a total of 10,284 patients with CKD stages 3–5 treated with Roxadustat, 5604 on dialysis and 4680 not on dialysis. The overall incidence of AEs in the Roxadustat group did not change significantly (OR = 1.13; 1.00–1.27); however, the incidence of SAEs was significantly higher than in the control group (OR = 1.13; 1.04–1.23). Specifically, the incidence of hypertension (OR = 1.39; 1.13–1.73) and hyperkalemia (OR = 1.31; 1.02–1.69) was higher in the Roxadustat group than in the placebo group of NDD patients. All AEs except MACEs and hyperkalemia increased with treatment > 30 weeks. No differences were found in the incidence of any adverse effects studied compared with ESAs. Conclusions: Roxadustat is associated with an increased risk of SAEs, including hypertension and hyperkalemia in NDD patients. Therefore, monitoring potassium levels and blood pressure is recommended in these patients. Full article
(This article belongs to the Section Pharmacology)
14 pages, 719 KB  
Systematic Review
Daratumumab in Transplant-Ineligible Newly Diagnosed Multiple Myeloma: A Meta-Analysis of Randomized Controlled Trials
by Chi Wang, Zhengyang Xu, Meilin Jiang, Yuzhe Chen and Yu Lan
Cancers 2025, 17(20), 3349; https://doi.org/10.3390/cancers17203349 - 17 Oct 2025
Abstract
Background: Treatment for transplant-ineligible (TIE) newly diagnosed multiple myeloma (NDMM) has improved with anti-CD38 monoclonal antibodies. Among them, daratumumab, combined with standard therapies, has shown promising results in clinical trials. This meta-analysis consolidates evidence on the effectiveness and safety of daratumumab-based treatments for [...] Read more.
Background: Treatment for transplant-ineligible (TIE) newly diagnosed multiple myeloma (NDMM) has improved with anti-CD38 monoclonal antibodies. Among them, daratumumab, combined with standard therapies, has shown promising results in clinical trials. This meta-analysis consolidates evidence on the effectiveness and safety of daratumumab-based treatments for this patient group from all available randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and clinical trial registries from inception to September 2025 for phase II and III RCTs comparing daratumumab-containing regimens to non-daratumumab controls in TIE NDMM patients. Primary outcomes were progression-free survival (PFS) and overall survival (OS). Secondary outcomes included minimal residual disease (MRD) negativity rate and adverse events (AEs). Heterogeneity was assessed using I2 statistics, and subgroup analyses were performed to explore potential sources of heterogeneity. Results: Six RCTs involving 2478 patients were included. Daratumumab-based regimens significantly improved PFS (hazard ratio [HR] = 0.544, 95% confidence interval [CI]: 0.483–0.612, p < 0.001; I2 = 28.6%) and OS (HR = 0.693, 95% CI: 0.606–0.791, p < 0.001; I2 = 30.6%). The MRD negativity rate was significantly higher with daratumumab (risk ratio [RR] = 2.322, 95% CI: 1.486–3.627, p < 0.001). Furthermore, daratumumab-based regimens yielded a four-fold increase in the rate of sustained MRD negativity (≥12 months) (RR = 3.999, 95% CI: 1.094–8.403, p < 0.001). However, these regimens were associated with increased risks of serious adverse events (SAEs) (RR = 1.146, 95% CI: 1.064–1.233, p < 0.001), overall grade 3/4 AEs (RR = 1.075, 95% CI: 1.038–1.115, p < 0.001), neutropenia, lymphopenia, infections, pneumonia, and fatal AEs. No significant differences were observed in thrombocytopenia or anemia. Conclusions: Daratumumab-based regimens significantly improve survival outcomes and the depth/durability of treatment response in TIE NDMM patients, supporting their use as first-line therapy. However, the increased risk of specific AEs necessitates careful patient selection, proactive infection prevention, and vigilant monitoring. These findings provide robust evidence for clinical practice guidelines and underscore the need to balance efficacy with safety in this vulnerable population. Full article
(This article belongs to the Special Issue Myeloma: Pathogenesis and Targeted Therapies)
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30 pages, 5691 KB  
Systematic Review
Do SGLT2 Inhibitors Improve Cardiovascular Outcomes After Acute Coronary Syndrome Regardless of Diabetes? A Systematic Review and Meta-Analysis
by Ioana Maria Suciu, Silvia Ana Luca, Simina Crișan, Alina-Ramona Cozlac, Svetlana Stoica, Constantin Tudor Luca, Bogdan Timar and Dan Gaita
Medicina 2025, 61(10), 1866; https://doi.org/10.3390/medicina61101866 - 17 Oct 2025
Abstract
Background and Objectives: This systematic review and meta-analysis aims to evaluate whether the benefits of sodium–glucose co-transporter-2 (SGLT2) inhibitors on cardiovascular outcomes extend when initiated in patients with acute coronary syndrome (ACS), regardless of diabetic status. Materials and Methods: PubMed, Embase, [...] Read more.
Background and Objectives: This systematic review and meta-analysis aims to evaluate whether the benefits of sodium–glucose co-transporter-2 (SGLT2) inhibitors on cardiovascular outcomes extend when initiated in patients with acute coronary syndrome (ACS), regardless of diabetic status. Materials and Methods: PubMed, Embase, and the Cochrane Library were searched from 2015 up to July 2025, according to PRISMA 2020 guidelines. Eligible studies were randomized controlled trials (RCTs) and observational studies comparing SGLT2 inhibitors with controls in post-ACS patients. Articles without full-text data for extraction, with unavailable outcome data or evaluating patients with stable coronary artery disease (CAD) were excluded. Primary outcomes were all-cause and cardiovascular (CV) mortality. Secondary outcomes included recurrent myocardial infarction (MI), rehospitalization for ACS, revascularization and stroke. Meta-analysis was conducted using the R statistical software (Version 4.5.1). Subgroup analysis was performed by study design to evaluate outcomes in type 2 diabetes mellitus (T2DM) populations. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2.0 and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: A total of 16 studies were included in the meta-analysis, encompassing over 130,000 patients. Initiation of SGLT2 inhibitors after ACS was associated with a significant reduction in the primary outcome of all-cause mortality [hazard ratio (HR) = 0.77; (95% confidence interval (CI): 0.67–0.89)] and CV mortality [HR = 0.83; (95% CI: 0.70–0.99)]. In subgroup analyses, patients with T2DM experienced a significant reduction in all-cause mortality [HR = 0.73, (95% CI: 0.62–0.86)] and recurrent MI [HR = 0.83, (95% CI: 0.69–0.99)]. Conclusions: Initiation of SGLT2 inhibitors after ACS is associated with a significant reduction in all-cause and CV mortality. Subgroup analysis further demonstrated a reduction in all-cause mortality and recurrent myocardial infarction among patients with T2DM, while in patients without diabetes, no significant effects were observed. Although evidence certainty ranged from low to moderate and large RCTs are still ongoing, these findings support the early introduction of SGLT2 inhibitors in eligible patients with T2DM following ACS, pending confirmation by large, prospective clinical trials. Full article
(This article belongs to the Special Issue Advances in Acute Myocardial Infarction)
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16 pages, 663 KB  
Review
Evolving Role of Coronary Computed Tomography Angiography (CCTA) in Quantifying Atherosclerotic Coronary Artery Disease: A Narrative Review
by M. A. Manal Smail, Ram B. Singh, Jan Fedacko, Galal Elkilany, Krasimira Hristova, Sarthak Sharma, Ahmed Bathallah, Sherif A. Baathallah, Monika Jankajova and Fabiola Sozzi
Diseases 2025, 13(10), 343; https://doi.org/10.3390/diseases13100343 - 16 Oct 2025
Abstract
Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a [...] Read more.
Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a proper assessment of the burden of atherosclerotic plaque, as it is the direct cause of CAD. This review aims to emphasize the role of a staging system proposed by the Lancet Commission for the quantification of atherosclerotic coronary artery disease (ACAD) with an emphasis on preconception risk factors and protective factors, based on coronary computed tomography angiography (CCTA). Methods: It is suggested that the use of CCTA scanning makes it possible to quantify the atherosclerotic plaque burden into four stages. Results: CCTA enables us to see how much plaque has built up, as well as the type of plaque, but not the biochemistry of the plaque, to determine its vulnerability. However, if the plaque is a non-calcified fatty plaque, it is considered to be a strong predictor of the risk of myocardial infarction (MI), whereas a more stable calcified plaque is known to be protective against MI. There are several risk factors and protective factors which may influence the process of the rupture or vulnerability of the plaque. A randomized trial revealed that, after a median follow-up of 10·0 years, deaths due to CAD or non-fatal MI were less frequent in the CCTA group compared with a control group. Conclusions: Despite a few gaps in knowledge about the value of a staging system of ACAD, the available evidence indicates that it is helpful in decreasing morbidity and mortality with available therapies. Full article
(This article belongs to the Section Cardiology)
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27 pages, 590 KB  
Systematic Review
Impact of Artificial Sweeteners on Inflammation Markers: A Systematic Review of Animal Studies
by Pauline Celine Raoul, Maurizio Romano, Francesca Sofia Galli, Marco Cintoni, Esmeralda Capristo, Vincenzina Mora, Maria Cristina Mele, Antonio Gasbarrini and Emanuele Rinninella
Nutrients 2025, 17(20), 3251; https://doi.org/10.3390/nu17203251 - 16 Oct 2025
Abstract
Background: Artificial sweeteners, widely used as non-nutritive sugar substitutes, are increasingly prevalent in ultra-processed products. Although promoted for weight management due to their minimal caloric content, their impact on systemic inflammation remains uncertain. This systematic review of animal studies aims to evaluate the [...] Read more.
Background: Artificial sweeteners, widely used as non-nutritive sugar substitutes, are increasingly prevalent in ultra-processed products. Although promoted for weight management due to their minimal caloric content, their impact on systemic inflammation remains uncertain. This systematic review of animal studies aims to evaluate the association between artificial sweetener consumption and inflammatory biomarkers. Methods: A systematic literature search was conducted up to May 2025 across PubMed, Web of Science, and Scopus, following PRISMA guidelines and registered in PROSPERO (CRD420251084004). Risk of bias was assessed using the ARRIVE guidelines and SCYRCLE’s risk of bias tool. Results: Thirty-seven animal studies were included: aspartame (n = 17), sucralose (n = 16), acesulfame potassium (n = 5), and saccharin (n = 4). Protocols varied in terms of dosage, exposure duration, animal models, and assessment of inflammatory outcomes, including C-reactive protein, interleukins (IL-6 and IL-1β), and tumor necrosis factor alpha. Aspartame and sucralose could elevate inflammatory markers, with sucralose also disrupting gut integrity and microbiota. Acesulfame K and saccharin showed variable, dose-dependent effects. Conclusions: This systematic review of animal studies suggests a possible mechanistic association between the consumption of certain artificial sweeteners and systemic inflammation. However, this relationship remains to be clarified and warrants exploration through well-designed, large-scale randomized controlled trials. Full article
(This article belongs to the Special Issue Hot Topics in Clinical Nutrition (3rd Edition))
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12 pages, 655 KB  
Systematic Review
Descriptive Profile of Hip Rotation in Athletic, Injured and Non-Active Populations: A Systematic Review
by Maria Figueroa-Mayordomo, Cristina Salar-Andreu, Julio Fernández-Garrido, Luís González-Lago and Josep Benitez-Martinez
Encyclopedia 2025, 5(4), 170; https://doi.org/10.3390/encyclopedia5040170 - 16 Oct 2025
Abstract
Objectives: This systematic review aimed to examine hip rotator range of motion (ROM) and strength values across athletic, injured, and non-active populations, and to determine how these values differ when measured at different hip flexion angles. Methods: A systematic literature search was conducted [...] Read more.
Objectives: This systematic review aimed to examine hip rotator range of motion (ROM) and strength values across athletic, injured, and non-active populations, and to determine how these values differ when measured at different hip flexion angles. Methods: A systematic literature search was conducted in accordance with PRISMA guidelines across six electronic databases (PubMed, Scopus, Web of Science, SPORTDiscus, CINAHL, and Medline) from inception to June 2025. Eligible studies included observational, cross-sectional, case-control, or randomized controlled trial (RCT) studies that quantitatively assessed hip IR/ER ROM and/or strength in defined population groups (athletic, injured, or non-active). Two reviewers independently screened titles, abstracts, and full texts, extracted data on study design, population characteristics, measurement methods, and outcome variables, and assessed risk of bias using an established tool. Discrepancies were resolved by a third reviewer. Results: 11 studies met the inclusion criteria, including 1276 participants across athletic, injured, and non-active populations. Hip rotator ROM was measured in nine studies and strength in three, with varying testing angles (0° and/or 90° hip flexion). Overall, athletes showed greater ROM at 0° compared to injured and non-active groups, but had reduced ROM at 90° relative to non-active participants. Non-active individuals had the lowest ROM at 0°. Strength findings, though limited, indicated higher values at 90° than at 0°. Conclusions: Hip rotator ROM and strength vary across populations and testing angles, with ROM generally lower and strength higher at 90° of hip flexion. Due to methodological inconsistencies, findings should be interpreted as directional evidence, reinforcing the need for standardized assessment protocols in future research. Full article
(This article belongs to the Section Biology & Life Sciences)
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13 pages, 1022 KB  
Review
Preoxygenation in the ICU
by Clément Monet, Mathieu Capdevila, Inès Lakbar, Yassir Aarab, Joris Pensier, Audrey De Jong and Samir Jaber
J. Clin. Med. 2025, 14(20), 7305; https://doi.org/10.3390/jcm14207305 - 16 Oct 2025
Abstract
Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among [...] Read more.
Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among these, hypoxemia is particularly frequent and represents a major determinant of morbidity and mortality. Optimizing preoxygenation is therefore a cornerstone of safe airway management in critically ill patients. The aim of this review is to explore the advantages and limitations of each preoxygenation strategy and to provide clinicians with clear, practical guidance to optimize airway management in the ICU. Preoxygenation aims to increase oxygen reserves in order to prolong the duration of safe apnea. Conventional methods include high-flow oxygen delivery through a tightly fitted face mask, though efficacy depends on minimizing leaks. More advanced strategies include non-invasive ventilation (NIV), which improves both alveolar oxygen fraction and lung volume, and high-flow nasal cannula (HFNC), which additionally allows apneic oxygenation during intubation. Randomized controlled trials, including the recent PREOXY study, demonstrate the superiority of NIV over facemask preoxygenation in reducing peri-intubation desaturation, particularly in hypoxemic patients. HFNC is valuable when NIV is contraindicated, while combined approaches (NIV plus HFNC) may further enhance efficacy. Beyond technique, structured protocols and team organization are crucial to reduce complications. In conclusion, preoxygenation is an essential, patient-specific intervention that mitigates the risks of ICU intubation. Familiarity with available methods enables clinicians to tailor strategies, optimize oxygenation, and improve patient safety during this high-risk procedure. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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21 pages, 2152 KB  
Systematic Review
Non-Digestible Oligosaccharides and Constipation: A Systematic Review and Meta-Analysis of Randomized Trials on Stool Frequency, Stool Consistency, and Fermentation Biomarkers
by Huiyu Chen, Jiale Ren, Langrun Wang, Wenyi Zhang, Sufang Duan, Jie Guo, Qingshan Chen, Ran Wang, Jian He, Jingjing He and Ruixin Zhu
Nutrients 2025, 17(20), 3246; https://doi.org/10.3390/nu17203246 - 16 Oct 2025
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Abstract
Background: Chronic constipation lacks effective long-term treatments. Non-digestible oligosaccharides (NDOs) are short-chain carbohydrates that resist digestion and may improve bowel function. This systematic review and meta-analysis examines the effect of NDOs on constipation-related outcomes in humans. Methods: We searched Ovid MEDLINE, [...] Read more.
Background: Chronic constipation lacks effective long-term treatments. Non-digestible oligosaccharides (NDOs) are short-chain carbohydrates that resist digestion and may improve bowel function. This systematic review and meta-analysis examines the effect of NDOs on constipation-related outcomes in humans. Methods: We searched Ovid MEDLINE, Embase, and Web of Science (2010–May 2025) for randomized controlled trials (RCTs) comparing NDOs with placebo, reporting stool frequency, stool consistency, fecal pH, or short-chain fatty acids (SCFAs). Data were pooled using random-effects meta-analysis. All effect estimates are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroups were analyzed based on baseline constipation status and treatment duration. Results: We included 20 RCTs (1786 participants) evaluating seven NDO types. NDO supplementation significantly increased stool frequency overall, with larger effects in constipated individuals (SMD 0.99, 95% CI 0.58–1.28) than in non-constipated population (SMD 0.30, 95% CI 0.10–0.51). By duration, shorter interventions (≤3 weeks) yielded greater frequency gains (SMD 0.89, 95% CI 0.40–1.38) than longer ones (SMD 0.24, 95% CI 0.09–0.38). While the overall effect on stool consistency was non-significant, constipated patients (SMD 0.46, 95% CI 0.19–0.74) and short-term trials (SMD 0.20, 95% CI 0.03–0.37) showed modest improvements. NDOs also lowered fecal pH (SMD −1.02, 95% CI −1.25–−0.79). Data on SCFAs were inconclusive and based on very limited studies. Conclusions: NDOs modestly increase stool frequency and lower fecal pH, with greater effects in constipated individuals and short-term interventions. However, evidence certainty remains low due to heterogeneity and study limitations. Further studies are needed to establish clinical utility. Full article
(This article belongs to the Special Issue Advances in Nutrition and Dietetics in Gastroenterology)
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12 pages, 304 KB  
Article
Group Therapy to Promote Adolescents’ Mental Health: Clinical and Empirical Evidence
by Zipora Shechtman
Adolescents 2025, 5(4), 57; https://doi.org/10.3390/adolescents5040057 - 15 Oct 2025
Viewed by 121
Abstract
The contemporary world presents increasingly complex challenges for adolescents. In addition to normative developmental tasks, adolescents must now navigate epidemic health crises, armed conflicts, family dissolution, economic instability, and academic pressures. Consequently, adolescents experience diminished security and elevated levels of anxiety, loneliness, and [...] Read more.
The contemporary world presents increasingly complex challenges for adolescents. In addition to normative developmental tasks, adolescents must now navigate epidemic health crises, armed conflicts, family dissolution, economic instability, and academic pressures. Consequently, adolescents experience diminished security and elevated levels of anxiety, loneliness, and depression. While the need for emotional support has intensified across all demographics, adolescents’ psychological needs remain particularly underserved. The American Psychological Association has recently advocated for the expansion of group therapy services, a format that aligns particularly well with adolescents’ socioemotional needs, serving as a developmental bridge from childhood to adulthood. Research on adolescents’ group legs much behind the adult literature. The aim of the current paper is to show the potential power of group therapy with adolescents based on a selective review of our empirical studies examining the impact of therapy groups on adolescents’ well-being. The reviewed papers encompass randomized controlled trials and process research identifying critical therapeutic factors, collectively establishing the intervention’s validity. Results demonstrate the superiority of these groups compared to non-treatment controls and equivalence to individual therapy in reducing stress, anxiety, and aggression while enhancing self-perception, self-control, and academic functioning. These findings support the conclusion that group psychotherapy significantly contributes to adolescent well-being. Considering adolescents’ high yet unmet need for emotional support, group therapy appears to be a valid alternative. Full article
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30 pages, 5265 KB  
Systematic Review
Effects of Whole-Body, Local, and Modality-Specific Vibration Therapy on Gait in Parkinson’s Disease: A Systematic Review and Meta-Analysis
by Ji-Woo Seok and Se-Ra Park
Biomedicines 2025, 13(10), 2505; https://doi.org/10.3390/biomedicines13102505 - 14 Oct 2025
Viewed by 303
Abstract
Background/Objectives: Gait dysfunction is a major contributor to disability and reduced quality of life in Parkinson’s disease (PD). Although pharmacological treatments and exercise-based rehabilitation programs provide partial improvement, residual gait dysfunction often persists. Given these limitations, there has been growing interest in non-pharmacological [...] Read more.
Background/Objectives: Gait dysfunction is a major contributor to disability and reduced quality of life in Parkinson’s disease (PD). Although pharmacological treatments and exercise-based rehabilitation programs provide partial improvement, residual gait dysfunction often persists. Given these limitations, there has been growing interest in non-pharmacological and non-invasive strategies such as vibration therapy (VT). However, previous systematic reviews and meta-analyses have yielded inconsistent findings, largely summarizing the presence or absence of treatment effects without clarifying the clinical or therapeutic conditions under which VT may be most effective. Therefore, this study aimed to systematically review and synthesize evidence on the efficacy of VT for improving gait in PD and to identify clinical and therapeutic factors influencing treatment outcomes. Methods: A systematic search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted with no restrictions on the search period, including studies published up to July 2025. Eligible studies included randomized and quasi-experimental clinical trials that evaluated the effects of VT on gait-related outcomes in patients with Parkinson’s disease. Data extraction followed the PRISMA 2020 guidelines, and the risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Multilevel random-effects meta-analyses were conducted to estimate pooled effect sizes for gait outcomes, and meta-regression and subgroup analyses were performed based on disease stage, medication status, and vibration parameters. Results: A total of 14 studies (11 randomized and 3 non-randomized) were included. The pooled analysis showed that VT significantly improved gait performance in PD (Hedges’ g = 0.270, 95% CI: 0.115–0.424; 95% PI: −0.166–0.705). The sensitivity analysis restricted to randomized controlled trials yielded a comparable significant effect (g = 0.316, 95% CI: 0.004–0.628). Greater benefits were observed in patients with higher clinical severity, while the moderating effect of levodopa dosage was not significant. Optimal effects were identified with frequencies of 51–100 Hz, session durations ≤3 min, and 2–3 sessions per week. Improvements were evident in gait speed, cycle, and magnitude, whereas no consistent effects were observed for freezing of gait or gait variability. Conclusions: VT yields small but statistically significant improvements in fundamental gait parameters in Parkinson’s disease, particularly under optimized stimulation conditions and in individuals with greater disease severity. Although the pooled effect was modest and the certainty of evidence was rated as very low according to GRADE, these findings cautiously support the potential of vibration-based interventions as a supportive, non-pharmacological, and non-invasive adjunct within broader rehabilitation programs, rather than as a stand-alone treatment. Full article
(This article belongs to the Special Issue Challenges in the Diagnosis and Treatment of Parkinson’s Disease)
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24 pages, 456 KB  
Review
Noninvasive Preimplantation Genetic Testing in Recurrent Pregnancy Loss and Implantation Failure: Breakthrough or Overpromise?
by Grzegorz Mrugacz, Aleksandra Mospinek, Joanna Głowacka, Oskar Sprawski, Lidia Kawałek, Wiktoria Gąsior, Julita Machałowska, Yekaterina Sidorova, Patrycja Borecka, Aleksandra Bojanowska and Weronika Szczepańska
Cells 2025, 14(20), 1591; https://doi.org/10.3390/cells14201591 - 14 Oct 2025
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Abstract
Background: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are significant challenges in reproductive medicine. For both, embryonic aneuploidy is the leading etiological factor. Preimplantation genetic testing for aneuploidy (PGT-A) via trophectoderm biopsy is the current standard for embryo selection. However, [...] Read more.
Background: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are significant challenges in reproductive medicine. For both, embryonic aneuploidy is the leading etiological factor. Preimplantation genetic testing for aneuploidy (PGT-A) via trophectoderm biopsy is the current standard for embryo selection. However, it is limited by its invasiveness, potential for embryo damage, and diagnostic errors due to mosaicism. Rationale/Objectives: This review critically evaluates the emerging role of noninvasive PGT (niPGT). NiPGT analyzes cell-free DNA from spent blastocyst culture media, thus, it is a potential alternative for managing RPL and RIF. Hence, the primary objective is to determine whether current evidence supports niPGT as a reliable replacement for conventional biopsy-based PGT-A in these high-risk populations. Outcomes: The analysis reveals that niPGT offers significant theoretical advantages. These include complete non-invasiveness, enhanced embryo preservation, and high patient acceptability. However, its clinical application is hampered by substantial limitations. Key amongst them is the inconsistent and often suboptimal diagnostic accuracy (sensitivity 70–85%, specificity 88–92%) compared to biopsy. Other significant factors include the high rates of amplification failure (10–50%), vulnerability to maternal DNA contamination, as well as low DNA yield. Crucially, there is a definitive lack of robust, prospective randomized controlled trial (RCT) data demonstrating improved live birth rates or reduced miscarriage rates specifically in RPL and RIF cohorts. As such, niPGT is not yet ready to be a standalone clinical adoption in RPL and RIF cases. However, it may serve as a valuable adjunct for rescue scenarios following biopsy failure or for ethical reasons. Wider Implications: The integration of niPGT with artificial intelligence, time-lapse imaging, and multi-omics profiling underlies a promising future. However, its transition from a predominantly research tool to a clinical standard necessitates various critical undertakings. These include rigorous multicenter RCTs, standardizing international protocol, and tailoring validation for the RPL and RIF subgroups. This review highlights the need for cautious optimism, positing that evidence-based integration, rather than premature adoption, is essential to realizing niPGT’s full potential without compromising patient care in these complex fertility scenarios. Full article
(This article belongs to the Special Issue Advances in Reproductive Biology: Cellular and Molecular Mechanisms)
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22 pages, 642 KB  
Systematic Review
The Impact of Novel Therapies on Quality-of-Life in Triple-Negative Breast Cancer: A Systematic Review of Clinical Trials
by Banice Kamau, Maxim Shulimovich and Sinha Samridhi
Cancers 2025, 17(20), 3307; https://doi.org/10.3390/cancers17203307 - 13 Oct 2025
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Abstract
Background: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by poor prognosis and limited therapeutic options. Chemotherapy regimens are associated with significant adverse effects negatively impacting patients’ quality of life (QoL). This systematic review aims to evaluate and compare QoL [...] Read more.
Background: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by poor prognosis and limited therapeutic options. Chemotherapy regimens are associated with significant adverse effects negatively impacting patients’ quality of life (QoL). This systematic review aims to evaluate and compare QoL outcomes of patients with TNBC receiving novel therapies—including immunotherapy, antibody–drug conjugates, and targeted therapies—versus standard chemotherapy. Methods: We systematically reviewed randomized controlled trials (RCTs) published within the past 15 years, identified through comprehensive searches in PubMed, Google Scholar, Research4Life, and Elicit. Included studies involved FDA-approved novel therapies (pembrolizumab, atezolizumab, sacituzumab-govitecan, olaparib, and talazoparib) administered to TNBC patients, and assessed QoL using validated tools such as EORTC QLQ-C30. Observational studies, case reports, and non-standardized assessments were excluded. Results: Eight RCTs comprising 3929 patients met the inclusion criteria. Sacituzumab govitecan and PARP inhibitors (olaparib and talazoparib) significantly improved QoL, notably delaying deterioration across physical, emotional, and functional domains compared to standard chemotherapy. Conversely, immunotherapies (pembrolizumab, atezolizumab) showed non-significant trends toward QoL improvement, with effects varying by patient subgroup and disease stage. Interpretation was limited by study design differences, inconsistent compliance, and incomplete data reporting. Conclusions: Immunotherapy showed a neutral effect on quality of life, providing neither significant improvement nor additional decline. Olaparib was associated with a delayed deterioration in quality of life, showing a more favorable tolerability profile compared to chemotherapy. Talazoparib leads to clinically meaningful enhancements in quality of life, while sacituzumab govitecan effectively improves patient-reported outcomes relative to standard chemotherapy. Full article
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
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14 pages, 1658 KB  
Systematic Review
Music Therapy for Managing Dental Anxiety in Children: A Systematic Review and Meta-Analysis of Clinical Evidence
by Laura Marqués-Martínez, Jorge Andrés, Esther García-Miralles, Carla Borell-García, Juan Ignacio Aura-Tormos and Clara Guinot Barona
Children 2025, 12(10), 1382; https://doi.org/10.3390/children12101382 - 13 Oct 2025
Viewed by 254
Abstract
Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have [...] Read more.
Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children’s dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4–14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = −0.48, 95% CI: −0.72 to −0.25, p < 0.001). Heart rate was also significantly reduced (SMD = −0.42, 95% CI: −0.68 to −0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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