Search Results (413)

Synthetic aperture radar (SAR) object detection has long been affected by spatial speckle interference, spectral energy imbalance, and structural bias in cross-scale feature fusion. In this article, we propose the Multi-Domain Interference-Suppressed Detection Transformer (MDIS-DETR), a unified multi-domain interference-suppressed detection framework built on the Real-Time Detection Transformer (RT-DETR) architecture. Specifically, spatial-domain interference is suppressed by learnable fusion of complementary denoising responses at the input stage. Furthermore, frequency-domain interference is suppressed by polarization-guided attention together with adaptive frequency refinement within the encoder. In addition, structural-domain interference is suppressed by non-sequential cross-scale interaction to enhance multi-scale consistency. Extensive experiments on multiple SAR benchmarks demonstrate that MDIS-DETR establishes state-of-the-art (SOTA) performance across datasets. Notably, on SARDet-100K, currently the largest SAR detection dataset with a scale comparable to the Common Objects in Context (COCO) dataset, it achieves 58.82% mAP, surpassing the RT-DETR baseline by 4.58%. Full article

High-dynamic amusement ride conditions involving impacts, rapid rotations, and abrupt posture changes introduce severe motion artifacts that degrade vital sign quality and destabilize physiological state recognition. This study aims to develop an engineering-ready closed-loop framework for robust passenger monitoring and intelligent diagnosis. A multimodal sensing and modeling pipeline was designed to jointly leverage physiological signals such as heart rate and SpO₂ and kinematic measurements, including acceleration, angular rate, velocity, and attitude. Inertial and PPG signals were preprocessed into supervised samples through wavelet multiresolution denoising and coordinate frame unification, while a strapdown inertial navigation system was used to propagate a 12-channel physical quantity sequence. To ensure interpretability and standards compliance, constraints from GB 8408-2018 were translated into executable threshold rules, enabling standards-driven auto-labeling and rule-based early warning. Building on this foundation, three learning modules were developed: a fusion model for high-dynamic heart rate estimation, a CNN–LSTM dynamic-threshold-enhanced network TAPNet for rapid kinematic anomaly screening, and an attention-augmented hybrid model HS-BANet integrating one-dimensional residual blocks, bidirectional LSTM, and multi-head attention for fine-grained arrhythmia classification. Experimental results demonstrated accurate and consistent heart rate estimation with RMSE of 1.18 bpm on HSSH-I and 1.24 bpm on the independent HSSH-II set, strong agreement with training and testing correlations of 0.9928 and 0.9865, and near-zero bias in Bland–Altman analysis. TAPNet achieved 96.9% validation accuracy and 98.2% test accuracy for kinematic anomaly recognition, maintaining robust generalization under class imbalance. HS-BANet enabled multi-class identification of PVC, PAC, VT, SVT, and AF, achieving an accuracy of 92.37%, an F1-score of 86.87%, a precision of 88.45%, a sensitivity of 88.14%, and a specificity of 89.42%. Overall, the proposed two-stage multimodal closed-loop—fast, interpretable early warning based on physical quantity thresholds followed by fine-grained diagnosis from physiological signals—supports stable feature extraction and reliable decision-making under strong motion artifacts and non-stationary dynamics, balancing responsiveness and diagnostic credibility, while showing potential for practical safety early warning and future deployment-oriented operational support in amusement ride scenarios. Full article

Background/Objectives: Composite endpoints are commonly used in chronic kidney disease (CKD) trials to enhance statistical efficiency but may not reflect clinically meaningful outcomes. We assessed agreement between composite endpoints and key components using the bias attributable to composite outcome (BACO) index and explored determinants of variability. Methods: We performed a meta-epidemiological analysis of randomized controlled trials evaluating sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists in CKD. BACO was defined as the ratio of the log-hazard ratio for the composite endpoint to that of the reference outcome (kidney failure or cardiovascular death), with variance estimated using the delta method. Determinants were analyzed using inverse-variance weighted mixed-effects meta-regression. Results: Eight trials comprising 38 composite endpoints were included. Higher reference-event rates were associated with higher BACO values overall (β: 0.06, 95% CI: 0.02; 0.10) and in kidney failure-referenced analyses (β: 0.07, 95% CI: 0.02; 0.12). Stronger composite treatment effects correlated with higher BACO (β: −1.07, 95% CI: −1.84; −0.30). The number of components and follow-up duration showed no significant association. In cardiovascular death-referenced models, BACO was associated with trial size (β: 0.12 per 1000 participants), mean age (β: −0.04 per 10 years), and female proportion (β: 0.09 per 10% increase). Conclusions: Agreement between composite endpoints and clinically relevant outcomes is driven by the relative frequency and treatment responsiveness of component events rather than endpoint complexity. Composite endpoints in which clinically important outcomes are infrequent may not reliably reflect treatment effects, underscoring need for clinically aligned endpoint strategies. Full article

Background/Objectives: Respiratory tract symptoms, urinary symptoms, and acute fevers frequently prompt emergency urgent care visits. Distinguishing bacterial from viral or non-bacterial etiology remains difficult because clinical features overlap and laboratory microbiological tests are often non-specific or delayed. The MeMed BV^® test is a rapid host-response assay that combines TRAIL, IP-10, and CRP into a composite score to differentiate between bacterial and viral/non-bacterial infections within 15 min. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy and clinical utility of the MeMed BV test in adults and children with suspected respiratory tract infections, urinary tract infections, and undifferentiated fever. Methods: The review followed PRISMA-DTA guidelines. Medline, Embase, CINAHL, and the Cochrane Library databases were searched. The risk of bias was assessed using the QUADAS-2, Cochrane RoB 2.0, ROBINS-I, and JBI tools. Where appropriate, meta-analyses were performed using a bivariate random-effects or HSROC model. Results: Sixteen studies (12 diagnostic test accuracy (DTA) studies and four non-DTA studies) were included. The pooled sensitivity was 91% (95% CI: 86–94%), and specificity was 92% (95% CI: 91–93%), with consistent accuracy in adults (Sensitivity 93%/Specificity 91%) and children (Sensitivity 88%/Specificity 93%). The non-DTA studies demonstrated that MeMed BV-guided management improved antibiotic stewardship: antibiotics were prescribed in 20.6% of viral versus 73.2% of bacterial cases, and clinician adherence to MeMed BV results reached 75–80%. Conclusions: The MeMed BV test demonstrates consistently high diagnostic accuracy and is associated with improved antibiotic decision-making, supporting its integration into clinical workflows. Full article

Background/Objectives: Incorporating parent training into cognitive-behavioral therapy for anxious youth has not been shown to significantly improve outcomes perhaps because these interventions have not addressed potential interfering psychological barriers to implementing parenting changes and rarely offer between-session support. There is growing evidence that Acceptance and Commitment Therapy (ACT) can target these psychological barriers and generate more flexible and adaptive behavioral repertoires in parents of children with a variety of presenting challenges. Methods: Following a pilot trial of “Acceptance and Commitment Therapy for Parents of Anxious Children (ACT-PAC)” a six-week group-based intervention focused on targeting psychological barriers to parenting change using mindfulness and acceptance approaches, we collected qualitative feedback from participants in two post-treatment phases by conducting individual interviews and a focus group with participants that completed the intervention. Results: Analysis of interview responses revealed that parents found ACT principles and processes to be helpful, and many also appreciated the ACT-PAC group setting that allowed parents to recognize their experiences were shared by others and to self-disclose in a non-judgmental space. Feedback from the focus group further provides preliminary evidence that ACT-PAC is acceptable to and feasible for parent participants and suggests modifications such as involving additional caregivers, making resources more readily available, and creative structural changes that may facilitate between-session practice. Conclusions: Results suggest that the group-based intervention can be both maintained and improved for future participants. Limitations to generalizability in light of possible selection bias and the small focus group sample size are addressed. Full article

Background/Objectives: Immunotherapy has emerged as an important field of research in non-small-cell lung cancer (NSCLC) and has demonstrated promising results in clinical practice. In recent years, multiple studies have been conducted, increasing the amount of available data. Therefore, the aim of this systematic review is to assess the combination of perioperative immunotherapy with chemotherapy compared to chemotherapy only in patients with resectable NSCLC in terms of survival, pathological response, and adverse events. Methods: The clinical databases PubMed, Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) were systematically searched, up to March 2026. A two-step selection process served as the screening for eligibility, in which the assessment was based on pre-defined inclusion and exclusion criteria. This process was visualized via a PRISMA diagram. For each included study, the risk of bias was assessed with the help of the Cochrane Risk of Bias 2.0 tool and the Newcastle Ottawa Scale. A narrative synthesis was performed due to heterogeneity. Data were extracted into tables. Results: A total of 16 studies, involving 4646 patients in total, met the eligibility criteria, and their data on study population, intervention, comparison, and outcome were extracted into tabular form. Survival and pathological response rates are continuously higher in patients treated with immunochemotherapy. Findings on adverse events differed across the individual studies, though the results indicate an increased risk of treatment-related adverse events (TRAEs) in patients undergoing the combined treatment approach. Discussion/Conclusions: Chemoimmunotherapy leads to superior clinical outcomes in terms of survival and pathological response rates, though the trend towards a higher incidence and severity of TRAEs warrants further research. The interpretation of findings is limited by differences in study characteristics, mechanism of conduct, and endpoints between the individual studies. Full article

Background/Objectives: Curcumin has been proposed as a nutritional strategy to support exercise recovery through antioxidant and anti-inflammatory actions. However, trials differ in sport context, training status, supplementation timing, dose, formulation, and methodological control. This systematic review evaluated its effects on recovery outcomes in active individuals and athletes, with particular attention to the applicability of the evidence to real-world sport settings. Methods: PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library/CENTRAL were searched from 2012 to June 2026. Randomized double-blind placebo-controlled trials were eligible when they evaluated oral curcumin, curcuminoids, Curcuma-derived preparations with a specified curcumin dose, or curcumin combined only with bioavailability enhancers. Studies using artificial muscle-damage protocols, clinical populations, non-randomized designs, or combined bioactive interventions were excluded. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale, supplemented by a Cochrane Risk of Bias 2 (RoB 2) assessment and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty-of-evidence evaluation. Owing to heterogeneity, findings were synthesized narratively by outcome domain, supplementation timing, formulation type, exercise context, and training status. Results: Fifteen trials were included. Favorable effects were reported in 6/7 studies assessing oxidative stress, 4/6 assessing muscle damage, 3/8 assessing inflammation, 3/7 assessing subjective recovery, soreness, or fatigue, and 4/8 assessing physical or athletic performance. However, effects varied substantially according to population, exercise context, biomarker selection, timing of assessment, and formulation type. The certainty of evidence was low for oxidative stress and very low for muscle damage, inflammation, subjective recovery/soreness/fatigue, and performance. Conclusions: Curcumin supplementation may support selected aspects of exercise recovery, particularly oxidative stress responses. However, these findings should be interpreted cautiously because the evidence derives mostly from small trials with heterogeneous populations, exercise protocols, supplementation regimens, formulations, biomarkers, and assessment time points. Evidence for muscle damage, inflammation, subjective recovery, fatigue, and performance remains inconsistent, and further well-controlled trials in trained and high-performance athletes are needed before practical recommendations can be established. Full article

Background: Missing data, particularly progression-driven dropout, introduces substantial bias in longitudinal oncology studies, directly impacting response classification based on RECIST criteria. While machine learning-based imputation methods are increasingly used, their performance is rarely evaluated in a clinically interpretable framework centered on patient-level endpoints such as Best Overall Response (BOR). Methods: We propose a clinically grounded evaluation framework based on RECIST 1.1 focused on patient-level Best Overall Response classification. Longitudinal tumor trajectories were simulated for 270 patients (1:1, HER2+ and HER2−) across nine follow-up visits using both Gompertz and Stein–Fojo growth models, resulting in 2700 patient-visit observations. Realistic missingness was introduced through a combination of random mechanisms and progression-driven dropout. Three machine learning imputation models, long short-term memory (LSTM), MissForest, and Multiple Imputation (MI) were evaluated under both direct (MAR-based) and non-responder imputation strategies. Performance was assessed using BOR classification metrics, including accuracy and Cohen’s kappa. Result: Across both simulation frameworks, imputation substantially improved BOR classification performance. Under the Gompertz model, accuracy increased from 0.84–0.89 with direct imputation to 0.94–0.99 with non-responder imputation, with corresponding kappa improvements from 0.73–0.82 to 0.90–0.99. Similar trends were observed under the Stein–Fojo model (accuracy: 0.82–0.84 vs. 0.91–0.96; kappa: 0.69–0.72 vs. 0.86–0.94). Across all evaluated methods, NRI improved classification performance by approximately 10 percentage points in accuracy and up to 17 percentage points in kappa. The improvement was observed consistently across both tumor growth models and different missingness scenarios, demonstrating the robustness of the findings. Conclusions: This study demonstrates that successful handling of missing data depends not only on the imputation method itself, but also on the choice of a clinically meaningful endpoint and appropriate estimand strategies aligned with the underlying missing data assumptions. In the METABRIC-derived simulations, clinically informed handling of progression-related missingness substantially improved RECIST-based BOR classification across all evaluated methods, suggesting that appropriate endpoint selection and the corresponding estimand strategy for missing data handling may have a greater influence on classification performance than the choice among the imputation models applied. Full article

Background/Objectives: Rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection remain major contributors to morbidity and mortality, particularly in high-burden settings. HIV-related clinical factors, including viral suppression, CD4-defined immune status, HIV drug resistance, virological failure, and ART failure, may influence RR-TB treatment response; however, existing evidence remains fragmented. This systematic review and meta-analysis protocol aims to synthesize evidence on the impact of HIV viral suppression, immune status, and HIV drug resistance/ART resistance status on RR-TB treatment outcomes. Methods: This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Published peer-reviewed studies and relevant grey literature from January 2005 to December 2025 will be searched in PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, ScienceDirect, EBSCOhost, PsycINFO, Google Scholar, and other relevant sources. No language restriction will be applied at the search stage. Where feasible, non-English records will be translated for title/abstract and full-text screening. Two reviewers will independently screen studies, extract data, and assess study quality, with disagreements resolved by a third reviewer. Study-level risk of bias will be assessed using design-appropriate tools, and the certainty of evidence for each outcome will be evaluated using GRADE. Results: Evidence will be synthesized narratively and, where studies are sufficiently homogeneous, quantitatively through meta-analysis. Outcomes of interest will include treatment success, treatment failure, mortality, treatment completion, microbiological cure, and adverse events. Subgroup analyses will be considered by viral suppression status, CD4-defined immune status, HIV drug resistance/ART resistance status, geographic region, and treatment regimen where data permit. Conclusions: This review will provide evidence on how HIV viral suppression, immune status, and HIV drug resistance/ART resistance influence RR-TB treatment outcomes. The findings may inform integrated TB/HIV care, clinical monitoring, and treatment strategies for individuals co-infected with HIV and RR-TB. Full article

Magnetic anomaly detection is vulnerable to environmental noise and insufficient prior target information, making non-periodic anomaly signals difficult to detect at low-signal-to-noise-ratio (SNR) conditions. This paper proposes a detection method based on a multi-parameter-constrained mirror dual-branch biased monostable stochastic resonance (SR) system. Nonlinear odd-order bias terms are introduced into the conventional biased monostable potential function to build a multi-parameter-controllable SR model. This improves regulation of potential-well width, depth, and wall morphology, enhancing noise-energy utilization and responses to non-periodic features. Considering peak-type, valley-type, and bipolar anomaly morphologies, a mirror dual-branch SR structure is developed to cooperatively detect features with different polarities. To preserve temporal waveforms and time–frequency structures during parameter optimization, a composite metric combining the correlation coefficient and wavelet-domain image structural similarity index is constructed. Multi-fidelity robust Bayesian optimization is used to obtain a unified robust parameter set for the magnetic anomaly signal family. Experiments with simulated colored noise and measured geomagnetic noise show that the proposed method effectively recovers magnetic anomaly features under strong noise. At −19 dB SNR, its detection probability remains above 80%. Compared with orthogonal basis function decomposition, empirical mode decomposition, and complete ensemble empirical mode decomposition with adaptive noise, the method achieves better noise suppression, feature preservation, and detection performance under low-SNR conditions. Full article

Background/Objectives: Immune checkpoint inhibitors (ICIs) have changed the treatment landscape for several advanced malignancies, but their use is accompanied by immune-related adverse events, including liver injury. Some cases resemble autoimmune hepatitis (AIH), although many are more accurately described as AIH-like immune-mediated hepatitis rather than classical AIH. This distinction matters, as diagnosis is often based on exclusion and management must balance hepatic recovery against interruption of potentially life-prolonging cancer therapy. This systematic review summarised the clinical phenotype, diagnostic assessment, treatment strategies, treatment response, ICI discontinuation, and rechallenge outcomes in patients with ICI-associated AIH-like liver injury. Methods: A systematic PubMed search was performed for English-language human studies reporting autoimmune hepatitis, AIH-like liver injury, or immune-mediated hepatitis following exposure to ICIs. Eligible studies included case reports, case series, retrospective cohorts, prospective cohorts, and pharmacovigilance-type studies with extractable clinical, treatment, or outcome data. Reviews, guidelines, non-original articles, animal studies, non-English publications, and reports without usable liver injury data were excluded. The review followed PRISMA principles. Risk of bias was assessed using Joanna Briggs Institute tools and summarised with ROBVIS. Given the heterogeneity of study design, diagnostic criteria, treatment definitions, and outcome reporting, formal meta-analysis was not appropriate; results were therefore synthesised descriptively. Results: Twenty-two studies were included, comprising 195 patients with ICI-associated AIH-like or immune-mediated hepatitis. Of these, 140 patients received active treatment, and 133/140 achieved clinical or biochemical recovery with varying therapies. Corticosteroids were the most frequently used first-line therapy, with recovery reported in 102/105 patients treated with corticosteroids alone. Mycophenolate mofetil was the main second-line agent for steroid-refractory disease, with response reported in 9/10 treated patients. Other therapies, including tacrolimus, azathioprine, ursodeoxycholic acid, bezafibrate, tocilizumab, basiliximab, infliximab, budesonide, and double plasma molecular adsorption system with or without plasma exchange, were described only in small numbers or isolated cases. Spontaneous recovery without pharmacological treatment was reported in 19 patients. ICI interruption or discontinuation occurred in 141 patients, and rechallenge was reported in 55 patients after recovery, with no recurrent hepatic toxicity documented in the extracted dataset. Conclusions: ICI-associated AIH-like liver injury is an important immune-related toxicity, but the available literature remains fragmented and methodologically heterogeneous. Most reported patients recovered, particularly with corticosteroids, and MMF appears to be the most consistently used escalation therapy in steroid-refractory cases. However, the strength of evidence is limited by uncontrolled designs, variable terminology, inconsistent diagnostic work-up, and non-standardised outcome definitions. Future studies should separate classical AIH from AIH-like immune-mediated hepatitis, use uniform criteria for severity and response, and report treatment denominators clearly, especially for rechallenge and steroid-refractory disease. Full article

Background/Objectives: Assisted verticalization and supported upright activity are relevant components of rehabilitation in adults with severe acquired brain injury (sABI), although patient selection and implementation remain challenging. This retrospective observational study aimed primarily to describe the implementation feasibility and documented safety of GRILLO-based training in routine inpatient multidisciplinary rehabilitation, and secondarily to report exploratory pre–post functional changes. Methods: We reviewed clinical records of 34 adults screened or considered for GRILLO-based training at Centro Cardinal Ferrari KOS, Italy, between June 2022 and December 2024. GRILLO training was delivered as part of standard care and not as an experimental intervention. Functional outcomes included the Barthel Index (BI), Trunk Control Test (TCT), Tinetti Balance Scale, and Tinetti Gait subscale, extracted from routine documentation. Non-parametric descriptive analyses were used. Results: Of 34 screened patients, 4 did not meet diagnostic criteria for ABI, 5 interrupted training because of pain or poor tolerance to prolonged upright positioning, and 3 were not included because of poor compliance/motivation or an incomplete clinical pathway. The paired functional-analysis cohort comprised 22 patients: 20 (91%) completed 15 sessions and 2 (9%) completed 10 sessions. No serious device-related adverse events were documented in available clinical records, although minor adverse events were not systematically monitored. Among patients with paired observations, median BI increased from 16 to 22.5 (median change, +3; p = 0.008; n = 20), median TCT from 72 to 74 (median change, +12; p < 0.001; n = 21), and median Tinetti Balance Scale from 1 to 2 (median change, +1; p = 0.006; n = 22). Individual responses were heterogeneous and floor effects were evident, especially for balance and gait-related measures. Conclusions: In this retrospective real-world cohort, GRILLO-based training could be implemented in selected severely impaired inpatients, but feasibility may be overestimated if interrupted and non-completing cases are not considered. The non-completion cases may suggest that feasibility depends not only on initial clinical indication, but also on the appropriate timing of introduction, tolerance to prolonged upright physical effort, pain/discomfort, motivation, and behavioral engagement. The retrospective design, survivorship bias, non-systematic adverse-event monitoring, concurrent multidisciplinary rehabilitation, and absence of a comparator group preclude conclusions regarding device-specific safety or efficacy. Nevertheless, these preliminary findings support further prospective controlled studies. Full article

There is growing interest in non-operative management (NOM) for rectal cancer patients who achieve a complete response to neoadjuvant therapy. The patients’ perspectives of these approaches are limited. Here, we describe a qualitative study where we conducted semi-structured interviews with fourteen rectal cancer patients, including seven men and seven women, who were successfully treated by NOM at our center between 2020 and 2022. The responses were analyzed using the constant comparative method. Four major thematic categories emerged: impact of rectal cancer diagnosis, treatment values, decision-making factors, and the impact of NOM surveillance. Avoidance of a stoma was a major theme in both determining patient treatment values as well as ultimately driving their decision-making. Trust in the treating physician was also found to be a major theme in decision-making. While the psychological burden of surveillance did emerge as a major theme, patients who did not have recurrence were still quite satisfied with their decision to pursue NOM. Limitations of this study include selection bias, the single-center design, and the lack of patients who ultimately experienced recurrence following NOM. As NOM of rectal cancer becomes more commonplace, understanding the patients’ perspectives will ensure appropriate counseling and shared decision-making. Full article

Existing accounts of platform-mediated complementor growth rest on two limiting assumptions: that platform enablement constitutes a homogeneous environmental input and that firm growth is a unitary outcome. This double simplification obscures how distinct platform provisions generate qualitatively different forms of firm transformation. This study asks which combinations of mechanistically distinct platform enablement types and internal strategic response capabilities activate which forms of leapfrog growth among complementor firms operating under dual institutional governance. We employ fuzzy-set Qualitative Comparative Analysis (fsQCA) on survey data from 374 complementor firms in China’s autonomous driving platform ecosystem. Five antecedent conditions are examined across two dimensions: platform enablement, comprising rule-based enablement (RE) and business platform enablement (BPE); and strategic response capabilities, comprising network linkage capability (NLC), organizational ambidexterity (OA), and policy responsiveness (PR). Three outcome variables capture three non-reducible leapfrog dimensions: technology-chain (TL), value-chain (VL), and institutional-chain (IL) transitions. A reverse-causality robustness check and a common-method-bias assessment corroborate the validity of findings. The analysis identifies equifinal configurational pathways with distinct dominant logics across the three chains. Technology-chain transitions are predominantly network-linkage-driven; value-chain transitions are policy-responsiveness-anchored; institutional-chain transitions exhibit genuine equifinality between network-linkage and policy-responsiveness pathways, both requiring dual-platform enablement as a universal structural precondition. No single enabling condition or capability suffices; leapfrog growth is irreducibly configurational and causally asymmetric. The study offers a dual-enablement, three-chain configurational framework for understanding platform-mediated firm growth under dual institutional governance. For complementor firms, findings support dimension-selective capability investment over uniform accumulation strategies. For platform orchestrators, differentiated governance design calibrated to specific complementor upgrading trajectories outperforms homogeneous resource provisioning. For policymakers, institutionalized consultative channels linking private platform governance with public regulatory processes are recommended to facilitate coordinated digital industrial transformation. Full article

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed. Full article