Search Results (3,864)

Background: Percutaneous epidural neuroplasty (PEN) and related adhesiolysis procedures are widely used for managing chronic spinal pain. Although generally safe, complications—ranging from minor to life-threatening—have been reported. This review aimed to estimate the incidence and characteristics of complications following PEN and to evaluate the medical rationale for post-procedural inpatient monitoring. Methods: We systematically searched PubMed, Embase, and the Cochrane Library for studies published from January 2000 to April 2025 reporting complications associated with PEN. We performed a random-effects meta-analysis on five eligible cohort studies to estimate the pooled complication rate and evaluated heterogeneity. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Five cohort studies (n = 1740) were included in the meta-analysis, with a pooled complication rate of 9.0% (95% CI: 4.8–13.1%, I² = 97.5%). A total of 133 complications were identified from cohort studies and case reports. Mechanical and neurological complications were most common. Serious complications, including hematoma, meningitis, and cardiopulmonary arrest, were concentrated within the first 6 h post-procedure. Conclusions: This meta-analysis highlights a quantifiable risk of complications associated with PEN. Our findings support structured inpatient monitoring during the immediate post-procedural period to enhance safety and outcomes. Full article

Systematic reviews are a cornerstone of evidence-based research, providing comprehensive summaries of existing studies to answer specific research questions. This article offers a detailed guide to conducting high-quality systematic reviews in biology, health and social sciences. It outlines key steps, including developing and registering a protocol, designing comprehensive search strategies, and selecting studies through a screening process. The article emphasizes the importance of accurate data extraction and the use of validated tools to assess the risk of bias across different study designs. Both meta-analysis (quantitative approach) and narrative synthesis (qualitative approach) are discussed in detail. The guide also highlights the use of frameworks, such as GRADE, to assess the certainty of evidence and provides recommendations for clear and transparent reporting in line with the PRISMA 2020 guidelines. This paper aims to adapt and translate evidence-based review principles, commonly applied in clinical research, into the context of biological sciences. By highlighting domain-specific methodologies, challenges, and resources, we provide tailored guidance for researchers in ecology, molecular biology, evolutionary biology, and related fields in order to conduct transparent and reproducible evidence syntheses. Full article

Background/Objectives: Mucosal vaccines, delivered intranasally or via inhalation, are being studied for respiratory infectious diseases like COVID-19 and influenza. These vaccines aim to provide non-invasive administration and strong immune responses at infection sites, making them a promising area of research. This systematic review and meta-analysis assessed their immunogenicity, safety, and protective efficacy. Methods: The study design was a systematic review and meta-analysis, searching PubMed and Cochrane databases up to May 30, 2025. Inclusion criteria followed the PICOS framework, focusing on mucosal vaccines for COVID-19, influenza, RSV, pertussis, and tuberculosis. Results: A total of 65 studies with 229,614 participants were included in the final analysis. Mucosal COVID-19 vaccines elicited higher neutralizing antibodies compared to intramuscular vaccines (SMD = 2.48, 95% CI: 2.17–2.78 for wild-type; SMD = 1.95, 95% CI: 1.32–2.58 for Omicron), with varying efficacy by route (inhaled VE = 47%, 95% CI: 22–74%; intranasal vaccine VE = 17%, 95% CI: 0–31%). Mucosal influenza vaccines protected children well (VE = 62%, 95% CI: 30–46%, I² = 17.1%), but seroconversion rates were lower than those of intramuscular vaccines. RSV and pertussis vaccines had high seroconversion rates (73% and 52%, respectively). Tuberculosis vaccines were reviewed systemically, exhibiting robust cellular immunogenicity. Safety was comparable to intramuscular vaccines or placebo, with no publication bias detected. Conclusions: Current evidence suggests mucosal vaccines are immunogenic, safe, and protective, particularly for respiratory diseases. This review provides insights for future research and vaccination strategies, though limitations include varying efficacy by route and study heterogeneity. Full article

This study explores the challenges and theoretical transformations that the widespread application of AI technology in social governance brings to the protection of citizens’ fundamental rights. By examining typical cases in judicial assistance, technology-enabled law enforcement, and welfare supervision, it explains how AI characteristics such as algorithmic opacity, data bias, and automated decision-making affect fundamental rights including due process, equal protection, and privacy. The article traces the historical evolution of privacy theory from physical space protection to informational self-determination and further to modern data rights, pointing out the inadequacy of traditional rights-protection paradigms in addressing the characteristics of AI technology. Through analyzing AI-governance models in the European Union, the United States, Northeast Asia, and international organizations, it demonstrates diverse governance approaches ranging from systematic risk regulation to decentralized industry regulation. With a special focus on China, the article analyzes the special challenges faced in AI governance and proposes specific recommendations for improving AI-governance paths. The article argues that only within the track of the rule of law, through continuous theoretical innovation, institutional construction, and international cooperation, can AI technology development be ensured to serve human dignity, freedom, and fair justice. Full article

High-precision time–frequency systems are essential for low Earth orbit (LEO) navigation satellites to achieve real-time (RT) centimeter-level positioning services. However, subject to stringent size, power, and cost constraints, LEO satellites are typically equipped with oven-controlled crystal oscillators (OCXOs) as the system clock. The inherent long-term stability of OCXOs leads to rapid clock error accumulation, severely degrading positioning accuracy. To simultaneously balance multi-dimensional requirements such as clock bias accuracy, and frequency stability and phase continuity, this study proposes a linear quadratic Gaussian (LQG) frequency precision steering method that integrates a four-dimensional constraint integrated (FDCI) model and hierarchical weight optimization. An improved system error model is refined to quantify the covariance components (Σ₁₁, Σ₂₂) of the LQG closed-loop control system. Then, based on the FDCI model that explicitly incorporates quantization noise, frequency adjustment, frequency stability, and clock bias variance, a priority-driven collaborative optimization mechanism systematically determines the weight matrices, ensuring a robust tradeoff among multiple performance criteria. Experiments on OCXO payload products, with micro-step actuation, demonstrate that the proposed method reduces the clock error RMS to 0.14 ns and achieves multi-timescale stability enhancement. The short-to-long-term frequency stability reaches 9.38 × 10⁻¹³ at 100 s, and long-term frequency stability is 4.22 × 10⁻¹⁴ at 10,000 s, representing three orders of magnitude enhancement over a free-running OCXO. Compared to conventional PID control (clock bias RMS 0.38 ns) and pure Kalman filtering (stability 6.1 × 10⁻¹³ at 10,000 s), the proposed method reduces clock bias by 37% and improves stability by 93%. The impact of quantization noise on short-term stability (1–40 s) is contained within 13%. The principal novelty arises from the systematic integration of theoretical constraints and performance optimization within a unified framework. This approach comprehensively enhances the time–frequency performance of OCXOs, providing a low-cost, high-precision timing–frequency reference solution for LEO satellites. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

The use of orthodontic microimplants in daily practice is now an indispensable part of orthodontic treatment. Unfortunately, the use of skeletal anchorage is associated with a relatively high risk of loss of microimplant stability because of inflammation developing in the surrounding soft tissues. The aim of this systematic review is to identify possible methods of orthodontic microimplant surface modifications providing antibacterial properties. The PubMed, Web of Science, Embase, and Cochrane Reviews databases were searched, and a literature review was conducted. The search was performed between 1 December 2024 and 31 December 2024. The authors used the PICO format to facilitate the search of abstracts and ensure that the relevant components of the question are well defined. The systematic review was written based on the principles detailed in PRISMA. The quality of the papers was assessed based on a tool developed by the authors. Three papers were rated Low Risk of Bias (RoB), four were rated Moderate RoB, and three were rated High RoB. All of the studies presented a method to increase the antibacterial properties of microimplants. More research with a unified methodology is necessary to confirm the effectiveness of the analyzed methods. ZnO, antibiotics, chlorhexidine, silver compounds, selenium, HA, and PEG polymerization plasma represent an interesting perspective for improving the antibacterial properties of orthodontic microimplants. Full article

Objective: Craniopharyngioma recurrence risk studies comparing gross total resection (GTR) vs. subtotal resection (STR) with radiotherapy (XRT) provide inconclusive or contradictory results. This may be an effect of the small group sizes and diversity in the approaches used. Currently, the endoscopic endonasal approach (EEA) is preferred in craniopharyngioma management. Here, we aimed to perform a meta-analysis comparing recurrence risk after GTR vs. STR plus XRT in patients treated with the EEA regimen. Methods: We performed a systematic literature search of original English language papers on craniopharyngioma management published in the PubMed, Web of Science, and Scopus databases up to 18 October 2023. Eleven articles included data on recurrence rate after EEA: GTR vs. STR with XRT. We extracted the year of publication, number of patients, surgical approach, extent of resection, and follow-up duration. We used meta-analysis for the odds ratio (OR) in fixed and random effects models and Egger’s and Begg’s tests to assess heterogeneity and publication bias. Follow-up duration and time to recurrence were additionally included in Kaplan–Meier curves with log-rank test analysis. Results: We observed a lower recurrence rate in patients after GTR (10%) as compared to STR with XRT (30%), OR = 0.299, p < 0.001. To increase data reliability, we limited our analysis to studies with at least five patients in each subgroup and also observed lower recurrence in patients after GTR (12%) as compared to STR with XRT (27%), OR = 0.376, p = 0.011. Survival analysis confirmed significant differences in recurrence-free survival percentages between these groups (p = 0.008). Conclusions: To date, this is the largest meta-analysis evaluating the recurrence risk in patients undergoing EEA for craniopharyngioma resection, comparing outcomes between those treated with GTR and those treated with STR plus XRT. The results suggest that GTR significantly reduces recurrence risk. Full article

Background: Tongue squamous cell carcinoma (TSCC) is an aggressive oral malignancy characterized by early submucosal invasion and a high risk of cervical lymph node metastasis. Accurate and timely diagnosis is essential, but it remains challenging when relying solely on conventional imaging and histopathology. This systematic review aimed to evaluate studies applying artificial intelligence (AI) in the diagnostic imaging of TSCC. Methods: This review was conducted under PRISMA 2020 guidelines and included studies from January 2020 to December 2024 that utilized AI in TSCC imaging. A total of 13 studies were included, employing AI models such as Convolutional Neural Networks (CNNs), Support Vector Machines (SVMs), and Random Forest (RF). Imaging modalities analyzed included MRI, CT, PET, ultrasound, histopathological whole-slide images (WSI), and endoscopic photographs. Results: Diagnostic performance was generally high, with area under the curve (AUC) values ranging from 0.717 to 0.991, sensitivity from 63.3% to 100%, and specificity from 70.0% to 96.7%. Several models demonstrated superior performance compared to expert clinicians, particularly in delineating tumor margins and estimating the depth of invasion (DOI). However, only one study conducted external validation, and most exhibited moderate risk of bias in patient selection or index test interpretation. Conclusions: AI-based diagnostic tools hold strong potential for enhancing TSCC detection, but future research must address external validation, standardization, and clinical integration to ensure their reliable and widespread adoption. Full article

Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article

Background: Despite growing interest in the literature on Parkinson’s disease (PD) on cognitive functioning, financial incompetence—a crucial aspect of daily living—and its modulation susceptibility by PD treatment regimens remains relatively understudied. Objective: This systematic review and meta-analysis aimed to synthesize existing evidence on how PD treatments affect financial capacity, assessing both direct financial competence and cognitive or behavioral proxies of financial decision-making. Methods: A comprehensive literature search according to PRISMA protocol was conducted across major biomedical databases, supplemented by gray literature and manual reference list checks. Eligible studies assessed financial capacity directly or indirectly through cognitive proxies (e.g., executive function, decision-making) or financial risk behaviors (e.g., impulse control disorders). Two separate meta-analyses were performed. Heterogeneity (I²), publication bias (Egger’s test), and sensitivity analyses were conducted to assess robustness. Results: Twenty-three studies met inclusion criteria. One study directly measured financial capacity and was analyzed narratively, reporting diminished competence in patients on levodopa therapy. A meta-analysis of cognitive proxies (10 studies) showed a moderate effect size (Hedges’ g = 0.70, 95% CI [0.45, 0.92], p < 0.001), indicating that PD treatments negatively affect executive function and financial decision-making. A second meta-analysis of impulse control and financial risk behaviors (12 studies) revealed a larger effect size (Hedges’ g = 0.98, 95% CI [0.75, 1.22], p < 0.001), strongly linking dopamine agonists to increased financial risk-taking. Moderate heterogeneity (I² = 45.8–60.5%) and potential publication bias (Egger’s test p = 0.027) were noted. Conclusions: These findings suggest that PD treatments negatively impact financial decision-making both directly and indirectly through cognitive and behavioral pathways. Integrating financial decision-making assessments into PD care, particularly for patients on dopamine agonists, is recommended. Future research should prioritize longitudinal studies and standardized neuropsychological measures to guide clinical practice and optimize patient outcomes. Full article

Short sleep has been linked to overweight, possibly via alterations in appetite-regulating hormones, but findings are inconsistent. Sex differences may contribute to this variability. This systematic review examines whether sex modifies the hormonal response to sleep curtailment. PubMed, Embase, Cochrane, CINAHL, and PsycINFO were searched for English-language experimental studies published before December 2024. Included studies assessed at least one appetite-regulating hormone and presented sex-specific analyses. Studies involving health conditions affecting sleep, circadian misalignment, or additional interventions were excluded. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (RoB 2). Eight studies (n = 302 participants) met inclusion criteria. A narrative synthesis of the findings was conducted for each hormone separately to explore potential differences in their response to sleep restriction. Some sex-related variations in hormonal response to sleep restriction have been observed for leptin (four studies, n = 232), insulin (three studies, n = 56), glucagon-like peptide-1 (one study, n = 27), ghrelin (three studies, n = 87), adiponectin (two studies, n = 71) and thyroxine (two studies, n = 41). However, findings were inconsistent with no clear patterns. No sex-related differences were found for glucagon or PYY, though data were limited. Findings suggest sex may influence hormonal responses to sleep restriction, but inconsistencies highlight the need to consider factors such as BMI and energy balance. Well-controlled, adequately powered studies are needed to clarify these effects. Full article

Current research reported that the number of clinical studies found for botulinum toxin (BoNT) key effects on biochemical biomarkers in head and neck chronic conditions linked to inflammation was very low. There are no systematic reviews of animal studies on this topic, and hence our review aimed to evaluate the quality of the preclinical evidence. We searched PubMed, Scopus, and Web of Science databases, and registries up to 29 January 2024. There were 22 eligible records, and data were available for 11 randomised controlled trials. There were concerns about the risk of bias and great variations of data obtained regarding chronic conditions, which included mostly trigeminal neuralgia. The leading biomarkers were proinflammatory cytokines (IL-1β, TNF-α) and synaptosomal-associated protein-25 (SNAP25), followed by neuron activation marker c-Fos and calcitonin gene-related peptide (CGRP). Overall, data found that BoNT significantly altered the under/over-expression of biomarkers evoked by the investigated disease models and had no effect when the levels of these biomarkers were not changed by the induced chronic conditions in animals. However, there were some mixed results and exceptions, and the certainty evidence found was very low to low. Although the sample sizes detected significant effect size (p < 0.05), most studies are based on male inferior animals, which may limit the recommendations for clinical trials. This study is registered on PROSPERO (CRD42023432411). Full article

Background/Objectives: Biofeedback interventions are increasingly utilized in pediatric and adult care, with evidence in treating specific medical conditions and specific symptoms. However, evidence supporting their efficacy among children and adolescents and young adults (AYAs, aged 15–39) with cancer is limited. The aims of this systematic review are to present, assess, and synthesize the existing research on biofeedback in pediatric and AYA oncology, identify gaps in biofeedback research within this population, and provide recommendations for future research and clinical implications. Methods: A systematic search for articles was conducted using six bibliographic databases—PubMed/MEDLINE (NLM), EMBASE (Elsevier), CINAHL (EBSCO), SPORTDiscus (EBSCO), PsycINFO (OVID), and PEDro (NeuRA)—with an update on 5/7/2025. Included were studies involving pediatric/AYA oncology participants (0–39 years old) and those receiving at least one biofeedback modality. The methodological quality and risk of bias among included articles were assessed using the Cochrane Risk of Bias (ROB) Tool (modified version for non-randomized studies). A narrative synthesis of included studies examined the type of cancer studied, type of biofeedback used, study designs and methodological quality, and key outcomes evaluated. Results: While the literature suggests that biofeedback may offer beneficial outcomes for managing various pediatric/AYA oncology-related symptoms, such as pain, anxiety, and fatigue, only 8 studies out of 1013 screened (<1%) met inclusion criteria. Limitations included low study quality (small sample sizes, lack of control groups, and methodological inconsistencies). Conclusions: While biofeedback shows promise as a feasible and effective intervention, there is a call to action for well-designed, methodologically rigorous studies to substantiate its effectiveness and inform evidence-based practice specifically for pediatric/AYA oncology patients and clinicians. Full article

Compassion Focused therapy (CFT) is designed to reduce shame (internal and external) and self-criticism while enhancing the three flows of compassion (compassion to others, from others, and for the self). This systematic review evaluated the effectiveness of CFT on these core theoretical constructs in adult clinical populations. A systematic search of three databases (2000–2024) identified 21 studies (N = 450) meeting the inclusion criteria. The studies were narratively synthesised, and quality was assessed using the EPHPP tool. Consistent improvements in self-compassion (g = 0.23–4.14) and reductions in self-criticism (g = 0.29–1.56) were reported. Reductions in external shame were also observed (g = 0.54–1.22), though this outcome was examined in fewer studies. Limited and inconsistent evidence was found for internal shame and interpersonal compassion flows (compassion to and from others), with only a small number of low- to moderate-quality studies addressing these outcomes. Follow-up effects were rarely assessed, and comparator groups were limited. Most interventions were group-based and of variable methodological quality, with frequent selection bias, small sample sizes, and limited demographic diversity. Overall, CFT shows promise for targeting self-directed processes in clinical populations, though stronger evidence is needed to understand its effects on relational components of compassion. Future research should adopt standardised measures, improve methodological rigour, and recruit more diverse samples. Full article