Search Results (8,594)

Electronic cigarettes (e-cigarettes) have gained widespread diffusion as a perceived safer alternative to conventional smoking, particularly among women of reproductive age. The present systematic review provides an overview of the current literature on the effects of e-cigarette exposure on female reproductive function, embryonic development, and pregnancy outcomes, with a focus on underlying molecular mechanisms. A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar, and the review was conducted in accordance with the PRISMA 2020 guidelines. A total of 11 studies met the eligibility criteria and were included in the qualitative synthesis, comprising six experimental and five clinical studies. Experimental studies suggest that e-cigarette exposure may impair ovarian function, leading to morphological alterations, disrupted folliculogenesis, and altered steroidogenesis, mainly through oxidative stress, apoptosis, mitochondrial dysfunction, and dysregulation of pathways such as Hippo signaling. Non-nicotine components, including propylene glycol (PG), vegetable glycerin (VG), and flavoring agents, appear to be key contributors. Adverse effects on implantation, embryo development, and placental growth have also been reported in experimental models, although further studies are needed. Clinical evidence remains scarce, suggesting possible associations between e-cigarette smoking and reduced ovarian reserve and fecundability in naturally conceiving women. No conclusive associations have been identified with in vitro fertilization outcomes. Overall, e-cigarette exposure may negatively affect female reproductive function, although the predominance of experimental data and the limited clinical evidence preclude definitive conclusions. Full article

Background/Objective: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy are the standard first-line treatment for HR+/HER2− advanced/metastatic breast cancer (a/mBC), yet no head-to-head randomized trials have compared palbociclib, ribociclib, and abemaciclib. This systematic literature review (SLR) aimed to synthesize available real-world evidence (RWE) on the comparative effectiveness of these three CDK4/6i in the first-line setting. Methods: An SLR was conducted following PRISMA guidelines. Searches of MEDLINE, Embase, Cochrane, and gray literature (January 2015–September 2025) identified RWE studies reporting real-world progression-free survival (rwPFS) and/or overall survival (OS) for first-line CDK4/6i regimens. Eligible studies included adults with HR+/HER2− a/mBC receiving palbociclib, ribociclib, or abemaciclib, combined with endocrine-based therapy. Comparative outcomes were summarized qualitatively; study quality was assessed using the Newcastle–Ottawa Scale, ISPOR-AMCP-NPC questionnaire, and ESMO-GROW checklist. Results: From 13,345 records, 39 publications (32 unique studies) were identified, of which 21 were full-text studies meeting inclusion criteria. Most included studies used retrospective cohort designs, and approximately 50% evaluated all three CDK4/6is. Given the comparative nature of the included studies, quality issues were found to be related to study design and analytical approaches. Several analyses were unadjusted, and reporting of follow-up duration varied across studies, with some analyses providing incomplete follow-up information. Study sample sizes differed substantially across agents, with smaller populations generally reported for ribociclib and abemaciclib. Among the studies reporting rwPFS hazard ratios (HRs), 8/11 studies showed comparable rwPFS and 5/6 studies reported comparable OS outcomes between CDK4/6i regimens. Three full-text studies reported HRs favoring ribociclib or abemaciclib relative to palbociclib; these analyses primarily included populations receiving palbociclib, with smaller comparator cohorts for ribociclib and abemaciclib, as well as varied follow-up times. Conclusions: Most real-world studies included in the SLR suggested similar effectiveness of the three CDK4/6is in first-line HR+/HER2− a/mBC. Heterogeneity in patient characteristics, definitions of outcomes, follow-up time, sample size, and statistical approach may have important implications on study interpretability. Full article

Alcohol-related liver disease (ALD) and metabolic dysfunction and alcohol-related liver disease (MetALD) are increasingly recognised as biologically heterogeneous conditions, but circulating novel adipokines have not been systematically synthesised in this setting. We searched PubMed/MEDLINE, Embase, Web of Science, Scopus and Cochrane CENTRAL from inception to 31 December 2025 for studies measuring chemerin, visfatin/nicotinamide phosphoribosyltransferase (NAMPT), vaspin, omentin-1 or retinol-binding protein 4 (RBP-4) in adults with ALD or MetALD; data were synthesised narratively using Synthesis Without Meta-Analysis (SWiM). Grey literature and non-English databases were not searched, which may have led to incomplete retrieval of small single-centre studies. Five studies were included. Direct ALD evidence came mainly from three cross-sectional alcoholic cirrhosis cohorts, while one population cohort linked baseline RBP-4 to incident MetALD/ALD. RBP-4 showed a phase-dependent pattern, increasing before incident MetALD/ALD but decreasing in established cirrhosis with impaired synthetic function. Chemerin was reduced, omentin-1 was markedly elevated, vaspin was nonspecific and historical visfatin/NAMPT assays were difficult to interpret. Current evidence supports a hypothesis-generating three-axis framework: hepatic source failure, impaired hepatic clearance/portal-systemic shunting and alcohol-driven adipose-liver inflammation. The available evidence chiefly reflects chronic alcohol-related cirrhosis together with limited incident MetALD/ALD risk data, rather than the full ALD/MetALD spectrum. Prospective MetALD-stratified cohorts with isoform-specific assays and objective alcohol biomarkers are required. Full article

Background/Objectives: Non-suicidal self-injury (NSSI) in adolescence is associated with emotion dysregulation, experiential avoidance, psychiatric morbidity, and later suicidal risk. Interventions based primarily on acceptance and commitment therapy (ACT) target psychological flexibility, acceptance, cognitive defusion, and values-based action, whereas emotion regulation individual therapy for adolescents (ERITA) and internet-delivered emotion regulation individual therapy for adolescents (IERITA) principally target emotion dysregulation while incorporating selected acceptance-related and ACT-consistent components, making these approaches theoretically relevant to adolescent NSSI. Methods: We conducted a systematic review and exploratory meta-analysis informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed, Scopus, Web of Science, and EBSCO were searched on 10 April 2026. Eligible studies included adolescents or predominantly adolescent samples in which NSSI was the central clinical target or NSSI-specific outcomes were separately extractable and evaluated primarily ACT, ACT-informed, acceptance-based, ERITA, or IERITA interventions. Quantitative syntheses were restricted to controlled studies with extractable data. Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and dedicated regional or gray literature sources were not searched; 15 reports remained unretrieved, so the evidence base may be incomplete. Results: Six full-text primary adolescent NSSI intervention studies met inclusion criteria: two controlled primarily ACT studies, one randomized ERITA feasibility trial, two uncontrolled ERITA feasibility/open studies, and one randomized IERITA trial. The strongest single-study evidence came from therapist-guided IERITA, which reduced masked assessor-rated NSSI frequency more than treatment as usual, with an incidence rate ratio of 0.34 (95% confidence interval [CI] 0.20 to 0.57). Two-study exploratory random-effects syntheses yielded estimates in the direction of benefit for continuous NSSI outcomes, Hedges’ g = −0.45 (95% CI −0.85 to −0.05; k = 2), and process outcomes, Hedges’ g = 1.25 (95% CI 0.83 to 1.68; k = 2). These estimates are hypothesis-generating and imprecise as estimates of a generalizable treatment effect because each synthesis contained only two clinically and methodologically heterogeneous studies. Although I² was 0% in both syntheses, these estimates are highly uncertain with only two studies and should not be interpreted as evidence of true homogeneity. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, certainty was moderate for the single masked clinician-rated IERITA outcome and very low for the pooled continuous NSSI and process-outcome evidence. Conclusions: Primarily ACT, ERITA, and IERITA interventions may be promising for adolescent NSSI, but the evidence remains preliminary and mostly of very low certainty. The pooled estimates are exploratory, hypothesis-generating, and imprecise and should not be interpreted as evidence of treatment efficacy. The strongest single-study evidence concerns therapist-guided IERITA and was rated as moderate in certainty, whereas the evidence for primarily ACT interventions and pooled process outcomes was very low in certainty and requires confirmation in larger preregistered randomized trials with standardized outcomes, longer follow-up, active comparators, and process measures. Full article

Dysgeusia is a clinically consequential, but still under-standardized, toxicity of cancer treatment. In the immunotherapy era, taste disturbances are increasingly relevant for patients receiving immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapies and T-cell-redirecting bispecific antibodies, with G protein-coupled receptor family C group 5 member D (GPRC5D)-directed treatment in multiple myeloma representing a particularly instructive high-burden model. We performed a structured critical narrative review with evidence mapping. PubMed/MEDLINE was searched from database inception to June 2026, complemented by citation tracking in Google Scholar, ClinicalTrials.gov searches and guideline documents relevant to oncology nutrition, oral supportive care and cancer-related taste dysfunction. Search concepts covered cancer-related dysgeusia, immunotherapy-associated oral toxicity, GPRC5D/talquetamab-associated dysgeusia, oncology nutrition, oral–gut microbiome biology, natural taste modulators and miraculin-based interventions. Dysgeusia can reduce appetite, food enjoyment, dietary diversity and protein energy intake, thereby contributing to weight loss, malnutrition risk, distress, social withdrawal and, in severe cases, treatment modification or discontinuation. Available evidence is heterogeneous: general cancer-treatment-associated dysgeusia is supported by broader observational and interventional literature; immunotherapy-associated dysgeusia is less systematically characterized; and GPRC5D/talquetamab-associated dysgeusia represents the most clinically visible and target-specific immunotherapy-associated phenotype. Emerging pilot data suggest that dried miracle berry or miraculin-containing products may improve selected taste perception and nutritional parameters in cancer-related dysgeusia, but direct evidence in immunotherapy-associated dysgeusia is not yet established. We, therefore, propose a claim-disciplined precision supportive-care framework integrating systematic taste phenotyping, early nutritional risk assessment, oral health evaluation, microbiome-aware but hypothesis-generating endpoints, individualized flavor and texture adaptation, cautious use of natural taste modulators in selected patients and iterative monitoring of patient-centered outcomes. Future trials should test whether dysgeusia-focused nutritional and taste-modulating supportive care interventions can improve intake, quality of life and treatment persistence without compromising immunotherapy safety or efficacy. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects nearly one-fourth of the world population and is closely linked to obesity, metabolic syndrome, and poor diet. We conducted a systematic review and meta-analysis to evaluate the impact of exercise on key clinical outcomes in MASLD patients. Methods: A systematic literature search was conducted until 202 September 5, to identify randomized controlled trials (RCTs), post-hoc analyses, and quasi-experimental designs comparing exercise versus standard therapy in MASLD. A random-effects model pooled data as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). Analyses were conducted using R (version 4.5.1). Results: Our meta-analysis included 21 RCTs, 4 post-hoc analyses, and 1 quasi-experimental study (1124 patients; mean age 52.24 ± 7.24 years). Exercise reduced BMI (MD −0.82), serum cholesterol (MD −14.31), ALT (MD −6.56), AST (MD −5.32), FIB-4 (MD −0.19), and NAFLD fibrosis score (MD −0.59), and increased HDL (MD 4.36) versus standard therapy. Weight (MD −2.11) and HOMA-IR (MD −0.59) were not significantly different. Meta-regression showed age increased HOMA-IR (estimate 0.032) and higher BMI reduced HDL (estimate −0.71). Conclusions: Exercise significantly improves key clinical outcomes in MASLD, including BMI, cholesterol, liver enzymes, and fibrosis markers, supporting physical activity as a core component of MASLD management. Full article

Energy is fundamental to economic development and human well-being, yet its consumption patterns remain highly complex and influenced by a wide range of factors. This systematic literature review aims to comprehensively examine the determinants of energy consumption in the residential, commercial, and industrial sectors to promote sustainable use and support efforts to alleviate energy poverty. A structured search was conducted across three major databases: PubMed, Scopus, and Web of Science, for peer-reviewed articles published in English between January 2014 and July 2025. Seventy-three eligible studies were identified. The results reveal a significant research imbalance: 72 eligible studies were identified over the 11-year period, of which approximately 77% focused on the residential sector, while the commercial and industrial sectors, despite accounting for more than half of the global energy use and CO₂ emissions, remain underexplored. Moreover, existing studies are largely concentrated in developed and major emerging economies such as the United States (U.S.) and China, with minimal attention given to the Global South, where energy poverty is most severe. This review highlights the critical need for more inclusive and sectorally balanced research to uncover inefficiencies, inform effective policy interventions, and guide equitable energy transitions. Understanding the full spectrum of factors influencing energy use across all sectors and geographic contexts is essential to achieving global energy sustainability and addressing disparities in energy access. Full article

Background: Artificial intelligence (AI) is increasingly entering hospital practice through diagnostic, predictive, workflow, operational, and generative applications. Hospitals often govern these systems as procurement or information-technology projects rather than as clinical–organizational interventions requiring indication, evaluation, monitoring, accountability, and withdrawal. Objective: To refine the concept of an “AI Hospital Formulary” as an operational, proportional, and accountable framework for the safe, equitable, and sustainable adoption of hospital AI. Design and Methods: This is a perspective article using a structured, non-systematic narrative synthesis and conceptual framework development. Targeted literature and policy sources were identified through purposive searches and citation chaining through 20 July 2026. The synthesis compares the formulary with existing oversight approaches, maps its lifecycle gates to regulatory and risk management duties, and applies the framework to a worked example based on published evaluations of the Epic Sepsis Model. The EQUATOR reporting-guideline selection tool was consulted, and SANRA was used to strengthen the narrative synthesis component. Framework: The revised framework combines a hospital-wide AI register, a standardized formulary monograph, six lifecycle gates, proportional review pathways, governance-of-governance safeguards, cloud and data-sovereignty controls, continuous monitoring of technical and behavioral feedback loops, and explicit renewal or deprescribing criteria. The worked example shows how version-specific evidence can lead to local validation, controlled implementation, restriction, suspension, or renewal rather than automatic adoption. Conclusions: Hospitals should not merely purchase, install, and update AI systems. They should prescribe, monitor, audit, renew, restrict, and, when necessary, deprescribe them. The AI Hospital Formulary is proposed as a complementary institutional layer that converts external standards and existing governance approaches into documented portfolio decisions at the hospital level. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in youth mental health services, including clinical decision support, risk prediction, and digital therapeutics. However, existing frameworks provide limited guidance for integrating ethical, cultural, and relational considerations into the design, governance, and implementation of AI-enabled mental health technologies. This scoping review examined how digital humanities-informed approaches have been incorporated into AI-supported mental health interventions for children and adolescents. Methods: A scoping review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Peer-reviewed literature published between 2015 and 2025 was searched using PubMed and supplemented by semantic searches through Elicit. Systematic reviews, scoping reviews, and meta-analyses examining AI-enabled digital mental health interventions and digital humanities perspectives were included. Data were synthesized using inductive thematic analysis. Results: Seventeen review-level studies met the inclusion criteria. Six recurring themes were identified: engagement, participatory co-design, human oversight, equity, ethical governance, and implementation. Across the included reviews, humanities-informed approaches were associated with greater attention to relational engagement, stakeholder participation, transparency, contextual adaptation, and culturally responsive implementation. Evidence supporting intervention effectiveness was strongest in systematic reviews and meta-analyses, whereas findings related to ethics, governance, equity, and implementation were derived primarily from scoping reviews and conceptual syntheses. Conclusions: This review suggests that digital humanities provides a valuable interdisciplinary perspective for informing the design, governance, and implementation of AI-enabled youth mental health interventions. Although the current evidence base remains heterogeneous, integrating humanities-informed approaches may support the development of AI systems that are more ethical, equitable, and developmentally responsive. Future research should evaluate these approaches through empirical implementation studies and emerging generative AI applications. Full article

Introduction: Acute subdural hematoma (aSDH) represents one of the most lethal and debilitating forms of traumatic brain injury (TBI) encountered in neurosurgical emergency settings, carrying high mortality rates and severe long-term functional deficits. Historically, the timing of surgical decompression has been considered a critical modifiable prognostic factor. However, contemporary evidence regarding the relationship between time to surgery and clinical outcomes remains inconsistent. This systematic review and meta-analysis evaluates the impact of surgical timing on mortality and functional status in adult patients undergoing evacuation for acute subdural hematoma. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO. A database search was performed across PubMed, Scopus, Embase and Web of Science for relevant studies published between 2009 and 2026. Peer-reviewed cohort studies and clinical trials including adults (>18 years) with CT- or MRI-confirmed aSDH were included. Data extraction focused on baseline characteristics, surgical timing thresholds, and primary outcomes of mortality and functional status assessed using the Glasgow Outcome Scale (GOS). Methodological quality was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: The search identified 1815 records, of which six studies, including 926 patients, met the inclusion criteria. Meta-analysis found no statistically significant association between time to surgery and mortality (RR 1.01, 95% CI [0.69, 1.48], p = 0.96; RD −0.02, 95% CI [−0.19, 0.15]). High statistical heterogeneity was observed (I² = 80%) across the included cohorts. Most studies indicated that patients who underwent rapid neurosurgical intervention frequently presented with significantly worse baseline neurological status, which acts as a primary confounding factor and drives poorer prognostic trends. Conclusions: While historical paradigms emphasize a 4h period for subdural hematoma evacuation, our meta-analysis indicates that a straightforward linear relationship between time to intervention and improved survival or functional outcome is absent in contemporary clinical studies. Surgical timing thresholds must be interpreted cautiously, as the decision-making process is heavily guided by clinical triage bias, where rapidly deteriorating patients are prioritized for urgent decompression. Crude timing thresholds do not reflect a lack of causal benefit of early intervention but rather highlight the profound confounding by indication embedded in contemporary neurotrauma literature. Future multicenter investigations adjusting for admission severity, pupillary reactivity, associated intracranial pathology and other confounding factors are crucial to isolate the true prognostic value of surgical timing in aSDH. Full article

Timely graduation, time-to-degree, and degree completion are key indicators of student progression and institutional effectiveness in higher education. This study presents a PRISMA-based systematic literature review of machine learning approaches for graduation-related prediction, with attention to predictive targets, pipeline components, scalability, and bio-inspired optimization. Searches in Web of Science Core Collection and Scopus identified 278 records, of which 25 studies published between 2021 and 2025 met the eligibility criteria. The findings show that most studies formulated graduation prediction as a supervised classification task, relied heavily on academic performance variables, and frequently used tree-based or ensemble models. Feature selection, explainability, and hyperparameter optimization were commonly reported, but bio-inspired optimization was actively implemented in only two studies through Particle Swarm Optimization, Genetic Algorithms, or Ant Colony Optimization. The evidence base also remains limited in scalability, as most studies used single-institution datasets and provided little external validation. These findings identify an opportunity for Bio-Inspired Educational Analytics through scalable feature selection, efficient hyperparameter optimization, model simplification, and multi-objective trade-off analysis. Future research should evaluate whether lightweight, hybrid, and multi-objective metaheuristics can support accurate, interpretable, fair, and transferable graduation prediction systems. Full article

Background/Objectives: Colitis involves both local intestinal damage and systemic dysfunction, driven by oxidative stress and immune imbalance. Histamine, acting through its receptors, influences these processes, yet its therapeutic relevance in colitis remains unclear. This review systematically examines histamine-mediated signaling in colitic inflammation and evaluates preclinical and clinical data on antihistamines to assess their potential as a mechanism-based treatment. Methods: A structured literature search was conducted using PubMed and Google Scholar to identify studies addressing histamine signaling and the use of antihistamines in colitis, using keywords such as “colitis,” “histamine,” “histamine receptors,” and “antihistamines.” Relevant experimental and clinical studies were screened and critically analyzed to provide an integrated overview of mechanistic and therapeutic insights. This review was designed as a mechanistic narrative synthesis based on a structured search and qualitative appraisal rather than a formal systematic review with quantitative risk-of-bias grading. Results: Findings from preclinical investigations consistently indicate that pharmacological manipulation of histamine signaling—especially through H3 and H4 receptor subtypes—reduces inflammatory activity and modulates oxidative balance in animal models of colitis. Conversely, clinical evidence concerning H1 and H2 receptor antagonists remains scarce and discordant, lacking sufficient support for a definitive causal relationship or unambiguous therapeutic efficacy. Importantly, no clinical studies to date have assessed the effects of selective H3 or H4 receptor blockers in individuals with colitis, revealing a substantial disconnect between bench research and bedside application. Existing human trials have mainly concentrated on mucosal endpoints, with little attention paid to systemic manifestations or oxidative stress-related parameters. Conclusions: Histamine-dependent signaling constitutes a mechanistically credible target in colitis, connecting immune activation, impairment of the epithelial barrier, and oxidative injury. Although experimental data are encouraging, clinical corroboration remains absent. Antihistamines may hold greater promise for alleviating systemic oxidative stress than for directly ameliorating intestinal inflammation. Rigorously designed clinical trials that incorporate both gastrointestinal and systemic outcome measures are necessary to elucidate their therapeutic position. Full article

Background/Objectives: Pain and psychosocial distress are highly prevalent across acute and chronic medical conditions and may negatively affect quality of life, treatment adherence, and clinical outcomes. Green light therapy has emerged as a non-pharmacological intervention that may modulate neural, inflammatory, and sensory pathways involved in nociception and affective processing. This systematic review evaluated the current human evidence on green light therapy for pain, with consideration of pain-related psychosocial outcomes. Methods: A systematic search was conducted in PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for English-language human interventional studies of green light therapy reporting pain. Records were screened in Covidence by independent reviewers using predefined eligibility criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized studies and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Results: Of 2040 citations identified, 13 studies met inclusion criteria (9 randomized controlled trials, 4 non-randomized studies; 668 participants). Clinical populations included migraine, dental anxiety, fibromyalgia, autism spectrum disorder, and retinal examination discomfort. Most studies reported findings favoring green light, providing an encouraging evidence base that would be strengthened by future blinded, controlled designs. Certainty of evidence was very low for all outcomes across both comparisons. Conclusions: Preliminary evidence suggests green light therapy is a promising and accessible nonpharmacological approach for pain or pain-related psychosocial outcomes but remains insufficient to establish the efficacy of green light therapy. Well-designed, adequately powered, pre-registered, sham-controlled trials with blinded outcome assessment represent a clear and achievable path toward establishing its clinical role. Full article

Background/Objectives: Chronic orofacial pain represents a heterogeneous group of disorders affecting the trigeminal system and remains difficult to treat due to its complex pathophysiology, which involves glial cells in the development and maintenance of persistent pain states. This systematic review aimed to synthesize evidence from animal studies investigating the pathophysiological role of glial cells in chronic orofacial pain. Methods: After registering on PROSPERO, a systematic search of the literature, based on PRISMA guidelines, was conducted to identify experimental animal studies evaluating glial involvement in orofacial pain models. After screening and eligibility assessment, 10 studies met the inclusion criteria. Data regarding experimental models, glial populations investigated, and pain-related behavioral outcomes were extracted and qualitatively synthesized. Results: Activation of satellite glial cells, microglia, and astrocytes was consistently associated with increased neuroinflammatory signaling and enhanced neuronal excitability within trigeminal pathways, demonstrating that both peripheral and central nervous tissues were involved. Several studies reported that pharmacological modulation of glial activity may reduce pain-related behaviors. Conclusions: Glial cells are key modulators of chronic orofacial pain through neuroimmune interactions that contribute to peripheral and central sensitization. Although these findings highlight promising therapeutic targets, further translational research is required to clarify their relevance for human pain conditions. Full article

Endometriosis is a chronic gynecological disease affecting about 10% of reproductive age women, with a significant impact on socio-economic sphere and quality of life. It is a multifactorial phenomenon, in which genetic predisposition, immunologic malfunction, hormone imbalance, and environmental insult play an important role in disease development and progression. The aim of this review is to report the current evidence from the literature related to the association between endometriosis and endocrine disruptors. This study was designed as a systematic review and meta-analysis investigating the association between exposure to endocrine disruptors and the risk of endometriosis. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The systematic search identified 428 records from national and international scientific databases. The included studies were published between 2001 and 2020, with most studies classified as fair-to-good quality. The overall random-effects meta-analysis demonstrated a statistically significant association between exposure to endocrine-disrupting chemicals and endometriosis. This systematic review and meta-analysis provides evidence of a significant association between exposure to endocrine-disrupting chemicals and endometriosis, with the strongest and most consistent association observed for polychlorinated biphenyls. Full article