Search Results (1,433)

Background/Objectives: Thread-embedding acupuncture (TEA) involves the implantation of suture threads into therapeutic points for sustained stimulation; however, its safety evidence remains limited. This systematic review and meta-analysis evaluated adverse events (AEs) associated with TEA to establish its safety profile. Methods: Ten databases were searched up to April 5, 2026 for randomized controlled trials (RCTs) of TEA. Reported AEs were standardized using MedDRA terminology, WHO-UMC causality criteria, and CTCAE version 5.0. Pooled incidence proportions were estimated using generalized linear mixed models, and risk ratios (RRs) were pooled using random-effects models with 95% confidence intervals (CIs). Results: Of the 90 RCTs included, most were conducted in China (81, 90.0%). For TEA monotherapy, pooled AE incidence proportion was 3% (95% CI: 2–7%; I² = 53.7%). Local AEs were most common (111, 5.9%), followed by systemic (5, 0.3%) and other AEs (2, 0.1%). Among 118 participants with AEs, most were classified as Grade 1 (95, 80.5%), with Grade 2 (8, 6.8%) and unassessable cases (15, 12.7%). In comparative analyses, TEA showed no significant increase in AE risk versus sham TEA (RR: 1.15, 95% CI: 0.83–1.60), acupuncture (RR: 0.97, 95% CI: 0.64–1.49), or conventional medicine (RR: 0.28, 95% CI: 0.18–0.45). Only one serious TEA-related AE was reported among 1697 participants (0.06%); the withdrawal rate due to TEA-related AEs was 0.36% (9/2524). Conclusions: TEA demonstrated a favorable safety profile when used alone or as an add-on therapy, with most AEs mild and transient. However, inconsistencies in AE definitions and reporting highlight the need for standardized terminology and more rigorous safety evaluation in future studies. Full article

Background: Frailty complicates anticoagulation management in older patients with atrial fibrillation (AF), particularly when long-term vitamin K antagonist (VKA) therapy is already established. Whether switching to a direct oral anticoagulant (DOAC) improves outcomes in this setting remains uncertain, and guideline recommendations are limited. We performed a systematic review and meta-analysis comparing outcomes of VKA-to-DOAC switching versus VKA continuation in frail elderly patients with AF. Methods: MEDLINE, Scopus, and the Cochrane Library were systematically searched from inception through 4 April 2026. Studies enrolling frail elderly patients with AF receiving VKA therapy and directly comparing switching to a DOAC versus continued VKA treatment were eligible. The primary outcome was a composite of stroke/systemic embolism, major bleeding, or all-cause mortality. Adjusted hazard ratios (HRs) were pooled using three-level random-effects models. Results: Four studies (five treatment comparisons) comprising 57,099 patients were included. Overall, switching from VKA to DOAC therapy was not associated with a significant difference in the composite outcome compared with continued VKA treatment (HR 1.18, 95% CI 0.84–1.67). No significant differences were observed for major bleeding (HR 1.13, 95% CI 0.80–1.60), thromboembolism (HR 1.03, 95% CI 0.63–1.68), or all-cause mortality (HR 0.95, 95% CI 0.77–1.16). In analyses restricted to randomized trials, results remained neutral across all outcomes. Conclusion: In frail elderly patients with AF receiving VKA therapy, switching to a DOAC was not associated with significant reductions in thromboembolism, major bleeding, mortality, or the composite outcome compared with continued VKA treatment. Full article

Sechium edule (Jacq.) Sw. (chayote), a neglected and underutilized Cucurbitaceae crop widely cultivated across tropical and subtropical regions, has drawn growing interest as a source of health-promoting food components. This review critically synthesizes studies published between 2000 and 2026 on its botanical features, genome characterization, nutritional value, phytochemistry, bioactivities, safety, and food-industry applications, based on literature retrieved from PubMed, Scopus, Web of Science, ScienceDirect, and the Cochrane Library. Different plant parts (fruits, leaves, seeds, tuberous roots, and peels) contain diverse bioactive compounds, including flavonoids, phenolic acids, cucurbitacins, pectin polysaccharides, and carotenoids. Reported bioactivities include antioxidant, anti-inflammatory, hypoglycemic, cardioprotective, antiproliferative, and geroprotective effects, mediated in part through Nrf2-mediated antioxidant signaling and sirtuin (SIRT1/3/5/6) upregulation. Notably, a systematic meta-analysis demonstrated a significant reduction in serum glucose (MD = −20.56; 95% CI: −29.35 to −11.77) and HbA1c following three months of chayote intake in patients with metabolic syndrome and type 2 diabetes. Industrially, chayote has been developed into fermented products, starch- and peel-derived bioactive films, ultrasound-extracted pectin, α-amylase inhibitory seed protein isolates, and probiotic encapsulation systems. Recent genomic work has further revealed a chromosome-level genome assembly, whole-genome duplication events, and a domestication history tracing to Mexico’s Oaxaca region. Collectively, this evidence positions chayote as a promising underutilized resource for food, nutraceutical, and biomedical use, while highlighting key gaps: the need for standardized clinical trials, bioavailability studies, and comprehensive safety evaluation. Full article

Aging frailty is a multifactorial geriatric syndrome characterized by reduced physiological reserve across multiple interrelated systems, leading to increased vulnerability to adverse health outcomes. Mesenchymal stem cells (MSCs) have emerged as a potential therapeutic intervention due to their immunomodulatory and regenerative properties. This systematic review aimed to evaluate the available clinical evidence regarding the safety and efficacy of MSC administration in individuals with aging frailty. A systematic literature search was conducted in PubMed, Scopus, and the Cochrane Library from database inception to 15 April 2026. Only randomized controlled trials (RCTs) were eligible. Data were extracted according to study design, participants’ characteristics, MSC source and dosing, safety outcomes, functional performance measures, quality of life (QoL) indices, and inflammatory, immune, and vascular biomarkers. Three RCTs met the inclusion criteria, comprising a total of approximately 208 participants. MSC administration was well-tolerated, with no treatment-related serious adverse events reported. Signals of improvement were reported in mobility-related and physical performance outcomes, although the magnitude and consistency of the response varied across studies. A dose-dependent increase in 6 min walk distance was observed at nine months in one trial, while improvements in SPPB, TUG, and grip strength were reported in the other studies. Additionally, MSC therapy was associated with QoL improvement and reduction in circulating pro-inflammatory cytokine concentrations. MSC administration was also associated with changes in immune-cell activation and a dose-dependent reduction in circulating sTIE2. Because of substantial clinical and methodological heterogeneity among the included trials, a quantitative meta-analysis was not performed. Current randomized evidence remains limited but suggests that intravenous MSC therapy is generally well tolerated in older adults with aging frailty and may produce clinically relevant signals of improvement in mobility-related functional outcomes, quality of life, and selected inflammatory, immune, and vascular biomarkers. However, the small number of trials, heterogeneity in MSC source, dose, endpoints, and follow-up duration, and the exploratory nature of much of the evidence preclude definitive conclusions regarding efficacy. Larger, adequately powered trials with standardized frailty endpoints are required, while future trials specifically targeting sarcopenia should apply consensus diagnostic criteria and direct measures of muscle quantity, strength, and physical performance. Full article

Background: The immune landscape in head and neck squamous cell carcinoma (HNSCC) has been widely investigated. However, the crucial role played by the lymph node microenvironment in metastatic and non-metastatic HNSCC remains unknown. This systematic review aims to discuss the immunological crosstalk between the tumor and the nodal microenvironment and to describe the distribution of immune cells in metastatic and non-metastatic lymph nodes. Methods: A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus, and the Cochrane Library were searched for studies published between 1990 and 2025, with the final search performed in December 2025. Prospective and retrospective studies evaluating immune cell infiltration in metastatic and non-metastatic cervical lymph nodes were included, whereas studies focusing exclusively on non-cellular biomarkers and non-English publications were excluded. The risk of bias was assessed using the Newcastle–Ottawa Scale. The results were synthesized narratively, and no meta-analysis was performed. Results: The screening process identified 608 articles, of which 27 met our predefined inclusion criteria. These studies focused on macrophages, dendritic cells, neutrophils, natural killer cells, T helper cells, cytotoxic T cells, regulatory T cells, B cells, total lymphocytes, and surface markers. This systematic review provides a well-structured analysis of current knowledge on the impact of the innate and adaptive immune systems on the response against cancer cells and the recruitment of immune cells in lymph nodes. The most significant findings highlight the crucial role of antigen presentation in the antitumor response, particularly through the recruitment and activation of dendritic cells and subcapsular sinus macrophages in tumor-draining lymph nodes. It also presents in a fairly comprehensible manner that the density of mature dendritic cells, cytotoxic T cells, and B cells is higher in non-metastatic lymph nodes. Discussion: The lymph node microenvironment is highly enriched with immune cell infiltration, and their distribution between metastatic and non-metastatic lymph nodes can contribute to a better understanding of the underlying pathological processes. Particular attention should be given to the innate immune system cells and their implication in antigen presentation. Our findings suggest that identifying immunological profiles of lymph nodes may provide a rationale for treatment de-escalation protocols and raise the question of lymph node preservation in antitumor immune responses. However, the heterogeneity and bias assessment of the included studies warrant a cautious interpretation of these findings. Another important limitation is the limited number of studies comparing the immune microenvironment of primary tumors and lymph nodes. Full article

Sustainable poultry nutrition is increasingly challenged by feed variability, environmental constraints, resource competition, and the growing demand for precision feeding strategies. Conventional feed evaluation systems based on proximate analysis, static nutrient tables, and empirical formulation are often insufficient to predict the biological and functional value of modern sustainable feed resources. This critical integrative review examines emerging approaches for evaluating and optimizing sustainable feeds in poultry nutrition through the integration of advanced analytical technologies, biological validation systems, omics sciences, and artificial intelligence (AI). This review was developed as a structured narrative review following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-inspired workflow and organized around an integrated AI–omics–feed evaluation framework. Recent advances in spectroscopy-based analytical techniques, in vitro digestibility systems, microbiomics, metabolomics, nutrigenomics, machine learning, and predictive modeling are discussed in relation to feed characterization, nutrient utilization, host–microbiota interactions, and precision nutrition, with emphasis on the transition from static compositional assessment toward dynamic, system-oriented feed evaluation. Explainability, biological validation, and generalizability of AI-based models across heterogeneous production systems are highlighted as key challenges for practical implementation, alongside emerging frontiers in AI-driven nutritional decision-support. Integrating analytical, biological, molecular, and computational approaches may support adaptive precision nutrition systems capable of improving nutrient efficiency, reducing environmental emissions, and optimizing sustainable poultry production. Full article

Background/Objectives: Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Early identification of individuals at risk is essential to reduce disease burden. Lingual varices (LV), a common oral vascular condition, have been suggested as a potential non-invasive clinical marker of systemic vascular alterations. This study aimed to evaluate the association between lingual varices and cardiovascular diseases through a systematic review and meta-analysis. Methods: A systematic review was conducted according to PRISMA guidelines and Cochrane recommendations and registered in PROSPERO (CRD420251172737). Electronic searches were performed in PubMed, Web of Science, and Scopus databases. Observational studies assessing the association between lingual varices and cardiovascular diseases in adults were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated, and meta-analysis was performed using fixed- or random-effects models depending on heterogeneity. Results: Thirteen studies involving 6322 participants were included. The overall prevalence of lingual varices was 34.8%. The meta-analysis demonstrated a significant association between lingual varices and cardiovascular disease (OR = 4.54; 95% CI: 3.35–6.17). Among the cardiovascular conditions evaluated, hypertension also showed a significant association with lingual varices (OR = 4.14; 95% CI: 1.66–10.29). Lingual varices were also significantly associated with smoking (OR = 3.06; 95% CI: 1.61–5.82) and lower extremity varicose veins (OR = 1.64; 95% CI: 1.04–2.58). No significant association was observed with sex (OR = 0.95; 95% CI: 0.67–1.34; p = 0.77). Conclusions: Lingual varices are significantly associated with cardiovascular disease. Although they may represent a readily identifiable oral finding associated with cardiovascular risk profile, the available evidence does not support their use as an independent screening or diagnostic marker. Further prospective studies are required to determine their predictive value and clinical utility. Full article

Public parks support health, wellbeing, and social inclusion, yet conventional wayfinding approaches remain largely focused on physical mobility and directional navigation, often overlooking the cognitive and sensory experiences of neurodivergent users. This study develops a theory-informed framework for neuroinclusive wayfinding design through an integrative literature review. Using a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-informed protocol, 106 core sources were synthesized from landscape architecture, environmental psychology, public health, and neurodiversity research. A qualitative theory-building approach combining thematic analysis, theoretical mapping, and abductive synthesis identified four themes: Cognitive Navigation and Environmental Legibility, Sensory Processing and Environmental Regulation, Restorative Landscapes and Nature-Based Wellbeing, and Inclusive, Adaptive, and Neurodiverse Design. These themes were subsequently translated into eight environmental challenges and operationalized into eight neuroinclusive wayfinding design criteria organized within four support domains. The resulting framework conceptualizes wayfinding as a cognitive–sensory support system rather than a purely navigational function, linking interdisciplinary evidence to practical landscape architectural design strategies. By integrating fragmented knowledge across multiple disciplines, the study provides a foundation for future validation and the advancement of neuroinclusive public park design. Full article

Background: Sensorineural hearing loss (SNHL) has increasingly been recognized as an extra-articular manifestation of systemic autoimmune rheumatic disease (SARDs), but its burden and clinical characteristics remain inconsistent. This systematic review and meta-analysis evaluated the prevalence, risk, audiometric characteristics, diagnostic methods and prognostic factors of SNHL in patients with major SARDs. Methods: A systematic search of the PubMed, Scopus and Cochrane Library databases was conducted between 25 June and 3 July 2026 in accordance with PRISMA 2020 guidelines. Observational studies evaluating SNHL in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjögren syndrome (pSS) and systemic sclerosis (SSc) were included. Meta-analyses using a random-effects model were performed to estimate pooled prevalence and odds ratios (OR). Subgroup analyses, meta-regression, sensitivity analysis, publication bias assessment and certainty of evidence evaluation were performed. Results: Twenty-two studies met the eligibility criteria and were included. The pooled prevalence of SNHL was 50% (95% CI: 13–87%, p < 0.001) in patients with RA, 61% (95% CI: 22–95%, p < 0.001) in SLE, 31% (95% CI: 5–67%, p < 0.001) in pSS and 28% (95% CI: 14–44%, p < 0.001) in SS. Patients with RA (OR 1.92; 95% CI: 1.29–2.87) and SLE (OR 21.68; 95% CI: 4.65–100.99) had significantly increased odds of SNHL compared to healthy controls. Hearing loss was predominantly mild, bilateral, and cochlear in origin, and affected high or extended high frequencies. Longer disease duration and greater disease activity were associated with worse hearing thresholds. In exploratory analyses of RA studies, sample size, study setting, and study design were significant study-level moderators of heterogeneity. Conclusions: SNHL is reported with appreciable prevalence across several major systemic autoimmune rheumatic diseases, although prevalence estimates are highly heterogeneous and should be interpreted cautiously. Comparative evidence supports increased odds of SNHL in RA, whereas the magnitude of the association in SLE remains uncertain because of the limited and imprecise evidence. Evidence establishing increased comparative risk in pSS and SSc remains insufficient. Audiological assessment may be particularly relevant in patients with longstanding or active disease. Full article

Background: The health sector is getting transformed with the usage of AI, be it diagnosis, treatment planning, disease prediction, and or health system management. Research in this field has picked up in the last few years, which was made possible with the emergence of machine learning, natural language processing and the increasing number of e-health records. Objectives: The study aims to investigate the current trends in the implementation of artificial intelligence (AI) applications in medical settings by investigating the global scientific output/landscape on this theme, such as the annual publication trends, country-wise contributions, and publishing patterns. Methods: The current study is based on systematic review by combining bibliometric analysis and cluster analysis using VOSviewer version 1.6.20, R software version 4.5.0, and Biblioshiny (Bibliometrix package in R) along with preferred reporting items for systematic reviews and meta analyses (PRISMA), 2020 which provides transparency and rigorous visualization to examine the articles published in English on the use of AI in healthcare, after the onset of COVID-19 till date i.e., from 2020 to 2026 on the Scopus database. Results: Using the relevant search string, 5940 documents were identified between 2020 and 2026, 1434 were included for analysis after screening and relevant filters. The publications have increased remarkably after 2020 on this theme and more than half of the publications have their roots in the discipline of Medicine. The USA, China, and the United Kingdom have contributed the most to the volume of research. Natural language processing and diagnosis are the emerging themes. The Journal of Medical Internet Research, BMC Medical Informatics and Decision Making, Computers in Biology and Medicine, IEEE Journal of Biomedical and Health Informatics, Frontiers in Public Health, and Digital Health are some of the most influential sources in the field. Li J and Liu X are among the authors with remarkable local impact. Conclusions: The work aims to assist investigators, health care professionals, and policymakers to learn about modern trends and focus on critical areas of future research and collaboration in AI-enhanced health care. The limitation of the study is that it considered only the Scopus database but it has opened up opportunities for researchers for analysis using other databases such as Dimensions, Lens, and PubMed. Also, this review is considering the publication record since the onset of COVID-19 but a comparative analysis of pre and post-pandemic studies can also be conducted to get a holistic view of drastic collaboration of research in this field. Discussions: The findings suggest that the role of artificial intelligence in health care has paramount over recent years, with other supporting technologies but a technologically hesitant population as well as low acceptance of AI due to ethical issues, cannot be ignored for ensuring efficiency in the health sector. Full article

Climate change increasingly threatens Mediterranean ornamental horticulture and green infrastructure through elevated temperatures, prolonged drought conditions, soil salinity, and more frequent extreme weather events. As a result, plant growth, phenology and landscape sustainability are significantly affected. This systematic review aimed to identify and qualitatively synthesize the available evidence on the responses of ornamental plants and their production and end use systems to climate-related stress, with emphasis on Mediterranean native species and their potential contribution to climate-resilient landscaping. The review was conducted and reported in accordance with PRISMA 2020. An adapted Population–Exposure–Outcome framework was used to operationalize the overarching review question and guide eligibility assessment. Scopus and the Web of Science Core Collection were systematically searched for peer-reviewed English-language articles published between 1 January 2001 and 31 May 2026. Eligible publications examined ornamental plants, floricultural species, or native and endemic taxa with potential ornamental or landscape use and addressed climate-related stressors, plant resilience, adaptation strategies, cultivation or propagation practices, green-infrastructure applications, or related ecological trade-offs in Mediterranean-relevant contexts. Two reviewers independently assessed titles, abstracts, and full texts using predefined eligibility criteria. The review used a structured qualitative narrative synthesis organized into thematic domains to systematically identify, select, and synthesize the available evidence. Meta-analysis was not undertaken because of substantial heterogeneity in plant material, environmental stressors, study designs, and reported outcomes. A total of ninety studies were included and organized into five domains: climate stress and plant responses (n = 14), native Mediterranean ornamental species (n = 21), adaptation and resilience strategies (n = 16), urban landscaping and green infrastructure (n = 25), and ecological risks and invasive species (n = 14). The review revealed that several native Mediterranean plants possess morphological, physiological, or ecological characteristics associated with tolerance to drought, salinity, and other climate-related stresses, supporting their potential use in sustainable ornamental horticulture. Water-efficient irrigation, alternative water sources and substrates, nursery preconditioning, non-microbial biostimulants, and genotype or physiological screening showed adaptation potential, but their effectiveness depended on species, genotype, intervention intensity, and application context. Evidence remained limited for compound stresses, combined interventions, nursery-to-landscape transfer, long-term field performance, commercial scalability, and environmental trade-offs. Overall, climate-resilient ornamental horticulture requires the integration of plant selection, propagation, production, controlled stress screening, landscape validation, and ecological-risk assessment. This review proposes an evidence-to-application framework to support research, nursery production, landscape planning, and the responsible deployment of climate-adapted ornamental plants. Full article

Background/Objectives: Nanoparticle carriers can enhance cancer immunotherapy by improving tumor delivery, activating innate immune responses, and remodeling tumor microenvironments. This review evaluates four categories of formulations: poly(lactic-co-glycolic acid) (PLGA) nanoparticles, mesoporous silica nanoparticles (MSNs), magnetic or iron oxide nanoparticles (MNPs), and covalent organic frameworks (COFs). Methods: A reproducible PubMed audit identified 568 records. A rule-assisted title-and-abstract screen, followed by verification, removed 320 reviews, non-primary publications, and reports lacking qualifying in vivo formulation evidence. Of 248 potentially relevant reports, 15 primary studies were selected as representative examples; the remaining 233 were not classified as ineligible but were not selected as representative examples. These reports yielded 16 formulation-level records. One author conducted screening and extraction without protocol registration, duplicate review, or formal risk-of-bias scoring. Results: PLGA demonstrates the most robust polymer-level regulatory and manufacturing precedent; however, it remains limited by cargo instability, burst release, and challenges associated with process transfer. Biodegradable mesoporous silica nanoparticles (MSNs) facilitate pore-based protection and cytosolic delivery of cyclic dinucleotides, although their degradation and clearance are dependent on formulation specifics. Magnetic nanoparticles (MNPs) integrate magnetic targeting, imaging, and hyperthermia capabilities but necessitate formulation-specific magnetic characterization, field dosimetry, and repeated-dose safety assessments. Covalent organic frameworks (COFs) provide extensive stimulus-responsive and catalytic functionalities but exhibit the least mature evidence concerning biodegradation, scalable manufacturing, and independent reproducibility. Efficacy data across different studies were not pooled due to heterogeneity in models, schedules, comparators, and tumor-growth-inhibition formulas. Conclusions: The evidence does not endorse a universal platform ranking. Translation depends on standardized immune endpoints, explicit efficacy formulas, quantitative biodistribution assessments, mechanism-confirming experiments, repeat-dose toxicology studies, scalable manufacturing processes, and independent replication. The resulting evidence map serves as a descriptive and hypothesis-generating tool rather than a meta-analysis or clinical-priority scoring system. Full article

Background: Pharmacovigilance systems have flagged possible associations between mRNA COVID-19 vaccination and systemic autoimmune inflammatory rheumatic diseases (AIRDs), generating uncertainty for rheumatologists counselling patients. As the first population-scale deployment of an mRNA vaccine platform, COVID-19 vaccination provides a unique setting to examine whether autoimmune safety signals detected in spontaneous reporting systems correspond to measurable disease risk. We synthesised pharmacovigilance and population-based evidence on incident EULAR-defined systemic AIRDs after mRNA COVID-19 vaccination and assessed whether disproportionality signals were corroborated by analytical studies. Methods: We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library from 2019 to April 2026, supplemented by medRxiv and trial registries. Eligible studies included pharmacovigilance disproportionality analyses and analytical studies, including cohorts and randomised controlled trials, evaluating BNT162b2 or mRNA-1273 in adults without known pre-existing autoimmune disease. Risk of bias was assessed using READUS-PV, ROBINS-I, and RoB 2. Meta-analysis was not performed because of substantial heterogeneity. Results: Fourteen studies were included: seven pharmacovigilance studies and seven analytical studies. Disproportionality analyses suggested increased reporting of selected AIRDs, most consistently polymyalgia rheumatica and giant cell arteritis, mainly when all other adverse-event reports served as comparators. These signals were largely neutral when influenza vaccines were the reference. Across analytical studies, associations were inconsistent; modest increases in systemic lupus erythematosus appeared only in selected analyses. Long-term evidence was scarce: only four studies, from three countries (South Korea, Israel, and Norway), followed participants for up to approximately one year, and three of these reported at least one positive association—systemic lupus erythematosus, post-booster rheumatoid arthritis, and polymyalgia rheumatica in older adults—whereas studies restricted to risk windows of three months or less reported no increase. Conclusions: The available evidence does not indicate a consistent increase in incident systemic AIRDs after mRNA COVID-19 vaccination. Although pharmacovigilance studies identified comparator-dependent signals for selected diseases, particularly polymyalgia rheumatica and giant cell arteritis, these findings were generally not confirmed in comparative population-based studies and should be considered hypothesis-generating. Delayed-onset disease remains poorly characterised, and studies with at least one year of follow-up are needed. Full article

The Internet of Medical Things (IoMT) is transforming healthcare through continuous patient monitoring, telemedicine, cloud–edge services, and Healthcare 5.0. However, the rapid growth of interconnected medical devices has expanded the healthcare cyberattack surface, making intelligent intrusion detection essential for protecting sensitive medical data and ensuring resilient clinical operations. Existing reviews examine specific aspects of AI-powered intrusion detection but rarely provide a deployment-oriented synthesis linking technical performance with operational and clinical requirements. This review critically examines Artificial Intelligence (AI)-powered Intrusion Detection Systems (IDSs) for IoMT across six analytical dimensions: detection performance, explainability, privacy preservation, computational efficiency, benchmarking practices, and cross-dataset generalization. This structured narrative review adopted the PRISMA 2020 framework to ensure transparent record identification, screening, and reporting, with evidence synthesized qualitatively rather than through quantitative meta-analysis. A total of 5127 records published between 2021 and 2026 were screened, resulting in 24 primary studies supported by 115 complementary studies. The findings show that machine learning, deep learning, hybrid AI, Explainable Artificial Intelligence (XAI), Federated Learning (FL), blockchain-assisted security, and edge intelligence have significantly advanced IoMT intrusion detection. However, despite benchmark accuracies often exceeding 95%, deployment remains constrained by dataset dependency, weak cross-dataset generalization, computational overhead, limited explainability, fragmented benchmarking, and insufficient operational validation. This review identifies deployment readiness, rather than predictive accuracy alone, as the principal challenge for next-generation healthcare cybersecurity and provides a practical framework for developing trustworthy, interoperable, privacy-preserving, and deployment-ready IoMT cybersecurity architectures supported by standardized evaluation protocols. Full article

Background: Job stress is a pervasive issue in modern workplaces and is associated with numerous adverse outcomes, including employees’ turnover intention when stress levels are high. Objective: This study aimed to examine the association between job stress and turnover intention among employees working in healthcare institutions through meta-analysis. Methods: A systematic literature review and meta-analysis were performed following PRISMA guidelines. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42024581906). Considering variations in sample sizes, publication years, and measurement scales, a random-effects model was employed. Effect sizes were illustrated with a forest plot, and publication bias analyses were performed. Subgroup analyses were conducted by occupational group, COVID-19 period, and geographic region, while meta-regression tested the moderating effects of publication year. Study quality was assessed using the AXIS tool. Results: Based on predefined inclusion criteria, 38 independent studies were included. Findings revealed a moderate-to-high, positive, and statistically significant relationship (r = 0.441; 95% CI [0.389, 0.490]) between job stress and turnover intention among healthcare workers. Moreover, although between-study heterogeneity was substantial (I² = 95.5%), the direction and statistical significance of the association remained consistent across different countries and healthcare systems. Conclusions: This meta-analysis demonstrated a statistically significant positive association between job stress and turnover intention among healthcare workers (r = 0.441). Although substantial heterogeneity was observed across studies, the relationship remained consistent across occupational groups, regions, and study contexts. Addressing job stress may therefore play an important role in supporting workforce retention in healthcare organizations. Full article