Search Results (10,390)

Background: Recent studies suggest that prunes are one of the most effective fruits for preventing and reversing bone loss. Objectives: The purpose of the present systematic review was to summarize the evidence from the randomized controlled studies on the effect of prunes on bone health in humans and to pool the results in a meta-analysis. The hypothesis of the present review was that bone mineral density of the pulled intervention group would be higher than that of the control group. Methods: We conducted a systematic review of randomized controlled studies with a three-level mixed-effects meta-analysis. Results: Of two hundred and eighty-four studies that were initially identified in PubMed, Scopus, and Web of Science using the search words, eleven papers (747 participants) were considered eligible. The effect of prune intervention in postmenopausal women was borderline significant at the lumbar spine, with BMD slightly higher in the intervention group (SMD [95% CI] = 1.30 [−0.03, 2.63]; I² = 98%; p < 0.001). No significant differences were observed at other individual BMD sites. Heterogeneity across studies was high for all measured sites. The difference between the intervention and control groups in the levels of bone formation and resorption markers was not significant. The risk of bias of the included randomized controlled studies, assessed by the RoB v.2 tool, was low. Conclusions: Our meta-analysis provides preliminary evidence of modest skeletal benefits associated with consumption of 50–100 g of prunes, particularly at the lumbar spine, a trabecular-rich site. However, the overall body of research remains limited. Full article

Home Energy Management Systems (HEMS) are increasingly positioned at the center of residential flexibility, particularly as homes integrate photovoltaics, battery storage, electric vehicles, and responsive loads. This systematic review examines recent advances in optimization and multi-asset coordination for HEMS. Searches were conducted in Scopus, Web of Science, IEEE Xplore, and ScienceDirect for studies published between 2020 and 2025; after screening and eligibility assessment, 90 studies were included. The findings indicates that deterministic optimization remains well suited to structured scheduling problems, whereas metaheuristic, hybrid, and learning-based methods are better able to address nonlinearity, uncertainty, and real-time adaptation. Across the reviewed literature, multi-asset integration generally improves cost, peak demand, self-consumption, and, in some cases, user comfort and emissions. Yet the field remains dominated by simulation-based validation. Future progress of HEMS will depend on real-world validation, interoperable system design, explainable control, and stronger alignment with user behavior, communication constraints, and regulatory frameworks. Full article

Oxidative stress and gut microbiota dysbiosis establish a self-perpetuating loop that disrupts epithelial barrier integrity and fuels chronic inflammatory and metabolic disorders, including inflammatory bowel disease (IBD), metabolic syndrome (MS), and chronic kidney disease (CKD). This systematic review synthesizes mechanistic, preclinical, and clinical evidence linking reactive oxygen species (ROS), microbiota-derived metabolites, and host redox homeostasis, with a focus on probiotic-based interventions. Comprehensive searches of PubMed, Scopus, Web of Science, and Google Scholar (2000–March 2026) identified in vitro, animal, and human studies, as well as systematic reviews and meta-analyses, assessing oxidative biomarkers, microbiome profiles, and barrier function outcomes. Probiotic strains, predominantly Lactiplantibacillus, Bifidobacterium, and emerging next-generation taxa, attenuate oxidative stress by inducing antioxidant enzymes [superoxide dismutase (SOD), glutathione peroxidase (GPx)], activating Nrf2 signaling, and restoring short-chain fatty acid (SCFAs) production, thereby lowering malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) while enhancing total antioxidant capacity (TAC). At the mucosal interface, probiotics strengthen tight junction proteins, suppress NF-κB-mediated cytokine release, and mitigate dysbiosis, contributing to clinically meaningful improvements in disease activity, insulin sensitivity, and uremic toxin burden along gut–liver, gut–kidney, and other gut–organ axes. Overall, current evidence supports probiotics and synbiotics as promising adjuncts for nutrition-driven redox modulation, while highlighting the need for strain-resolved, multi-omics, multicenter trials with standardized redox and microbiome endpoints to optimize dosing strategies and long-term safety. Full article

Background: Urinary tract infections (UTIs) are prevalent bacterial infections associated with significant morbidity and healthcare burden. Traditional diagnosis relies on urine culture, which is limited by long turnaround times and potential contamination. Automated urine flow cytometry, particularly the UF-5000 (Sysmex Corporation, Kobe, Japan), offers rapid and precise screening through bacterial and white blood cell (WBC) quantification. This systematic review and meta-analysis evaluates the diagnostic accuracy of the UF-5000 for UTI screening. Methods: We searched PubMed, Embase, Science Direct, and Web of Science for studies assessing the UF-5000’s performance, including sensitivity and specificity, with a minimum sample size of 40 and at least 10 UTI cases. Quality assessment was performed using QUADAS-2. Pooled estimates for sensitivity, specificity, and agreement (kappa) were calculated using random-effects models. Results: Eighteen studies, encompassing 25,337 samples, were included in the analysis. Pooled sensitivity and specificity for bacterial count (nine studies) were 0.927 (95% CI, 0.872–0.959) and 0.751 (95% CI, 0.558–0.878), respectively. For WBC count (four studies), sensitivity was 0.897 (95% CI, 0.755–0.961) and specificity was 0.600 (95% CI, 0.293–0.844). The UF-5000 also demonstrated moderate agreement (pooled kappa 0.52, 95% CI, 0.08–0.79) in distinguishing Gram-negative bacteria. Conclusions: Despite heterogeneity across studies, the UF-5000 demonstrates high diagnostic accuracy, particularly high sensitivity, supporting its role as a useful UTI screening tool to rule out infection in clinical settings. The device further provides clinical value through its ability to assist in the differentiation of Gram-negative bacteria. Full article

Vanilla (Vanilla planifolia Jacks. ex Andrews) is a tropical orchid of high economic value, with an annual production of 8000 to 10,000 t and a market exceeding 800 million USD in over 40 countries. In vitro propagation has strengthened the innovation, production, and conservation of this species. Bibliometrics, as a quantitative approach, systematically examines the patterns, dynamics, and evolutionary trends of scientific production. A systematic search was conducted in Scopus and Web of Science until December 2025, using the terms “vanilla” and “micropropagation”. A total of 53 documents were identified in Scopus (1997–2025) and 39 in Web of Science (2000–2025). The evaluated indicators included: year of publication, country of origin, language, areas, main categories, document typology, authorship, and keyword distribution. VOSviewer was used for keyword analysis to identify author collaboration networks and emerging trends. The years with the most information were 2024 and 2025, with Mexico and India standing out prominently. The main thematic areas were Agricultural and Biological Sciences, and the role of researcher Ramírez-Mosqueda was highlighted. The keywords with the highest correlation and impact were bioreactors, vanillin, and cryopreservation. This bibliometric study provides a comprehensive perspective on scientific production related to vanilla micropropagation. The results highlight the multidisciplinary nature of biotechnology applied to this crop, integrating contributions from various areas of knowledge for the benefit of the main actors in the value chain. Full article

Background/Objectives: Congenital heart defects (CHDs) are the most common congenital anomalies, and survival into adolescence and adulthood now exceeds 90%. Increasing evidence suggests that children and adolescents with CHD face elevated risks of psychological, psychiatric and neurodevelopmental disorders. This systematic review aims to synthesize recent evidence on mental health outcomes, cognitive profiles, quality of life and associated risk factors in pediatric CHD. Methods: This review was conducted according to PRISMA 2020 guidelines. Five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched for studies published between January 2015 and November 2025. Eligible studies (observational, interventional and neuroimaging) included participants aged 0–18 years with any type of CHD and reported psychological, psychiatric, neurodevelopmental, cognitive or health-related quality-of-life outcomes. Due to substantial heterogeneity, findings were synthesized narratively. Results: Sixty-one studies involving over 120,000 participants were included. Children and adolescents with CHD showed increased prevalence of anxiety, depression, attention-deficit/hyperactivity disorder, autism spectrum disorder and post-traumatic stress symptoms compared with peers without CHD. Neurodevelopmental impairments, particularly in executive functioning, attention and memory, were frequently reported, especially in complex CHD and single-ventricle physiology. Health-related quality of life was consistently reduced, mainly in emotional and social domains. Parental mental health, disease severity and cumulative medical burden were significant correlates. Neuroimaging studies identified structural and functional brain alterations associated with cognitive and emotional vulnerability. Conclusions: Pediatric CHD is associated with substantial psychological and neurodevelopmental burden, particularly in complex disease. Early identification and integration of routine psychological care within multidisciplinary CHD programs are essential to improve long-term outcomes. Full article

Background: Adverse pregnancy outcomes such as preeclampsia (PE), preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth are major contributors to maternal and neonatal morbidity and mortality. Elevated maternal homocysteine (Hcy) levels, influenced by genetic, dietary, and lifestyle factors, have been increasingly associated with placental dysfunction and adverse pregnancy outcomes. This review aims to evaluate the link between hyperhomocysteinemia and pregnancy complications to inform clinical practice. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Library was conducted up to December 2024. Observational studies assessing maternal Hcy levels in relation to pregnancy complications were included. Heterogeneity was measured using the I² statistic, and a random-effects model using the DerSimonian–Laird method was applied to account for study variability. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. Elevated maternal Hcy was significantly associated with: PE (OR: 2.49; 95% CI: 1.41–4.40; I² = 96.03%; n = 9), preterm birth (OR: 4.01; 95% CI: 1.84–8.72; I² = 91.08%; n = 6), fetal loss (OR: 1.76; 95% CI: 1.22–2.52; I² = 41.47%; n = 6), SGA (OR: 1.69; 95% CI: 1.35–2.11; I² = 0.00%; n = 3), and LBW (OR: 2.46; 95% CI: 1.37–4.43; I² = 77.71%; n = 3). Conclusions: This review highlights a significant association between elevated maternal Hcy levels and various pregnancy complications. However, given the substantial heterogeneity and reliance on observational evidence, these findings should be interpreted with caution. Future well-designed prospective cohort studies with standardized definitions of hyperhomocysteinemia, consistent timing of exposure assessment across pregnancy trimesters, and adjustment for key confounders are needed to better clarify these associations and underlying mechanisms. Full article

This systematic review synthesized the existing evidence on neurofeedback interventions applied to football players, aiming to clarify their effects on cognitive, technical–tactical, physical and psychological performance. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases (PubMed, Web of Science, SCOPUS and SportsDiscus) were searched up to November 2025. Seven studies met the inclusion criteria, involving 133 players across youth, amateur, national and elite levels. Neurofeedback protocols primarily targeted alpha or sensorimotor rhythm (SMR) activity, and some were combined with heart rate variability (HRV) biofeedback. Across studies, neurofeedback may be associated with improvements in several cognitive outcomes, including improvements in working memory, visuospatial memory, task switching, mental rotation and decision-making. Limited evidence suggests potential improvements in technical skills (particularly shooting accuracy) and tactical decision-making. Some studies reported changes in physiological markers and stress-recovery capacity, although their interpretation remains uncertain. However, the evidence base remains constrained by small samples, heterogeneous protocols and limited use of randomized controlled designs. Overall, neurofeedback appears to be a potentially promising but still experimental tool to support cognitive and psychophysiological readiness in football, warranting more rigorous and standardized research to establish efficacy and optimal training parameters. Full article

Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH₂O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Full article

Background: Metabolic dysregulation is increasingly recognized as a contributor to carcinogenesis; however, the role of circulating lipid traits in ovarian cancer remains unclear. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, and Embase were searched from inception to March 2026. Observational studies evaluating triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) in relation to ovarian cancer risk were included. Random-effects models were used to pool relative risks (RRs). Robustness was assessed via sensitivity analyses, influence diagnostics, and multiverse analysis. Mendelian randomization (MR) evidence was integrated for causal inference. Results: Six observational studies were included in the meta-analysis. Elevated triglyceride levels were associated with increased ovarian cancer risk, while HDL-C showed a modest inverse association. LDL-C and total cholesterol were not significantly associated with risk. Sensitivity analyses excluding early follow-up strengthened the triglyceride association. MR analyses supported a potential causal role for triglycerides but not for HDL-C. Conclusions: Circulating triglycerides may represent a metabolically relevant risk factor for ovarian cancer. Further large-scale prospective and mechanistic studies are warranted. Full article

Background: Wireless capsule endoscopy is widely used for diagnosing gastrointestinal diseases, but manual interpretation of capsule videos is time-consuming and can vary between clinicians. Artificial intelligence has been increasingly studied to support capsule analysis and reduce clinical workload. This systematic literature review and meta-analysis summarizes current evidence on artificial intelligence methods applied to wireless capsule endoscopy, with a focus on diagnostic performance, validation strategies, and clinical readiness. Methods: A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar. Original journal articles were included based on predefined eligibility criteria. The reviewed studies addressed multiple artificial intelligence tasks, including detection, classification, segmentation, and localization of gastrointestinal abnormalities. Results: A total of 72 studies were included. Meta-analysis using random effects models showed high pooled diagnostic performance across clinical indications and gastrointestinal tract locations, with the strongest results reported for bleeding and vascular lesions and more variable performance for inflammatory bowel disease and mixed abnormality categories. The review also identified important clinical and technical barriers that may limit reliability and slow clinical adoption. These included limited external validation, small patient cohorts, retrospective study designs, and inconsistent reporting and evaluation practices. Conclusions: Artificial intelligence methods show strong potential to support wireless capsule endoscopy interpretation. Based on the findings, we propose practical recommendations to improve study design and validation. If these recommendations are applied, future studies may report more robust and reliable results, supporting better translation into clinical workflows. Full article

Background: Suicide among emerging adults has become a significant global public health concern. Suicidal ideation is the prerequisite for suicide, and social support is recognized as a key protective factor against suicidal ideation. However, the relationship between the strength and consistency of social support and suicidal ideation among undergraduate students remains unclear. This study synthesized empirical studies to quantify the relationship between social support and suicidal ideation among undergraduate students and determine the different correlations between various sources of social support and suicidal ideation. Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. Five electronic databases (Web of Science, Scopus, PubMed, ProQuest, and ScienceDirect) were searched for studies published from 2016 to 2025. Eligible studies reported quantitative associations between social support and suicidal ideation among undergraduate students. Correlation coefficients were transformed using Fisher’s z and pooled using a random-effects model. Heterogeneity was evaluated using Cochran’s Q and I² statistics. Risk of bias assessments, moderator analysis, sensitivity analysis, subgroup analysis, and publication bias assessments were conducted. Results: Fifteen studies with sixteen independent effect sizes and more than 26,000 participants were included. The meta-analysis showed a moderate negative association between social support and suicidal ideation (pooled r = −0.33, 95% CI [−0.40, −0.25]) under a random-effects model. A high heterogeneity was observed among studies (I² = 97%, p < 0.001). There are no studies classified as having a high risk of bias. The standardized sample size demonstrated a significant moderating effect (β = 0.2568, p = 0.0022). Sensitivity analysis confirmed the stability of the pooled effect. Subgroup analysis indicated that the strength of the association between social support and suicidal ideation did not differ significantly between Asian and non-Asian studies. No significant publication bias was detected (Egger’s p = 0.19). Narrative synthesis further suggested that family support showed the most consistent protective association compared with friends’ support and support from others. Conclusions: Social support is moderately and consistently associated with reduced suicidal ideation among undergraduate students. These findings highlight social connectedness, particularly family support, as a central interpersonal protective factor and strengthen social support’s role in university suicide prevention initiatives. Full article

Pregnancy is characterized by progressive maternal hyperlipidemia, including increased triglycerides, total cholesterol, and low-density lipoprotein, with dynamic fluctuations in high-density lipoprotein. Excess maternal free fatty acids induce oxidative stress through reactive oxygen species, causing mitochondrial dysfunction, lipid peroxidation, activation of inflammatory pathways, and epigenetic remodeling in the placenta and fetal tissues. These molecular alterations impair placental lipid transport and nutrient sensing, leading to hypertrophy of fetal liver, myocardium, and adipose tissue, while disrupting neonatal glucose and lipid homeostasis and increasing susceptibility to perinatal complications and long-term metabolic disorders. This review aims to evaluate mechanistic pathways linking maternal lipid metabolism, oxidative stress, placental function, and fetal organ remodeling. Mechanistic and translational studies were identified through searches of PubMed, Scopus, the Cochrane Library, and Web of Science (2000–2025) using predefined keywords including lipid metabolism, free fatty acids, oxidative stress, placental lipid transport, epigenetics, DNA methylation, fetal programming, and perinatal outcomes. Evidence indicates that maternal lipid imbalance drives placental oxidative and epigenetic modifications, directly contributing to fetal organ hypertrophy and neonatal metabolic dysregulation. In conclusion, maternal dyslipidemia represents a modifiable determinant of fetal organ hypertrophy and long-term metabolic risk, supporting the clinical relevance of maternal lipid monitoring and targeted metabolic interventions during pregnancy. Full article

Artificial intelligence (AI) is increasingly being applied in breast cancer care, yet its use across the post-diagnosis phase remains poorly mapped. This scoping review aimed to identify and categorise AI applications in post-diagnosis breast cancer care, encompassing treatment planning, treatment delivery, follow-up and surveillance, survivorship, and palliative care. Following JBI methodology and PRISMA-ScR reporting guidelines, four databases (MEDLINE, EMBASE, CINAHL, and Web of Science) were searched, identifying 3784 records. After screening and full-text assessment, 54 studies published between 2016 and 2024 were included. Machine learning was the predominant technology (81%), followed by generative AI (7%), conversational agents (6%), traditional natural language processing (4%), and data mining (2%). Follow-up and surveillance were the most represented care stage (48%), driven primarily by recurrence prediction models. Most applications were provider-focused (83%), while patient-facing tools accounted for 17% of studies and relied on either conversational agents or generative AI. No studies addressed palliative care. The evidence base was predominantly retrospective (70%) and concentrated in high-income countries (74%). Future research should prioritise prospective evaluation in clinical workflows, address unsupervised patient use of generative AI, and ensure equitable development across diverse populations and care settings. Full article

Urban squares remain underrepresented in conservation-oriented literature compared with parks, street trees and green infrastructure. This scoping review uses CS-derived categories as an analytical lens to examine how the literature on urban squares frames conservation targets, direct threats, contributing factors and conservation actions. Following PRISMA-ScR, we searched Scopus and Web of Science for English-language peer-reviewed articles (2014–2024). After screening, 69 studies were included. Full texts were coded into CS-derived components and synthesised through frequency distributions, a cross-case conceptual synthesis, and an exploratory clustering of recurrent CF-DT-CT configurations. The reviewed literature is strongly centred on human-centred outcomes, particularly health, air quality and water quality, while biodiversity-related targets remain comparatively underrepresented. The most frequently investigated direct threats are pollution-related and linked to natural system management and modification, whereas other pressures are addressed less consistently. Contributing factors are dominated by meteorological conditions and vegetation coverage and composition. Reported conservation actions emphasise monitoring technologies, regulatory policy and green infrastructure, while others receive limited attention. Together, these analytical steps help make recurrent pathways and underrepresented dimensions more explicit, providing a more transparent evidence base for context-sensitive urban planning and nature-based solutions. Full article