Search Results (9,007)

The Pacific Alliance has established itself as one of the most dynamic regional economic integration initiatives, standing out for its pragmatic and consensual approach to trade, capital and people liberalisation. However, between 2020 and 2025, the bloc faced both opportunities and challenges arising from the international situation, including global tensions, internal political crises and the need for technological adaptation. Against this backdrop, this study aims to conduct a systematic review of the scientific literature published between 2020 and 2025 on the Pacific Alliance, identifying the predominant theoretical approaches and the main findings on the integration process. This systematic review followed the PRISMA methodology, which contributed fundamentally to this research by providing a structured, transparent and rigorous framework for a deeper and more informed understanding of the integration process. The results show that, despite some progress, structural limitations persist, such as asymmetries between countries, institutional obstacles and superficial integration in economic and social aspects, as well as fragmentation in academic production and little incorporation of geopolitical perspectives. This study contributes to a critical understanding of the current state and future challenges of the Pacific Alliance, offering inputs for the formulation of public policies and future research in the field of Latin American integration. Full article

Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared it to hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy). Methods: Online databases were systematically searched and evaluated according to the PRISMA 2020 guidelines. Statistical heterogeneity was assessed. Diagnostic sensitivity, specificity and inter-method agreement were evaluated, along with mean pain scores. Results: This analysis included data from 9 studies and 1354 patients with conclusive diagnostic data from 2422 tubes and 1294 patients with data on intra-procedural pain. With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69%, respectively (p = 0.074), while pooled specificity was 95% and 85%, respectively, favoring HyFoSy (p < 0.001). HyFoSy was more tolerable with regard to pain, but this was not statistically significant. Regarding the HyFoSy and HSG comparison, pooled Cohen’s k was 0.38, indicating fair-moderate agreement. In subsequent analysis, with HSG as a reference standard, HyFoSy demonstrated low sensitivity (61%) but high specificity (87%). With regard to experienced pain, HyFoSy and HSG had a difference of 2.4 units on a 10-point scale, favoring HyFoSy (p < 0.001). Conclusions: HyFoSy was superior to HyCoSy and may be used as a first-line tubal assessment method, with HSG being utilized in inconclusive cases. However, further research is still required due to the small number of available studies. Full article

Neuroendocrine tumors (NETs) are a rare and heterogeneous class of neoplastic lesions, but their prevalence has increased significantly over the past three decades. These tumors are aggressive and difficult to treat. Improving diagnostic efficiency and treatment effectiveness is important for patients with neuroendocrine tumors. Radiopharmaceutical therapeutic diagnostics combines diagnosis and treatment technology and has broad prospects in precision medicine, especially for the early diagnosis and treatment of tumors. To compare the diagnostic advantages of radiolabeled somatostatin receptor agonists and antagonists for liver metastases from NETs and the disease control rate in NET patients. Systematic search of PubMed, Embase, Cochrane, Ovid, Scopus, and Web of Science databases up to 29 October 2024. Clinical trials of somatostatin receptor agonists and antagonists for NET diagnosis or treatment. Following PRISMA guidelines, data were independently extracted by two researchers. Pooled diagnostic or treatment effects and 95% CIs were reported using a random-effects meta-analysis model. Effect of somatostatin receptor agonists and antagonists in detecting liver metastases and disease control rate. Risk Ratio (RR) for liver metastasis detection and Effect Size (ES) for disease control rate were calculated. From 5291 articles, 52 were included in the meta-analysis. Radiolabeled somatostatin receptor antagonists were significantly more effective than agonists in detecting liver lesions (RR = 11.57, 95% CI: 4.10, 32.67). Disease control rates were higher with antagonists (ES = 0.90, 95% CI: 0.83, 0.96) compared to agonists (ES = 0.82, 95% CI: 0.78, 0.85, z = 2.12, p = 0.03). Radiolabeled somatostatin receptor antagonists outperform agonists in diagnosing hepatic lesions and controlling disease in NETs, highlighting their clinical superiority. This meta-analysis provides critical insights into the diagnostic and therapeutic efficacy of somatostatin receptor antagonists, and may offer a potential paradigm shift in the management of neuroendocrine tumors. Nevertheless, the smaller number of studies on antagonists may limit the generalizability of the findings and underscore the need for further clinical trials to validate these results. Full article

Background: The potential impact of maternal SARS-CoV-2 infection during pregnancy on the neurodevelopment of offspring has raised considerable concern. Emerging studies have evaluated various developmental domains in exposed infants, yet findings remain inconsistent. Objective: To synthesize current evidence regarding neurodevelopmental outcomes in infants born to mothers with confirmed SARS-CoV-2 infection during pregnancy. Methods: We conducted a narrative review following PRISMA guidelines. A literature search was performed in PubMed, Cochrane, and ScienceDirect using keywords including “COVID-19”, “pregnancy”, “neurodevelopment”, and “SARS-CoV-2”. Nineteen studies were included. Data were extracted regarding study design, sample size, timing of exposure, age at assessment, developmental tools used, and key findings. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Among 19 included studies, 12 reported at least some neurodevelopmental delays, particularly in motor and language domains. However, these delays were generally mild, domain-specific, and often not statistically significant. Seven studies, most of which were high-quality and low-risk, reported no significant differences between exposed and unexposed groups. Assessment tools and follow-up durations varied widely, limiting comparability. Conclusions: Current evidence does not support a consistent association between in utero SARS-CoV-2 exposure and an unfavorable neurodevelopmental outcome up to 24 months. However, heterogeneity in methods and short-term follow-up warrant further high-quality longitudinal research. Full article

Background: Chronic low back pain markedly impairs quality of life and imposes a significant economic burden on public health. The complex pathophysiology of chronic low back pain arises from the complex anatomical configuration of the lumbar region, which includes a diverse array of structures. Consequently, etiologies may involve intervertebral disc degeneration, facet joint osteoarthritis, spinal stenosis, spondylosis, and spondylolisthesis. Therapeutic interventions for chronic low back pain are equally varied, ranging from pharmacological treatments to physiotherapy, kinetotherapy, balneotherapy, and image-guided local injectable procedures such as prolotherapy. Prolotherapy is a regenerative injection technique designed to stimulate the body’s healing processes by applying a regenerative treatment (typically dextrose), which aims to modulate neurogenic inflammation and diminish nociceptive signaling. Methods: A systematic review of the literature was performed in alignment with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Studies published within the last ten years evaluating the effects of prolotherapy on pain reduction in individuals with chronic low back pain were included, following a search across six databases. Results: The review revealed several studies evaluating the influence of prolotherapy on pain in chronic low back pain patients. Findings were heterogeneous, with some studies indicating significant pain reduction and others showing minimal or no improvement. Conclusions: The current evidence regarding the efficacy of prolotherapy for pain relief in chronic low back pain remains inconclusive, highlighting the necessity for further in-depth research. Continued and updated investigations into prolotherapy’s role are imperative for enhancing the quality of life of affected patients. Full article

Chronic kidney disease (CKD) is a progressive global health burden often diagnosed in late stages due to reliance on invasive and centralized blood and urine tests. Saliva, as a non-invasive diagnostic fluid, has emerged as a promising alternative for assessing renal function. This scoping review aims to evaluate the diagnostic accuracy of salivary biomarkers compared to traditional methods, and to explore the potential of emerging biosensing technologies for CKD detection and monitoring. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library up to 1 July 2025, following the PRISMA-ScR guidelines. Studies involving adult CKD patients and healthy controls that assessed the diagnostic performance of salivary biomarkers against validated reference standards (e.g., serum creatinine, eGFR) were included. A total of 29 eligible studies were selected after applying predefined inclusion and exclusion criteria. Results: Salivary creatinine and urea were the most frequently assessed biomarkers and demonstrated strong correlations with serum levels (AUCs up to 1.00; sensitivity and specificity frequently >85%). Several studies reported high diagnostic potential for novel salivary markers such as Trimethylamine N-oxide (TMAO), cystatin C, and amino acids. Technological innovations, including electrochemical biosensors and ATR-FTIR spectroscopy, showed promise for enhancing sensitivity and enabling point-of-care testing. However, heterogeneity in sampling protocols and limited data for early-stage CKD were notable limitations. Conclusions: Salivary diagnostics, supported by biosensor technologies, offer a feasible and non-invasive alternative for CKD screening and monitoring. Standardization, broader clinical validation, and integration into dental workflows are key to clinical implementation. Full article

Truck drivers play a pivotal role in global freight transport systems, yet their occupational and behavioral risk exposures make them a priority population in road safety research. This systematic review examines the factors influencing risky driving behaviors among truck drivers and their impacts on road safety outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review aimed to identify hazardous driving behaviors, the internal and external factors contributing to these behaviors, and their consequences for traffic safety. Inclusion criteria targeted original research published in English between 2009 and 2024 specifically focused on truck driver behavior and road safety outcomes. Systematic searches across PubMed, Scopus, Web of Science, and IEEE Xplore yielded 104 studies meeting these criteria. The synthesis revealed prevalent risky behaviors—such as speeding, fatigue-related impairments, distracted driving, and substance use—driven by internal factors (e.g., health conditions, psychological stress) and external pressures (e.g., occupational demands, regulatory constraints). These behaviors were consistently associated with increased crash risk. Nonetheless, limitations including the exclusion of non-English studies, reliance on self-reported data, and lack of standardized metrics constrained cross-study comparability and generalizability. Effective interventions identified include fatigue management programs, driver monitoring technologies, and positive safety climates. Findings underscore the urgent need for evidence-based, multifaceted strategies to enhance truck driver safety and inform policy, industry practices, and future research. Full article

Artificial intelligence (AI) has emerged as a transformative technology in radiology, offering enhanced diagnostic accuracy, improved workflow efficiency and potential risk mitigation. However, its effectiveness in reducing clinical and occupational risks in radiology departments remains underexplored. This systematic review aimed to evaluate the current literature on AI applications in computed tomography (CT) radiology and their contributions to risk reduction. Following the PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Scopus and Web of Science for studies published between 2021 and 2025 (the databases were last accessed on 15 April 2025). Thirty-four studies were included based on their relevance to AI in radiology and reported outcomes. Extracted data included study type, geographic region, AI application and type, role in clinical workflow, use cases, sensitivity and specificity. The majority of studies addressed triage (61.8%) and computer-aided detection (32.4%). AI was most frequently applied in chest imaging (47.1%) and brain haemorrhage detection (29.4%). The mean reported sensitivity was 89.0% and specificity was 93.3%. AI tools demonstrated advantages in image interpretation, automated patient positioning, prioritisation and measurement standardisation. Reported benefits included reduced cognitive workload, improved triage efficiency, decreased manual annotation and shorter exposure times. AI systems in CT radiology show strong potential to enhance diagnostic consistency and reduce occupational risks. The evidence supports the integration of AI-based tools to assist diagnosis, lower human workload and improve overall safety in radiology departments. Full article

Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8/13 studies, −0.9 to −2.3 VAS points) and functionality (7/13 studies, WOMAC improvement 8–15%, TUG −1.2 to −2.8 s). Compliance was higher in most technology-assisted programs (6/7 studies, 70–100% adherence). Stability outcomes were less consistent, with only 1/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited. Full article

Background/Objectives: The purpose of this review was to determine the impact of osteoporosis on outcomes after surgery for cervical deformity. Cervical deformity involves abnormal curvature or misalignment of the cervical spine, often resulting in a significant loss of quality of life and requiring surgical correction. While osteoporosis has been associated with hardware failure including screw loosening and cage migration in spine surgery, its role in cervical deformity remains unclear. Existing studies report mixed findings with regard to postoperative sequelae in patients with osteoporosis undergoing surgical correction of cervical deformity. Methods: A systematic review using PRISMA guidelines and MeSH terms involving spine surgery for cervical deformity and osteoporosis was performed. The Medline (PubMed) database was searched from 1990 to August 2022 using the following terms: “osteoporosis” AND “cervical” AND (“outcomes” OR “revision” OR “reoperation” OR “complication”). This review focused on radiographic outcomes, as well as post-operative complications. Results: Eight studies were included in the final analysis. Three papers assessed risk factors for the development of post-operative distal junctional kyphosis (DJK), but only one found osteoporosis as a predictor for DJK. Although three studies found that osteoporosis was not significantly associated with the incidence of surgical complications, one highlights osteoporosis as a predictor of complications at 90 days postoperatively (p < 0.001) and another associates osteoporosis with overall poor outcomes (p = 0.021). Furthermore, one study assessing the relationship between osteoporosis and reoperation found no association. Conclusions: Overall, our systematic review suggests that in patients undergoing surgery for cervical deformity, osteoporosis is not predictive of the need for reoperation or the development of postoperative complications, such as DJK, dysphagia, superficial infection, and others. These findings highlight the need for further study regarding the role of osteoporosis in surgical correction of cervical deformity. Full article

Cooking skills (CSs) encompass both physical and behavioral abilities, and their transmission has evolved due to social changes and the rise of fast food as a convenient but unhealthy option. Studies show that patients are more likely to follow dietary plans when the advice includes healthy, simple, and practical cooking tips. Intervention programs supporting this approach have been shown to improve CSs and encourage balanced diets in the community. CSs of health professionals, and their ability to teach and impart, can thus play a key role in these strategies. This systematic review aimed to identify studies that have already discussed CSs among health professionals. PRISMA guidelines were followed, and Scielo, Pubmed, Scoppus, and Web of Science databases were searched in January 2024. From the identified 527 potentially relevant studies, 9 met the inclusion criteria. The studies analyzed address topics such as the suitability of CS as a professional competency, professionals’ viewpoints regarding culinary aptitude, integrating CSs into training, and assessment of their impact on enhancing professionals’ competencies. Results suggest that developing CSs can improve professionals’ confidence, potentially benefiting community eating behaviors. Despite available validated tools, a clearer CS definition is needed for consistent evaluation and a better understanding of its role among health professionals. Full article

Objective: this systematic review with a meta-analysis aimed to evaluate the available body of published peer-reviewed randomized controlled trial (RCT) studies on the effects of different doses and types of strength training (ST) on body composition, physical performance, and protein or calcium intake in older people with osteosarcopenia. Method: a systematic literature search was conducted between July 2024 and August 2025 using five databases: PubMed, Medline, CINAHL Complete, Scopus, and Web of Science. PRISMA, TESTEX, RoB 2, and GRADE tools assessed methodological quality and certainty of evidence. Hedge’s g effect sizes were calculated for the abovementioned variables for the meta-analysis. Results: the protocol was registered in PROSPERO (code: CRD42025643858). Of 141 registers, seven RCTs with 349 participants were included. Seven overall and two subgroup meta-analyses showed significant increases in skeletal muscle mass index (SMMI; p < 0.01), maximal isometric handgrip strength (MIHS; p = 0.03), and protein intake (p = 0.03). There were no significant differences in bone mineral density (BMD), body fat percentage (BFP), gait speed, and calcium intake. However, meta-analysis by subgroups showed significant decreases in BFP (p = 0.01) in favor of elastic band training versus resistance training, with no significant differences in BMD. Conclusions: ST in older people with osteosarcopenia conditions increases SMMI, MIHS, and protein intake. Full article

Background: Dental implants have become integral in restoring partially or completely edentulous patients due to their reported long-term success. While titanium remains the primary material for implants and abutments due to its mechanical properties and biocompatibility, zirconia has emerged as a promising alternative, especially for aesthetic regions. This systematic review aimed to assess whether zirconia abutments present a rational alternative to titanium in modern implantology, focusing on their mechanical and clinical performances. Method: The workflow used for this review included the PRISMA checklist. The eligibility criteria included various study types, with a preference given to clinical trials. The search strategy employed the PICO model, including a large number of relevant studies, and online research was carried on the online databases PubMed and Scopus, with “implant” AND “abutment” AND “zirconia” and “zirconia abutment” AND “mechanical properties” used as search strings. Results: Six clinical studies were included with an adequate follow-up and patient cohort; they suggest that while zirconia abutments offer improved aesthetics and biological integration, concerns persist regarding their mechanical properties, particularly regarding their fatigue resistance and connection stability. In vitro studies have revealed differences between titanium and zirconia abutments, with the latter showing greater susceptibility to fatigue-induced deformation and fretting wear. The clinical outcomes, however, demonstrate favourable long-term performance, with zirconia abutments promoting healthy soft tissue conditions. CAD/CAM technologies enable the precise customization of zirconia abutments, enhancing their compatibility and aesthetic outcomes. Conclusions: Although this review faces limitations due to the scarcity of comparative studies and varied methodologies, it underscores the potential of zirconia abutments in implantology. In conclusion, while zirconia abutments offer promising advantages, the careful consideration of patient-specific factors and the long-term outcomes is warranted for their optimal utilisation in implant-supported prostheses. Full article

Percutaneous vertebroplasty (PVP) has emerged as a key intervention for painful vertebral compression fractures in osteoporotic and metastatic disease, but its safety profile warrants comprehensive evaluation. We conducted a PRISMA-compliant systematic review of studies published between 2009 and 2024, identifying 15 clinical studies (n ≈ 8500 patients) that reported PVP-related complications in adults with osteoporotic or neoplastic fractures. Data extraction focused on complication incidence, presentation, imaging findings, risk factors, and management strategies. Cement leakage was the most frequently detected event (20–70% of levels, higher in neo-plastic lesions), yet symptomatic neural or vascular sequelae occurred in <1%. Pulmonary cement embolism appeared on imaging in 2–26% of cases but was clinically evident in ≤0.5%, with conservative management or brief anticoagulation sufficing for most patients. New vertebral fractures developed in 8–20% of osteoporotic and up to 30% of metastatic cohorts, paralleling underlying bone fragility rather than PVP itself. Postprocedural infection (0.2–0.5%) and neurologic injury (<0.5%) were uncommon but required prompt surgical and antibiotic interventions. Overall, PVP’s benefits—rapid pain relief and mechanical stabilization—outweigh its risks when performed with meticulous technique, vigilant imaging, and multidisciplinary follow-up, confirming its favorable safety profile in both osteoporosis and spinal malignancy. Full article

Background: Occupational risk prevention is a critical discipline for ensuring safe working conditions and minimizing accidents and occupational diseases. With the rise of artificial intelligence (AI) and machine learning (ML), these approaches are increasingly utilized for predicting and preventing workplace hazards. This systematic review aims to identify, evaluate, and synthesize existing literature on the use of AI algorithms for detecting and predicting hazardous environments and occupational risks in the workplace, focusing on predictive modeling and prevention strategies. Methods: A systematic literature review was conducted following the PRISMA 2020 protocol, with minor adaptations to include conference proceedings and technical reports due to the topic’s emerging and multidisciplinary nature. Searches were performed in IEEE Digital Library, PubMed, Scopus, and Web of Science, with the last search conducted on 1 August 2024. Only peer-reviewed articles published from 2019 onwards and written in English were included. Systematic literature reviews were explicitly excluded. The screening process involved duplicate removal (reducing 209 initial documents to 183 unique ones), a preliminary screening based on titles, abstracts, and keywords (further reducing to 92 articles), and a detailed full-text review. During the full-text review, study quality was assessed using six quality assessment (QA) questions, where articles receiving a total score below 4.5 or 0 in any QA question were excluded. This rigorous process resulted in the selection of 61 relevant articles for quantitative and qualitative analysis. Results: The analysis revealed a growing interest in the field, with a clear upward trend in publications from 2021 to 2023, and a continuation of growth into 2024. The most significant contributions originated from countries such as China, South Korea, and India. Applications primarily focused on high-risk sectors, notably construction, mining, and manufacturing. The most common approach involved the use of visual data captured by cameras, which constituted over 40% of the reviewed studies, processed using deep learning (DL) models, particularly Convolutional Neural Networks (CNNs) and You Only Look Once (YOLO). Conclusions: The study highlights current limitations, including an over-reliance on visual data (especially challenging in low-visibility environments) and a lack of methodological standardization for AI-based risk detection systems. Future research should emphasize the integration of multimodal data (visual, environmental, physiological) and the development of interpretable AI models (XAI) to enhance accuracy, transparency, and trust in hazard detection systems. Addressing long-term societal implications, such as privacy and potential worker displacement, necessitates transparent data policies and robust regulatory frameworks. Full article