Search Results (62)

Background/Objectives: This systematic review aims to synthesize recent studies on the integration of artificial intelligence (AI) into robotic surgery for oncological patients. It focuses on studies using real patient data and AI tools in robotic oncologic surgery. Methods: This systematic review followed PRISMA guidelines to ensure a robust methodology. A comprehensive search was conducted in June 2025 across Embase, Medline, Web of Science, medRxiv, Google Scholar, and IEEE databases, using MeSH terms, relevant keywords, and Boolean logic. Eligible studies were original research articles published in English between 2024 and 2025, focusing on AI applications in robotic cancer surgery using real patient data. Studies were excluded if they were non-peer-reviewed, used synthetic/preclinical data, addressed non-oncologic indications, or explored non-robotic AI applications. This approach ensured the selection of studies with practical clinical relevance. Results: The search identified 989 articles, with 17 duplicates removed. After screening, 921 were excluded, and 37 others were eliminated for reasons such as misalignment with inclusion criteria or lack of full text. Ultimately, 14 articles were included, with 8 using a retrospective design and 6 based on prospective data. These included articles that varied significantly in terms of the number of participants, ranging from several dozen to several thousand. These studies explored the application of AI across various stages of robotic oncologic surgery, including preoperative planning, intraoperative support, and postoperative predictions. The quality of 11 included studies was very good and good. Conclusions: AI significantly supports robotic oncologic surgery at various stages. In preoperative planning, it helps estimate the risk of conversion from minimally invasive to open colectomy in colon cancer. During surgery, AI enables precise tumor and vascular structure localization, enhancing resection accuracy, preserving healthy tissue, and reducing warm ischemia time. Postoperatively, AI’s flexibility in predicting functional and oncological outcomes through context-specific models demonstrates its value in improving patient care. Due to the relatively small number of cases analyzed, further analysis of the issues presented in this review is necessary. Full article

Background/Objectives: Non-small-cell lung cancer (NSCLC) frequently metastasizes to the brain, significantly impacting patient prognosis and quality of life. Anlotinib, a novel tyrosine kinase inhibitor, has shown promise in treating NSCLC with brain metastasis. So, we aimed to evaluate the clinical efficacy of anlotinib and various types of radiotherapy combinations used to treat NSCLC patients with brain metastasis regarding overall survival and the treatment of internal and external lesions. Methods: A comprehensive literature search was conducted in the databases PubMed, Scopus, WoS, MedLine, and Cochrane Library up to April 2024. Studies assessing the efficacy of anlotinib combined with whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or other radiotherapy modalities in NSCLC patients with brain metastasis were included. The primary outcomes were (a) the efficacy of anlotinib and radiotherapy on the intracranial lesions and OS and (b) the effectiveness of combined anlotinib and radiotherapy versus radiotherapy alone in NSCLC patients with brain metastasis. The secondary outcome was the efficacy of anlotinib and radiotherapy on extracranial progression. We used a combination of keywords and MeSH terms including ‘non-small cell lung cancer’ OR ‘NSCLC’, ‘brain metastases’, ‘anlotinib’, ‘radiotherapy’, ‘radiation therapy’, and ‘combined treatment’, among others. Boolean operators (AND, OR) were applied as appropriate to optimize the search strategy across databases. Results: Nine studies met the inclusion criteria, comprising 210 patients in the combination group and 228 patients in the radiotherapy alone group. The combination of anlotinib with radiotherapy showed a significant improvement in iPFS compared to radiotherapy alone, with a pooled risk ratio (RR) for iORR of 1.18 (95% CI: 1.00–1.39) and a pooled SMD for OS of 0.03 (95% CI: −0.29, 0.36). Radiotherapy combined with anlotinib also demonstrated enhanced intracranial and extracranial control rates. Conclusions: Anlotinib combined with radiotherapy, especially WBRT, offers a promising treatment strategy for NSCLC patients with brain metastasis, improving intracranial control. Further large-scale randomized controlled trials are needed to confirm these findings and optimize treatment protocols. Full article

Objectives: This study aimed to evaluate the efficacy of various nutritional supplements in enhancing endurance performance and subjective thermal perception in athletes exposed to high-temperature environments through a systematic review and network meta-analysis. Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and EBSCOhost from inception to January 2025. Studies were included if they evaluated the effects of nutritional supplements on either endurance performance or subjective thermal perception in athletes under heat stress. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias. A network meta-analysis was performed using R software (version 4.3.1). The search was limited to English-language publications and employed both MeSH and free-text terms related to “athletes,” “nutritional supplements,” and “exercise performance,” using Boolean operators (AND/OR) to construct the strategy. Results: Twenty-five randomized controlled trials (RCTs) involving 552 participants were included, yielding 22 comparisons: 18 assessed endurance performance, and 11 assessed subjective perception. Standardized mean differences (SMDs) and posterior probabilities (P-scores based on Bayesian ranking) were calculated using random-effects and Bayesian models. Menthol (SMD = −1.83, 95% CI [−3.15, −0.51]; P-score = 71.04%) and taurine (SMD = 0.91, 95% CI [0.08, 1.73]; P-score = 12.75%) demonstrated significant positive effects on endurance. Menthol energy gel showed the greatest improvement in thermal comfort (SMD = 2.14, 95% CI [1.01, 3.26]; P-score = 99.54%). Conclusions: Menthol and taurine appear effective in enhancing endurance in hot environments, while menthol energy gel substantially improves perceived thermal comfort. Future research should apply stricter controls regarding environmental conditions, supplement dosage, and participant characteristics. While individual supplements may offer limited benefits, synergistic combinations may yield greater improvements in performance and comfort. Full article

Background: Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is a critical predictor of morbidity and mortality in patients with cirrhosis. In chronic liver disease, sarcopenia exacerbates adverse clinical outcomes and deteriorates quality of life. Physical activity, particularly resistance training, has demonstrated beneficial effects in reversing muscle depletion in various chronic conditions. Aim: This systematic review aimed to evaluate the impact of resistance training on sarcopenia among cirrhotic patients, with a focus on both pre-liver transplant and post-liver transplant populations, to improve clinical outcomes and enhance quality of life. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE databases were searched for randomized controlled trials (RCTs) using a standardized search command combining MESH terms and Boolean operators. Studies meeting eligibility criteria and reporting improvements in sarcopenia following resistance training were selected for data extraction. Results: Out of 109 references identified, 12 RCTs were included—10 in pre-transplant and 2 in post-transplant populations. Across studies, resistance training led to measurable improvements in key outcomes: peak VO₂ increased by up to 5.3 mL/kg/min, 6 min walk distance improved by 18–97 m, quadriceps muscle thickness increased by up to 1.05 cm, and grip strength gains ranged from 0.4 to 3.8 kg. Postoperative studies reported reductions in fatigue severity scores and length of hospital stay, along with improvements in respiratory pressures and peripheral muscle strength. Conclusions: Resistance training is effective in ameliorating sarcopenia in cirrhotic patients, thereby enhancing pre-transplant status and postoperative quality of life. Clinically, structured exercise programs should be routinely implemented. Full article

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of insecticides, from mostly using dichlorodiphenyltrichloroethane (DDT) and pyrethroids from 1997 to 2010 to carbamates in 2011 and organophosphates in 2013. In addition, other vector control measures, like the use of long-lasting insecticide-treated bed nets (LLINs), have also been employed for malaria control. Despite the implementation of these mosquito vector control interventions, malaria remains a disease of public health concern, especially in sub-Saharan Africa, which bears over 90% of the disease burden. This review will thus collate evidence on the effectiveness of IRS for malaria control in sub-Saharan Africa. Methods and analysis: The systematic review will be conducted following a priori criteria developed using the PRISMA guidelines. Articles will be obtained through a search of the Web of Science, Google Scholar, Medline via PubMed, Scopus and Embase databases. Mesh terms and Boolean operators (“AND”, “OR”) will be used in the article search. Additionally, websites of malaria research institutions will be searched. The article search will be conducted by two independent librarians (AAK and RS). All identified articles will be transferred to EPPI-reviewer v6.15.1.0 software. Article screening and data abstraction will be performed in duplicate by four reviewers (KOO, LN, GK and MO), and any further disagreements will be resolved through discussion and consensus. We shall extract data on the country, region, study design, insecticide combination, season, susceptibility procedure used, vector control interventions, population, mosquito species, malaria incidence or prevalence, insecticide efficacy, susceptibility, genotypic resistance, vector mortality and knockdown effect. Data analysis will be performed using STATA v17.0. Effect sizes will be statistically pooled using inverse-variance-weighted random-effects meta-analysis. Heterogeneity and publication bias in the articles will be assessed using the I² statistic and a funnel plot, respectively. For the studies that will not be included in the meta-analysis, a narrative synthesis will be written following the Cochrane Consumer and Communication Review Group format. Results: The findings of this review will help generate evidence on the effectiveness of indoor residual spraying using WHO pre-qualified insecticides in malaria control in sub-Saharan Africa. This protocol was registered in PROSPERO, registration number CRD42024517119. Full article

Background/Objectives: Food allergies represent a growing public health challenge, showing an alarming increase in prevalence over the past few decades. Children with multiple food allergies face not only allergic reaction risks but also nutritional gaps, affecting diet, nutrition, and growth. This review summarizes the impact on nutrient intake and growth, highlighting key challenges and strategies to improve clinical care. Methods: The literature search was conducted using a structured search strategy in PubMed up to 31 January, using MeSH terms with Boolean operators (AND, OR) to combine searches (food hypersensitivity AND growth, food hypersensitivity AND nutrition, food hypersensitivity AND micronutrient, food hypersensitivity AND vitamin, food hypersensitivity AND trace element, and soy hypersensitivity) for human studies meeting pre-defined PICOS criteria that simultaneously assessed the reproducibility and validity. Results: Nearly 2000 studies were identified in the literature search, with 31 articles selected for full-text evaluation and 11 articles included in the final review. Dietary restrictions imposed by the need to avoid multiple allergens can lead to a reduced intake of essential nutrients, particularly proteins, calcium, iron, zinc, iodine, folate, vitamin B12, and vitamin D. Children with multiple FAs appear to be at an increased risk of impaired growth, as evidenced by the lower height-for-age, weight-for-age, head-circumference, and weight-for-length Z-scores compared to non-allergic peers. Conclusions: Evidence from the studies reviewed suggests that children with multiple FAs may be at increased risk for growth impairments and nutritional inadequacies, especially where dietary management does not adequately compensate for nutrient losses, and highlights that tailored dietary counseling is crucial. Full article

Background and Objectives: Total knee arthroplasty (TKA) is one of the most common medical procedures worldwide. However, 10 to 20% of patients are still dissatisfied despite implants and surgical technique advancements. Recently, several medial-stabilized TKAs have been developed in attempts to replicate the native kinematics of the knee. The aim of this scoping review on medial-stabilized TKA inserts—medial congruent (MC) and medial pivot (MP)—is to focus on their clinical outcomes and the role of the posterior cruciate ligament (PCL), aiming to systematically map the existing research and highlight current knowledge gaps. Materials and Methods: A search of the PubMed, Embase and Cochrane databases was performed to identify relevant studies on the kinematics and outcomes of medial pivot (MP) or medial congruent (MC) inserts. The following Mesh terms were used in combination with the Boolean operators “AND” and “OR”: “total knee arthroplasty”, “total knee replacement”, “medial pivot”, “medial congruence”, “outcomes” and “kinematic”. Original studies reporting on clinical outcomes assessed with validated patient-reported scales, surgical techniques and reoperation rates for any reason with a minimum follow-up of 18 months were included. Results: A total of 39 articles met the inclusion criteria, accounting for 6143 total knee replacements. The overall reoperation-free survivorship rate was 98.4% (6047 out of 6143 knees) at a weighted average follow-up of 6.3 years (range 1.5–15.2 years, SD 0.7). Both MP and MC inserts demonstrated good outcomes, with no differences between groups. Few studies evaluated the role of the PCL in MP and MC inserts, with no differences in terms of clinical outcomes between retaining and sacrificing the PCL. Conclusions: MS-TKA demonstrated good outcomes in the literature independently of the specific design (medial pivot or medial congruent). Different possible biases may be present when evaluating the outcomes of these inserts, including different types of alignment and soft tissue balancing philosophies. Full article

Cardiovascular diseases (CVDs) remain the leading cause of death globally. In recent years, interest in multicomponent interventions has grown as a response to the multifactorial complexity of CVDs. However, the literature still shows little systematic investigation into the effectiveness of multicomponent training (MCT) in the field of CVDs, accompanied by terminological confusion. This study aims to summarize and critically appraise the recent literature through a narrative review. A narrative review was conducted, synthesizing evidence from studies published between 2010 and January 2025. The databases searched included PubMed, Scopus, and Google Scholar using predefined search terms related to CVDs and MCT, and medical subject headings (MeSHs) and Boolean syntax. Two team authors independently extracted relevant information from the included studies. MCT significantly improved hemodynamic parameters in CVD patients, with reductions in systolic, diastolic, mean blood pressure, and heart rate. Physical fitness measures showed consistent enhancements whereas anthropometric improvements often corresponded with blood pressure reductions. Psychological outcomes varied across studies, with intervention duration emerging as a key factor in effectiveness. MCT interventions could lead to improvements in clinical outcomes, risk factor reduction, and patient adherence. Although findings on psychological parameters remain inconsistent, the overall evidence supports their integration into both clinical and community settings. Full article

Background: Pheochromocytoma and paraganglioma are catecholamine-secreting tumors, rarely presenting with pheochromocytoma multisystem crisis (PMC), a life-threatening endocrine emergency. The severity of the condition includes a refractory cardiogenic shock and may therefore require the use of temporary mechanical circulatory support. The aim of this review is to describe the incidence of pheochromocytoma and paraganglioma crises associated with refractory cardiogenic shock, the physiopathological impact of this condition on the myocardial function, the role of temporary mechanical circulatory support (tMCS) in its management, and the outcomes of this specific population. Methods: For the purpose of this narrative review, a literature search of PubMed was conducted as of 16 November 2024. Medical Subject Headings (MeSH) terms used included extracorporeal circulation”, “Impella”, “pheochromocytoma”, “paraganglioma”, and “cardiogenic shock”, combined with Boolean “OR” and “AND”. Data from case series, retrospective studies, and systematic reviews were considered. Seven studies reporting on 45 patients who developed PMC with cardiogenic shock requiring tMCS were included. Patients were young, with a median age of 43 years (range 25–65) at presentation. Most cases presented with severe hemodynamic instability, blood pressure lability, and rapid progression to severe left ventricular dysfunction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was the most common tMCS used to stabilize patients, initiate specific pheochromocytoma treatments, and, in some cases, provide circulatory support during emergent surgery. The median duration of VA-ECMO support was 4 days (range 1–7) and the reported mean in-hospital survival rate was 93.5%. Following VA-ECMO weaning, survivors showed full recovery of the left ventricular ejection fraction (LVEF). Conclusions: The cardiac dysfunction observed in PMC-associated cardiogenic shock may be severe and life-threatening but appears reversible. tMCS should therefore be considered in eligible cases, as a bridge to recovery, treatment, or surgery. The reported survival rates are impressively high, suggesting possibly a substantial risk of publication bias. Full article

Objectives: This study aims to review the scientific literature on the prevention of white spot lesions (WSLs) associated with fixed orthodontic treatment. WSLs result from enamel demineralization and pose aesthetic and functional challenges. The study evaluates the effectiveness of various preventive interventions to reduce the risk of WSLs during orthodontic care. Methods: A comprehensive literature search was conducted using MeSH terms such as “white spot”, “fixed orthodontic treatment”, “CPP-ACP”, “topical fluoride”, and “demineralized lesion”, combined with the Boolean operator ‘AND’. Databases searched included PubMed, EMBASE, Scopus, and OpenGrey, focusing on studies published between January 2014 and September 2024. The inclusion criteria required studies to evaluate interventions aimed at reducing WSL risk in patients undergoing fixed orthodontic treatment. A total of 41 articles were screened, with 17 selected based on relevance and methodological rigor. Results: The review identified several effective strategies for preventing WSLs. Topical fluoride applications, particularly high-concentration varnishes, significantly reduced WSL prevalence, with some studies favoring fluoride varnish over other interventions. CPP-ACP and CPP-ACPF formulations demonstrated potential for remineralizing demineralized enamel, especially when combined with fluoride toothpaste. High-fluoride toothpaste and acidulated phosphate fluoride mouthwash were effective in reducing lesion incidence, emphasizing the importance of patient compliance in daily oral hygiene routines. Professional interventions, such as fluoride varnish applications, showed enhanced outcomes when re-applied periodically. Conclusions: Preventing WSLs during orthodontic treatment is crucial for ensuring the aesthetic and functional success of therapy. Strategies combining fluoride-based interventions with casein phosphopeptide formulations offer significant benefits. However, patient education and adherence to recommended oral hygiene practices remain critical. Further research is needed to compare the long-term effectiveness of these interventions and to explore new technologies for WSL prevention. Full article

In this paper, we propose an unstructured cut-cell generation method for complex geological modeling. The method can robustly and quickly generate cut results for surface and polyhedral meshes. First, we correctly identify intersecting elements in the input and compute intersection points and lines. Then, we integrate the intersection points and lines into the mesh face and subdivide it into a set of triangles. Finally, each mesh element is considered to be inside or outside each input object, and the result is finally extracted from the mesh elements generated in the above steps. To support topological queries and modifications in cutting process, we design a novel polyhedral mesh data structure, which introduces the concept of half-edge but represents it in an implicit manner. For each cell, we record its incident faces. For each face, we store the incident half-edges. For each vertex and edge, we store one of its incident faces. Our method is properly proved in a complex 3D geological model. Full article

Dental caries remains a prevalent chronic disease driven by dysbiosis in the oral biofilm, with Streptococcus mutans playing a central role in its pathogenesis. Objective: This study aimed to assess the effect of D-tagatose on cariogenic risk by analyzing randomized clinical trials (RCTs). Methods: A systematic literature review was conducted targeting RCTs published up to 2024 in eight databases and two gray literature sources. The search strategy utilized Medical Subject Headings (MeSHs) and relevant keywords combined via Boolean operators using the query “Tagatose OR D-tagatose AND Dental Caries”. Eligible studies must evaluate the impact of D-tagatose on cariogenic risk, as indicated by reductions in colony-forming units (CFUs) and/or improvements in salivary pH levels in treatment groups. Results: From 1139 retrieved records, three studies met the inclusion criteria. Two of these studies consistently demonstrated significant reductions in CFU counts in vitro and changes in oral bacteria in groups treated with D-tagatose alone or in mixtures with other agents compared to controls using other non-caloric sweeteners or placebos (p < 0.01). However, the quality of the evidence was heterogeneous, with certain methodological concerns. Conclusions: Although the findings suggest potential benefits of D-tagatose in reducing cariogenic risk, limitations such as small sample sizes and variability in study methodologies warrant caution. Further robust investigations are needed to substantiate these promising results and support the integration of D-tagatose into oral care formulations aimed at reducing cariogenic risk. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health challenge, particularly in low- and middle-income countries (LMICs). Understanding the knowledge, attitudes, motivations, and expectations of community members regarding antimicrobial use is essential for effective stewardship interventions. This scoping review aimed to identify key themes relating to the critical areas regarding antimicrobial use among community members in primary healthcare (PHC), with a particular focus on LMICs. Methods: OVID Medline, PubMed, and CINAHL databases were searched using Boolean operators and Medical Subject Headings (MeSH) terms relevant to antimicrobial use and community behaviors. The Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework guided study selection, which focused on community members seeking care in PHC in LMICs. Data management and extraction were facilitated using the Covidence platform, with the Critical Appraisal Skills Programme (CASP) qualitative checklist applied for qualitative studies. A narrative synthesis identified and grouped key themes and sub-themes. Results: The search identified 497 sources, of which 59 met the inclusion criteria, with 75% of the studies conducted in outpatient primary care settings. Four key themes were identified: (1) the ’patient’ theme, highlighting beliefs, knowledge, and expectations, which was the most prominent (40.5%); (2) the ’provider’ theme, emphasizing challenges related to clinical decision-making, knowledge gaps, and adherence to guidelines; (3) the ’healthcare systems’ theme, highlighting resource limitations, lack of infrastructure, and policy constraints; and (4) the ‘intervention/uptake’ theme, emphasizing strategies to improve future antibiotic use and enhance access to and quality of healthcare. Conclusions: Stewardship programs in PHC settings in LMICs should be designed to be context-specific, community-engaged, and accessible to individuals with varying levels of understanding, involving the use of information and health literacy to effectively reduce AMR. Full article

Background/Objectives: Acetabular fractures are rare fractures of the pelvis which usually result from trauma. Whilst data are reported on sexual and genitourinary function in those with pelvic fractures, less is known about those with isolated acetabulum fractures. This systematic review aimed to determine, first, the frequency of sexual and genitourinary dysfunction following isolated acetabulum fractures and, second, the nature of these complications. Methods: A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Results: Seven studies based on 648 individuals were identified with a mean follow-up time of 33.6 ± 22.4 months. Five papers described sexual functional outcomes, and two reported genitourinary function. Acetabulum fractures were noted to have an impact on sexual function ranging from 20.0% to 39.8% within the groups analysed. With respect to genitourinary outcomes, incidence of lower urinary tract injury and spontaneous voiding failure was quite low, but due to the existence of little data, firm conclusions cannot be made. Conclusions: This review has highlighted a paucity of data related to outcomes of sexual and genitourinary function in patients who are post-acetabulum fracture. The limited available data suggests that acetabular fractures have an impact on sexual function, but the impact on genitourinary function is less clear. Further prospective work is required to better understand the relationship between baseline demographics, injury characteristics, injury mechanism and concurrent injuries, and surgical fixation and acetabular-fracture outcomes. Full article

Background: Systemic arterial hypertension contributes to cardiovascular morbidity and mortality worldwide. Many patients cannot achieve optimal blood pressure (BP) control with traditional therapies, which often results in poor patient adherence and limited long-term efficacy. We investigated the potential of RNA interference (RNAi) therapies targeting hepatic angiotensinogen (AGT) for hypertension management. Methods: This scoping review was conducted by the Joanna Briggs Institute, following a six-stage methodological framework and adhering to PRISMA recommendations. A comprehensive search was conducted across seven databases to identify relevant studies published until May 2024. Data extraction was performed separately, and both quantitative and qualitative analyses were conducted. A population, concept, and context model-based search was performed, selecting controlled MeSH terms and uncontrolled descriptors and cross-referencing them using Booleans. Results: Fifteen articles met our inclusion criteria. Focusing on the efficacy and safety of RNAi-based therapies, this review discusses several key approaches, including antisense oligonucleotides (IONIS-AGT-LRx), small interfering RNA (siRNAs; zilebesiran), and adeno-associated viruses carrying short hairpin RNAs. Notably, zilebesiran conjugated with N-acetylgalactosamine significantly reduced systolic BP by 20 mmHg, sustained for up to six months post-administration, with minimal adverse effects. Conclusions: RNAi-based therapies, particularly those using siRNAs, such as zilebesiran, are promising for the treatment of hypertension. They offer long-term BP control with fewer doses, potentially improving patient adherence and outcome. Although these therapies address several limitations of current antihypertensive treatments, further studies are required to confirm their long-term safety and efficacy. Full article