Search Results (38,574)

Background: Instrument separation is a frequent issue in root canals, often complicated by intriguing anatomical variations that make treatment more challenging. These variations in canal structure can lead to various iatrogenic complications, such as missed canals, instrument separation, gouging, perforation, and overextension of obturation materials. One such complication is instrument breakage, which can disrupt the cleaning and shaping processes and potentially cause pain or discomfort. Materials and Methods: The present systematic review was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The present systematic review aimed to identify all clinical trials focused on the removal of separated instruments from endodontic canals using an endodontic surgical approach. Results: A total of 21 studies were included, reporting 22 cases involving surgical approaches for separated instrument removal. Conclusions: The analysis of available evidence, although prim Information added.arily based on clinical cases and case series, emphasizes that surgical approaches for removing separated endodontic instruments are a viable therapeutic option when non-surgical treatments are ineffective or not feasible. Techniques such as apicoectomy, intentional replantation, surgical removal, and the technique provide innovative, customized solutions for addressing complications related to separated instruments, showing favorable clinical and radiographic success rates in follow-up assessments. Full article

At present, artificial intelligence (AI) has shown significant potential in digestive endoscopy image analysis, serving as a powerful auxiliary tool for the accurate diagnosis and treatment of gastrointestinal diseases. However, mainstream models represented by deep learning are often characterized as complex “black boxes,” with decision-making processes that are difficult for humans to interpret. The lack of interpretability undermines physicians’ trust in model results and hinders the broader use of models in clinical practice. To address this core challenge, Explainable AI (XAI) has emerged to enhance the transparency of decision-making, thereby establishing a foundation of trust for human–machine collaboration. The review systematically reviews 34 articles (7 articles in esophagogastroduodenoscopy, 13 articles in colonoscopy, 9 articles in endoscopic ultrasonography, and 5 articles in wireless capsule endoscopy), focusing on the research progress and applications of XAI in the field of digestive endoscopic image analysis, with particular emphasis on the visual explanation-based methods. We first clarify the definition and mainstream classification of XAI, then introduce the principles and characteristics of key XAI methods based on visual explanation. Subsequently, we review the applications of these methods in digestive endoscopy image analysis. Lastly, we explore the obstacles presently faced in this domain and the future directions. This study provides a theoretical basis for constructing a trustworthy and transparent AI-assisted digestive endoscopy diagnosis and treatment system and promotes the implementation and application of XAI in clinical practice. Full article

Background: Electroencephalographic (EEG) neurofeedback training is gaining traction as a non-pharmacological treatment option for Parkinson’s disease (PD). This paper reports the first pre-registered, integrated systematic review and meta-analysis of studies examining the effects of EEG neurofeedback on cortical activity and motor function in people with PD. Method: We searched Cochrane Databases, PubMed, Embase, Scopus, Web of Science, PsycInfo, grey literature repositories, and trial registers for EEG neurofeedback studies in people with PD. We included randomized controlled trials, single-group experiments, and case studies. We assessed risk of bias using the Cochrane Risk of Bias 2 and Risk of Bias in Non-Randomized Studies tools, and we used the Grading of Recommendations, Assessment, Development and Evaluations tool to assess certainty in the evidence and resultant interpretations. Random-effects meta-analyses were performed. Results: A total of 11 studies (143 participants; Hoehn and Yahr I–IV) met the criteria for inclusion. A first meta-analysis revealed that EEG activity is modified in the prescribed way by neurofeedback interventions. The effect size is large (SMD = 1.30, 95% CI = 0.50–2.10, p = 0.001). Certainty in the estimate is high. Despite successful cortical modulation, a subsequent meta-analysis revealed inconclusive effects of EEG neurofeedback on motor symptomology. The effect size is small (SMD = 0.10, 95% CI = −1.03–1.23, p = 0.86). Certainty in the estimates is low. Narrative evidence revealed that interventions are well-received and may yield specific benefits not detected by general symptomology reports. Conclusion: EEG neurofeedback successfully modulates cortical activity in people with PD, but downstream impacts on motor function remain unclear. The neuromodulatory potential of EEG neurofeedback in people with PD is encouraging. Additional well-powered and high-quality research into the effects of EEG neurofeedback in PD is warranted. Full article

This review aims to provide an overview of the role of vitamin D in peri-implant and periodontal tissue. Electronic searches were carried out of the PubMed/Medline database. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was performed. Vitamin D plays a crucial role in bone balance and metabolism, contributing to reducing early implant failure and improving dental implant osseointegration. Vitamin D deficiency poses a challenge to clinical outcomes, and its supplementation can be an effective alternative to overcome this limitation. The results reported in this article show that vitamin D application on implants can improve the osseointegration, bone-to-implant contact, implant stability, and bone density. Moreover, vitamin D supplementation can increase RUNX2, ALP, OPN, and OCN expression, contributing to periodontal tissue health and its regeneration. Together, findings provide an overview of these topics and present future perspectives for clinical practice in dentistry. Full article

Type 2 diabetes (T2D) presents growing public health challenges due to its strong links to modifiable behaviors. This systematic review examined how researchers have studied behavioral domains such as diet, physical activity, medication adherence, and blood glucose monitoring in adults with T2D. A structured search of PubMed, Scopus, and Web of Science identified peer-reviewed studies published between 2003 and 2025, with studies from 2014 onward prioritized to reflect the rise in mobile health technologies. 30 core studies were systematically reviewed, with 10 additional comparative studies included for supplementary methodological insights. Quantitative approaches were most common, offering measurable outcomes but often relying on self-report. Qualitative studies provided valuable cultural and psychosocial context yet lacked generalizability. Mixed-methods designs integrated statistical and narrative insights but posed practical challenges in execution. Technology-assisted methods, such as mobile applications and wearable devices, supported real-time monitoring and improved accuracy but raised concerns regarding privacy and equitable access. Physical activity and dietary behaviors were most frequently studied, while medication adherence and glucose monitoring received less consistent attention. Despite methodological diversity, most studies relied on cross-sectional designs and underutilized culturally tailored frameworks. This review emphasizes the need for longitudinal, equity-focused research methodologies to improve diabetes prevention and management strategies. Full article

Small and medium-sized enterprises face significant challenges in effectively implementing design thinking due to limited resources, leadership skepticism, and a paucity of suitable frameworks. This study addresses these challenges by developing and validating a web-based Design Thinking and Innovation Strategy Toolbox tailored to SME needs. The Toolbox is designed to align with the ISO 56001:2024 Innovation Management Systems standard and was developed through systematic literature reviews and expert interviews, shaping practical modules based on previously identified barriers and success factors. A multi-round Delphi study with 14 experienced consultants refined the Toolbox, focusing on usability, ISO compliance, and practical relevance. The results indicate strong consensus among experts regarding its clarity, adaptability, and alignment with SME constraints, while also highlighting areas for improvement such as visual design and continuous feedback mechanisms. Preliminary validation suggests that the Toolbox can support SMEs in improving sustainable innovation, strategic alignment, and capability development. By addressing contextual constraints, this research contributes to the field of design-led innovation in SMEs by offering a practical, ISO-compliant tool that connects theory and practice in resource-limited environments. Full article

Arsenic pollution in potable water is a significant worldwide health concern. This study systematically evaluates current progress in adsorption technology, the most promising restorative approach, to provide a definitive framework for future research and use. The methodology entailed a rigorous evaluation of 91 peer-reviewed studies (2012–2025), classifying adsorbents into three generations: (1) Natural adsorbents (e.g., agricultural/industrial wastes), characterized by cost-effectiveness but limited capacities (0.1–5 mg/g); (2) Engineered materials (e.g., metal oxides, activated alumina), which provide dependable performance (84–97% removal); and (3) Advanced hybrids (e.g., MOFs, polymer composites), demonstrating remarkable capacities (60–300 mg/g). The primary mechanisms of removal are confirmed to be surface complexation, electrostatic interactions, and redox precipitation. Nevertheless, the critical analysis indicates that despite significant laboratory efficacy, substantial obstacles to field implementation persist, including scalability limitations (approximately 15% of materials are evaluated beyond laboratory scale), stability concerns (e.g., structural collapse of MOFs at extreme pH levels), and elevated costs (e.g., MOFs priced at approximately $230/kg compared to $5/kg for alumina). The research indicates that the discipline must transition from only materials innovation to application science. Primary objectives include the development of economical hybrids (about $50/kg), the establishment of uniform WHO testing standards, and the implementation of AI-optimized systems. The primary objective is to attain sustainable solutions costing less than $0.10 per cubic meter that satisfy worldwide deployment standards via multidisciplinary cooperation. Full article

Intracranial aneurysms (IAs) are potentially devastating cerebrovascular lesions, and predicting rupture risk remains a major clinical challenge. Conventional radiological and clinical scores offer only partial risk stratification, highlighting the need for complementary approaches. Liquid biopsy represents a promising non-invasive strategy to identify circulating biomarkers that reflect aneurysm biology and instability. We conducted a systematic review according to PRISMA 2020 guidelines, screening PubMed, Scopus, and Web of Science up to August 2025. Forty-eight eligible studies, encompassing 3515 IA patients, evaluated circulating RNA species, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) in serum, plasma, blood, or cerebrospinal fluid. Multiple candidates emerged as consistently dysregulated: upregulation of miR-21, miR-126, and miR-200a-3p, and downregulation of miR-143 and let-7b-5p were recurrently observed across independent cohorts. LncRNAs, such as MALAT1 and MIAT, and circRNAs, including circ_0000690 and circ_0021001, demonstrated diagnostic and prognostic potential, with some correlating with rupture status and clinical severity indices. Despite encouraging findings, heterogeneity in study design, sample handling, and analytic methods limits reproducibility. Large-scale, multicenter validation studies are essential to translate these biomarkers into clinical practice. Full article

Background: Emergency laparotomy (EL) carries high morbidity and mortality relative to elective abdominal surgery. While Enhanced Recovery After Surgery (ERAS) principles improve outcomes in elective care, their translation to emergencies is inconsistent. The emergency department (ED) provides a window for rapid risk stratification and pre-optimization, provided that interventions do not delay definitive surgery. Methods: We conducted a PRISMA-ScR–conformant scoping review to map ED-initiated, ERAS-aligned strategies for EL. PubMed, Scopus, and Cochrane were searched in February 2025. Eligible sources comprised ERAS guidelines, systematic reviews, cohort studies, consensus statements, and programmatic reports. Evidence was charted across five a priori domains: (i) ERAS standards, (ii) comparative effectiveness, (iii) ED-feasible pre-optimization, (iv) risk stratification (Emergency Surgery Score [ESS], frailty, sarcopenia), and (v) oncological emergencies. Results: Thirty-four sources met inclusion. ERAS guidelines codify rapid assessment, multimodal intraoperative care, and early postoperative rehabilitation under a strict no-delay rule. Meta-analysis and cohort data suggest ERAS-aligned pathways reduce complications and length of stay, though heterogeneity persists. ED-feasible measures include multimodal analgesia, goal-directed fluids, early safe nutrition, respiratory preparation, and anemia/micronutrient optimization (IV iron, vitamin B12, folate, vitamin D). Sarcopenia, frailty, and ESS consistently predicted adverse outcomes, supporting targeted bundle activation. Evidence from oncological emergencies indicates feasibility under no-delay governance. Conclusions: A minimal, ED-initiated, ERAS-aligned bundle is feasible, guideline-concordant, and may shorten hospitalization and reduce complications in EL. We propose a practical framework that links rapid risk stratification, opportunistic pre-optimization, and explicit continuity into intra- and postoperative care; future studies should test fidelity, costs, and outcome impact in pragmatic emergency pathways. Full article

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) is a leading cause of hospitalization and functional decline in older adults, accounting for over 80% of all heart failure cases. Given the narrow therapeutic window of currently available inotropes and the vulnerability of this population, levosimendan has been proposed as a potential alternative. This systematic review aimed to evaluate the clinical efficacy and safety of levosimendan in older adults with decompensated HFrEF. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted between January and May 2025, following PRISMA 2020 guidelines. The review was registered in PROSPERO (CRD420251032329). Of 379 articles initially identified, 8 studies (randomized, observational, and single-arm designs) enrolling patients aged ≥65 years with decompensated HFrEF met the inclusion criteria. Study quality was assessed using the Cochrane RoB-2 tool and JBI Critical Appraisal Checklists. No meta-analysis was performed due to heterogeneity in study designs, populations, and interventions. Results: A total of 2838 patients were analyzed. Levosimendan was associated with short-term improvements in hemodynamic parameters, including an increase in cardiac index (from 1.65 to 2.37 L/min/m²) and a reduction in pulmonary capillary wedge pressure (from 31 to 16 mmHg) within 24–72 h (p < 0.002). However, no statistically significant differences were observed in 30-, 90-, or 180-day mortality (p > 0.05), and findings on rehospitalization were inconsistent. Reported adverse events included hypotension (36–57%) and atrial arrhythmias (9–50%), with low treatment discontinuation rates (5–8%). Conclusions: Levosimendan may improve short-term hemodynamic parameters in older adults with decompensated HFrEF, but the available evidence is limited and heterogeneous. Its effects on mortality and rehospitalization remain inconclusive. Clinical use should be individualized and closely monitored, particularly in frail patients. Full article

Background: Despite evidence supporting exercise in cancer care, adherence remains low. Nordic Walking (NW), a pole-assisted outdoor activity, may overcome barriers and improve fitness. However, a comprehensive synthesis of its effects on physical fitness in cancer patients is lacking. Objective: To evaluate NW’s effects on physical fitness, health-related quality of life (HRQoL), adherence, and safety in patients living with and beyond cancer, compared with no intervention or other exercise programs. Methods: This PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD42024551608) included randomized or quasi-randomized trials. Five databases were searched through November 2024. Risk of bias (Joanna Briggs Institute) and evidence certainty (GRADE) were assessed. Results: This systematic review included six RCTs comparing NW with no intervention. NW significantly improved overall muscle strength (Std. MD = 0.46, 95%CI:0.14–0.78; low-certainty) and self-reported physical activity (MD = 3181.51 MET-min/week, 95%CI:2085–4278; moderate-certainty). Cardiorespiratory fitness (6-min walk) showed no significant improvement in random-effects modeling (MD = 84.78 m, 95%CI:−35.6–205.19; very low-certainty). HRQoL data were insufficient for meta-analysis. Adherence exceeded 90% in supervised sessions, with no serious intervention-related adverse events. Conclusions: When compared with no intervention NW is feasible and safe, potentially improving muscle strength and physical activity in patients with cancer. Evidence for cardiorespiratory endurance and HRQoL remains inconclusive. To date, no studies have compared NW with other structured exercise programs. Higher-quality RCTs with diverse populations are needed. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Results: Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Conclusions: Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches. Full article

The COP9 signalosome (CSN) is a highly conserved eukaryotic protein complex that plays a crucial role in plant growth, development, and stress responses by modulating the ubiquitination pathway. Emerging evidence underscores its significance in plant immunity, where it orchestrates diverse defense mechanisms, including hormone signaling, reactive oxygen species (ROS), homeostasis, and secondary metabolite (SM) biosynthesis. As a key regulator, CSN influences multiple layers of immune responses, such as pattern-triggered immunity (PTI), effector-triggered immunity (ETI), and systemic acquired resistance (SAR). However, the intricate interplay between CSN and immune regulatory networks remains incompletely understood, and a comprehensive model of its mechanistic framework is still lacking. This review systematically consolidates current knowledge on CSN-mediated immune regulation in plant–pathogen interactions and highlights its role in disease resistance. Full article

Equine sarcoids are the most common dermatological neoplasm in horses worldwide, associated with bovine papillomavirus (BPV) infection and characterized by high recurrence rates after conventional therapies. Bacillus Calmette–Guérin (BCG) immunotherapy has historically been used for sarcoid treatment, yet its role in contemporary veterinary oncology remains debated. This narrative review critically examines the immunological mechanisms, clinical efficacy, and limitations of BCG in equine sarcoid therapy, while integrating insights from comparative oncology and One Health perspectives. A systematic search following PRISMA-based criteria identified 55 relevant studies published over the past four decades. Evidence indicates that BCG activates innate and adaptive immunity through TLR2/4 signaling, macrophage polarization, and enhanced CD8+ T-cell responses, leading to partial or complete sarcoid regression in select cases. However, therapeutic outcomes are highly variable due to heterogeneity in protocols (dose, strain, adjuvant use) and frequent adverse inflammatory reactions. Comparative analyses highlight that modern alternatives—such as cryotherapy, cisplatin-based protocols, and topical imiquimod—achieve higher efficacy and lower recurrence rates in many clinical settings. Although BCG is now rarely considered a first-line therapy, it remains relevant in resource-limited regions, such as the Amazon Biome, where cost-effectiveness and accessibility are critical. Future directions include randomized controlled trials, standardized protocols, and innovative approaches such as checkpoint inhibition, CRISPR-Cas9 targeting of viral oncogenes, and nanoparticle delivery systems. This review provides a balanced and data-driven synthesis of BCG immunotherapy, clarifying its historical contributions, current limitations, and translational opportunities for advancing equine and comparative oncology. Full article

Background: Shoulder subluxation and pain are common complications of stroke that impair upper limb function. Objectives: This study conducted a systematic review and network meta-analysis to compare multiple therapeutic interventions for post-stroke shoulder subluxation, establishing an evidence-based hierarchy of treatment efficacy to optimize rehabilitation strategies and guide clinical practice. Methods: A comprehensive search was conducted using the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases until 8 August 2025. Randomized controlled trials evaluating treatments for shoulder subluxation, including neuromuscular electrical stimulation (NMES), Kinesio taping, corticosteroid injections, slings, repetitive peripheral magnetic stimulation, and electroacupuncture, were included. The follow-up duration in the included trials ranged from 1 to 12 weeks. Effect sizes were calculated using standardized mean differences with a random-effects model, and treatment rankings were determined using surface under the cumulative ranking curve (SUCRA). Results: Thirteen studies including 402 patients were analyzed. NMES was the most effective intervention for reducing subluxation distance (SUCRA: 84.9), while corticosteroid injections provided the greatest pain relief at rest (SUCRA: 73.6). Kinesio taping was most effective for functional recovery, as measured by the Fugl–Meyer Assessment (SUCRA: 98.5), and for pain relief during activity (SUCRA: 87.7). Conclusions: Our network meta-analysis suggests that different interventions are optimal for specific aspects of post-stroke shoulder impairment. NMES most effectively reduces subluxation distance, whereas corticosteroid injections are most effective for alleviating pain at rest. Kinesio taping appears superior for enhancing functional recovery and reducing pain during movement. These findings, based on short-term follow-up durations (1–12 weeks), provide an evidence-based ranking of interventions to support multimodal rehabilitation and inform clinical decision-making. The observed heterogeneity across studies underscores the need for standardized treatment protocols and rigorous long-term investigations. Full article