Background: Distal radial access (DRA) through the anatomical snuff-box is a novel technique for coronary procedures. Emerging evidence suggests that DRA is associated with a lower risk of certain complications compared to proximal radial access (PRA). Methods: A systematic review was conducted to compare clinical and procedural outcomes between both access sites for coronary angiography and percutaneous coronary intervention. We searched PubMed, Web of Science, Cochrane, and Scopus to identify relevant randomized controlled trials. Results: We included 23 randomized controlled trials enrolling 10 062 patients (DRA group: 5042; PRA group: 5020) in this review. DRA was associated with a lower risk for radial artery occlusion (RAO) at the longest reported follow-up [risk ratio (RR): 0.30, P < 0.00001], in-hospital RAO (RR: 0.28, P < 0.00001), any bleeding (RR: 0.40, P = 0.04), hand clumsiness (RR: 0.05, P < 0.00001), and shorter time to hemostasis [mean difference (MD): −40.93, P < 0.00001]. However, DRA showed a higher access failure rate (RR = 2.64, P < 0.00001), longer access time (MD = 0.77, P < 0.00001), more puncture attempts (MD: 0.60, P < 0.0001), and greater access-related pain [standardized mean difference (SMD) = 0.23, P = 0.02]. Both approaches were comparable in terms of major adverse cardiac events (RR = 0.74, P = 0.60), and hand function (SMD = −0.05, P = 0.68). Conclusion: DRA is a safe alternative to PRA for coronary procedures, with a lower risk of complications, including RAO. However, it is limited by access-related challenges.

Background: CKD-related anemia remains a major complication in patients receiving peritoneal dialysis (PD), with limited treatment options beyond erythropoiesis-stimulating agents. Roxadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, has shown promise in correcting CKD-related anemia and modulating iron and metabolic parameters. However, its evidence in PD remains limited. Methods: We conducted a systematic search of PubMed, Scopus, and Web of Science from inception to July 20, 2025. We included studies reporting the efficacy and safety of roxadustat in PD. Statistical analysis was performed using Review Manager (RevMan 5.4 for Windows) and R Studio. Results: Eight studies were included in the meta-analysis ( n = 607). Roxadustat significantly increased hemoglobin at all time points (MD 0.35 g/dL, 95% CI 0.28–0.41; p < 0.00001), serum iron (MD 0.95 µmol/L, 95% CI 0.02–1.89; p = 0.05), and total iron-binding capacity (MD 6.25 µmol/L, 95% CI 3.95–8.55; p < 0.00001), and reduced hepcidin (MD − 12.28 ng/mL, 95% CI − 21.06 to − 3.50; p = 0.006). No significant effects were observed for ferritin ( p = 0.49), transferrin saturation ( p = 0.45), cholesterol ( p = 0.07), LDL ( p = 0.14), HDL ( p = 0.27), triglycerides ( p = 0.26), CRP ( p = 0.75), systolic blood pressure ( p = 0.10), or diastolic blood pressure ( p = 0.08). Heterogeneity was low to moderate for most outcomes. Conclusion: Roxadustat is effective in improving hemoglobin and iron metabolism in patients with PD, while exerting neutral effects on lipids, inflammation, and blood pressure. These findings support its role as a promising therapy for CKD-related anemia in PD. Clinical trial number: Not applicable.

Drug-resistant epilepsy (DRE), defined as failure of at least two anti-seizure medications, affects nearly one-third of individuals with epilepsy and remai