The transition from conventional analogue techniques to digital workflows is transforming implant dentistry. However, a comprehensive synthesis of comparative clinical evidence is lacking. This systematic review and meta-analysis aimed to evaluate the clinical effectiveness, accuracy, and patient-centred outcomes of fully digital versus conventional workflows for fabricating implant-supported restorations. This review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered with PROSPERO (International Prospective Register of Systematic Reviews). A comprehensive search of PubMed/MEDLINE, Embase, and Cochrane Library was performed to identify randomized controlled trials (RCTs) and non-randomized clinical studies comparing digital (intraoral scanning) and conventional (elastomeric impression) restorative workflows for single-unit or full-arch implant prostheses. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 and ROBINS-I tools. The primary outcomes were time efficiency, accuracy/fit, and patient-reported outcome measures (PROMs). Secondary outcomes included biological and prosthetic complication rates. Random-effects meta-analyses were conducted using the Hartung-Knapp method, with heterogeneity assessed using the statistic. The certainty of the evidence was evaluated using the GRADE approach. Ten clinical studies (six RCTs, four non-randomized) met the inclusion criteria. Most RCTs demonstrated a low risk of bias, while non-randomized studies showed a moderate risk of bias. Meta-analysis revealed that digital workflows significantly reduced mean procedure time compared to conventional methods (mean difference (MD):-4.28 minutes; 95% CI:-8.40 to-0.16; p < 0.05). No statistically significant difference was found in restorative accuracy or fit between the two workflows (standardized mean difference (SMD): 0.20; 95% CI:-3.72 to 4.12). Patient-reported outcomes showed a trend toward favoring the digital workflow for comfort and satisfaction (MD: 13.98; 95% CI:-7.74 to 35.70). Implant survival rates were high (>98%) and comparable for both groups, with no significant difference in complication rates. The certainty of the evidence ranged from Low for accuracy to Moderate for time efficiency and PROMs. Fully digital workflows for implant-supported restorations are significantly more time-efficient and are preferred by patients, while demonstrating comparable clinical accuracy and survival rates to conventional methods. These findings support the adoption of digital technologies as a robust and effective alternative in modern implant prosthodontics.

Patients with non-valvular atrial fibrillation (AF) and advanced chronic kidney disease (CKD), including those with end-stage kidney disease (ESKD) on dialysis, present a unique therapeutic challenge. This population is at an elevated risk for both thromboembolic events and severe bleeding complications. Because patients with creatinine clearance <25-30 mL/min were excluded from pivotal trials, the comparative safety and efficacy of direct oral anticoagulants (DOACs) versus traditional vitamin K antagonists (VKAs) in this cohort remain debated. A search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed from inception to the present to identify randomized controlled trials (RCTs) and adjusted observational studies comparing DOACs to VKAs in patients with AF and advanced CKD (stages 4-5 or dialysis). The primary outcomes were stroke or systemic embolism (SE) (efficacy) and major bleeding (safety). Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using a random-effects (DerSimonian-Laird) model. Meta-regression, trial sequential analysis (TSA), and GRADE certainty assessments were applied. The final analysis included 21 studies (four RCTs, 17 observational cohorts) encompassing 184,136 participants. Compared to VKAs, DOACs were associated with a statistically significant 28% reduction in the risk of stroke or SE (heart rate (HR), 0.72; 95% confidence interval (CI), 0.60-0.86; p = 0.0004; moderate certainty). For safety, DOACs significantly reduced the risk of major bleeding by 26% compared to VKAs (HR, 0.74; 95% CI, 0.61-0.90; p = 0.0026; low to moderate certainty). However, substantial statistical heterogeneity was observed for the bleeding outcome (I² = 80.2%). Heterogeneity was primarily driven by agent-specific effects, with apixaban demonstrating the most favorable safety profile. Meta-regression confirmed that the specific DOAC agent was a significant moderator of bleeding risk (p < 0.0001), with apixaban (HR, 0.63) and rivaroxaban (HR, 0.75) driving the safety benefits, whereas dabigatran was associated with increased bleeding (HR, 1.48). TSA for stroke reduction indicated that while the cumulative Z-curve crossed the conventional benefit boundary, the information size remained below the heterogeneity-adjusted requirement. In patients with AF and advanced CKD or ESKD requiring dialysis, the use of DOACs, specifically apixaban and rivaroxaban, demonstrated superior efficacy in stroke prevention and a safer bleeding profile compared to VKAs. These findings suggest that factor Xa inhibitors, specifically apixaban and rivaroxaban, should be preferred over VKAs in this high-risk population; however, adequately powered RCTs are needed to refine specific dosing strategies.

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric condition. While selective serotonin reuptake inhibitors (SSRIs) are a standard treatment, many patients experience an inadequate response to monotherapy. For individuals with treatment-resistant OCD (TR-OCD), antipsychotic augmentation is a commonly utilized pharmacological strategy. This review aimed to systematically review the literature and conduct a frequentist network meta-analysis (NMA) to evaluate the comparative efficacy, safety, and tolerability of first-, second-, and third-generation antipsychotic augmentation in adults with TR-OCD. A systematic search was conducted from database inception to March 2026. Double-blind randomized controlled trials (RCTs) and observational studies evaluating antipsychotic augmentation of ongoing SRI therapy in adults with TR-OCD were included. The primary outcome was the mean change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score. The secondary outcomes included categorical treatment response (Y-BOCS reduction ≥ 35%) and tolerability. Pairwise meta-analyses utilized an inverse-variance random-effects model with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. The NMA established an empirical treatment hierarchy using surface under the cumulative ranking curve (SUCRA) probabilities. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Forty-three studies (22 RCTs and 21 observational studies) encompassing 890 patients were included. Pairwise meta-analysis of the RCTs demonstrated that, as a class, antipsychotic augmentation was significantly superior to placebo in reducing continuous Y-BOCS scores (standardized mean difference (SMD) = -0.49; 95% CI: -0.99 to -0.00; p < 0.05) and increasing the odds of categorical response (odds ratio (OR) = 2.38; 95% CI: 0.97 to 5.86). The NMA revealed a distinct hierarchy of efficacy: haloperidol exhibited the largest effect compared to placebo (SMD = -1.34; SUCRA = 0.799), followed by olanzapine (SMD = -0.80; SUCRA = 0.596), risperidone (SMD = -0.74; SUCRA = 0.625), and aripiprazole (SMD = -0.57; SUCRA = 0.532). The evidence for quetiapine (SMD = -0.45; SUCRA = 0.450) and paliperidone (SMD = -0.22; SUCRA = 0.356) was less robust and indistinguishable from that of the placebo. Although haloperidol was highly efficacious, its use was limited by poor tolerability. Risperidone and aripiprazole demonstrated the most optimal balance of robust anti-obsessional efficacy and acceptable tolerability. Preliminary data highlighted the potential of third-generation agents, such as brexpiprazole. Antipsychotic augmentation is a highly effective, evidence-based strategy for managing TR-OCD. Based on comparative efficacy and tolerability profiles, risperidone and aripiprazole are the preferred augmenting agents. The routine use of quetiapine should be reconsidered because of its marginal superiority over placebo. Future large-scale active-comparator RCTs are essential to define the long-term metabolic burden and evaluate novel agents to advance precision psychiatry in refractory OCD.

Respiratory failure following extubation is a major contributor to patient morbidity and death in intensive care settings. While various methods exist, the relative effectiveness of high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and conventional oxygen therapy (COT) in preventing reintubation remains an area of active research. This systematic review and network meta-analysis assessed these techniques in adult patients after scheduled extubation. A search of MEDLINE, Embase, and Cochrane CENTRAL was performed for relevant randomized controlled trials (RCTs) available up to December 2025. Data extraction was performed independently by two researchers. To synthesize findings, a random-effects network meta-analysis was employed, focusing on reintubation rates within a 72-hour window as the primary endpoint. Results were expressed as risk ratios (RR) accompanied by 95% confidence intervals (CI), and the Confidence in Network Meta-Analysis (CINeMA) tool was used to evaluate evidence quality. The analysis included 14 RCTs involving a total of 4,146 participants. Results indicated that both NIV (RR 0.56; 95% CI 0.34-0.94) and HFNC (RR 0.68; 95% CI 0.47-0.97) significantly decreased the reintubation risk when compared to COT. No significant difference in efficacy was observed between HFNC and NIV (RR 1.20; 95% CI 0.76-1.89). Based on surface under the cumulative ranking curve (SUCRA) rankings, NIV emerged as the most effective intervention (88% probability), followed by HFNC (60%) and then COT (2%). The certainty of evidence was moderate for comparisons involving COT, but low for the HFNC versus NIV comparison because of imprecision. HFNC and NIV are more effective than COT at preventing reintubation in the ICU. HFNC serves as a dependable preventative measure due to its ease of application and performance comparable to NIV. These findings support a shift away from standard COT toward more advanced noninvasive respiratory support.

Surgical extraction of impacted mandibular third molars near the inferior alveolar nerve (IAN) carries a risk of neurosensory injury. Coronectomy (intentional partial odontectomy) is a neuroprotective alternative, but concerns regarding long-term complications like root migration and the necessity for re-operation persist. This systematic review and meta-analysis evaluates the comparative safety and efficacy of coronectomy versus total surgical extraction. A literature search was conducted across PubMed, Embase, Scopus, and Cochrane Library for randomized controlled trials (RCTs) and prospective cohort studies comparing coronectomy to total extraction in high-risk lower third molars. Primary outcomes included IAN injury, dry socket, and infection. Secondary outcomes included pain, root migration, and re-operation rates. Data were pooled using random-effects models (REML) with Hartung-Knapp-Sidik-Jonkman adjustment. Trial sequential analysis (TSA) was performed for the primary outcome. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Eight studies (three RCTs, five cohorts) comprising 1,488 teeth were included. Coronectomy significantly reduced the risk of IAN injury compared to total extraction (Peto OR 0.23, 95% CI (0.13, 0.39), p < 0.0001). TSA confirmed that the evidence for IAN injury prevention is conclusive. No statistically significant differences were found between groups for dry socket (RR 0.68, p = 0.22) or postoperative infection (RR 0.87, p = 0.71). Root migration was a common physiological sequela, but the pooled rate of re-operation to retrieve roots was low at 1.2% (95% CI (0.0%, 4.4%)). Coronectomy is a superior neuroprotective technique for high-risk mandibular third molars, significantly reducing nerve injury without increasing the risk of infection or dry socket compared to total extraction. While root migration is frequent, secondary surgical intervention is rarely required. Coronectomy is a highly effective surgical alternative that should be prioritized for radiographically high-risk impactions.

Dietary sodium restriction is a cornerstone of cardiovascular disease management guideline recommendations. However, sodium restriction's impact on hard clinical endpoints in patients with heart failure remains controversial, showing conflicting results compared to the established benefits in essential hypertension. A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies evaluating the effect of sodium restriction on all-cause mortality and cardiovascular hospitalization was conducted. Databases were searched through December 2025. Randomeffects models were used to pool hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic, and potential bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale. A total of 20 studies (11 RCTs, nine observational cohorts) involving 306,019 participants were included. In RCTs, the impact of sodium restriction varied significantly by clinical population. While restriction reduced mortality risk in patients with hypertension, it showed a nonsignificant trend toward harm in patients with established heart failure. In observational studies, low sodium intake was associated with increased mortality risk, supporting a J-shaped relationship. These findings suggest that while sodium restriction is beneficial for hypertension, aggressive restriction in heart failure may not improve outcomes and could be detrimental. This challenges uniform guideline recommendations and highlights the urgent need for personalized dietary management. In observational studies, low sodium intake was associated with increased mortality risk (HR, 1.20 (1.05-1.38)), supporting a J-shaped relationship. Sodium restriction is beneficial for mortality reduction in hypertension but does not improve clinical outcomes in heart failure patients and may be associated with harm in restrictive (<1.5 g/day) regimens. These findings challenge current uniform guideline recommendations for aggressive sodium restriction in heart failure and suggest a need for personalized dietary management.