This systematic review and meta-analysis compared the diagnostic performance and complication profiles of transperineal biopsy (TPBx) versus transrectal biopsy (TRBx) for prostate cancer, incorporating recent randomized and large observational studies. Following PRISMA 2020 guidelines, PubMed, Scopus, Embase, and Cochrane Library were searched till April 2025. Studies directly comparing TPBx and TRBx were included. Risk of bias was assessed using RoB 2.0 for randomized trials and the Newcastle - Ottawa Scale for observational studies. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses and a GRADE assessment were performed to evaluate the certainty of evidence. Twenty-nine studies (n = 90,621) were included. TPBx showed higher PCa detection (RR 1.08; 95% CI 1.01-1.15; p = 0.02) and csPCa detection (RR 1.14; 95% CI 1.05-1.24; p = 0.001), though the certainty of evidence was low to moderate. Heterogeneity was moderate to high. TPBx also showed lower infection-related complications and comparable overall events, though procedure-related pain was slightly higher. TPBx offers improved diagnostic yield and lower infection risk compared with TRBx, with comparable safety. However, given the moderate heterogeneity and limited high-quality RCTs, further confirmatory trials are necessary. https://www.crd.york.ac.uk/PROSPERO identifier is CRD420251035763.

Background: The efficacy of tenecteplase for acute ischemic stroke (AIS) beyond 4.5 h remains uncertain, particularly across care pathways with and without endovascular thrombectomy (EVT). We performed an updated systematic review and meta-analysis using an EVT-stratified framework. Methods: PubMed, Embase, Scopus, and the Cochrane Library were searched through February 2026 for randomized controlled trials comparing tenecteplase with control in imaging-selected patients with AIS presenting 4.5–24 h from last known well. The primary outcome was excellent functional outcome (mRS 0–1) at 90 days. Secondary outcomes were good functional outcome (mRS 0–2), recanalization, early neurological improvement, symptomatic intracranial hemorrhage, and 90-day mortality. Random-effects models with Hartung–Knapp adjustment were used. Subgroup analyses by EVT availability were interpreted as exploratory because of the limited number of trials. Results: Five trials including 1844 patients were analyzed. Tenecteplase improved excellent functional outcome (RR 1.25, 95% CI 1.10–1.42; p = 0.0005) with no heterogeneity (I² = 0%) and no interaction by EVT status (p-interaction = 0.961). Good functional outcome was not significantly different overall (RR 1.10, 95% CI 0.97–1.24; p = 0.135). Significant subgroup interactions were observed for recanalization (p-interaction = 0.004) and early neurological improvement (p-interaction = 0.002), with benefits concentrated in non-EVT settings. However, the larger effect on recanalization did not translate proportionally into functional recovery, supporting separation of vessel-opening outcomes from patient-centered outcomes. Symptomatic intracranial hemorrhage showed a nonsignificant increase in four estimable studies (RR 1.88, 95% CI 0.94–3.78; p = 0.074), whereas 90-day mortality did not differ significantly (RR 1.11, 95% CI 0.85–1.43; p = 0.43). Conclusions: In imaging-selected AIS presenting 4.5–24 h after onset, tenecteplase improved excellent functional outcome irrespective of EVT availability, while benefits for recanalization and early neurological improvement were largely confined to non-EVT settings. Because recanalization is an intermediate endpoint, these findings should not be interpreted as proof of a proportional clinical benefit. Future extended-window trials should specify EVT status.

Background: Type 2 diabetes mellitus (T2DM) often progresses to require basal insulin therapy. Despite the efficacy of once-daily basal insulins such as glargine and degludec, daily injections remain a barrier to adherence. Insulin efsitora alfa, a novel once-weekly fragment crystallizable (Fc)-fusion basal insulin, may improve treatment convenience while maintaining glycemic control. Objective: To evaluate the efficacy and safety of once-weekly insulin efsitora alfa compared with once-daily basal insulin analogs in adults with T2DM. Methods: An updated systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251118205). PubMed, Embase, and CENTRAL were searched up to 30 July 2025 for randomized controlled trials (RCTs) comparing insulin efsitora alfa with once-daily basal insulins. Pooled analyses were performed using a random-effects model in RevMan 5.4. Risk of bias was assessed with the Cochrane RoB-2 tool, and evidence certainty with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Six RCTs comprising 4115 participants were included. Once-weekly insulin efsitora showed non-inferior HbA1c reduction compared with daily basal insulin (mean difference = −0.04; 95% confidence interval: –0.13 to 0.05; P = 0.35). No significant differences were observed in fasting serum glucose or body weight change. Incidents of level 1, level 2 (clinically significant), and level 3 (severe) hypoglycemia, as well as adverse and serious adverse events, were comparable between groups. Conclusion: Once-weekly insulin efsitora alfa demonstrates comparable efficacy and safety to daily basal insulin. However, further large-scale, long-term trials are warranted to confirm its durability, safety, and real-world effectiveness.