Citations

ABSTRACT Following the introduction of meta‐analytic methodology into anatomical research, anatomical meta‐analyses have increased substantially. However, extremely high statistical heterogeneity is frequently observed in these studies, while its implications remain insufficiently discussed within anatomical research. The present study investigated the current state and patterns of heterogeneity in anatomical meta‐analyses and explored the interpretive implications of heterogeneity in anatomical evidence synthesis. A PubMed search was performed on May 21, 2026, using the title‐based search strategy: ((meta‐analysis[Title]) OR (meta analysis[Title])) AND (anatomy[Title]). Anatomical meta‐analyses focused on human structural anatomy were included. Reported I 2 values were extracted and descriptively analyzed by overall distribution and anatomical category. A total of 132 studies were identified, of which 61 anatomical meta‐analyses with analyzable heterogeneity data were included. The mean reported I 2 value was 95.27% (range 41%–100%), with a median I 2 of 98.77%. Most studies demonstrated extreme heterogeneity, with 86.9% reporting I 2 values exceeding 90%. Category‐specific analysis demonstrated consistently elevated heterogeneity across anatomical systems, including skeletal structures (mean I 2 = 99%), peripheral nerves (mean I 2 = 95%), and vascular anatomy studies (mean I 2 = 94.56%). Despite this, pooled prevalence estimates were frequently reported with highly precise numerical values and narrow confidence intervals. Extreme statistical heterogeneity is highly prevalent across anatomical meta‐analyses and appears to represent a widespread characteristic of anatomical synthesis research rather than an isolated statistical phenomenon. Although such heterogeneity likely reflects genuine biological and methodological variability, pooled anatomical estimates should be interpreted with caution, particularly when highly precise numerical estimates are reported despite substantial interstudy inconsistency. These findings highlight the importance of transparent heterogeneity reporting and anatomically stratified approaches in future anatomical meta‐analyses.

Introduction: This study aimed to develop and evaluate a deep learning (DL) deblurring algorithm for computed tomography (CT). Phantom testing assessed whether DL deblurring could improve CT image quality and coronary artery calcium (CAC) detectability. Materials and Methods: The algorithm consisted of 2 sequential convolutional neural networks (CNNs): one for denoising and one for deblurring. After deblurring, the estimated noise from the first model was reintroduced to preserve image texture. The CNN denoising model was trained to map high-noise images to routine low-noise ones. The CNN deblurring model was trained using natural images—blurred inputs paired with sharp targets. To assess performance, an anthropomorphic phantom with 100 small calcifications was scanned on a CT system using a CAC scoring protocol. Data were acquired at clinical and high doses, then reconstructed with and without DL deblurring, using 25% of the maximum denoising strength. Detectability was defined as the ability to calculate an Agatston score (≥3 adjacent voxels >130 HU). Results: At high dose, CAC detectability increased from 39% (standard reconstruction) to 48% with deblurring. Similar detectability (39%) was achieved at the routine dose with deblurring, representing a 6% improvement compared with the original routine dose data. Discussion: Quantitative results from phantom testing demonstrate that DL deblurring can improve image quality, based on a clinically relevant, task-based CAC detection metric at clinical dose levels.

Background Congenital anomalies of the urogenital system frequently coexist with renal abnormalities due to their shared origin from the intermediate mesoderm. Skeletal anomalies may also be associated, reflecting overlapping embryological development of mesodermal derivatives. Such multisystem involvement can pose a diagnostic challenge, particularly when identified incidentally. Case Presentation We report a 15-year-old female who presented with abdominal swelling and pain, later diagnosed as an umbilical hernia. During radiological evaluation, incidental findings of right renal agenesis, scoliosis, and a bicornuate uterus were identified. The patient underwent successful surgical management of the umbilical hernia. This case highlights the importance of recognizing coexisting anomalies and adopting an integrated approach in evaluation and management. Conclusion This case highlights the need for a systematic, bidirectional evaluation when a congenital anomaly is identified, particularly involving the renal, genital, and skeletal systems. A syndromic perspective is essential to avoid missed diagnoses, facilitate appropriate follow-up, and anticipate long-term implications in such patients.

Breathing is a physiological process that extends beyond gas exchange, linking neural, cardiovascular, glymphatic, and autonomic systems. This narrative review summarizes how breathing-based practices modulate physiological processes in the body and brain, emphasizing their applicability in clinical care. Regulating the pace and depth of breathing, particularly with relaxed exhalation, may engage vagal pathways that lower heart rate and blood pressure and promote a shift toward increased parasympathetic tone relative to sympathetic activity. Neuroimaging studies show that controlled breathing reduces activity in stress-related brain regions while enhancing networks supporting calm attention and emotional steadiness. Changes in breathing depth also influence cerebrospinal fluid movement, though direct evidence of waste clearance in humans is lacking. This review identifies populations requiring caution, including individuals with panic symptoms, significant cardiopulmonary disease, or pregnancy. Clinicians should distinguish between breathing-only and multimodal protocols when interpreting research findings, as combined interventions preclude attribution of benefit to breathing alone. Study design quality, particularly the use of active rather than waitlist controls, should inform how effect sizes are interpreted. Breathing practices are not a replacement for medical treatment but may represent accessible, low-cost adjuncts for stress reduction and cardiovascular regulation.

ABSTRACT Background In patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), atrioventricular node ablation (AVNA) and permanent pacing are often pursued when rhythm control is not pursued. Biventricular pacing (BiVP) has demonstrated benefits over right ventricular pacing, while conduction system pacing (CSP) has emerged as an alternative. However, evidence directly comparing CSP with BiVP in this high‐risk population remains inconsistent. Objective To compare CSP versus BiVP in patients with AF and HFrEF undergoing AVNA, focusing on cardiac function, clinical outcomes, and procedural metrics. Methods Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through February 2026 for studies comparing CSP and BiVP in adults with AF and HFrEF undergoing AVNA. Outcomes included all‐cause mortality, heart failure hospitalization (HFH), changes in left ventricular ejection fraction (LVEF), QRS duration, New York Heart Association (NYHA) class, pacing threshold, procedure duration, and fluoroscopy duration. A random‐effects model was used to pool mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results Six studies (one randomized crossover trial and five observational studies; N = 766 patients: CSP = 356, BiVP = 410) were included. All‐cause mortality was significantly reduced in favor of CSP (RR 0.64 [CI: 0.44 to 0.94], p = 0.02, I 2 = 0%). There was also a trend towards lower HFH, but it marginally missed statistical significance (RR 0.77 [CI: 0.58 to 1.03], p = 0.08; I 2 = 0%). Additionally, CSP decreased NYHA class (MD ‐0.64 [CI: −1.18 to −0.10], p = 0.02; I 2 = 85%) and significantly reduced QRS duration (MD −33.56 ms [CI: −52.36 to −14.76], p = 0.0005; I 2 = 97%). LVEF improvement did not significantly differ between groups (MD 4.51% [95% CI: −1.50 to 10.52], p = 0.14; I 2 = 98%). Procedure duration and fluoroscopy times did not show statistically significant difference between the two groups (MD −11.54 min [CI: −50.05 to 26.97], p = 0.56, I 2 = 96%), and (MD −5.75 min [CI: −13.13 to 1.63], p = 0.13, I 2 = 88%), respectively. Overall pacing thresholds did not significantly differ between CSP and BiVP; however, modality‐specific subgroup analysis showed comparable thresholds between HBP and BiVP, whereas LBBP was associated with significantly lower pacing thresholds than BiVP. Conclusions Among patients with AF and HFrEF undergoing AVNA, CSP may offer symptomatic and electrocardiographic advantages over BiVP, with a possible signal toward improved major clinical outcomes that requires confirmation in larger randomized studies.

Background Surgeons face elevated risks of musculoskeletal disorders due to prolonged operating times, awkward postures, and repetitive tasks, which can impair performance and well-being. Microbreaks have emerged as a potential ergonomic intervention to reduce discomfort and fatigue during surgery. Objective The main goal of this study was to investigate and compare the intraoperative usability and effectiveness of two break scheduling strategies using the OR-Stretch TM Web-App. Furthermore, surgeons’ feedback on the primary barriers to implementation of the OR-Stretch Web-App was recorded. Methods This study used a randomized, within-subjects crossover design. Fourteen surgeons (eight females) performed three surgical procedures with the following microbreak schedules; (1) microbreaks every 30 min with an optional ten-minute snooze (Break-30), (2) microbreaks every 60 min with an optional ten-minute snooze (Break-60), or (3) no microbreaks (Baseline). Outcomes were measured using self-reported subjective surveys (e.g., discomfort, fatigue, workload, and usability). Results Surgeons found both Break-30 and Break-60 conditions aided physical performance, mental focus, body pain/discomfort, and level of fatigue (self-reported improvement between 28.6% and 78.6%). No significant differences were observed in surgeons’ subjective evaluations of the Break-30 and Break-60 conditions; however, the data suggest that Break-60 is preferable to the Break-30 condition. Conclusions This study provides evidence supporting the OR-Stretch Web-App as a potential surgical ergonomic intervention. However, enhancing the Web-App's user-friendliness and developing strategies to synchronize microbreaks with appropriate times during surgeries, to avoid disrupting the surgical workflow, are critical areas for future studies.

TAF7, a core subunit of the general transcription factor TFIID, regulates transcription and additionally functions as an RNA chaperone that directs nascent nuclear RNAs to cytoplasmic polysomes, thereby influencing protein synthesis. Here, we identify a set of novel cytoplasmic interactors and a previously unappreciated cytoplasmic role for TAF7 in oncogenesis. BioID-mediated proximity labeling identified STAT3 and the CCT and WASH complexes as prominent cytoplasmic interactors of TAF7. These interactions were validated by co-immunoprecipitation and proximity ligation assays. We further showed that cytoplasmic TAF7 levels increased during oncogenesis in proportion to cancer cell pathogenicity. Notably, TAF7 engagement with STAT3, CCT and WASH complexes is markedly enhanced during cellular transformation, consistent with their functions in cancer progression. Together, these findings reveal a cytoplasmic TAF7 interactome and implicate elevated cytoplasmic TAF7 as associated with oncogenesis.

Cardiac arrest is a leading cause of global mortality, with low survival rates despite advances in resuscitation science. Reported survival ranges from 8% to 34% for out-of-hospital and in-hospital cardiac arrest. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue therapy for patients unresponsive to conventional CPR, leveraging veno-arterial extracorporeal membrane oxygenation (ECMO) to provide artificial circulation, gas exchange, and maintenance of organ perfusion in the absence of spontaneous native circulation. Successful ECPR depends on minimizing time to ECMO initiation and selecting appropriate patients. While several aspects are consistent across countries, ECPR protocols vary in logistics, team composition, cannulation methods, and monitoring, which may influence patient-important outcomes such as survival and neurological recovery. This narrative review explores current global practices in ECPR, and identifies opportunities for standardization while recognizing elements that should remain context specific.

Abstract Technological advancements have increased the number of human spaceflights, including the advent of space tourism and deep space travel. The structure and function of the pulmonary system are gravitationally dependent, highlighting the importance of understanding functional changes within the pulmonary system during transient and sustained microgravity exposure. This systematic review and meta-analysis provide an overview of effects of microgravity (0G) on various functional outcome measures of the human lungs relative to Earth gravity (1G). Twenty-eight studies comprising parabolic flights (~20 seconds), short- (≤30 days) and long-duration spaceflight (>30 days) were assessed. Outcome measures reported in 1G (before flight) and 0G (in-flight) were extracted. Fixed effects models showed microgravity caused a reduction in elastic work and carbon dioxide production, and increases in pulmonary diffusion capacity, compliance, and pulmonary capillary blood volume. Despite this, the effect sizes were small and likely have little clinical significance in healthy individuals. However, they could impact space tourists who have lower health requirements for space travel, and those with underlying obstructive respiratory disorders. The results demonstrate how traditional functional pulmonary testing provides essential physiological benchmarks that complement high-throughput data collection methods, enabling an integrated understanding of how molecular changes translate into functional respiratory outcomes in microgravity.

Abstract Background Hospitalists work in complex clinical environments with rising patient acuity and competing demands. Uncertainty is an inescapable part of this work, yet little is known about how hospitalists experience and manage clinical uncertainty. Objectives To explore how hospitalists experience and manage uncertainty in clinical practice. Methods We conducted a single‐center qualitative study using reflexive thematic analysis within a constructivist paradigm. We interviewed hospitalist attending physicians during and/or after their work week and analyzed data inductively, drawing on literature about uncertainty in other clinical contexts. To strengthen rigor and trustworthiness, we held return‐of‐findings feedback sessions with participants. Results We interviewed 12 hospitalists between April 2023 and September 2024. Across diverse clinical situations, participants framed uncertainty through the lens of hospital discharge, using it as an anchor for decision‐making. Managing uncertainty required cognitive and emotional resources and was influenced by participants’ “bandwidth,” or perceived capacity to manage competing professional and personal demands. Perceived bandwidth shaped participants’ responses to uncertainty. Adequate bandwidth encouraged uncertainty engagement, while limited bandwidth prompted deferral or offloading. Participants described how they attempted to ease the burden of uncertainty for their oncoming colleagues by adjusting their documentation and care plans during handoffs. Conclusions Hospitalists experience uncertainty as a routine part of clinical practice and manage it pragmatically to advance patients toward discharge. Their approaches are shaped by their perceived bandwidth. The influences of uncertainty should be considered when assessing workload, organizing clinical service, and planning handoffs.