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Recently, transradial access (TRA) for mechanical thrombectomy in acute ischemic stroke has been proposed as an alternative due to potential advantages such as reduced access site complications. However, its safety and efficacy compared to the traditional transfemoral access (TFA) remain debated. We conducted a comprehensive search on PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 15, 2024. We included all randomized controlled trials and observational studies. The primary outcome was successful recanalization, defined as achieving Thrombolysis in Cerebral Infarction (TICI) grades 2b–3. Secondary outcomes included complete recanalization (TICI grade 3), achieving TICI 2c or higher, functional outcomes (modified Rankin Score (mRS) at discharge and 90 days, mRS 0–2 at 90 days, National Institutes of Health Stroke Scale (NIHSS) at discharge, Length of hospital stay (LOS)), procedural efficiency (access-to-perfusion time, first-pass reperfusion, mean number of passes, crossover to alternate approach), and safety/survival outcomes (access site complications, symptomatic intracranial hemorrhage, in-hospital and 90-day mortality). This study was registered in PROSPERO (CRD42023462293). The meta-analysis included 13 studies with a combined total of 4759 patients. No statistically significant difference was found between TRA and TFA for successful recanalization (RR = 1.00 [95 % CI, 0.97–1.04], P = 0.88). Analysis also showed no significant difference in favorable functional outcomes between groups (RR = 0.88, [95 % CI, 0.71–1.09], P = 0.25) with significant heterogeneity (P = 0.008, I² = 71 %), which was resolved by excluding the study of Phillips et al., 2020 (P = 0.58, I² = 0 %), then favoring TFA over TRA (RR = 0.80, [95 % CI, 0.70–0.92], P = 0.002). TFA also had a statistically significant lower risk of crossover to TRA (RR = 1.68, [95 % CI, 0.99–2.86], P = 0.05). Overall, TRA was associated with a significantly shorter length of stay (MD = −1.49, 95 % CI [-2.93 to −0.05], P = 0.04, I² = 75 %), though sensitivity analysis showed a non-significant mean difference still favoring TRA (MD = −0.59; 95 % CI: [-1.28 to −0.10], P = 0.09, I² = 0 %). There was no difference between TRA and TFA regarding complete recanalization, achieving TICI 2c or higher, procedural efficiency, functional outcomes, safety, and survival. Our updated meta-analysis demonstrates that TRA is comparable to TFA, except for a higher proportion of patients achieving mRS 0–2 at 90 days with TFA, lower crossover rates with TFA, and possibly a shorter length of stay (LOS) with TRA. Further research, particularly randomized studies, is needed to confirm these findings due to the observational nature of included studies. •TRA and TFA access show no significant difference in successful and complete recanalization rates.•No significant difference in safety or functional outcomes between TRA and TFA approaches.•TRA is associated with a shorter hospital stay compared to TFA.•TRA may reduce access site complications, though not statistically significant.•Further research needed to confirm findings due to observational nature of included studies.

Introduction : Dabigatran is a direct oral anticoagulant associated with a high incidence of gastrointestinal bleeding, which presents a significant clinical concern. Genetic polymorphisms in the enzymes responsible for drug absorption (ABCB1) and activation (CES1) may influence dabigatran’s pharmacokinetics, potentially altering drug concentration and therapeutic response. The current systematic review and meta-analysis aim to identify genetic variants correlated with dabigatran exposure and evaluate their importance. Methods We systematically searched PubMed, Web of Science, Scopus, Cochrane Library, and Embase to identify studies on dabigatran pharmacogenomics. The review included observational and clinical studies that met eligibility criteria. RevMan 5.4 was used to conduct the meta-analysis. Quality assessment was done using ROB 2.0 and NOS tools. Results Out of 1336 records retrieved, 1008 were screened, resulting in 16 studies included in the systematic review and 9 in the meta-analysis. Data from 3834 participants (61.8% males) were reviewed. For the ABCB1 polymorphism rs4148738 , both CT and TT genotypes decreased C trough compared to CC genotype (MD = − 9.82, 95% CI [− 17.65, − 1.99], P  = 0.01) and (MD= − 7.69, 95% CI [− 15.54, 0.16], P  = 0.05), respectively. While CES1 rs8192935 GG increased C max compared to AA (MD = 22.66, 95% CI [5.04, 40.27], P  = 0.01). For CES1 rs2244613 AA , both C max and C trough exhibited higher levels compared to GG (MD = 13.58, 95% CI [− 0.08,27.25], P  = 0.05) and (MD = 13.41, 95% CI [8.05,18.77], P  < 0.01), respectively. Also, compared to GG the heterozygote type GA increased the C max (MD = 32.02, 95%CI [16.54,47.5], P  < 0.01). Bleeding risk did not significantly differ across ABCB1 rs1045642 , ABCB1 rs4148738 and CES1 rs8192935 polymorphisms. Only CES1 rs2244613 T allele showed significant effect on bleeding (OR = 2.43, P  = 0.002). Stroke incidence did not differ across ABCB1 rs4148738 , CES1 rs2244613 , and CES1 rs8192935 genotypes. Conclusion ABCB1 rs4148738 T allele reduced dabigatran trough levels, while CES1 rs8192935 GG increased peak levels. CES1 rs2244613 TT raised both peak and trough levels, and its T allele was linked to higher bleeding risk. No consistent associations were found for other variants. These findings highlight CES1 rs2244613 as a key contributor to variability in dabigatran response, warranting further large-scale studies to confirm its role in personalized anticoagulation therapy.

Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (EDs) for diagnosing conditions, managing critical scenarios, and guiding procedures due to its portability, ease of use, and lack of radiation. This study aims to systematically review and analyze the efficacy of POCUS compared to conventional diagnostic methods in pediatric emergency settings. A literature search was conducted across PubMed, SCOPUS, Web of Science, Embase, and Cochrane Library up to February 2025. The inclusion criteria were pediatric patients aged 1 month to 18 years in EDs, with studies comparing POCUS to conventional methods. Primary outcomes included first-attempt procedural success and overall success rates. Secondary outcomes included time to procedure completion, mean number of attempts, hospitalization rates, and discharge rates. Data analysis was conducted in R employing a random-effects model, with dichotomous data analyzed as risk ratio (RR) and 95% confidence interval (CI), and continuous data as unbiased standardized mean difference (SMD). Statistical significance was defined at p  < 0.05. Eighteen randomized controlled trials involving 2264 patients met the inclusion criteria. POCUS significantly improved first-attempt success (RR = 1.25; 95% CI: 1.09–1.43). The overall procedural success showed a significant benefit with POCUS (RR = 1.12; 95% CI: 1.03–1.22). However, no significant differences were noted in the time to procedure completion, number of attempts for a successful procedure, and rates of hospitalization and discharge to home. POCUS significantly improves first-attempt and overall procedural success rates in pediatric emergency settings, although it does not significantly reduce procedure times or the number of attempts. These findings underscore the importance of integrating POCUS into pediatric emergency care to enhance diagnostic accuracy and procedural success, though further research is needed to optimize its implementation across different age groups and procedures.