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BackgroundAcellular dermal matrices (ADMs) have become popularly used in implant-based breast reconstruction (IBBR) due to their potential to decrease the risk of implant complications such as capsular contracture and malposition. AlloDerm and DermACELL are two of the most commonly used human ADMs, each processed differently to enhance sterility and biocompatibility. Despite their widespread use, the comparative effectiveness and safety of these ADMs remain debatable among plastic surgeons, with conflicting evidence in the literature regarding their complication profiles. This systematic review and meta-analysis aims to evaluate the clinical outcomes associated with AlloDerm versus DermACELL in breast reconstruction.MethodsThis review will follow the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Clinicaltrials.org targeting studies from inception to search date. Studies will be screened using inclusion and exclusion criteria and data extracted into a spreadsheet. Screening, extraction, and risk-of-bias assessments will be performed independently by two reviewers and discrepancies resolved by a third independent reviewer. Primary outcomes include complication rates (e.g., capsular contracture, infection, implant malposition), patient-reported satisfaction (BREAST-Q), and drain time. Data analysis and meta-analysis will be performed using Microsoft Excel and Review Manager 5.4 software. Heterogeneity will be assessed using the I2 statistic. A random-effects model will be applied in cases of significant heterogeneity followed by a sensitivity analysis. This review will be reported in accordance with the PRISMA 2020 checklist.DiscussionWith the increasing use of ADMs in IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. This meta-analysis will help surgeons determine whether one ADM is better than the other. This could potentially minimize the risk of patient complications, improve patient satisfaction, and decrease unnecessary hospital readmissions or reoperations due to avoidable complications, thereby decreasing healthcare costs.Systematic review registrationPROSPERO CRD42024542928.

The integration of artificial intelligence (AI) chatbots in medicine is expanding rapidly, with notable models like ChatGPT by OpenAI, Gemini by Google, and Copilot by Microsoft. These chatbots are increasingly used to provide medical information, yet their reliability in specific areas such as cardiovascular imaging remains underexplored. This study aims to evaluate the accuracy and reliability of ChatGPT (versions 3.5 and 4), Gemini, and Copilot in responding to patient inquiries about cardiovascular imaging. We sourced 30 patient-oriented questions on cardiovascular imaging. The questions were submitted to ChatGPT-4, ChatGPT-3.5, Copilot Balanced Mode, Copilot Precise Mode, and Gemini. Responses were evaluated by two cardiovascular radiologists based on accuracy, clarity, completeness, neutrality, and appropriateness using a structured rubric. Inter-rater reliability was assessed using Cohen's Kappa. ChatGPT-4 achieved the highest performance with 78.3% accuracy, 86.87% clarity and appropriateness, 81.7% completeness, and 100% neutrality. Gemini showed balanced performance, while Copilot Balanced Mode excelled in clarity and accuracy but lagged in completeness. Copilot Precise Mode had the lowest scores in completeness and accuracy. Penalty assessments revealed that ChatGPT-4 had the lowest incidence of missing or misleading information. ChatGPT-4 emerged as the most reliable AI model for providing accurate, clear, and comprehensive patient information on cardiovascular imaging. While other models showed potential, they require further refinement. This study underscores the value of integrating AI chatbots into clinical practice to enhance patient education and engagement.

BackgroundAcellular dermal matrices (ADMs) such as human-derived AlloDerm and Cortiva are widely used in implant-based breast reconstruction (IBBR) to provide soft-tissue support. AlloDerm is considered a standard ADM, while Cortiva (and its thinner variant, Cortiva Silhouette) is a newer alternative that may offer cost advantages. Individual studies including a recent randomized trial suggest Cortiva is non-inferior to AlloDerm in terms of clinical outcomes, with some evidence of lower seroma rates, and reduced material cost with Cortiva. To date, no comprehensive synthesis has focused specifically on comparing AlloDerm versus Cortiva in breast reconstruction. This protocol describes a systematic review and meta-analysis to evaluate differences in surgical complications, patient-reported outcomes, and cost between AlloDerm and Cortiva.MethodsWe will search MEDLINE (PubMed), Embase, Scopus, Web of Science, and the Cochrane Library for studies comparing AlloDerm to Cortiva in implant-based breast reconstruction. Both randomized controlled trials and observational studies (cohort or case–control designs) will be included. Two reviewers will independently screen titles/abstracts and full texts against predefined inclusion criteria, and extract data using a standardized form. Outcomes of interest include complication rates (seroma, infection, capsular contracture, implant malposition); patient-reported outcomes (BREAST-Q scores); revision or explantation surgeries; and cost measures. Study quality will be appraised using the Cochrane risk-of-bias tool for RCTs and the Newcastle–Ottawa Scale for observational studies. We will perform meta-analysis using random-effects models if ≥ 2 studies report comparable outcomes. Risk ratios or odds ratios will be pooled for dichotomous outcomes, and mean differences for continuous outcomes, with 95% confidence intervals. Heterogeneity will be assessed with the I2 statistic and Cochran Q test. Subgroup analyses will be performed to minimize confounding, and sensitivity analyses (e.g., excluding high risk-of-bias studies) are planned to assess robustness of findings.DiscussionThis review will synthesize the available evidence comparing AlloDerm and Cortiva ADMs in breast reconstruction. Given that a high-level RCT found no significant differences in overall failure or complications and multiple cohort studies indicate equivalent safety profiles, our meta-analysis will clarify if any true differences exist in complication rates or patient outcomes. We will also quantify any advantages of Cortiva in lowering costs.Systematic review registrationPROSPERO 2025 CRD420251078451. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078451

Background: Three-dimensional (3-D) printing paired with tissue-engineering strategies promises to overcome the volume, contour, and donor-site limitations of traditional breast reconstruction. Patient-specific, bioabsorbable constructs could enable one-stage procedures that better restore aesthetics and sensation. Methods: A narrative review was conducted following a targeted PubMed search (inception—April 2025) using combinations of “breast reconstruction,” “tissue engineering,” “3-D printing,” and “scaffold.” Pre-clinical and clinical studies describing polymer-based chambers or scaffolds for breast mound or nipple regeneration were eligible. Data was extracted on scaffold composition, animal/human model, follow-up, and volumetric or histological outcomes. Results: Forty-three publications met inclusion criteria: 35 pre-clinical, six early-phase clinical, and two device reports. The predominant strategy (68% of studies) combined a vascularized fat flap with a custom 3-D-printed chamber to guide adipose expansion. Poly-lactic acid, poly-glyceric acid, poly-lactic-co-glycolic acid, poly-4-hydroxybutyrate, polycarbonate, and polycaprolactone were the principal polymers investigated; only poly-4-hydroxybutyrate and poly-lactic acid have been tested for nipple scaffolds. Bioabsorbable devices supported up to 140% volume gain in large-animal models, but even the best human series (≤18 months) achieved sub-mastectomy volumes and reported high seroma rates. Mechanical testing showed elastic moduli (5–80 MPa) compatible with native breast tissue, yet long-term load-bearing data are scarce. Conclusions: Current evidence demonstrates biocompatibility and incremental adipose regeneration, but clinical translation is constrained by small sample sizes, incomplete resorption profiles, and regulatory uncertainty. Standardized large-animal protocols, head-to-head polymer comparisons, and early human feasibility trials with validated outcome measures are essential next steps. Nevertheless, the convergence of 3-D printing and tissue engineering represents a paradigm shift that could ultimately enable bespoke, single-stage breast reconstruction with superior aesthetic and functional outcomes.

Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34–1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67–0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92–0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43–4.51). Polypill users had higher adherence rates compared with the free‐dose combination (OR: 1.21, 95% CI 1.2–1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed‐dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

Background and AimLow serum Vitamin D levels have been associated with diabetic nephropathy (DN). Our study aimed to analyse the serum levels of vitamin D in patients suffering from DN and the subsequent changes in serum vitamin D levels as the disease progresses.MethodsPubMed, Embase, SCOPUS and Web of Science were searched using keywords such as ‘25 hydroxyvitamin D’ and ‘diabetic nephropathy’. We included observational studies that reported the association between the serum 25 hydroxy vitamin D levels and diabetic nephropathy without restriction to age, gender, and location. R Version 4.1.2 was used to perform the meta-analysis. The continuous outcomes were represented as mean difference (MD) and standard deviation (SD) and dichotomous outcomes as risk ratios (RR) with their 95% confidence interval (CI).ResultsTwenty-three studies were included in our analysis with 7722 patients. Our analysis revealed that vitamin D was significantly lower in diabetic patients with nephropathy than those without nephropathy (MD: −4.32, 95% CI: 7.91–0.74, p-value = .0228). On comparing diabetic patients suffering from normoalbuminuria, microalbuminuria, or macroalbuminuria, we found a significant difference in serum vitamin D levels across different groups. Normoalbuminuria versus microalbuminuria showed a MD of −1.69 (95% CI: −2.28 to −1.10, p-value = .0002), while microalbuminuria versus macroalbuminuria showed a MD of (3.75, 95% CI: 1.43–6.06, p-value = .0058), proving that serum vitamin D levels keep declining as the disease progresses. Notwithstanding, we detected an insignificant association between Grade 4 and Grade 5 DN (MD: 2.29, 95% CI: −2.69–7.28, p-value = .1862).ConclusionSerum Vitamin D levels are lower among DN patients and keep declining as the disease progresses, suggesting its potential benefit as a prognostic marker. However, on reaching the macroalbuminuria stage (Grades 4 and 5), vitamin D is no longer a discriminating factor.

Background and Aims Antibiotic resistance is seen as a worldwide health risk as a result of the overuse of antibiotics. Many countries noted that antibiotic usage was high during the COVID‐19 pandemic. The purpose of this study is to evaluate Syrians' knowledge, attitudes, and practice about the use of antibiotics and antibiotic resistance during the COVID‐19 epidemic. Methods A cross‐sectional study was conducted using an online questionnaire to collect the data from the Syrian population from February 5 to March 4, 2022. Syrians 18 years or older all over the world were able to participate in this study. A convenience snowball sampling method was used. SPSS version 20.0 was used to analyze the data. To examine the results, binominal logistic regression was used. Statistical significance was defined as a p < 0.05. Results Out of 2406 respondents, 60.2% knew that transmission of COVID‐19 could occur even if the patient has not developed any symptoms, and 91.6% were able to recognize the main clinical symptoms of COVID‐19. There was a statistically significant difference between male and female knowledge of COVID‐19 (p = 0.002), with males having 3.78 ± 2.1 (2.7–3.87) and females scoring 3.93 ± 2.3 (3.7–4.1). Newly graduated students have more knowledge of COVID‐19 than other subtypes of Job (p = 0.0001), and those with medical practice are more knowledgeable than those without (p = 0.0001). Only 16.6% answered that taking antibiotics would not speed up the recovery from all the infections. 65.3% answered correctly that misuse of antibiotics could cause antibiotic resistance. Conclusion Our study concluded that the Syrian population demonstrated good knowledge of COVID‐19 and moderate acceptance of the new norm. Knowledge regarding antibiotic use and resistance and practice of preventive measures was poor, which can encourage the health authorities to develop community education programs to increase public awareness of the usage of antibiotics and safety protocols during the COVID‐19 pandemic.