Background: Postoperative nausea and vomiting (PONV) is a common complication following laparoscopic surgery and remains a significant source of patient discomfort and healthcare burden. Although pharmacologic prophylaxis is widely used, PONV incidence remains considerable, particularly in low- and middle-income countries (LMICs), where resource constraints may limit access to newer antiemetics. Ginger ( Zingiber officinale ), a widely available and inexpensive herbal remedy, has demonstrated potential antiemetic effects in clinical trials. However, evidence remains inconsistent, and no focused synthesis has evaluated its role specifically in laparoscopic procedures in LMICs. This protocol outlines a systematic review and meta-analysis to assess the efficacy and safety of ginger versus placebo for preventing PONV after laparoscopic surgery in LMICs. Methods: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov will be searched through February 2026 to identify randomized controlled trials comparing ginger with placebo in adults undergoing laparoscopic procedures in LMICs. Gray literature, including Google Scholar and citation tracking, will also be searched. Study selection, data extraction, and risk-of-bias assessment will be conducted independently by two reviewers using the Cochrane Risk of Bias 2 tool. Primary outcomes will include PONV incidence. Secondary outcomes will include nausea and vomiting severity, rescue antiemetic use, and adverse events. Random-effects meta-analysis will be performed using risk ratios or mean differences with 95% confidence intervals. Pre-specified subgroup and sensitivity analyses will be conducted, and evidence certainty will be assessed using GRADE. Results: This review aims to provide a focused synthesis of randomized evidence evaluating ginger for PONV prevention after laparoscopic surgery in LMICs. The findings are expected to clarify its comparative efficacy and safety profile relative to placebo. Conclusion: The findings of this systematic review and meta-analysis are expected to inform perioperative care strategies in resource-limited settings and clarify the potential role of ginger as a low-cost option for PONV prevention.
Rapid weight loss following Metabolic bariatric surgery (MBS) is associated with an increased risk of developing de novo gallstone formation. We aimed to evaluate the efficacy of prophylactic ursodeoxycholic acid (UDCA) in preventing gallstone formation and reducing gallstone-related outcomes after MBS. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following the PRISMA guidelines through PubMed/MEDLINE, Cochrane, Embase, Scopus, Google Scholar, and clinicaltrials.gov. The primary outcome was gallstone formation at 12–24 months, while symptomatic gallstones and cholecystectomy incidence were secondary outcomes. Pooled risk ratios (RRs) with 95
Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) administered during surgery on major morbidity after cerebral endovascular procedures. Methods:A single-center randomized controlled trial was conducted in Xijing hospital. 158 participants scheduled for cerebral endovascular procedures are randomly assigned to the TEAS group and the control group in a 1:1 ratio, receiving TEAS and no stimulation, respectively. The primary outcome is the incidence of in-hospital major complications after surgery. The secondary outcomes include the VAS score of pain and the QoR-40 score at 1 day and 3 days after surgery, the incidence of major complications and mortality by 30 days and 90 days after surgery, and the length of postoperative hospital stay. Ethics and Dissemination:This study protocol was approved by the Ethics Review Committee of Xijing hospital. All participants are required to provide written informed consent. This study will be published on completion in peer-reviewed publications. Conclusion:The results of this study will provide evidence of TEAS as a standardized perioperative adjunctive therapy for patients undergoing cerebral endovascular procedures. Trials Registration Number:NCT05413460.
Background:Thoracic trauma significantly contributes to Iraq's trauma mortality. While the Thoracic Trauma Severity Score (TTSS) and the Trauma and Injury Severity Score (TRISS) are validated internationally, their effectiveness in low-resource settings like Iraq remains unclear. This study aims to address this critical gap by evaluating and comparing the predictive performance of both tools in predicting clinical outcomes. The findings of this study will lay the groundwork for developing a more suitable chest trauma scoring model tailored to this unique setting and similar environments with limited resources. Methods:Prospective cohort study that will recruit 195 adult chest trauma patients (blunt/penetrating) from March to December 2025. Based on standardized protocols, TTSS and TRISS scores will be calculated within 6 hours of admission. Primary outcome: in-hospital mortality. Secondary outcomes: intensive care unit (ICU) admission, morbidity, early hospital discharge, and surgical intervention. Predictive accuracy will be compared using ROC-AUC analysis and sensitivity/specificity. Discussion:TTSS is likely to demonstrate greater specificity for thoracic outcomes than TRISS. Possible limitations include resource-related constraints that lead to inappropriate ICU allocation and prehospital delays affecting physiological measures. If validated, TTSS may streamline emergency room triage across Iraq-utilizing scarce critical care resources more effectively. Further studies should be done to validate findings across the various trauma centers in Iraq and develop hybrid scoring models.
Background and aim:Superficial musculoaponeurotic system (SMAS) rhytidectomy techniques are widely used in facelift surgery to achieve long-lasting facial rejuvenation. Nonetheless, variations in technique lead to differences in complication rates, aesthetic outcomes, and longevity of results. Current literature lacks a comprehensive network meta-analysis (NMA) that ranks these techniques based on both safety and efficacy. Thus, the aim of this study is to perform a NMA to determine their rankings based on complication and aesthetic outcomes. Methods and analysis:A network meta-analysis comparing different facelift techniques following PRISMA-NMA guidelines will be conducted. MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Clinicaltrials.org will be searched from inception to search date. Screening, data extraction, and risk-of-bias assessments will be performed independently by two reviewers and discrepancies resolved by a third independent reviewer. Eligible studies will include randomized controlled trials (RCTs) and observational studies of adult patients undergoing a facelift procedure (SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS, deep plane facelift, and composite rhytidectomy) and reporting at least one complication outcome (e.g., facial nerve injury, hematoma, seroma, skin necrosis, infection) and/or aesthetic outcome (e.g., patient satisfaction, longevity of results). R 4.4.2 Software (netmeta package) will be used to generate forest plots, treatment rankings, evaluate consistency between direct and indirect evidence, and assess heterogeneity. The ROBINS tool will be used to assess the risk of bias in nonrandomized studies and the RoB 2 tool will be used for RCTs. We will conduct a frequentist fixed- and/or random-effects NMA using the graph theory approach for each outcome. For dichotomous outcomes, odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) will be calculated for all possible pairwise comparisons between the SMAS techniques. For continuous outcomes, standardized mean differences (SMDs) with 95% CIs will be calculated. Sensitivity analyses will be performed in cases of significant heterogeneity. Subgroup analyses by patient characteristics will be performed if sufficient data is available in the included studies.
Background:Prostate cancer is the second most commonly diagnosed cancer in men worldwide. Prostate biopsies are essential for diagnosis but often induce significant pain and anxiety despite local anesthesia. Virtual reality (VR) has emerged as a promising non-pharmacological tool for pain management during medical procedures. This study aims to assess the effect of virtual reality hypnosis (VRH) as an adjunct to standard local anesthesia during prostate biopsies. Methods:This single-center, prospective, randomized, controlled, parallel-group, single-blind trial will compare standard prostate biopsies under local anesthesia with and without VRH. A total of 130 patients will be randomized in a 1:1 ratio to receive either standard care with local anesthesia alone or standard care plus VRH. The VRH will be initiated 15 minutes pre-procedure and continue throughout. The primary outcome is the maximum pain assessed using a 0-10 Numerical Pain Rating Scale immediately post-procedure by a blinded assessor. Secondary outcomes include post-procedure pain, anxiety, physiological stress response, immersion level, patient satisfaction, procedural success, additional analgesia needs, procedure duration, and adverse events. Follow-up will occur at 1 month. Discussion:This trial will provide high-quality evidence regarding VRH effectiveness as a non-pharmacological adjunct for pain management during prostate biopsies. By targeting both anticipatory anxiety and procedural pain, this approach may significantly improve patient comfort. If effective, this technique could transform the standard of care for prostate biopsies and potentially extend to other invasive urological procedures.
Background:Capsular contracture remains a significant complication in implant-based breast reconstruction, particularly in the context of prepectoral direct-to-implant (DTI) techniques. The advent of acellular dermal matrices (ADMs) has enabled broader adoption of prepectoral reconstruction by enhancing implant support and tissue integration. FlexHD Pliable PRE is a novel ADM designed specifically for prepectoral breast reconstruction, featuring fenestrations and conformable architecture to optimize pocket support and aesthetic outcomes. However, clinical data evaluating capsular contracture rates and associated risk factors with this product remain limited. Objective:To determine the incidence of capsular contracture and identify associated risk factors in patients undergoing prepectoral DTI breast reconstruction using FlexHD Pliable PRE. Methods:This retrospective cohort study includes all consecutive patients who underwent prepectoral DTI breast reconstruction with FlexHD Pliable PRE between February 2017 and June 2024. Exclusion criteria include subpectoral placement, autologous reconstruction, and follow-up under 12 months. Patient demographics, procedural details, and postoperative outcomes (including capsular contracture, implant malposition, infection, implant loss, and other potential complications) will be collected. Capsular contracture will be defined as Baker grade III/IV. Univariate analysis and multivariable logistic regression will identify independent predictors of contracture.
Introduction:Follow-up data in breast cancer is essential and forms the basis for survival metrics and key statistical measures related to morbidity and mortality. Standard practice classifies any woman who does not engage in reviews/follow-up as "lost to follow-up (LTFU)," effectively excluding her from further analysis and disregarding her data. This study aims to evaluate patterns and predictors of LTFU among women with non-metastatic breast cancer. Design:This is a single-center prospective cohort study involving women diagnosed with non-metastatic breast cancer between 2017 and 2018. The study will follow a three-phase approach. In Phase I, 5-year follow-up data will be collected retrospectively through hospital records and electronic medical records (EMRs) up to 2024. In Phase II, patients identified as LTFU will be contacted using phone, SMS, or email to assess health status and update follow-up data. Informed consent will be obtained during outreach. In Phase III, patients who respond will be asked about reasons for missed follow-up visits, including barriers related to logistics, finance, awareness, or physician advice. Data will be analyzed using descriptive statistics, logistic regression, and thematic analysis. Objectives:To determine the proportion of patients who are lost-to-follow-up at 5 years, identify factors associated with LTFU, and explore patient-reported barriers to follow-up in a public sector cancer care setting. Discussion:This study uses a mixed-methods approach, combining quantitative tracking with qualitative insights, with the aim of understanding patient retention and long-term oncology care. This study will provide real-world evidence on follow-up adherence and its determinants in a high-volume, resource-constrained oncology setting. The study is registered with ClinicalTrials.gov (Trial identifier: NCT06927102).
Background:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains the diagnostic benchmark for mediastinal staging, though geriatric patients require optimized anesthesia due to compromised pharmacokinetics and elevated perioperative risks. Methods:A prospective, double-blinded, randomized controlled clinical trial is conducted at a tertiary hospital. Sixty eligible patients aged over 70 years who underwent EBUS-TBNA under general anesthesia were enrolled. Participants were randomized 1:1 to receive either propofol (Group P, n = 30) or remimazolam besylate (Group R, n = 30) with protocolized perioperative management. Primary outcome assessed anesthesia emergence quality. Secondary outcomes encompassed serial hemodynamics, cumulative vasoactive drug requirements, recovery metrics (time/quality), 24-hour QoR-40 scores, and perioperative complications. Discussion:This randomized trial compared remimazolam and propofol for EBUS-TBNA anesthesia in elderly patients. Remimazolam demonstrated accelerated Steward recovery and enhanced hemodynamic stability, whereas propofol exhibited risks of adipose tissue deposition and hypotension. These pharmacodynamic profiles inform anesthetic optimization in geriatric cohorts, necessitating multicenter validation of age-adjusted protocols.
Traumatic injuries remain a leading cause of preventable death globally, and continue to burden global healthcare services, particularly in low-resource settings. Mobile phone-based community injury response and coordination (mCIRC) systems represent a promising solution in facilitating rapid identification of injured persons, and coordinating a community-led response as an alternative or adjunct to a formal emergency service. mCIRC systems may use technologies such as geolocation and push notifications to mobilize trained responders in the vicinity of the incident, ensuring timely intervention before professional medical services arrive. This scoping review aims to provide a comprehensive overview of the existing evidence on the effectiveness and implementation of mCIRC systems in response to trauma as well as other medical emergencies, such as out-of-hospital cardiac arrest. We will evaluate their deployment in both high- and low-resource settings. In particular, the review will assess how these systems improve health outcomes of patients, such as reducing mortality and morbidity, and the feasibility and uptake of such systems by the global community. Additionally, the review will explore the operational challenges and facilitators of implementing such systems, particularly in low- and middle-income countries where healthcare infrastructure is often limited. This review will offer a comprehensive insight into the role of mobile technologies in improving trauma care at the community level, highlighting possible avenues for future research in this domain.
Background:Direct-to-implant (DTI) breast reconstruction has become a widely accepted approach for postmastectomy breast reconstruction. Traditionally, implants were placed in the subpectoral (SP) plane to maximize soft tissue coverage; however, recent advances in surgical technique and implant materials, such as acellular dermal matrices (ADMs) and meshes, have led to a resurgence in the prepectoral (PP) approach. Recent studies have shown conflicting evidence regarding their respective complication profiles and patient-reported outcomes. Thus, comprehensive head-to-head meta-analysis is needed to evaluate the safety and effectiveness of PP versus SP in DTI breast reconstruction. Methods:Following PRISMA guidelines, this systematic review and meta-analysis will compare complication rates and patient-reported outcomes between PP and SP in DTI reconstruction. MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Clinicaltrials.org will be searched to identify comparative studies. Eligible studies must report at least one primary outcome, such as capsular contracture or surgical complications. Secondary outcomes will include BREAST-Q scores, pain scores, and length of hospital stay. Data will be extracted independently by two reviewers, and methodological quality will be assessed using appropriate risk of bias tools (ROBINS-I for nonrandomized studies and Rob 2 for randomized controlled trials). Meta-analysis will be performed using Review Manager 5.4, applying random-effects models in cases of significant heterogeneity. Subgroup and sensitivity analyses will be conducted where applicable. Discussion:This study aims to synthesize the current evidence comparing PP and SP in DTI breast reconstruction to inform surgical decision-making and optimize patient outcomes. The results will provide surgeons and patients with a clearer understanding of the benefits and risks associated with each reconstructive plane.
Background:Postoperative pain management remains a critical determinant of functional recovery following total knee arthroplasty (TKA). While local infiltration analgesia (LIA) is commonly employed, its clinical utility is limited by inconsistent analgesic duration (median duration of 8-12 hours), technical variability among surgeons, and systemic toxicity risks associated with high-volume injections. This phase II randomized controlled trial evaluates a dual-optimization strategy combining anatomic mapping-guided periarticular cutaneous nerve (PCN) blockade with a sustained-release triamcinolone-ropivacaine formulation to address these limitations. Method:In this single-center, assessor-blinded, 2 × 2 factorial design, 120 adults undergoing primary unilateral TKA were randomized to four intervention arms: Group 1: Conventional iPACK (interspace between the popliteal artery and posterior knee capsule) site + novel formulation (1% ropivacaine + 40 mg triamcinolone); Group 2: PCN block site + standard formulation (1% ropivacaine + 5 mg dexamethasone); Group 3: PCN block + novel formulation; Group 4: Control (iPACK + standard formulation). Triamcinolone acetonide replaces dexamethasone in the new formulation due to its prolonged anti-inflammatory effect and demonstrated efficacy in periarticular analgesia. Primary endpoints included: resting/movement-induced pain intensity (Visual Analog Scale) at 6, 24, and 48 h postoperatively, cumulative opioid consumption (morphine milligram equivalents), functional recovery metrics (knee flexion angle, Timed Up-and-Go test). Secondary outcomes assessed safety through adverse event rates (infection, neurologic symptoms, hemodynamic instability). Conclusions:Anatomic mapping-guided PCN blockade combined with triamcinolone-ropivacaine formulation significantly improves postoperative analgesia and functional outcomes compared to conventional LIA techniques. This dual-optimization approach may redefine periarticular infiltration standards in TKA, particularly for patients at high risk of opioid-related complications.
Background:Patients who undergo gastrectomy for gastric cancer experience gastrointestinal symptoms, psychological responses, and social problems. These factors reduce a patient's quality of life (QoL) after surgery. A web-based platform (Wecare®) has been developed to address distress and provide solutions. This study aimed to evaluate whether Wecare® improved the QoL of patients who underwent gastrectomy. Methods:A total of 88 patients who undergo gastrectomy for gastric cancer will be randomly allocated to either the "Wecare®" group or the control group at a 1:1 ratio. After using the "Wecare®" platform for the first 22 patients and making modifications, the next 66 patients will be randomized equally. The primary outcome of this trial is the QoL among gastric cancer survivors (KOQUSS-40). The values of weight change, nutritional index change, KOQUSS-40 questionnaire compliance, self-efficacy, physical activity change, and satisfaction will be compared between the two groups as secondary outcomes. The investigator will follow-up with the patients at 1, 3, and 6 months after surgery at the outpatient clinic. Discussion:This is the first randomized controlled trial to analyze the usefulness of a symptom management platform (Wecare®) among gastric cancer survivors. This study aimed to verify the efficacy of web-based platforms in relieving discomfort after gastric cancer surgery. Future large-scale clinical trials are planned.
Purpose:This planned scoping review aims to map the current knowledge on preoperative risk factors associated with anastomotic leakage following colorectal cancer surgery. Methods:The review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extensions for Scoping Reviews guidelines. The search will be conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Additionally, we will include grey literature sources. Only original studies examining a risk factor for anastomotic leakage will be included. Data will be charted based on trial characteristics, demographic data, population size, the investigated risk factors, and potential interventions. Results:The structured overview will be presented as a narrative summary with supplementary statistics. Conclusion:This protocol describes the methodology for a scoping review which aims to map primary research on preoperative risk factors for anastomotic leakage following colorectal surgery. By systematically collecting and presenting the existing evidence, this review seeks to identify key findings and highlight research gaps to guide clinicians and researchers.
Background:Rheumatic heart disease (RHD) remains a major health challenge in Africa, where the prevalence is notably high. Valvular surgery is a crucial procedure for managing severe RHD. However, the current state and historical trend of research on this subject in African populations is not well understood. Understanding the scope, subject matter, and quality of the literature on this topic over time is essential to inform future research and clinical practice. Objective:This paper aims to assess the current published literature to evaluate vital outcomes such as surgical outcomes, survival rates, postoperative complications, long-term quality of life, morbidities, mortalities, and barriers to valve surgery for patients with RHD in Africa. Methods:This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An extensive search will be conducted across different databases, including PubMed, Scopus, Web of Science, Cochrane Library, African Index Medicus, and African Journals Online. Studies will be identified through keyword searches and will be reviewed against predefined inclusion and exclusion criteria by two reviewers, with a third reviewer resolving any discrepancies. A narrative synthesis will be conducted to describe the findings. Conclusion:The findings from this scoping review will provide an understanding of the current literature on valvular surgery for RHD in African contexts. This will help guide future research directions in this field.
Introduction:Water-Jet (WJ) dissection is an innovative technique for liver surgery that uses high-pressure saline jets to selectively dissect liver parenchyma while preserving vascular and biliary structures. Compared to the Cavitron Ultrasonic Surgical Aspirator (CUSA), WJ offers advantages such as reduced thermal damage, lower blood loss, and shorter operative times. These benefits are particularly important in living-donor liver transplantation (LDLT), where donor safety and rapid recovery are critical. This WORLD trial ("W"ater-Jet versus CUSA f"o"r Liver Pa"r"enchymal Transection in "L"iving "D"onor Liver Transplantation) aims to compare the efficacy and safety of WJ and CUSA in LDLT. Methods and analysis:This single-blind, randomized controlled trial will include 48 living liver donors, allocated in a 1:1 ratio to the WJ or CUSA group. Experienced surgeons will perform liver parenchymal transection using standardized protocols. The primary endpoint is transection speed (cm2/min), with secondary outcomes including operative time, blood loss, complication rates, length of postoperative hospital stays, and postoperative liver function tests. Statistical analysis will assess the non-inferiority of WJ using JMP and R software, with a one-sided α of 2.5% and 80% power. Ethics and dissemination:This study protocol was approved by the institutional review board of Kyushu University (No. 20232001). The study is registered in UMIN-CTR as UMIN000051662. Written informed consent will be obtained from all participants. The results will be published in a peer-reviewed journal and will be presented at medical meetings.
Prostate cancer is one of the most prevalent malignancies among men, with early and accurate diagnosis is essential for optimizing clinical outcomes. The Trinetra-ProstateTM study is a prospective multicenter observational trial designed to evaluate the diagnostic performance of a novel blood-based test for detection of clinically significant prostate cancer. The test, developed by Datar Cancer Genetics, identifies circulating tumor cells (CTCs) in peripheral blood and is assessed against standard diagnostic modalities, including multiparametric magnetic resonance imaging and prostate biopsy. The primary objective of this study is to determine the sensitivity and specificity of the CTC assay for detecting cancer in men with elevated prostate-specific antigen levels and/or abnormal digital rectal examinations. Secondary objectives include assessing concordance with histopathological findings, potential to reduce unnecessary biopsies, and integration with existing diagnostic pathways. The study aims to enroll 250 men aged 45-75 years across multiple centers, applying the defined inclusion and exclusion criteria to ensure methodological rigor. The protocol includes detailed procedures for blood sampling, imaging, biopsy, and data analysis. Ethical approval was obtained and data protection measures are in place in accordance with international research standards. If validated, the CTC-based assay may offer a noninvasive and accurate alternative to current diagnostic approaches, improving patient stratification and reducing the burden of invasive procedures in prostate cancer diagnostics.
Background:Large language models (LLMs) are increasingly used in healthcare settings to provide patient education and answer medical inquiries. However, their reliability in delivering accurate, clear, and unbiased information remains uncertain. This study aims to evaluate the quality of responses generated by LLMs to common patient questions regarding facial plastic surgery. Methods:A total of 60 patient-oriented questions related to facial plastic surgery will be selected from professional bodies, patient support groups, and social media platforms. These questions will be categorized into six main topics: fundamental knowledge, preoperative considerations, surgical procedures, procedural risks and postoperative complications, preparation and recovery, and miscellaneous concerns. Seven LLMs - ChatGPT 4o, Claude, Copilot, DeepSeek, Gemini, Grok, and OpenEvidence - will be tested by inputting each question twice using the "New Chat" feature to assess response consistency. Responses will be evaluated by ten American board-certified plastic surgeons using a structured scoring rubric covering four criteria: accuracy, clarity, completeness, and appropriateness. A standardized scoring system will be employed, and inter-rater reliability will be measured to ensure consistency among evaluators. Discussion:By systematically assessing the responses of multiple LLMs to patient inquiries on facial plastic surgery, this study will provide insights into their reliability and clinical applicability. Findings may help refine LLM-based tools for patient education and identify areas requiring improvement to ensure safe and effective AI-assisted communication in plastic surgery.
Introduction:There are multiple surgical options such as fistulotomy and fistulectomy to treat anal fistula (AF), yet treatment failure rates can be as high as 50%. In 1976, Parks et al classified AF into inter-sphincteric, trans-sphincteric, supra-sphincteric, and extra-sphincteric based on sphincter anatomy. This system overlooks complex features, which prompted Emile et al to incorporate risk factors into a modified version. In this retrospective cohort study, the external validity of this new classification will be investigated. Methods:A retrospective cohort design will be used and patients with cryptoglandular anal fistula who had preoperative MRI will be consecutively enrolled. Patients will be categorized according to the modified Parks classification. We will use descriptive analysis to describe imaging and clinical data. Moreover, logistic regression will be employed to develop a predictive model for recurrence. A P <0.05 will be considered significant, and the results will be reported with 95% confidence intervals (CI), if applicable. The study was approved by the institutional ethics committee. Discussion:Patient with cryptoglandular AF often experience recurrent disease. Modified Parks classification integrates risk factors to guide management. This retrospective study is the first to externally validate Parks classification using MRI findings.
Background:Stroke is a leading cause of death and disability globally, with significant impairments in upper limb motor function affecting the quality of life of survivors. Despite the potential of transcranial direct current stimulation (tDCS) as a noninvasive neuromodulation technique for enhancing post-stroke recovery, current findings regarding its efficacy and optimal parameters remain heterogeneous and controversial. The purpose of this study is to systematically evaluate the effects of different tDCS parameters on upper limb motor impairments in stroke patients and provide guidance for selecting optimal stimulation parameters via a meta-analysis of available literature. Methods:A comprehensive literature search (up to 31 December 2024) will be conducted in MEDLINE via PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data to gather relevant data on tDCS interventions for post-stroke upper limb impairments. We will use EndNote 21 software for study selection and Stata 16.0 software for data analysis. Studies included will be randomized controlled trials involving adult stroke patients receiving tDCS interventions, with primary outcomes focusing on upper limb motor function scores and secondary outcomes including activities of daily living and adverse events. Results:This study aims to provide the most up-to-date evidence and recommendations for clinicians and stroke patients to choose an optimal type of tDCS intervention. It will elucidate the impact of different stimulation parameters (e.g., current density, stimulation duration, and target location) on therapeutic outcomes. Conclusion:tDCS has the potential to positively impact upper limb motor function in stroke patients. This study will provide insights into optimal stimulation parameters, encouraging the integration of tDCS into clinical rehabilitation protocols.
