Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Medicine
Comparative safety and effectiveness of stents in drainage of pancreatic fluid collections guided by endoscopic ultrasonography: A systematic review and network meta-analysis
BACKGROUND: Endoscopic ultrasonography-guided drainage is an effective treatment for pancreatic fluid collections (PFCs). However, the optimal stent strategy for endoscopic ultrasonography-guided drainage of PFCs is still unclear. This study aims to compare the clinical outcomes of different stent types to identify the best option. METHODS: Databases including PubMed, EMBASE, and Cochrane were searched up to August 2024. The analysis focused on comparisons between bi-flanged metal stents (BFMS), double-pigtail plastic stents (DPPS), fully covered self-expanding metal stents (FCSEMS), lumen-apposing metal stents (LAMS), and the combination of LAMS and DPPS (LAMS + DPPS). RESULTS: A total of 38 studies, involving 4265 patients with PFCs, were analyzed. In all of these patients, LAMS (risk ratio [RR]: 1.07, 95% confidence interval [CI]: 1.02-1.13) and BFMS (RR: 1.08, 95% CI: 1.01-1.15) showed higher clinical success rates compared with DPPS. LAMS + DPPS reduced infection rates compared with BFMS (RR: 0.32, 95% CI: 0.10-0.99), DPPS (RR: 0.19, 95% CI: 0.06-0.62), and FCSEMS (RR: 0.23, 95% CI: 0.07-0.76). Within the pancreatic pseudocysts subgroup, LAMS (RR: 1.08, 95% CI: 1.01-1.16) and LAMS + DPPS (RR: 1.24, 95% CI: 1.03-1.48) demonstrated higher clinical success rates compared with DPPS. Similarly, in the walled-off necrosis subgroup, LAMS (RR: 1.10, 95% CI: 1.02-1.17), LAMS + DPPS (RR: 1.19, 95% CI: 1.01-1.41), FCSEMS (RR: 1.14, 95% CI: 1.03-1.26), and BFMS (RR: 1.11, 95% CI: 1.03-1.20) all showed higher success rates compared with DPPS, with BFMS exhibiting a lower bleeding rate than DPPS (RR: 0.32, 95% CI: 0.18-0.99). CONCLUSION: Newer metal stents, including BFMS, LAMS, and LAMS + DPPS, offer advantages over plastic stents like DPPS alone. BFMS is preferable when bleeding risk is a concern, while LAMS + DPPS is more effective in reducing infection rates in PFCs.
26 July 2026
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Physically intelligent capsule robots with embodied memory and logic in the gastrointestinal tract
Miniaturized medical robots offer a promising solution for minimally invasive measurements and interventions in the gastrointestinal (GI) tract. Clinical assessment of GI disorders is commonly guided by threshold-based physiological indicators, including pressure, temperature, and pH, which motivate event-triggered strategies for personalized medicine. However, identifying homeostatic dysregulation and enabling in-situ therapy remains challenging, because ingestible robotic systems must tightly integrate sensing, decision-making, and actuation under severe constraints of size, power, and biosafety. Inspired by the autonomy of microorganisms that operate without neural processing, this work introduces physically intelligent capsule robots (PI Capbots) that enable homeostatic monitoring and targeted delivery within the GI tract, without relying on centralized electronic control. Through embodied stimuli-responsive memory and logic, PI Capbots effectively distill rich, detailed, and redundant physiological information into a small set of decoupled and event-triggered outputs suitable for operations in in vivo environments. In each PI Capbot, multistable metamaterials encode intraluminal pressure as mechanical memory, programmable hydrogels implement orthogonal sensing and logic operations, and helical fibers enable multimodal locomotion. Ex vivo and in vivo studies in large animal models demonstrate the efficacy, robustness, and reproducibility of PI Capbots, highlighting its potential for their translational medical applications.
15 July 2026
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