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Alternatively, physical stimuli such as ultrasound can disrupt the vessel wall, facilitating gene transfer into the tissue [126]

This bidirectional paradigm also has implications for trial design and guideline development

Methodological Quality and Risk of Bias Assessment We used the Cochrane Risk of Bias 2 (RoB 2) tool (crossover extension where applicable) for assessing the risk of bias to evaluate the methodological quality of RCTs

The incidence of adverse effects, particularly gastrointestinal complications, psychiatric disorders, and ocular problems, highlights the critical need for thorough patient assessment and continuous monitoring to ensure both the safety and effectiveness of treatment