We systematically reviewed neuroimaging predictors for malignant brain oedema (MBE) after thrombectomy in patients with ischemic stroke.

We searched MEDLINE and EMBASE in November 2023 for studies of patients with ischemic stroke. We included studies investigating neuroimaging predictors or prediction models for MBE after thrombectomy. We estimated effect size for the association between predictors and MBE by odds ratios (ORs) or standardized mean differences (SMDs), and pooled results using random-effects modelling.

We included 19 studies (n = 6007) with 17 neuroimaging factors and 5 models. Lower Alberta Stroke Program Early CT scores (ASPECTS, n = 3052, SMD -1.84, 95% CI -2.52 - -1.16; df = 9) and longer extent of arterial occlusion at baseline were associated with higher risk of MBE. Post-thrombectomy ASPECTS was associated with MBE in general stroke patients (n = 453, SMD -2.91, -4.02 - -1.79; df = 1), but not in successfully reperfused patients (n = 110, SMD 0.24, -0.16 - 0.65). Successful reperfusion reduced risk of MBE (n = 4851, OR 0.39, 0.30-0.51; df = 13). Contrast enhancement on CT after thrombectomy was associated with higher risk of MBE (n = 998, OR 4.82, 2.53-9.20; df = 4). More reserved brain volume capacity (baseline: n = 683, OR 0.83, 0.77-0.91, p < .001; post-thrombectomy: n = 329, OR 0.53, 0.37-0.77, p < .001) and good collaterals (baseline: n = 2301, OR 0.14, 0.10-0.20, df = 3; post-thrombectomy: n = 1006, OR 0.28, 0.15-0.51; df = 2) were associated with lower risk of MBE.

Lower ASPECTS and longer arterial occlusion at baseline, and post-thrombectomy CT contrast enhancement increased risk of MBE. Reperfusion after thrombectomy, more reserved brain volume and good collaterals at baseline and post-thrombectomy reduced its risk.

The effective implementation of vaccination heavily depends on the society's willingness to pay (WTP). There is currently a dearth of comprehensive evidence about WTP for vaccines in China. This systematic review aims to review studies on the WTP for vaccines, to summarize factors affect WTP in China. Base-case analysis and Sensitivity analysis of WTP for every vaccine were estimated via single-arm Bayesian meta-analysis. A total of 28 studies were included for systematic review. The point estimates and 95% Credible Interval of pooled WTP for influenza and HPV (9-valent) vaccine were $27.409 (23.230, 31.486), $464.707 (441.355, 489.456). Influencing factors to WTP were age, income, peer influence, health condition and etc. Future research should give focus to improving sample representativeness and survey tool, conducting intervention trials, identifying effective methods to promote WTP.

Intravenous fluid resuscitation forms a crucial part of the sepsis bundle. However, the perception is that patients with comorbidities such as congestive heart failure, chronic kidney disease, and cirrhosis receive lower volumes due to concerns regarding potential for fluid overload. We review outcomes relating to resuscitation with conservative versus liberal volumes in specific patient populations.

We searched MEDLINE, Embase+Embase Classic, Cochrane library, Web of Science, CINAHL Complete, and ClinicalTrials.gov for studies that compared outcomes related to different volumes of resuscitation in adult patients with sepsis, along with congestive heart failure, chronic kidney disease, cirrhosis. The primary outcome was all-cause mortality up to 30 days post-discharge. Secondary outcomes included length of stay, intubation rates and duration, and use of vasopressors.

A total of 37 observational studies were included. We found no statistically significant difference in all-cause mortality (Odds Ratio [OR] 1.01; 95 % Confidence Interval [CI] 0.86-1.19), rates of ICU admission (Risk Ratio [RR] 0.89; 95 % CI 0.70-1.11), hospital length of stay (Mean Difference [MD] -0.01; 95 % -0.18-0.15), ICU length of stay (MD -0.06; 95 % CI -0.30-0.18), intubation rates (OR 1.00; 95 % 0.76-1.32), duration of mechanical ventilation (MD 0.01; 95 % CI -0.31-0.32) or use of vasopressors (RR 0.81; 95 % CI 0.64-1.02).

Among patients with comorbid conditions presenting with sepsis, we found no differences in outcomes related to the volume of fluid administered. Further evidence is needed to guide decisions regarding volume of fluid to administer in these patient populations given the lack of high certainty evidence.

This study aimed to summarize and compare the evidence on the efficacy and safety of automated insulin delivery (AID) systems using ultra-rapid-acting insulin analogues (URAIs), such as fast-acting insulin aspart (FIASP) and ultra-rapid lispro (URLi) (referred to as AID-URAIs), versus those using rapid-acting insulin analogues (RAIs) (referred to as AID-RAIs) in patients with type 1 diabetes (T1D).

We conducted a systematic review and meta-analysis of AID-URAI versus AID-RAI. We systematically searched PubMed, Scopus, ProQuest, Web of Science, Cochrane Library, Clinicaltrial.gov, and medRxiv for articles up to 30 October 2024. Percent time-in-range (TIR; 3.9-10 mmol/L), time-below-range (TBR; 3.9- and 3.0-mmol/L), and time-above-range (TAR; >10.0- and 13.9-mmol/L) were extracted. This study was registered in the PROSPERO (CRD42024602279).

Sixteen randomized controlled trials (664 participants) were included in this study. AID-URAI were associated with an increased percentage of TIR, but not clinically significant (pooled mean difference {MD} = 1.07% [95% confidence interval {CI}: 0.11 to 2.02]; I2 = 0%; p = 0.029; high certainty). The favourable effect was consistent in AID systems incorporating automated bolus correction, adults, study duration >4 weeks, and FIASP subgroups. AID-URAI has a 0.35% lower percentage of TBR (<3.9 mmol/L) compared with AID-RAI. There were no significant differences in the risk of diabetic ketoacidosis and severe hypoglycemia between the two groups.

AID-URAI slightly improves the percentage of TIR and has a good safety profile without increasing the risk of diabetic ketoacidosis and severe hypoglycemia.

Although transcranial direct current stimulation (tDCS) has been used in the treatment of epilepsy for many years, further research is needed on the efficacy and safety of tDCS treatment. This systematic review and meta-analysis aimed to explore the effectiveness of tDCS on seizure frequency (SF), epileptiform discharges, depression, anxiety, and cognitive function in epilepsy.

We searched the Cochrane Library, PubMed, Embase, Scopus, and Web of Science databases from inception to 9 September 2024. The primary outcomes included SF. The secondary outcomes included epileptiform discharges, depression, anxiety, cognitive function, and adverse events. The meta-analysis was conducted using Review Manager 5.4 software.

12 trials were included, 356 participants (219 in the tDCS group and 137 in the sham group). Among the included studies, three were of high risk, two were of some concern, and seven were of low risk. For the primary outcome metrics, tDCS can reduce the frequency of epileptic seizures (SMD = - 0.63, 95 % CI = [-0.90, - 0.36], P < 0.00001). For secondary outcome measures, there are no statistical differences between the tDCS group and the sham group in epileptiform discharges (SMD = - 0.27, 95 % CI = [-0.71, 0.16], P = 0.22) and adverse events (MD = 1.30, 95 % CI = [0.49, 3.45], P = 0.60). The outcomes of tDCS treatment for depression and anxiety were inconsistent. tDCS did not enhance or impair cognitive function.

tDCS can reduce SF but has no effect on epileptiform discharges in patients with epilepsy. The current evidence is limited to support tDCS treatment for depression, anxiety, and cognitive function in epilepsy patients. Future studies should be standardized and personalized, ensure higher methodological rigor, and probe long-term effects to prove the findings further.

Transverse colon cancer, which accounts for approximately 10% of all colon cancers, has a significant gap in the available scientific literature regarding the optimal minimally invasive surgical approach. This meta-analysis aims to compare the robotic and laparoscopic approaches for the surgical management of transverse colon cancer.

Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, in addition to Cochrane Handbook for Systematic Reviews of Interventions. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Embase databases. A comprehensive literature search was conducted for comparative population studies concerning patients who underwent robotic or laparoscopic colectomy for transverse colon cancer). The risk of bias was assessed by the Cochrane Risk-of-Bias tool for randomized trials (Version 2) (RoB 2) and the Risk Of Bias In Non-randomized Studies - of Interventions (Version 2) ROBINS-I. We evaluated two groups of outcomes: intraoperative and postoperative. RevMan (Computer program) Version 5.4.1 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I2 statist.

The 4 included comparative studies (373 patients: 116 robotic colectomy versus 257 laparoscopic colectomy) had a time frame of approximately 26 years (2005-2021) and an observational nature. Meta-analysis showed a longer operative time (MD: 62.47, 95% CI: 18.17, 106.76, I2 = 92%, P = 0.006) and a shorter hospital stay (MD:-1.11, 95% CI: -2.05, -0.18, I2 = 63%, P = 0.002) for the robotic group. No differences in terms of conversion to laparotomy, estimated blood loss, time to flatus, time to solid diet, overall postoperative complications rate, minor (Clavien-Dindo or CD I-II) and major (Clavien-Dindo or CD ≥ III) postoperative complications rate, anastomotic leakage, surgical site infections, bleeding, lymph nodes harvested, were shown between robotic and laparoscopic groups.

Our meta-analysis revealed that the robotic approach to transverse colon cancer appears to be a safe and feasible option, with results comparable to those of laparoscopic surgery, with longer operating times but a shorter hospital stay. Further high-quality methodological studies are needed to evaluate and compare the short- and long-term outcomes, healthcare costs, and the learning curve between the robotic and laparoscopic surgical approaches.

Reducing the stroke time metric in patients with stroke who underwent thrombectomy is associated with good functional recovery. We compared direct transfer to angiosuite (DTAS) vs conventional workup (CWU) in patients who underwent endovascular treatment due to large vessel occlusion (LVO).

A systematic search was conducted in four electronic databases. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI, while the binary outcomes were analyzed using the odds ratio (OR) and 95 % confidence interval (CI).

We included a total of 3145 patients, which 1168 patients were in DTAS group and 1977 were in CWU group. DTAS showed a significantly higher likelihood of 90-day mRS0-1 (OR 1.6, p = 0.002) and mRS0-2 (OR 1.47, p < 0.0001), successful reperfusion (OR 1.53, 95 % CI 1.1 to 2.1, p = 0.0122), and lower door-to-puncture (SMD -4.36, 95 % CI -7.4 to -1.3, p = 0.0096) than CWU. There was no significant difference between the two triage protocols in 90-day mortality (OR 0.98, 95 % CI 0.6 to 1.64, p = 0.94) and symptomatic intracranial hemorrhage (OR 0.78, p = 0.14). The proportion of patients who were triaged to DTAS with non-LVO on diagnostic angiography in angiosuite was 5.76 % (95 % CI 1.8 % to 11.4 %). There was a significant difference between randomized trials versus observational studies in 90-day mRS0-2 (OR 1.91 vs 1.16, p = 0.0042), 90-day mortality (OR 0.62 vs 1.27, p = 0.12), and door-to-puncture time (SMD -1.25 vs -5.53, p = 0.027).

DTAS is a feasible, safe, and cost-effective triage approach for managing patients with acute stroke due to LVO.

Type 1 Thyroplasty is a well-established procedure used for medializing an immobile vocal fold. Silastic and Gore-Tex are the two most common materials used to accomplish this, but comparative data on their relative efficacy are scarce. We sought to compare outcomes between Silastic and Gore-Tex implants via systematic review and meta-analysis for unilateral vocal fold immobility.

We collected available data from PubMed, Embase, and Web of Science on demographics, maximum phonation time (MPT), voice handicap index (VHI-10/30) score, and any other relevant metrics encountered before comparatively evaluating differences in outcomes.

The search yielded 1,534 records with 55 manuscripts ultimately included. There were 41 unique studies that utilized Silastic for a total of 1038 patients. There were 13 unique studies that utilized Gore-Tex for a total of 245 patients. The pooled mean increase in MPT for Silastic patients was 7.8 s (+1.3 SMD) compared with 5.7 s for Gore-Tex (+1.6 SMD). There was significant publication bias present in both analyses. The pooled mean change in VHI-30 with Silastic was -45.4 (62.2%, -2.09 SMD) compared with -51.6 (73.5%, -1.1 SMD) with Gore-Tex. The pooled mean change in VHI-10 with Silastic was -15.6 (54%, -0.46 SMD) compared with -11.6 (43%, -0.86 SMD) with Gore-Tex. There was no significant publication bias present in VHI outcomes.

Silicone and Gore-Tex implants provide adequate and comparable results in TT1. The data supporting this conclusion are limited by follow-up, diversity in outcomes, limited data availability, and publication bias. Future research should be dedicated to comparing implants in a well-randomized environment. Laryngoscope, 135:1236-1247, 2025.

The postnatal management of preterm infants at birth may influence their clinical course in the short, medium, and long term. The concept of the "Golden Hour" (GH) has emerged in neonatology, aiming to standardize this management.

We conducted a meta-analysis to assess GH's impact on early clinical outcomes and on the comorbidities of prematurity.

Pubmed, Embase, Scopus, and Cochrane Library were searched without any restriction.

We included randomized, prospective, and retrospective studies comparing periods with and without the application of a GH protocol for preterm birth.

Two independent reviewers screened titles and abstracts and assessed full texts for eligibility.

Twelve prospective and 6 retrospective studies were included, for a total of 5104 patients. There was a significant reduction in hypothermia both on admission and at 1 hour (odds ratio [OR], 0.40 [95% CI, 0.27-0.60] and OR 0.39 [95% CI, 0.18-0.85]), with increased temperature (mean difference [MD], +0.57 °C [95% CI, 0.07-1.07]). Mean blood glucose and hypoglycemia rates on admission were not statistically affected. However, time to intravenous infusion was reduced (MD, -27.51 minutes [95% CI, -49.40 to -5.56]). There was a significantly lower rate of severe intraventricular hemorrhage (OR, 0.65 [95% CI, 0.47-0.89]) and a trend toward decreased bronchopulmonary dysplasia (OR, 0.69 [95% CI, 0.47-1.02]). Time to administration of surfactant was statistically reduced (MD, -23.6 minutes [95% CI, -42.2 to -5]). Mortality and other comorbidities of prematurity were not different.

Four studies were judged to be of poor quality, and certainty for evidence was graded as low or very low.

The application of a GH at birth reduced the rate of hypothermia and the time required for intravenous infusion without statistically significant impact on glycemic control.

Stoma reversal surgery is known for relatively high complication rates. While Enhanced Recovery After Surgery (ERAS) protocols are extensively validated for colorectal surgery, their use in stoma reversal remains underexplored. This systematic review and meta-analysis evaluates clinical outcomes of stoma reversal surgery under ERAS protocols compared to standard care (SC) practices. Medline, EMBASE, and Cochrane Central databases were searched for studies that compared clinical outcomes of stoma reversal surgery under ERAS protocols versus SC practices. The endpoints of interest were length of stay (LOS), ileus, wound infection, anastomotic leak, time to first stool, overall, minor, and major postoperative complications, readmission rates, and reoperation rates. Mean difference (MD) was calculated for continuous variables and Odds Ratio (OR) for dichotomous variables. Statistical analysis was performed with R version 4.4.0. We included eight studies comprising 1322 patients. Among these, 603 (45.6%) followed an ERAS protocol, while 719 (54.4%) received SC practices. ERAS was associated with a significant decrease in LOS (MD -1.83; 95% CI -2.55 to -1.12; p < 0.01), wound infection (OR 0.47; 95% CI 0.23 to 0.97; p = 0.041), and time to first stool (MD -1.02; 95% CI -1.22 to -0.81; p < 0.01). No statistically significant difference was observed regarding ileus, anastomotic leak, overall, minor, and major postoperative complications, readmission rates, or reoperation rates. The implementation of ERAS protocols in stoma reversal procedures should be considered, as it was associated with a shorter length of hospital stay without increasing morbidity, and may even reduce complications such as wound infections.

To undertake a systematic review and meta-analysis to examine the evidence base for the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in patients with sarcopenia.

Systematic review and meta-analysis.

The literature was searched via the PubMed, MEDLINE, Web of Science, EMBASE, CINAHL, Scopus, WANFANG, CNKI and VIP databases, through 23rd February 2024. The inclusion criteria were: randomized controlled trials (RCTs); patients diagnosed with sarcopenia defined according to well-accepted clinical consensus; HMB as an intervention; outcomes on muscle mass and/or muscle strength and/or physical performance. Data extraction was completed by independent pairs of reviewers. Meta-analyses of continuous outcomes were performed on the extracted data. Standard mean difference (SMD) with 95 % confidence intervals (CIs) between treatment and control group were used to express intervention effect estimates of HMB for each study. Risk of bias was assessed according to Version 2 of the Cochrane tool for assessing risk of bias in randomized trials (ROB 2).

Of 196 records retrieved and screened, five RCTs met the eligibility criteria for qualitative and quantitative analysis, yielding 154, 359 and 359 participants for muscle mass, muscle strength, and physical performance, respectively. For the overall risk of bias, no studies were graded as "high risk of bias", one (20.0 %) as "some concerns", and four (80.0 %) as "low risk of bias" according to the ROB 2. The overall meta-analysis revealed a beneficial effect on muscle mass and strength, as demonstrated by a higher skeletal muscle mass index (SMD = 0.32; 95 % CI: [0.00,0.64]; Z value =1.98; P = 0.048), along with an elevated handgrip strength (SMD = 0.65; 95 % CI: [0.05, 1.25]; Z value = 2.12; P = 0.034) in the HMB intervention groups compared with the control groups. However, there was no evidence of a benefit on physical performance, assessed by gait speed (SMD = 0.19; 95 % CI: [-0.14, 0.53]; Z value = 1.14; P = 0.255).

Overall, although limited and requiring interpretation with utmost caution, current evidence indicates that HMB supplementation is beneficial for improving muscle mass and strength, but there is no evidence of a benefit on physical performance in patients with sarcopenia. In future, more well-designed HMB intervention trials should be conducted that include populations diagnosed with sarcopenia according to well-accepted clinical consensus.

We performed this systematic review and dose-response meta-analysis of randomized clinical trials (RCTs) to determine the effects of oral nutritional supplements (ONS) in cancer patients undergoing chemo (radio) therapy on body weight, body mass index (BMI), serum albumin, fatigue, quality of life (QOL), patient-generated subjective global assessment (PG-SGA) score and C-reactive protein (CRP).

Appropriate search terms were used for systematic search in PubMed, Scopus, and Web of Science, till April 2024. Both pairwise and dose-response meta-analyses were done. Random effects model was applied for analyses.

We found that ONS administration significantly improved weight gain [weighted mean difference (WMD): 1.18 kg; 95 % CI, 0.20 to 2.17, P = 0.019; I2 = 56.2 %, PQ-test = 0.002], fatigue scores [standard mean difference (SMD): -1.45; 95 % CI, -2.48 to -0.42, P = 0.006; I2 = 90.1 %, PQ-test< 0.001], PG-SGA scores (WMD: -1.11; 95 % CI, -2.93 to 0.70, P = 0.229; I2 = 72.4 %, PQ-test = 0.001), and QOL (SMD: 1.38; 95 % CI, 0.45 to 2.31; P < 0.001; I2 = 94.4 %, PQ-test< 0.001). The dose-response meta-analysis found a significant relationship between each 200 ml/d increase in ONS and improvement in fatigue (SMD: -7.30; 95 % CI, -10.17 to -4.42, P < 0.001; I2 = 97 %, PQ-test< 0.001) and QOL scores (SMD:7.01; 95 % CI, 3.89 to 10.12, P = 0.001; I2 = 98.3 %, PQ-test < 0.001). Based on a non-linear dose-response meta-analysis, the most significant reduction in fatigue was observed at ONS dosages of ≥400 ml/day, while the most significant improvement in QOL score was seen at ≥ 500 ml/day dosages. Our analysis also showed a significant association between higher albumin levels and ONS intake of ≥200 ml daily.

In conclusion, ONS can help improve various cancer-related complications; however, further good-quality research is still needed. The study found that ONS significantly improves QoL, reduces fatigue, and promotes body weight gain in cancer patients. However, there were no significant effects on BMI, serum albumin, CRP, or PG-SGA scores.

Robot-assisted surgery (RAS) has steadily become more prevalent in urology. The Da Vinci multiport surgical robot (DVM-SR) continues to lead the field. In recent years, new multiport surgical robots (NM-SRs) have been introduced to the market; however, their safety and efficacy remain unassessed. This study aims to give a comprehensive evaluation of the perioperative, oncological, and functional outcomes of NM-SRs and a comparison with the DVM-SR.

A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and clinicaltrial.gov to identify studies that evaluate NM-SRs in major urological surgeries assessing perioperative, functional, and oncological endpoints. A meta-analysis was performed comparing NM-SRs with the DVM-SR for safety, and functional and oncological outcomes.

Seventy-four studies involving 5487 patients were included in the review. Nine platforms were studied: Hinotori, Hugo RAS, Revo-I, Versius, Avatera, Senhance, KangDuo Surgical Robot-01, Dexter, and Toumai. NM-SRs were used to perform robot-assisted radical prostatectomy (RARP; 41 studies), partial nephrectomy (RAPN; 14 studies), radical nephrectomy (RARN; four studies), adrenalectomy (four studies), nephroureterectomy (two studies), RARN and thrombectomy (one study), colpopexy (four studies), pyeloplasty (seven studies), simple nephrectomy (four studies), simple prostatectomy (three studies), and ureteral surgery (four studies). Cystectomies with NM-SRs were described only in case reports and were excluded. The comparative analysis between NM-SRs and the DVM-SR showed similar outcomes in terms of intraoperative SATAVA grade ≥2 complications (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.25, 3.1, p = 0.9 for RARP and OR 0.59, 95% CI 0.11, 3.3, p = 0.5 for RAPN), postoperative high-grade complications (Clavien-Dindo ≥IIIa, OR 0.85, 95% CI 0.4, 2, p = 0.7 for RARP and OR 0.59, 95% CI 0.1, 3.3, p = 0.6 for RAPN), and positive surgical margins (OR 0.90, 95% CI 0.72, 1.1, p = 0.3 for RARP and OR 1.65, 95% CI 0.3, 9.1, p = 0.6 for RAPN). For patients undergoing RARP, biochemical recurrence and urinary continence rates at 3 mo were comparable (OR 0.99 [95% CI 0.5, 1.8, p = 1] and OR 0.99 [95% CI 0.77, 1.3, p = 0.9], respectively). The achievement of the trifecta for RAPN appeared to be similar between the included studies on NM-SRs and the DVM-SR (OR 1.3, 95% CI 0.4, 4.4, p = 0.7). The small sample size of the included studies and the preliminary nature of the results represent the major limitations.

When compared with the DVM-SR, NM-SRs may offer similar safety, and oncological and functional outcomes across most surgeries for both benign and malignant diseases. Further research is needed to explore the potential of NM-SRs, given the promising initial findings.

New multiport surgical robots (NM-SRs) appear to be safe and effective compared with the Da Vinci surgical robotic system. However, further research is required to thoroughly assess their long-term outcomes and cost effectiveness. NM-SRs represent an opportunity to spread the use of robot-assisted surgery globally.

BackgroundAutoimmune diseases can reduce ovarian reserves. Women in reproductive ages are susceptible to an autoimmune disorder known as antiphospholipid syndrome (APS). The aim of this study is to investigate the association between APS and ovarian reserve (OR).MethodPubMed, Scopus, Web-of-Science, Science Direct, and the Google scholar search engine were searched (22 June 2024) for studies that investigated the effect of APS on OR. Literature screening, data extraction, and assessment of the risk of bias of the included studies were conducted by two reviewers independently. Mean differences were computed using a random effects model. Heterogeneity was assessed by I2%.ResultsFour cross-sectional studies were included in this meta-analysis. None of the studies had a high risk of bias. There was no significant association identified between primary (MD = -0.27, 95% CI, -1.42 to 0.87, p = 0.639) and secondary APS (SMD = -0.38, 95% CI, -2.46 to 1.69, p = 0.717) with antimullerian hormone amounts. The antral follicle count (AFC) was investigated in two studies revealed lower levels of AFC in women with primary APS. Regarding the levels of gonadotropins and estradiol in the participants' serum, the results are contradictory.ConclusionsThe results of this meta-analysis identified there is no relationship between primary and secondary APS with the reduction of ovarian reserves in women with APS. This issue should be considered in the reproductive health of women with APS, who can have children at the right time by consulting a rheumatologist and reproductive health specialist.

Recent studies suggest that duloxetine administration before non-laparoscopic surgery may reduce postoperative pain and analgesic requirement without increasing adverse event occurrence.

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on preoperative administration of duloxetine versus placebo for postoperative pain relief in adults undergoing laparoscopic surgery, assessing efficacy- and safety-related outcomes.

We systematically searched MEDLINE, Embase, and Cochrane Library, covering all records up to July 19, 2024. Inclusion criteria consisted of RCTs comparing preoperative administration of duloxetine versus placebo in adults undergoing laparoscopic surgery and reporting at least one outcome of interest. The random-effects model was used to estimate the mean difference (MD) and risk ratio (RR), along with their respective 95% confidence intervals (95%CIs).

We included four RCTs (227 patients). Compared with placebo, duloxetine provided a statistically lower pain scores at 2 (MD - 1.04; 95%CI - 1.75, - 0.33), 4 (MD - 1.28; 95%CI - 1.77, - 0.79), 8 (MD - 1.22; 95%CI - 1.72, - 0.72), 12 (MD - 1.64; 95%CI - 2.88, - 0.41), and 24 h (MD - 1.05; 95%CI - 1.72, - 0.39) after surgery. Duloxetine also granted a statistically longer time to first analgesic requirement (MD 128.38 min; 95%CI 41.31, 215.46), compared with placebo. Additionally, the duloxetine group had a significantly lower risk of nausea/vomiting (RR 0.48; 95%CI 0.25, 0.90), while there were no significant differences between both groups for the risk of dizziness, headache, and somnolence.

Compared with placebo, duloxetine administration before laparoscopic surgery significantly minimized postoperative pain intensity, delayed analgesic requirement, and reduced nausea/vomiting risk.

External ventricular drainage (EVD) is a mainstay for intraventricular hemorrhage (IVH) treatment, improving ventricular clearance and reducing mortality but with suboptimal complications and morbidity. Meanwhile, several studies have shown that neuroendoscopic drainage (NED) provides superior results and is a promising therapy. Thus, we aimed to compare NED and EVD in patients with IVH. A systematic literature review was conducted using Embase, PubMed, and Cochrane databases. The primary outcome was shunt dependency. Secondary outcomes were infection, length of intensive care unit (ICU) and hospital stay, mortality, and functional outcome. Inclusion criteria: studies comparing NED and EVD with predefined outcomes. Exclusion criteria: age < five years. Statistical analysis was performed using RStudio 2024.04.1 + 748. Sensitivity analysis was performed with subgroup analysis. The risk of bias was assessed using ROBINS-I and RoB-2. Of 234 potential articles, 17 met our criteria, involving 1043 patients, with 495 undergoing NED and 548 receiving only EVD. Patients who underwent NED had lower odds of shunt dependency (OR 0.17; 95% CI 0.12,0.25; p < 0.001), infection (OR 0.29; 95% CI 0.16,0.53; p < 0.001), and mortality at one month (OR 0.44; 95% CI 0.20,0.96; p = 0.039) and six months (OR 0.31; 95% CI 0.16,0.58; p < 0.001), shorter hospital (MD -6.02; 95% CI -9.58,-2.45; p < 0.001) and ICU stay (MD -6.64; 95% CI -10.46,-2.83; p < 0.001), and better functional outcomes according to Glasgow Outcome Scale (MD -0.65; 95% CI -0.98,-0.32; p < 0.001) and modified Rankin Scale (MD -1.25; 95% CI -1.90,-0.60; p < 0.001) compared to patients who underwent EVD. To confirm the robustness of the results, we performed sensitivity analyses with subgroups of the RCT, which also showed significant superiority of NED over EVD. Our results suggest that NED has a positive impact on patients with IVH and may be a breakthrough intervention in this scenario.

The role of anatomical factors in predicting outcomes after radical prostatectomy (RP) remains unclear. This review aims to evaluate the impact of various anatomical factors on the perioperative outcomes of patients undergoing RP for localized prostate cancer (PCa).

A comprehensive literature search was conducted through January 2024 using the PubMed/Medline, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. Data were extracted and pooled for a meta-analysis, with outcomes including operative time, blood loss, transfusion rates, overall complications, and positive surgical margins (PSMs). Heterogeneity was assessed using Cochrane Q test, and subgroup analyses were conducted to explore the influence of surgical approach.

A total of 91 studies met our inclusion criteria. Among the anatomical factors, prostate volume (PV), prostate weight, and median lobe (ML) were suitable for the meta-analysis. Larger prostates were associated with increased operative time, blood loss, and complication rates, but with fewer PSMs (all p < 0.05). ML presence was not associated with a higher risk of complications. Heterogeneity was high across studies (Cochrane Q tests <0.05), reflecting inconsistent definitions and methods. In subgroup analyses, the open approach was associated with a longer operative time than robotic surgery for large prostates (p = 0.03) and a lower PSM rate (p < 0.001).

Anatomical factors, particularly PV, play a significant role in RP outcomes. Larger prostates are associated with higher complication rates but fewer PSMs. Further research with standardized outcome measures is necessary to clarify these relationships and guide clinical decision-making.

In this study, we examined how a patient's individual anatomy might affect the results of prostate surgery for cancer. We found that larger prostates tend to lead to longer surgeries and increased blood loss, but these also have a lower risk of leaving cancer cells behind. These findings could help doctors in better planning surgeries and improving patient outcomes.

We aimed to undertake a meta-analysis of cohort studies to evaluate gender-based differences for patients with acute type A aortic dissection. A systematic search was performed across PubMed, Embase, and Cochrane Library (2000 to 2023) for studies reporting gender-related discrepancies in clinical presentation, in-hospital management, and/or outcomes. Study effects were assessed using mean difference or risk ratio (RR) as aggregated estimates. Besides, individual patient-level data on survival were reestablished to form gender-related Kaplan-Meier curves to evaluate long-term survival outcome. The study protocol was registered in PROSPERO (ID: CRD42024524125). The 21 studies were analyzed, comprising 6,728 women and 12,839 men. Women had lower risks of postoperative acute kidney injury (RR 0.85; 95% confidence interval [CI] 0.72 to 1.00, p = 0.049) and reoperation (RR 0.89; 95% CI 0.81 to 0.99, p = 0.024) but a higher perioperative mortality (RR 1.11; 95% CI 1.03 to 1.18, p = 0.005) than men. In addition, the overall survival was poorer in women (p <0.001), with 10-year survival rates of 66.5% for men and 60.0% for women. In conclusion, acute type A aortic dissection presents gender differences, with women facing higher perioperative and long-term mortality despite lower acute kidney injury and reoperation risks, suggesting a need for tailored management and prevention strategies.

Although gastric peroral endoscopic myotomy (G-POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long-term data on its effectiveness are lacking.

We conducted a systematic review and meta-analysis including observational studies assessing long-term efficacy after G-POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1-year after G-POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification.

Thirteen studies, involving 952 patients with refractory GP undergoing G-POEM, were eligible. The pooled 1 year-clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I2 = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I2 = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1-year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I2 = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I2 = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I2 = 0%).

G-POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long-term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G-POEM outcomes more accurately.

To examine the relationship between postpartum physical activity and maternal postnatal cardiometabolic health, breastfeeding, injury, and infant growth and development.

Systematic review with random-effects meta-analysis and meta-regression.

Eight online databases were searched up until 12 January 2024.

Studies of all designs in all languages were eligible (except case studies and reviews) if they contained information on the population (postpartum people), intervention (frequency, intensity, duration, volume, or type of exercise, alone ('exercise-only') or in combination with other intervention components (eg, dietary; 'exercise+co-intervention'), comparator (no or low volumes of physical activity), and outcomes: hypertension, diabetes, cardiometabolic risk factors (systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, glycated hemoglobin (HbA1C), glucose and insulin concentration), breastfeeding (breast milk quality and volume), infant growth (length and weight) and development, or postpartum injury.

46 unique studies (n=8766 participants) from 20 countries were included. Moderate certainty of evidence showed exercise+co-interventions reduced the odds of developing diabetes by 28% (7 randomised controlled trials (RCTs), n=2496; OR 0.72 95% CI 0.54, 0.98, I2 12%), reduced SBP (10 RCTs, n=2753; mean difference (MD) -2.15 95% CI -3.89 to -0.40, I2 73%) and DBP (9 RCTs, n=2575; MD -1.38 95% CI -2.60 to -0.15, I2 66%) compared with controls. Infant growth and development, breast milk quality and quantity, and risk of injury were not different between exercise and control groups.

Physical activity improves cardiometabolic health without adversely impacting breast milk supply or quality, infant growth or maternal injury.

To examine the impact of exercise on musculoskeletal pain (low back pain (LBP), pelvic girdle pain (PGP), lumbopelvic pain (LBPP) and bodily pain) and kinesiophobia during the postpartum period.

Systematic review with random effects meta-analysis.

Online databases were searched from database inception to 12 January 2024. Studies of all designs (except case studies) of any publication date or language were included if they contained information on the population (women and people in the first year postpartum), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ('exercise-only') or in combination with other interventions (eg, electrotherapy, infrared irradiation, ultrasound; 'exercise+cointervention')), comparator (no exercise or different exercise measures) and outcome (symptom severity of LBP/PGP/LBPP, related disability, bodily pain and kinesiophobia).

37 studies (N=3769 participants) from 15 countries were included. Moderate certainty evidence showed that exercise-only interventions, including various strengthening exercises targeting the trunk muscles, were associated with a greater reduction in LBPP symptom severity (4 randomised controlled trials (RCTs), n=210; mean difference -2.21 points (on a 0-10 Visual Analogue Scale) 95% CI -3.33 to -1.08) and related disability (6 RCTs, n=296; standardised mean difference -1.17, 95% CI -1.92 to -0.43; large effect size) as compared with no exercise. Similar results were found for bodily pain (2 RCTs, n=318). Evidence was limited and inconclusive regarding the impact of exercise interventions on kinesiophobia.

Postnatal exercises, including a variety of muscular strengthening exercises targeting the trunk muscles, decrease the symptom severity of LBPP and related disability.

This systematic review and meta-analysis examined the relationship between postpartum exercise and maternal postpartum anthropometrics.

Systematic review with random-effects meta-analysis and meta-regression.

Online databases were searched from database inception until 12 January 2024. Randomised controlled trials (RCTs) written in any language were eligible if they contained information on the population (postpartum women and people); intervention (frequency, intensity, duration, volume or type of exercise, alone ('exercise-only') or in combination with other interventions (eg, dietary; 'exercise+cointervention')); comparator (no exercise) and outcomes (anthropometric measures including weight, postpartum weight retention (PPWR), body mass index (BMI), fat mass, lean body mass (LBM), body fat percentage, waist circumference, hip circumference or waist-hip ratio).

64 RCTs (n=12 684 participants) from 20 countries were included. Moderate to high certainty of evidence showed that exercise-only interventions reduced weight by 1.34 kg (18 studies, n=771; 95% CI -2.06 to -0.61, I2 0%), BMI by 0.73 kg/m2 (14 studies, n=662; 95% CI -1.21 to -0.25, I2 60%) and fat mass by 1.55 kg (5 studies, n=135; 95% CI -3.01 to -0.09, I2 0%) compared with no exercise. The duration of the exercise interventions ranged from 3 months to 3 years. Dose-response analysis found 560 MET-min/week of exercise (eg, 120 min/week of brisk walking) was associated with 1 kg/m2 reduction in BMI. Low certainty of evidence showed that exercise-only interventions had no effect on LBM (5 RCTs, n=135; standardised mean difference -0.13; 95% CI -0.48, 0.21, I2 0%) compared with no exercise.

These findings highlight physical activity as an effective intervention to improve postpartum anthropometrics and reduce PPWR.

CRD42022359282.

To examine the effect of exercise during the first year postpartum on pelvic floor disorders and diastasis recti abdominis.

Systematic review with random effects meta-analysis.

MEDLINE, EMBASE, CINAHL, SPORTDiscuss, Evidence-Based Medicine Reviews (Ovid), Scopus, Web of Science and ClinicalTrials.gov were searched until 12 January 2024.

Studies of all designs (except case studies) and languages were included if they contained information on the Population (individuals in the first year postpartum), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise alone ('exercise-only') or in combination with other intervention (eg, biofeedback; 'exercise+co-intervention')), Comparator (no exercise or different exercise measures) and Outcome (symptom severity and risk of urinary incontinence, anal incontinence, pelvic organ prolapse, diastasis recti abdominis and sexual function).

65 studies (n=21 334 participants) from 24 countries were included. 'Moderate' certainty of evidence revealed that pelvic floor muscle training reduced the odds of urinary incontinence by 37% (seven randomised controlled trials (RCTs), n=1930; OR 0.63, 95% CI 0.41 to 0.97, I2 72%) and pelvic organ prolapse by 56% (one RCT, n=123; OR 0.44, 95% CI 0.21 to 0.91) compared with control groups. 'Low' certainty of evidence showed a greater reduction in inter-rectus distance measured at rest and during a head lift following abdominal muscle training compared with no exercise. Evidence on the effect of exercise on the risk of anal incontinence and diastasis recti abdominis, as well as the severity of anal incontinence, urinary incontinence, pelvic organ prolapse and sexual function, is limited.

Evidence supports the effectiveness of postpartum pelvic floor muscle training in reducing the odds of urinary incontinence and pelvic organ prolapse and postpartum abdominal exercise training in reducing inter-rectus distance.

CRD42022359282.

To examine the relationship between postpartum physical activity and maternal sleep.

Systematic review with random-effects meta-analysis. Online databases were searched through 20 January 2025.

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1 year post partum); interventions/exposures (including subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ('exercise only') or in combination with other intervention components (eg, dietary; 'exercise+co-intervention')); comparator (low volume or no physical activity) and outcomes: sleep duration, quality, latency, efficiency, disturbance and fatigue.

12 unique studies (n=3096) from nine countries were included. Moderate certainty of evidence showed that exercise-only interventions were associated with a greater improvement in sleep quality (five randomised controlled trials (RCTs), n=375, standardised mean difference (SMD) -0.44, 95% CI -0.79 to -0.09) compared with no exercise. High certainty of evidence showed that exercise interventions were associated with a greater improvement in daytime/general fatigue (six RCTs, n=535, SMD -0.56, 95% CI -1.06 to -0.05) compared with no exercise. No effect was found for sleep duration, latency, efficiency, or disturbance.

Postpartum physical activity improves maternal sleep quality and daytime/general fatigue.

To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes.

Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024.

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence.

60 studies (n=20 684) from 14 countries were included. 'High' certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference -0.27, 95% CI -0.40 to -0.14; small effect). Sleep interventions had no impact on the odds of developing depression ('moderate' certainty of evidence) or anxiety or anxiety symptom severity ('low' certainty of evidence). Additionally, 'low' certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. 'Low' certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. 'Low' and 'very low' certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR.

Postpartum sleep interventions reduced the severity of depression symptoms.

Noninvasive prediction and identification of the H3K27M mutation play an important role in optimizing therapeutic strategies and improving outcomes in gliomas. In this systematic review and meta-analysis, we aimed to evaluate the performance of machine learning (ML)-based models in predicting H3K27M mutation in gliomas.

Literature records were retrieved on September 16th, 2024, in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from the included studies were extracted. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software.

A total of 15 studies were included in our study. Our meta-analysis demonstrated a pooled AUC, sensitivity, and specificity of 0.87 (95% CI: 0.77-0.97), 92% (95% CI: 83%-96%), and 89% (95% CI: 86%-91%)), respectively. The subgroup meta-analysis revealed that despite the higher sensitivity of the deep learning (DL) models, the sensitivity is not superior to ML (P = 0.6). In contrast, the ML-based pooled specificity was significantly higher (P < 0.01). The meta-analysis revealed a 78.1 (95% CI: 33.3 - 183.5). The SROC curve indicated an AUC of 0.921, and the estimated sensitivity is 0.898 concurrent with the false positive rate of 0.126, which indicates high sensitivity with a low false positive rate.

Our systematic review and meta-analysis demonstrated that ML-based magnetic resonance imaging (MRI) radiomics models are associated with promising diagnostic performance in predicting H3K27M mutation in gliomas.

To examine the influence of postpartum exercise on maternal depression and anxiety.

Systematic review with random effects meta-analysis and meta-regression.

Online databases up to 12 January 2024, reference lists, recommended studies and hand searches.

Randomised controlled trials (RCTs) and non-randomised interventions of any publication date or language were included if they contained information on the Population (postpartum people), Intervention (subjective or objective measures of frequency, intensity, duration, volume, type, or mode of delivery of exercise), Comparator (no exercise or different exercise measures), and Outcome (postpartum depression, anxiety prevalence, and/or symptom severity).

A total of 35 studies (n=4072) were included. Moderate certainty evidence from RCTs showed that exercise-only interventions reduced the severity of postpartum depressive symptoms (19 RCTs, n=1778, SMD: -0.52, 95% CI -0.80 to -0.24, I2=86%, moderate effect size) and anxiety symptoms (2 RCTs, n=513, SMD: -0.25, 95% CI -0.43 to -0.08, I2=0%, small effect size), and the odds of postpartum depression by 45% (4 RCTs, n=303 OR 0.55, 95% CI 0.32 to 0.95, I2=0%) compared with no exercise. No included studies assessed the impact of postpartum exercise on the odds of postpartum anxiety. To achieve at least a moderate reduction in the severity of postpartum depressive symptoms, postpartum individuals needed to accumulate at least 350 MET-min/week of exercise (eg, 80 min of moderate intensity exercise such as brisk walking, water aerobics, stationary cycling or resistance training).

Postpartum exercise reduced the severity of depressive and anxiety symptoms and the odds of postpartum depression.

Visfatin and apelin are adipocytokines, with visfatin linked to vascular dysfunction and apelin involved in renal homeostasis. This systematic review and meta-analysis explored the serum/plasma levels of these adipocytokines in chronic kidney disease (CKD) patients versus healthy controls.

Relevant databases, including PubMed, Web of Science, Scopus, and Embase, were searched up to August 2024, and studies reporting visfatin and apelin concentrations in CKD and controls were retrieved for data synthesis. Random-effect meta-analysis was performed to calculate standardized mean differences (SMD) and 95% confidence intervals (CI) for comparison of visfatin and apelin levels in CKD subjects vs. controls.

Out of the 564 studies screened, 14 fulfilled the inclusion criteria, encompassing a collective sample of 1,377 CKD subjects. The CKD group's mean age was 49.51 years (53.50% male), and the control group's mean age was 48.87 years (49.38% male). The meta-analysis indicated a trend of elevated visfatin levels in the CKD group compared to controls (SMD 1.53; 95% CI 0.88-2.19; p < 0.01; I2 = 96%). Moreover, visfatin levels were consistently elevated across all stages of CKD when compared to controls. There were no notable variations in apelin levels between CKD subjects and those in the control group (SMD 0.07; 95% CI,  - 0.45 to 0.59; p = 0.80; I2 = 77%).

Our findings suggest visfatin could be a potential biomarker for CKD, potentially reflecting disease severity; however, apelin levels were not different in CKD and controls. These results may aid in the earlier diagnosis of CKD but need validation through larger, well-structured studies.

Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.

A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.

Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I2 = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I2 = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I2 = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.

TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.

Hypoxemia is a common symptom among patients with chronic obstructive pulmonary disease (COPD). The constant flow oxygen system (CFOS) is often insufficient to correct this symptom. The automatically titrating oxygen system (ATOS), a new oxygen therapy mode, remains undetermined in its ability to improve exercise performance more effectively than CFOS in COPD patients. The main objective of this meta-analysis was to explore this issue.

We conducted a thorough search of randomized controlled trials (RCTs) in PubMed, Embase, Web of Science (from inception to 1 November 2024). Study selection, data extraction, and risk of bias assessment were performed independently by two authors. Data synthesis was conducted using Stata software (Version 17.0). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to rate evidence quality.

Five eligible studies (n = 120) were included. Compared to CFOS, ATOS was more effective in extending the distance (MD = 180.28 m, 95%CI:133.03 to 227.52) and duration (MD = 237.63 s, 95%CI: 181.18 to 294.07) of endurance shuttle walking test (ESWT). Besides, ATOS could better prolong the percentage time of sustaining targeted SpO2 (92%-96%) (MD = 29.43%,95%CI:21.15 to 37.71) and relieve dyspnea at isotime (MD = -1.65, 95%CI -3.19 to -0.11) during ESWT.

ATOS may have more advantages in improving exercise tolerance, sustaining targeted SpO2, and ameliorating dyspnea during exercise in COPD patients.

The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prosp ero/, and the ID is CRD 42024574955) and we didn't make a protocol.

Severe community-acquired pneumonia (sCAP) is associated with higher morbidity and mortality. The use of glucocorticoids to improve the prognosis of severe community-acquired pneumonia remains a topic of controversy.

Following the guidelines given in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), we conducted a systematic review and meta-analysis to evaluate the effects of glucocorticoids on mortality and duration of mechanical ventilation in patients with sCAP. Randomized controlled studies investigating the use of glucocorticoids in the treatment of sCAP were extracted from PubMed, Embase, Cochrane Library, and Web of Science. Statistical analysis was performed to compare the differences in in-hospital mortality, mechanical ventilation duration, gastrointestinal bleeding, secondary infection, and other outcome measures between the glucocorticoid group and the control group.

A total of 8 studies involving 1769 patients were included in the analysis. The hospital mortality in the glucocorticoid group was significantly lower than that in the control group [8 studies, relative risk (RR) 0.59; 95% CI 0.47-0.76, p < 0.01. I2 = 25%, low certainty]. The duration of mechanical ventilation in the glucocorticoid group was significantly shorter than that in the control group [Mean Difference (MD) -3.08; 95% CI -4.96 to -1.19, p < 0.01; I2 = 0%, low certainty]. There was no significant difference in the incidence of gastrointestinal bleeding (RR 0.94; 95% CI 0.55-1.63, p = 0.84, I2 = 0%, low certainty) or secondary infection (RR 0.85; 95% CI 0.58-1.25, p = 0.85, I2 = 2%, moderate certainty) between the glucocorticoid group and the control group. In subgroup analysis, mortality was significantly lower in the hydrocortisone group compared to the control group (6.3% vs. 14.6%, RR 0.43; 95% CI 0.29-0.62, p < 0.01, I2 = 0%, very low certainty). However, there was no significant difference in mortality between the methylprednisolone group and the control group (15.6% vs. 19.9%, RR 0.78; 95% CI 0.57-1.08, p = 0.14, I2 = 0%, moderate certainty).

Glucocorticoids can reduce mortality in patients with sCAP, and the effect may vary depending on the type and the dose of glucocorticoids used. Additionally, glucocorticoid treatment can lead to a shorter duration of mechanical ventilation, as well as the length of ICU stay, without increasing the risk of gastrointestinal bleeding or secondary infection in patients with sCAP. PROSPERO registration: CRD42023416525.

Several anthropometric indices, such as body mass index and waist circumference, have been used as clinical screening tools for the prediction of nonalcoholic fatty liver disease (NAFLD). To further refine these clinical tools for NAFLD, the body roundness index (BRI) has recently been evaluated. In this systematic review and meta-analysis, the objective was to evaluate the relationship and predictive capability of the BRI in identifying NAFLD.

A comprehensive search was conducted in PubMed, Embase, Web of Science, and Scopus up to December 31, 2024. Eligibility criteria included observational studies on adults (≥ 18 years old) with measured BRI and its association with NAFLD. The Joanna Briggs Institute tool was used for risk of bias assessment. Meta-analyses used random-effects models to pool data on mean difference, odds ratio, sensitivity, specificity, and the area under the curve (AUC), with heterogeneity and publication bias assessed.

Ten studies involving 59,466 participants were included. The pooled mean difference in BRI between the NAFLD and non-NAFLD groups was 1.73 (95% confidence interval [CI]: 1.31-2.15). The pooled sensitivity and specificity of BRI for diagnosing NAFLD were 0.806 and 0.692, respectively. The pooled AUC for BRI was 0.803 (95% CI: 0.775-0.830), indicating good diagnostic accuracy. Unlike subgroup analysis by country, subgroup analysis by sex showed no significant differences. Higher BRI values were associated with increased odds of NAFLD (pooled OR = 2.87, 95% CI: 1.39; 5.96). Studies provided mixed results on the predictive ability of BRI compared to other indices like body mass index, mostly favoring BRI over conventional indices.

BRI demonstrates a good diagnostic performance for NAFLD, suggesting it may be a valuable clinical tool for NAFLD assessment. Further research is necessary to validate these findings and strengthen the evidence base.

By 2025, global obesity rates are projected to reach 16% in men and 21% in women, imposing a significant public health burden. Obesity is a major contributor to hypertension (HTN), exacerbating cardiovascular risks. This review and meta-analysis evaluated the effectiveness of non-surgical treatments versus bariatric surgery in managing hypertension among obese individuals.

We searched PubMed, Scopus, Embase, and Cochrane databases up to May 2024. Randomized controlled trials (RCTs) comparing bariatric surgery (e.g., Roux-en-Y Gastric Bypass (RYGB), Sleeve gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Duodenal-jejunal bypass liner/Biliopancreatic diversion (DJBL/BPD)) with non-surgical interventions (e.g., lifestyle modifications, medications) in hypertensive obese patients were included. Primary outcomes were changes in systolic and diastolic blood pressure. Secondary outcomes included changes in fasting blood sugar (FBS), HbA1c, and lipid profiles. Data were synthesized using a random-effects model, with heterogeneity and publication bias assessed.

From 7,187 records, 29 studies involving 2,548 patients met the inclusion criteria. Bariatric surgery resulted in greater reductions in systolic (MD: -4.506 mmHg; 95% CI: -6.999 to -2.013) and diastolic (MD: -3.040 mmHg; 95% CI: -4.765 to -1.314) blood pressure compared to non-surgical interventions. Roux-en-Y gastric bypass had the most significant impact. Bariatric surgery also led to substantial reductions in FBS (MD: -30.444 mg/dl; 95% CI: -41.288 to -19.601), HbA1c (MD: -1.108%; 95% CI: -1.414 to -0.802), and triglycerides (MD: -39.746 mg/dl; 95% CI: -54.458 to -25.034), and increased HDL levels (MD: 7.387 mg/dl; 95% CI: 5.056 to 9.719). The quality of evidence was high for most outcomes, supporting these findings.

Bariatric surgery is superior to non-surgical treatments in managing obesity-related hypertension and metabolic disorders. Reductions in blood pressure, glycemic indexes, and lipid profiles highlight bariatric surgery's critical role in improving cardiovascular health and metabolic outcomes in obese hypertensive patients.

Infertility affects 15% of couples in developed countries, 50% accounting for male origin. In 2021, sperm DNA fragmentation (SDF) testing was incorporated into male fertility evaluations as an evidence-based functional test. We aimed to assess the effect of interventions that could potentially improve SDF. A random-effect meta-analysis was performed with a systematic search in three databases. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated. Initially, 36,531 articles were found, of which 86 papers with over 8,000 patients were included. Three months following varicocelectomy, the decrease in SDF was -6.74% (CI: -9.40, -4.08) compared to preoperative data of patients, whereas it was -12.39% (CI: -22.41, -2.36) after six months and -10.06% (CI: -22.69, + 2.56) at twelve months. A dose-dependent effect could also be observed in grade II and III varicoceles. The overall SDF decrease at three months was -4.27% (CI: -6.11, -2.43) for antioxidants, -4.51% (CI: -6.81, -2.20) for combined antioxidant therapy and -3.36% (CI: -4.44, -2.28) for monotherapy. In terms of follicle-stimulating hormone treatment (FSH) at three months, the change in SDF was -6.66% (CI: -9.64, -3.69). For lifestyle modifications, a change of -3.24% (CI: -5.33, -1.16) was observed at three months. Other interventions are narratively summarized in the systematic review. Of the interventions reviewed, varicocelectomy is the most effective in reducing SDF at six months, FSH treatment might be useful, antioxidants appear questionable, and lifestyle interventions require more studies of similar designs to draw firm conclusions.

This study evaluates the efficacy and safety of High-Intensity Laser Therapy (HILT) and Photobiomodulation (PBM) in treating Oral Lichen Planus (OLP), and explores optimal PBM parameter settings. A search of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and SinoMed was conducted for randomized controlled trials (RCTs) on laser therapy for OLP up to October 30, 2024. Study quality was assessed using the Cochrane risk of bias tool and the Jadad score. Eighteen studies were identified, with 16 involving 742 participants included in the meta-analysis. Eleven studies compared PBM with topical corticosteroids (TCS), and five compared HILT with TCS. HILT provided superior pain relief compared to TCS (SMD = -0.51, 95% CI [-0.79,-0.23]), while PBM showed comparable outcomes (SMD = -0.41, 95% CI [-0.87, 0.04]). PBM was more effective at pain relief with total energy density below 120 J/cm2. Both HILT and PBM reduced recurrence rates (RR = 0.33,95%CI [0.15,0.73]; RR = 0.43, 95% CI [0.25, 0.74]) and improved cure rates (RR = 1.44, 95% CI [1.01, 2.06]; RR = 1.47, 95% CI [1.05, 2.05]). PBM had no adverse reactions, while HILT and TCS had associated adverse events. HILT and PBM may be considered effective alternatives to TCS. For PBM treatment of OLP, a total energy density below 120 J/cm2 is advisable. Further large-scale studies are required to confirm these findings and refine laser parameters.

Preeclampsia (PE) is a severe hypertensive disorder affecting approximately 6.7% of pregnancies worldwide. Identifying reliable biomarkers for early prediction could significantly reduce the incidence of PE and facilitate closer monitoring and timely management. This study aims to investigate the association between albuminuria in early pregnancy and the subsequent development of PE, and to explore its predictive abilities.

A systematic search was conducted across PubMed, Embase, and Web of Science on July 15, 2024, for studies published between January 1, 1990, and June 30, 2024. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal and Risk of Bias in Non-randomized Studies - of Exposures Checklists. Random-effects models in STATA were used to conduct meta-analyses comparing urine albumin and albumin-to-creatinine ratio levels in patients who later developed PE versus those who did not. The incidence of PE was also compared between patients with and without albuminuria in early pregnancy. The predictive ability of albuminuria for PE was assessed using META-DISC software.

A total of 26 studies comprising 7,640 pregnant women were systematically reviewed. Of these, 17 studies met the quality criteria for inclusion in the meta-analyses. Our findings indicate that urine albumin (Hedges's g = 0.48 [95% confidence interval (CI): 0.16-0.80]; p-value < 0.001) and albumin-to-creatinine ratio (Hedges's g = 0.48 [95% CI: 0.16-0.80]; p-value = 0.003) were significantly higher in the early stages of pregnancy in patients who later developed PE compared to those who did not. The incidence of PE was higher in patients with early-diagnosed albuminuria (log odds ratio = 2.56 [95% CI: 1.75-3.38]; p-value < 0.001). The pooled sensitivity and specificity for albuminuria in predicting PE were 56% [95% CI: 48-64%] and 87% [95% CI: 85-89%], respectively.

Elevated maternal urine albumin and albumin-to-creatinine ratio in early pregnancy are associated with a higher risk of developing PE. While these biomarkers show promise for early identification of at-risk patients, the relatively low sensitivity suggests that albuminuria alone may not be a robust predictor of PE, which underscores the need for future research in this regard.

Review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42024575772.

Direct or indirect internal fixation for posterior ankle fractures remains a controversial topic. While direct plate or screw internal fixation is believed to provide better reduction, it may also cause more severe soft tissue damage, while indirect screw internal fixation is thought to result in less damage but may carry the risk of poor reduction. We conducted this meta-analysis to investigate the clinical efficacy and safety of direct versus indirect reduction internal fixation for posterior ankle fractures. The Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) guidelines were used to search the China Knowledge Network database (CNKI), PubMed, Web of Science, Embase, and other databases from the year of establishment- February 2025, and relevant journals were manually searched to collect the relevant literature, and articles that met the requirements were screened and analyzed. Meta-analysis was conducted using RevMan 5.4 software, and a systematic evaluation was carried out when the data from the included studies could not be synthesized. A total of 17 articles involving 1538 study subjects were included, and the results showed that there were no statistical differences in postoperative AOFAS scores, complications, and Dorsiflexion restriction between ankle fractures after direct plate or screw reduction and fixation and those after indirect screw reduction and fixation; however, the Radiological evaluation>2mm However, Radiological evaluation >2mm and Osteoarthritis (P<0.05) were statistically different. Direct reduction and fixation of posterior ankle fractures has better imaging performance and reduces the incidence of postoperative arthritic events.

The debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p < 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p < 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328.