Acute Kidney Injury (AKI) is a health problem worldwide, accounting for high hospital morbidity and mortality. There is little available information regarding the characteristics and incidence of AKI in Latin America (LA), especially in Mexico.

Systematically search the literature and perform a meta-analysis of the epidemiology of AKI in Mexico, to provide data on AKI and kidney replacement therapy (KRT) that would contribute to general knowledge in this matter.

We performed a systematic search for articles in pediatric and adult patients admitted to the general ward, Emergency Room or Intensive Care Unit published between January 1, 2000, and September 30, 2024. MEDLINE LILIACS, EMBASE and SciELO were searched, as additional reports from supplements, abstracts, and conference sessions. We performed a random-effects meta-analysis for clinically and methodologically comparable studies to estimate the frequency of AKI and KRT. We calculated pooled estimates stratified by age group, year of publication, and setting.

83 full-text articles were included. The percentage of AKI was calculated at 35% (95% CI, 28-42). Mortality for AKI adult patients was 36% (95% CI, 28-45). An overall KRT rate was 7% (95% CI, 6-9), all-cause mortality for AKI requiring KRT was 49% (95% CI, 42-56), with a global Ι2 estimated in 99.87% (p < 0.01).

AKI is common in Mexico and remains a main public health problem that needs to be addressed at every level of care. Efforts should be made to reinitiate AKI research and control in Mexico and LA.

The prognostic value of C-reactive protein (CRP) in patients with bladder cancer (BCa) has been widely analysed; however, the results remain conflicting. Therefore, we performed this meta-analysis to identify the precise role of CRP level in predicting BCa prognosis.

PubMed, Web of Science, Embase and Cochrane Library databases were comprehensively searched until 19 April 2024. The impact of CRP level on predicting the prognosis of patients with BCa was examined using combined hazard ratios (HRs) and 95% confidence intervals (CIs). The relationship between CRP level and BCa clinicopathological characteristics was investigated by combining the odds ratios (ORs) with 95%CIs.

Twenty studies with 7276 patients were enrolled in this study. As revealed by pooled data, elevated CRP levels were markedly related to poor overall survival (OS) (HR = 2.02, 95%CI = 1.41-2.90, p < .001), inferior cancer-specific survival (CSS) (HR = 1.46, 95%CI = 1.29-1.66, p < .001), shortened recurrence-free survival (RFS) (HR = 1.25, 95%CI = 1.17-1.33, p < .001) and dismal progression-free survival (PFS) (HR = 2.28, 95%CI = 1.80-2.90, p < .001) in BCa patients. Nevertheless, there was no significant relationship between CRP level and sex, tumour size, tumour grade or lymph node metastasis (LNM) in BCa.

Elevated CRP levels were significantly related to poor OS, CSS, RFS and PFS of BCa patients with BCa. CRP could act as a reliable biomarker for predicting the short- and long-term survival of patients with BCa in clinical practice.

Research about public health impacts of COVID-19 on post-secondary students is slowly beginning to emerge. This scoping review identified common public health challenges among post-secondary students in higher-income countries during the COVID-19 pandemic. Five databases were searched to find relevant peer-reviewed literature up to March 2022. Results were categorized according to reported public health challenges and relevant socio-economic variables. After screening, 53 articles were reviewed. Most articles were from the USA (39/53). The seven main public health challenges identified were mental health (35/53), financial instability (25/53), physical health (13/53), food insecurity (12/53), social well-being (8/53), digital access (7/53), and housing or relocation (6/53). Students with low socioeconomic status experienced heightened public health challenges. This review offers insight and opportunities for the development of longitudinal tools to support social determinants of health in post-secondary populations in high-income countries and may offer insight into similar experiences for students in other settings.

Hot flashes and night sweats, common vasomotor symptoms (VMS) during menopause, are strongly associated with poor sleep quality and disorders. Physical activity is proposed as a strategy to improve menopausal health and sleep outcomes. This systematic review and meta-analysis synthesizes and evaluates evidence on the relationship between physical activity and sleep parameters in women experiencing VMS. Comprehensive searches were conducted in October 2024 across multiple databases, including MEDLINE/PubMed, Cochrane Library, and EMBASE, alongside manual backward and forward searches. Randomized controlled trials (RCTs) investigating physical activity or exercise interventions and their effects on subjective and objective sleep outcomes in women with VMS were included. The risk of bias was assessed using the revised Cochrane RoB 2 tool, and data were pooled for meta-analysis. Nine studies with a total of 1579 participants were analyzed. Physical activity interventions did not significantly improve sleep quality (-0.03 [-1.23, 1.18]; P = 0.96; I2 = 78 %) or insomnia (-1.65 [-3.52, 0.21]; P = 0.08; I2 = 0 %) but produced minor improvements in sleep problems (-0.08 [-0.16, -0.00]; P = 0.04; I2 = 0 %). Despite concerns regarding bias, none of the studies were classified as high-risk, supporting result reliability. The findings suggest heterogeneity in the effects of physical activity on sleep, influenced by intervention-specific factors like type, frequency, intensity, timing, and duration. Environmental variables may also moderate these outcomes, highlighting the complexity of sleep regulation and the need for tailored approaches to improve sleep in menopausal women. Review protocol is registered in PROSPERO: CRD42024599593.

Inflammatory bowel diseases (IBDs) are a major health burden, and incidence as well as prevalence have increased over the last decades. Colitis animal models are used to explore the underlying pathogenesis of and therapeutic options for IBD. Since the reporting of specific aspects of colitis studies using mice has been criticized in the past, we performed a scoping review based on the PRISMA guidelines to assess putative improvements in the quality of reporting. A defined search for dextran sulfate sodium (DSS) murine colitis models was performed in three literature databases (PubMed, PubMed Central®, and Embase) for two time periods: 2007/2008 and 2017. Data were extracted from 122 articles published in 2007/2008 and 236 publications from 2017. We checked the articles for the reporting of details of the colitis model (DSS properties, manufacturer, concentration, duration of application, mouse strain, sex, source), measures to reduce allocation, performance and detection bias (randomization and blinding), and information on clinical assessment, refinements, and humane endpoints. Our results showed that there was significant improvement over time in the scores for refinement and, based on this, also the completeness score. However, the other aspects were poorly reported, suggesting that this research field may need to adopt reporting guidelines such as ARRIVE, the Gold Standard Publication Checklist, or the colitis methods checklist when writing and reviewing publications.

This is an update of a Cochrane review first published in 2007. Allergic disease and food allergy are prevalent, and contribute to a significant burden of disease on the individual, their family and the healthcare system. Probiotics are live bacteria that colonise the gastrointestinal tract, and have been studied in many clinical trials for preventing allergic conditions.

To evaluate the benefits and harms of a probiotic, or a probiotic with added prebiotic ('synbiotic'), compared with control (placebo or no treatment) for preventing allergic diseases (asthma, eczema, allergic rhinitis) and dietary allergies in infants by two years of age.

We searched CENTRAL, MEDLINE, Embase and trial registries in December 2023. We reviewed the reference lists of studies selected for inclusion in this review, and systematic reviews on similar topics. We manually searched conference abstracts.

We included randomised controlled trials that compared a probiotic to a control, or a probiotic added to a prebiotic ('synbiotic'). We included enterally fed infants in the first six months of life without clinical evidence of allergic disease. We included probiotics added to human milk or infant formula, added in the manufacturing process or given separately.

Infant incidence by two years of age and childhood incidence (up to 10 years of age or up to the age of latest report between 2 and 10 years) of specific allergic diseases, including: asthma, eczema, allergic rhinitis, immunoglobulin E (IgE)-mediated food allergy, IgE-mediated cow's milk protein allergy. Events of anaphylaxis and potential harms including adverse effects, harms or infection with probiotic bacteria.

We used the Cochrane RoB 2 tool to assess bias in the studies.

We used the random-effects (Mantel-Haenszel) model for meta-analysis where possible. Where this was not possible due to the nature of the data, we synthesised and interpreted individual studies separately. We used GRADE to assess the certainty of evidence for each outcome.

We included 24 studies (7077 mother-infant pairs). The studies were conducted in many parts of the world, including the USA, Europe, South Korea, Japan, Singapore and Australia, with most being conducted in Europe. Studies were published between 2001 and 2020. As some studies measured outcomes such as eczema using different criteria, we made assumptions to allow us to combine data.

Probiotics may result in little to no difference in asthma (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.65 to 1.44; 4 studies, 954 participants; low-certainty evidence), allergic rhinitis (RR 0.89, 95% CI 0.45 to 1.77; 5 studies, 1045 participants; low-certainty evidence) and IgE-mediated cow's milk protein allergy (RR 0.99, 95% CI 0.82 to 1.20; 4 studies, 259 participants; low-certainty evidence) by two years of age. Probiotics may result in a slight reduction in eczema by two years of age (RR 0.87, 95% CI 0.78 to 0.97; 18 studies, 3494 participants; low-certainty evidence); however, sensitivity analysis of the studies at low risk of bias showed little or no difference in eczema by two years of age (RR 0.86, 95% CI 0.69 to 1.07; 4 studies, 892 participants). Probiotic supplementation may have little to no effect on the incidence of food allergy by two years, but the evidence is very uncertain (RR 1.12, 95% CI 0.57 to 2.20; 3 studies, 857 participants; very low-certainty evidence). The evidence is very uncertain about the effect of synbiotics on eczema by two years of age (RR 0.88, 95% CI 0.52 to 1.47; 3 studies, 1235 participants; very low-certainty evidence). Synbiotics may result in little to no difference in food allergy by two years of age (RR 1.06, 95% CI 0.55 to 2.07; 1 study, 223 participants; low-certainty evidence). There were no data for the effect of synbiotics on asthma, allergic rhinitis and IgE-mediated cow's milk protein allergy by two years of age. Probiotic or synbiotic supplementation may result in little to no difference in potential harms including adverse effects, harms or infection with probiotic bacteria at any point during the study intervention by two years of age. There were no serious adverse events related to probiotics or synbiotics reported. We had some concerns about risk of bias for most studies, with only a few judged at low risk of bias. Some studies had a high risk of bias due to unclear randomisation, missing data and lack of prespecified intentions. Estimates were often imprecise, with wide CIs due to limited events. The limited data prevented subgroup analyses on infant risk factors and feeding methods for outcomes other than the effect of probiotics on eczema. Only three studies assessed synbiotic supplementation, leaving their role in allergic disease prevention uncertain. The included studies were mainly in high-income countries in many different areas of the world, but may have limited applicability to other regions.

There is insufficient evidence to make conclusions about the effect of probiotics and synbiotics on preventing the development of allergic diseases by two years of age and during childhood up to 10 years of age. Although there were no serious adverse events reported for the use of probiotics in infants, incorporating probiotics and synbiotics into routine practice requires further information to support their use.

This Cochrane review had no dedicated funding.

Protocol (2007) available via https://doi.org/10.1002/14651858.CD006475. Original review (2007) available via https://doi.org/10.1002/14651858.CD006475.pub2.

Ecological momentary interventions (EMIs) delivered via smartphone apps have gained attention as a potential tool for addressing self-injurious thoughts and behaviors (SITB), particularly non-suicidal self-injury (NSSI). This systematic review aims to assess the efficacy and feasibility of smartphone-based EMIs in reducing SITB and improving mental health outcomes.

A systematic review was conducted, focusing on smartphone-based EMIs targeting SITB, with particular emphasis on those addressing NSSI. The latest search was made in February 2025.

Sixteen studies featuring smartphone-based EMIs were included. Overall, these studies showed promising evidence for the reduction of SITB. Specifically, several studies reported reductions in NSSI frequency and improvements in emotional regulation among participants. Feasibility and acceptability data showed good results.

Key limitations include small sample sizes, study heterogeneity, lack of follow-up, reliance on self-reports, and absence of standardized tools to distinguish NSSI from other self-injurious behaviors.

Results are promising, while the efficacy of smartphone-based EMIs SITB requires further validation through large-scale and well-designed studies. The integration of digital interventions into broader mental health care strategies offers a potential avenue for addressing the treatment gap in at-risk populations, particularly those with limited access to traditional care.

This systematic review aimed to evaluate the efficacy of immunoenhancing nutritional therapy compared to conventional nutritional care in reducing perioperative complications in adult patients undergoing surgery for oral cancer. Given the unclear role of immunonutrition in this specific surgical setting, we synthesized available randomized controlled trials to assess outcomes such as surgical site infections, wound healing complications, hospital stay, and adverse events.

Patients who underwent planned oral cancer surgery were included. The intervention group received oral or enteral immunoenhancing nutritional agents preoperatively, postoperatively, or both, while the control group received standard care (intravenous fluids) and/or macromolecular nutritional supplements. PubMed, Cochrane CENTRAL, and Central Medical Journal were comprehensively searched for randomized controlled trials (RCTs); eight RCTs were included. The primary outcomes were mortality, suture/healing failure, surgical site infection (SSI), and hospital stay length, with evidence certainty assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

Although mortality estimation was not feasible, hazard ratios from the meta-analysis showed that the intervention significantly improved suture/healing failure, SSI, and hospital stay length. The certainty of evidence was "low" for suture/healing failure and SSI and "moderate" for hospital stay length.

Perioperative management with enteral nutritional agents fortified with immunonutrients should be considered in adult patients scheduled for (advanced) oral cancer surgery.

In the fight against antimicrobial resistance, mathematical transmission models have been shown as a valuable tool to guide intervention strategies in public health.

This review investigates the persistence of modelling gaps identified in earlier studies. It expands the scope to include a broader range of control measures, such as monoclonal antibodies, and examines the impact of secondary infections.

This review was conducted according to the PRISMA guidelines. Gaps in model focus areas, dynamics, and reporting were identified and described. The TRACE paradigm was applied to selected models to discuss model development and documentation to guide future modelling efforts.

We identified 170 transmission studies from 2010 to May 2022; Mycobacterium tuberculosis (n = 39) and Staphylococcus aureus (n = 27) resistance transmission were most commonly modelled, focusing on multi-drug and methicillin resistance, respectively. Forty-one studies examined multiple interventions, predominantly drug therapy and vaccination, showing an increasing trend. Most studies were population-based compartmental models (n = 112). The TRACE framework was applied to 39 studies, showing a general lack of description of test and verification of modelling software and comparison of model outputs with external data.

Despite efforts to model antimicrobial resistance and prevention strategies, significant gaps in scope, geographical coverage, drug-pathogen combinations, and viral-bacterial dynamics persist, along with inadequate documentation, hindering model updates and consistent outcomes for policymakers. This review highlights the need for robust modelling practices to enable model refinement as new data becomes available. Particularly, new data for validating modelling outcomes should be a focal point in future modelling research.

Bullous pemphigoid (BP) is a chronic autoimmune blistering disease primarily affecting the elderly population. While awaiting the results from randomized clinical trials to assess the effect of dupilumab in patients with BP, clinicians have begun to introduce dupilumab into their therapeutic arsenal, with few data supporting their clinical decisions. The objectives were to assess time to disease control, predictors of response, achievement of disease control, disease recurrence, and occurrence of adverse events. Randomized and non-randomized studies of interventions (NRSIs) from Medline and Embase were reviewed. A total of 315 studies were identified and 5 NRSIs (167 participants with moderate-to-severe BP) meeting our inclusion criteria were found. Dupilumab was significantly associated with shorter time to disease control compared with the control group (HR 2.71  [95% CI, 1.85-3.96; I2 = 35%; 127 participants; 4 studies]). The overall strength of the evidence was graded as very low due to serious risk of bias and imprecision of effect measures. There were insufficient data to inform conclusions regarding BP recurrence and adverse events. Evidence was found that dupilumab reduces time to disease control in BP. It was not possible to assess predictors of response using pre-planned meta-regression. Randomized controlled trials are needed to determine dupilumab's place in therapeutic algorithms for BP. PROSPERO number: CRD42024599235.

Machine learning (ML) may be superior to traditional methods for clinical outcome prediction. We sought to systematically review the literature on ML for clinical outcome prediction in cerebrovascular and endovascular neurosurgery.

A comprehensive literature search was performed, and original studies of patients undergoing cerebrovascular surgeries or endovascular procedures that developed a supervised ML model to predict a postoperative outcome or complication were included.

A total of 60 studies predicting 71 outcomes were included. Most cohorts were derived from single institutions (66.7%). The studies included stroke (32), subarachnoid hemorrhage ((SAH) 16), unruptured aneurysm (7), arteriovenous malformation (4), and cavernous malformation (1). Random forest was the best performing model in 12 studies (20%) followed by XGBoost (13.3%). Among 42 studies in which the ML model was compared with a standard statistical model, ML was superior in 33 (78.6%). Of 10 studies in which the ML model was compared with a non-ML clinical prediction model, ML was superior in nine (90%). External validation was performed in 10 studies (16.7%). In studies predicting functional outcome after mechanical thrombectomy the pooled area under the receiver operator characteristics curve (AUROC) of the test set performances was 0.84 (95% CI 0.79 to 0.88). For studies predicting outcomes after SAH, the pooled AUROCs for functional outcomes and delayed cerebral ischemia were 0.89 (95% CI 0.76 to 0.95) and 0.90 (95% CI 0.66 to 0.98), respectively.

ML performs favorably for clinical outcome prediction in cerebrovascular and endovascular neurosurgery. However, multicenter studies with external validation are needed to ensure the generalizability of these findings.

This review article outlines the key aspects of electronic search strategies used for systematic reviews, with a particular focus on developing a search strategy for systematic reviews in reproductive medicine. Additionally, we aimed to gather information on studies assessing the quality of literature searches and address conceptualization, search terms, database selection, peer review, translation, documentation, and report of searches. This review and practical guide has been written to assist not only those with experience and knowledge in health research but also beginner teams seeking the skills to conduct systematic reviews in the field. It uses the MEDLINE database, with both PubMed and Ovid interfaces, as examples to illustrate the process of developing a search strategy.

A narrative review of the literature was conducted, and a practical guide for developing search strategies was developed.

There is a significant lack of information on the quality and effectiveness of search strategies used in systematic reviews within the field of reproductive medicine, as well as on the workflow for developing these strategies. For specialized topics, searching at least three to five databases is recommended to achieve high recall. It is also advisable to follow the PRESS guidelines and to report the databases searched, the date of access, and terms used.

This review may serve as a foundation for future research to address these gaps. We provided a concise and practical overview of the key elements of search strategy development as a kick-off. The appendices, which include practical examples, a compilation of existing sources, guidelines, and a glossary of terms, can be useful for health professionals and researchers in creating a more advanced and reproducible literature search when planning a systematic review project.

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one of the criteria air pollutants that (1) serve as an essential carrier of airborne toxicants arising from combustion-related events including emissions from industries, automobiles, and wildfires and (2) play an important role in transient to long-lasting cognitive dysfunction as well as several other neurological disorders. A systematic review was conducted to address differences in study design and various biochemical and molecular markers employed to elucidate neurological disorders in PM2.5 -exposed humans and animal models. Out of 340,068 scientific publications screened from 7 databases, 312 studies were identified that targeted the relationship between exposure to PM2.5 and cognitive dysfunction. Equivocal evidence was identified from pre-clinical (animal model) and human studies that PM2.5 exposure contributes to dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity disorder, and neurodevelopment. In addition, there was substantial evidence from human studies that PM2.5 also was associated with Alzheimer's disease, anxiety, neuropathy, and brain tumors. The role of exposome in characterizing neurobehavioral anomalies and opportunities available to leverage the neuroexposome initiative for conducting longitudinal studies is discussed. Our review also provided some areas that warrant consideration, one of which is unraveling the role of microbiome, and the other role of climate change in PM2.5 exposure-induced neurological disorders.

Higher muscle strength is associated with improved overall health and lower mortality. Muscle strength changes during gender-affirming hormone therapy is possibly linked to gender-affirming hormone therapy modality, age at initiation, gender-affirming hormone therapy duration, and physical activity.

To review published literature on muscle strength changes during gender-affirming hormone therapy.

Studies were included if they met the PICOS criteria; P: transgender individuals ≥18 years, I: gender-affirming hormone therapy, C: gender-affirming hormone therapy-naïve transgender persons or cisgender controls, O: muscle strength and physical activity in relation to muscle strength, S: prospective cohorts or cross-sectional.

Fifteen studies with data on 1206 transgender persons (722 transmasculine persons, median age 23-37 years and 484 transfeminine persons, median age 27-41 years) were included. Prospective design was used in eight out of 15 studies (two out of eight on transmasculine, two out of eight on transfeminine, and four out of eight on both) and seven out of 15 were cross-sectional (two out of seven on transmasculine, four out of seven on transfeminine, and one out of seven on both). Isometric elbow flexion/extension, lower body strength, and handgrip strength were assessed in one out of 15 studies, four out of 15, and 12 out of 15 studies, respectively. Bias rating was moderate to high.

Masculinizing gender-affirming hormone therapy resulted in increased (four out of six studies) or unchanged (two out of six studies) muscle strength, while feminizing gender-affirming hormone therapy resulted in decreased (three out of six studies) or unchanged (three out of six studies) muscle strength. Muscle strength changes mainly occurred during the first year after initiating gender-affirming hormone therapy and age at initiation had no impact.

Transmasculine and transfeminine persons had higher strength compared with cisgender women, but lower strength than cisgender men. Physical activity was unchanged during gender-affirming hormone therapy in five out of prospective studies, while transfeminine persons were less physically active than cisgender men in five out of five prospective studies.

Muscle strength appeared to increase during masculinizing gender-affirming hormone therapy and decrease during feminizing gender-affirming hormone therapy, whereas physical activity was unchanged. Given high risk of bias, more research is necessary. Improving transgender care requires engagement of transgender persons in physical activity.

The fibrinogen-to-albumin ratio (FAR) has been explored for its role in predicting non-small cell lung cancer (NSCLC) prognosis, but findings remain inconsistent. This study aimed to determine the exact impact of FAR on predicting NSCLC prognosis through a meta-analysis.

This study conducted a comprehensive search of PubMed, Web of Science, Embase, Cochrane Library, and CNKI up to April 2, 2025, and determined pooled hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the prognostic value of FAR in NSCLC.

This meta-analysis included seven studies with a total of 2,655 cases. The pooled analysis revealed that an elevated FAR significantly predicted poor overall survival (OS) (HR = 1.82, 95% CI = 1.56-2.14, p < 0.001) and poor progression-free survival (PFS) (HR = 1.50, 95% CI = 1.29-1.74, p < 0.001) in patients with NSCLC, which was strongly associated with male sex (OR = 1.53, 95% CI = 1.12-2.08, p = 0.008) and tumor size ≥ 5 cm (OR = 1.52, 95% CI = 1.08-2.14, p = 0.017). However, FAR showed no significant correlation with smoking history (OR = 1.44, 95% CI = 0.80-2.59, p = 0.218) or Eastern Cooperative Oncology Group performance status (OR = 1.60, 95% CI = 0.74-3.45, p = 0.230).

This meta-analysis suggests that elevated FAR is a strong predictor of OS and PFS in patients with Chinese NSCLC and correlates with larger tumor size.

The objective of this systematic review and meta-analysis was to evaluate the influence of non-surgical periodontal therapy (NSPT) on subgingival microbiota in systemically healthy patients with periodontitis.

A systematic literature search was conducted in Medline, Embase, LILACS, and the Cochrane Library, supplemented by a manual search for studies investigating the effect of NSPT on subgingival microbiota in systemically healthy patients.

In this review, 115 studies were included, of which 41 used checkerboard DNA-DNA hybridisation technology, 30 real-time quantitative PCR, 36 bacterial culture, and 8 16S ribosomal ribonucleic acid (rRNA) gene sequencing technology. Meta-analyses showed a significant decrease in mean counts of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis), Tannerella forsythia (T. forsythia), Eubacterium nodatum (E. nodatum), Prevotella intermedia (P. intermedia), and Campylobacter rectus (C. rectus) after NSPT. Supportive periodontal care provided a further decrease in mean counts of P. gingivalis and T. denticola at 6 months after NSPT. Qualitative analysis of 16S rRNA gene sequencing studies indicated significant effects of NSPT on the relative abundance of selected disease-and health-associated species and genera, whereas findings on changes in alpha and beta diversity in the subgingival microbiome were heterogeneous.

This systematic review showed that NSPT leads to significant reduction of mean abundance of disease-associated microbial species. However, 16S rRNA gene sequencing studies reported heterogeneous findings, which may be associated with methodological aspects. To deepen the understanding of the effect of NSPT on subgingival microbiota, further studies, powered for microbiome changes and with clustered analysis of site-specific samples, are needed.

Emerging evidence highlights that arm movements exert a substantial and functionally relevant contribution on postural control in healthy individuals. However, performance differences between free versus restricted arm movement for different balance categories with varying levels of task difficulty have not been systematically investigated yet.

The objective of this systematic review and meta-analysis was to characterise, aggregate, and quantify performance discrepancies between free and restricted arm movement conditions for diverging balance categories with varying levels of task difficulty in healthy individuals.

A systematic search of the literature according to the PRISMA guidelines was performed on the electronic databases PubMed, Web of Science, and SPORTDiscus from their inception date till 1st September 2024. To be applicable for analysis, studies had to report at least one measure of balance performance in healthy individuals. The included studies were coded according to the following criteria: age, sex, status, arm movement conditions, balance test, and test modality. Methodological study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences (SMD) were calculated and classified according to their magnitude.

The literature search identified a total of N = 941 records, 25 of which met the inclusion criteria and were analysed in this review. A total of 725 participants (n = 331 females) participated in the studies. The free use of arm movement resulted in moderate (static: SMD = 0.51, dynamic: SMD = 0.66, proactive: SMD = 0.52, reactive: SMD = 0.50) improvements of balance performance. In addition, the performance enhancements were more pronounced for balance tasks with a high (static: SMD = 0.89, dynamic: SMD = 1.04) compared to a low (static: SMD = 0.20, dynamic: SMD = 0.76) difficulty level. Due to a lack of studies, no analysis for measures of proactive and reactive balance was performed.

The findings revealed that the free use of arm movement positively affects several measures of balance performance, and this is effect is more pronounced for balance tasks with a high difficulty level.

Axillary management of patients with early-stage breast cancer (ESBC) has evolved, especially with the implementation of precision radiotherapy techniques that have resulted in a significant reduction in treatment-related toxicities, but it is unclear whether post-mastectomy radiotherapy (PMRT) improves survival outcomes in breast cancer with lymph nodes micrometastases (BCLNMM, that is T0, T1 ~2NmiM0). Our study is to systematically evaluate the effect of PMRT on survival in breast cancer with lymph nodes micrometastases.

A literature search was performed for randomized controlled trials (RCTs) or retrospective studies related to PMRT versus non-post-mastectomy radiotherapy (non-PMRT) in the adjuvant treatment of ESBC in PubMed, Cochrane Library, Embase, CNKI and other databases. R package meta software was used to perform meta-analyses with hazard ratio (HR). Newcastle Ottawa scale was selected for quality assessment. The review was prospectively registered on PROSPERO (CRD42024562444).

10 relevant studies were screened, all of which were retrospective studies. The difference in overall survival (OS) was not statistically significant (HR = 0.92, 95%CI: 0.81 ~ 1.04; Z = 1.35, P = 0.177). The difference in breast cancer-specific survival (BCSS) between the PMRT group and the non-PMRT group was not statistically significant HR = 1.18, 95%CI: 0.94 ~ 1.48; Z = 1.41, P =0.160). The difference in disease-free survival (DFS) was statistically significant (HR = 0.47, 95%CI: 0.23 ~ 1.00; Z = 1.96, P =0.049). The difference in local recurrence free survival (LRRFS) was also not statistically significant (HR = 0.50, 95%CI: 0.11 ~ 2.26, P = 0.190). The difference in distant-metastasis free survival (DMFS) was not statistically significant (HR = 0.54, 95%CI: 0.22 ~ 1.35, P = 0.356).

Despite the tendency of PMRT in BCLNMM to improve DFS, OS, BCSS, LRRFS, and DMFS showed no benefit, therefore, PMRT should be used with caution in BCLNMM.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024562444.

D-amino acid oxidase inhibitors (DAOI) have demonstrated potential therapeutic benefits for schizophrenia and cognitive impairment; however, existing studies present conflicting results. This meta-analysis aimed to assess the symptomatic and cognitive effects of DAOI on the treatment of schizophrenia. An electronic search was conducted using PubMed, Cochrane Systematic Reviews, and the Cochrane Central Register of Controlled Clinical Trials for double-blinded, randomized controlled trials evaluating DAOI for the treatment of schizophrenia. Published trials up to November 2024 were included in the analysis. A random-effects model was employed to pool data for comparing the treatment effects of DAOI. Participants diagnosed with schizophrenia were recruited. Clinical and cognitive improvements were compared between baseline and post-DAOI treatment using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity across the trials was assessed through funnel plots and the I² statistic. A total of five trials with 530 participants met the inclusion criteria. Four trials utilized sodium benzoate, while one trial employed luvadaxistat. The Positive and Negative Syndrome Scale (PANSS) was used in all studies to evaluate clinical symptoms, with four studies also assessed cognitive function. This analysis highlighted that DAOI surpassed the comparator in reducing the scores of PANSS total (SMD = -0.270, P = 0.035), PANSS positive (SMD = -0.399, P = 0.022), PANSS negative (SMD = -0.171, P = 0.026), and PANSS general psychopathology (SMD = -0.180, P = 0.019). Subgroup analyses identified significant effects in trials using sodium benzoate (SMD = 0.368, P = 0.021). Moreover, DAOI showed greater improvements in cognitive functions (SMD = 0.359, P = 0.017), with a better effect correlated with more female participants. The findings of this meta-analysis suggest that DAOI may be effective in improving clinical symptoms and cognitive function in patients with schizophrenia. Further studies with larger sample sizes are needed to confirm these results.

Understanding long-term retention rates and complications associated with different materials for fabricating pediatric crowns for primary teeth is crucial for material selection and optimizing clinical outcomes.

This systematic review aimed to descriptively analyze the crown-retention rates and complications associated with crown retention, as well as the biological and technical complications of pediatric crowns, for primary teeth. The meta-analysis reported herein was performed to estimate long-term (3-year and 5-year) retention rates of these pediatric crowns fabricated using various materials.

Using the PICOS (Population, Intervention, Comparison, Outcomes, and Study design) paradigm, a systematic search was conducted between July and August 2023 in the Cochrane, Embase, and PubMed databases to identify randomized controlled trials (RCTs) and clinical (prospective and retrospective) studies reporting retention rates, complications of crown retention, and biological and technical complications. After selecting studies with a predefined set of selection criteria, data from included studies were used for a systematic review aimed at a descriptive analysis of factors associated with the failure of crowns for primary teeth. Data from the included RCTs were used for meta-analysis, wherein 3-year and 5-year crown-retention rates were estimated using Poisson regression models.

This systematic review included 13 RCTs and 5 clinical studies on dental crowns for primary teeth, involving 454 children (1172 crowns) in RCTs and 810 children (2667 crowns) in clinical studies. The median follow-up durations were 12 months for RCTs and 20.8 months for clinical studies, with a 10.6% (124/1172) dropout rate in RCTs. Meta-analysis of pooled 5-year retention rates for different crown materials revealed the following retention rates: 88.90% for compomer crowns, 92.18% for composite resin crowns, 90.30% for resin-modified glass ionomer cement (RMGIC) crowns, and 97.88% for stainless steel crowns. Additionally, strip crowns exhibited a retention rate of 83.48%, while zirconia crowns had a retention rate of 97.09%. Poisson regression estimated 3-year and 5-year crown-retention rates, indicating good outcomes across materials. Complications included secondary caries (up to 21.8% in zirconia crowns) and marginal adaptation issues (up to 22.2% in compomer crowns). These findings highlight material-specific considerations necessary for optimizing outcomes in pediatric dental crown treatments.

While retentive complications such as chipping, material loss, and fractures do occur across materials, compomer, composite resin, stainless steel, strip, and zirconia crowns all have clinically acceptable retention rates. However, the differences in biological and technical complications between materials may provide insights for selecting appropriate materials for pediatric crowns based on clinical considerations.

Assessment of patient safety culture (PSC) is critical for health care organizations worldwide to recognize areas that require urgent attention, promote patient safety, and improve quality of care. The aim of this systematic review was to determine the overall PSC score among nurses worldwide and identify the dimensions of PSC that score the highest and the lowest, as well as any geographical differentiations.

Literature research was conducted in PubMed and Scopus search engines and the Agency for Healthcare Research and Quality (AHRQ) Research Reference List to identify studies published in English between January 2004 and May 2023 that used the Hospital Survey on Patient Safety Culture, version 1, to measure hospital nurses' assessment of PSC. This review followed the PRISMA 2020 guidelines and was registered in PROSPERO.

From 1,507 records, 21 studies were included with 10,951 participants. The overall PSC score was 3.341 (95% confidence interval [CI] 3.221-3.460). The dimension scored highest was Teamwork Within Units, with a mean score of 3.719 (95% CI 3.594-3.844). Staffing, with a mean score of 3.096 (95% CI 2.980-3.212) was scored lowest. Statistically significant differences related to geographical distribution were found for overall PSC score and five of the PSC dimensions.

Nurses throughout the world rated the PSC at their organizations moderate to good. Certain dimensions of PSC were reported to need reinforcement to create a strong overall safety culture in health care. Participants rated European hospitals as having a stronger PSC than South American or Middle Eastern hospitals. Differentiations need to be further studied and analyzed for effective and targeted global interventions.

The purpose of this study was to assess the efficacy of aspirin versus low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty.

PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6-69.0) years and 66.8 (57.9-68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48-1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11-2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40-1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40-1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21-1.98; p < 0.001).

This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures.

Level I.

Children with autism spectrum disorder (ASD) are five times more likely to have feeding difficulties than neurotypical peers, although the majority of evidence describes feeding difficulty in children age 2 years and older. The purpose of this study is to systematically review the literature on feeding characteristics of children age 0-24 months who were later diagnosed with ASD with an emphasis on the measurement tools used to assess these feeding behaviors. We conducted a systematic review of the literature using PRISMA guidelines. Using selected keywords, a search was conducted using PubMed, PsycINFO, and CINAHL databases for relevant articles to identify feeding characteristics in infants and toddlers (age 0-24 months) later diagnosed with ASD. Sixteen studies were selected for this review by two independent reviewers. Among the selected studies, feeding difficulties were reported in all infant oral feeding modalities (breastfeeding, bottle feeding, and complementary feeding) by infants later diagnosed with ASD. However, the evidence was conflicting among studies regarding feeding characteristics, such as sucking differences while breastfeeding, use of the spoon with feedings, and preference of solid food texture, that presented in infants later diagnosed with ASD. A lack of consistent measurement of feeding behaviors in infants later diagnosed with ASD contributes to the difficulty in comparison across studies. Future research should focus on developing targeted, validated instruments for measuring feeding difficulty in this population with emphasis on breastfeeding and bottle feeding difficulty.

Circulating tumor DNA (ctDNA) has emerged as a promising tool in the treatment of HPV-associated oropharyngeal squamous cell cancer (OPSCC). This systematic review sought to answer the question: what is the current role of ctDNA in the diagnosis, treatment, and surveillance of HPV-associated OPSCC?

Medline (Ovid), Embase (Ovid), Scopus.

Original articles studying the role of ctDNA in the diagnosis or surveillance of HPV-associated OPSCC were eligible for inclusion. Two authors independently reviewed studies for inclusion and abstracted data, including study design, characterization of liquid biopsy technology, and diagnostic outcomes.

After a preliminary screening of 441 studies, 23 were selected for inclusion. Ten studies were conducted retrospectively, and 13 were conducted prospectively. In these studies, diagnostic testing included plasma-based droplet digital polymerase chain reaction (ddPCR, n = 13), quantitative PCR (qPCR, n = 4), digital PCR (dPCR, n = 3), next-generation sequencing (NGS) (n = 3), or a ctDNA detection kit (n = 1). Diagnostic outcomes were reported for pre-diagnosis (n = 1), pre-treatment (n = 17), during treatment (n = 6), and surveillance/recurrence (n = 11) timepoints. Test sensitivities ranged from 20.6 %-100 % pre-treatment and 72 %-100 % during surveillance, while test specificities ranged from 95 %-100 % pre-treatment and 87.2 %-100 % during surveillance.

The majority of studied ctDNA technologies allow for detection of HPV-associated OPSCC with high diagnostic accuracy. However, heterogeneity is introduced by test type and assay used. These findings highlight the utility, as well as limitations, of ctDNA in the diagnosis, treatment monitoring, and surveillance of HPV-associated OPSCC. Future studies and clinical consensus will need to address acceptable diagnostic accuracy thresholds for clinical use.

Multiligamentous knee injuries (MLKIs), defined as injuries involving at least two of the four primary knee ligaments, are rare but severe, with potentially limb- or life-threatening complications. Despite numerous publications, the low incidence and heterogeneity of injury patterns limit high-level evidence for optimal surgical timing, technique, and management of complications. This systematic review aims to consolidate the available evidence on MLKI surgery complications, with a particular focus on arthrofibrosis as the underlying cause of stiffness, infection, and graft failure.

This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (no. CRD42024618025). A comprehensive search of PubMed, EMBASE, and MEDLINE from January 2013 to November 2024 identified studies reporting complications in surgically treated MLKIs with at least a 12-month follow-up. The studies were screened independently by two reviewers. Data on demographics, injury mechanisms, surgical techniques, and complication outcomes were extracted. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

A total of 33 studies with 2863 patients met the inclusion criteria. The mean age was 32.4 years (standard deviation, SD ± 5.37), with males constituting 69.4% of the sample. Arthrofibrosis was the most common complication, requiring surgical management in 8.4% of cases. Graft failure was reported in 5%, while infection, the third most common complication, occurred in 2.86% of cases. Management of lack of range of motion varied, with manipulation under anesthesia and arthroscopic arthrolysis utilized. Surgical timing also influenced outcomes; 54.2% of patients underwent acute surgery (< 21 days), which seems to be associated with increased stiffness rates.

This systematic review highlights the complexity of managing MLKIs, with a 19.2% overall complication rate. Stiffness demanding reoperation remains a rare but a significant challenge, underscoring the need for standardized treatment protocols. However, the included studies demonstrate heterogeneity and lack high methodological rigor, highlighting the need to account for these limitations.

Hypothermia after very preterm birth, typically defined as a temperature less than 36 °C, is variably linked to neonatal mortality and morbidities.

To examine the association between admission hypothermia and adverse outcomes in very preterm infants with a gestational age (GA) of less than 32 weeks.

CENTRAL, MEDLINE, and Embase from inception to February 18, 2024.

Observational or randomized designs reporting on the association between admission temperature and adverse outcomes in very preterm infants.

Two reviewers screened abstracts and full texts, extracted the data, and assessed the risk of bias, following Meta-analysis Of Observational Studies in Epidemiology /Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We planned to perform random-effects meta-analyses, subgroup (GA, birthweight [BW], and income), sensitivity analysis (NOS, study type), and meta-regression (GA, BW). Outcomes included mortality and neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), and sepsis.

This review included 32 studies with >300 000 infants. The mean hypothermia rate was 42% (range 14%-88%). Hypothermia was associated with increased mortality (crude odds ratio [cOR] [95% CI] 2.02[1.84;2.21]; adjusted OR 1.55[1.29;1.87]). Subgroup and sensitivity analyses upheld these results. Meta-regression analysis showed an inversed relationship between effect size and BW. Hypothermia was associated with higher risks of BPD (cOR 1.13[1.01;1.27]), IVH (cOR 1.37[1.17;1.61]), ROP (cOR 1.55[1.41;1.69]), and sepsis (cOR 1.32[1.16;1.51]).

Only observational studies were included.

Hypothermia is associated with increased mortality and morbidity in very preterm infants. The strength of this association may be influenced by BW, definitions of hypothermia and outcomes, and exclusion criteria. Given the robustness of our results and our sample size, identical cohort studies might not provide different insights.

Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.

We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.

Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I2 = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I2 = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I2 = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.

Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.

PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.

Circulating tumor DNA (ctDNA) has emerged as a novel biomarker with the advantages of being non-invasive and enabling dynamic monitoring, providing significant clinical insights into the prognosis and management of malignancies. However, its prognostic role in patients with urothelial carcinoma (UC) receiving immune checkpoint inhibitors (ICI) remains controversial. This study aims to systematically review and perform a meta-analysis to evaluate the prognostic significance of ctDNA levels in this specific patient population.

We conducted a comprehensive search of the PubMed, Cochrane Library, CNKI, and EMBASE databases to include studies published up to November 14, 2024, assessing the prognostic value of ctDNA in UC patients treated with ICI. Fixed-effects or random-effects models were used to evaluate the association between ctDNA levels and overall survival (OS), progression-free survival (PFS)/disease-free survival (DFS). Funnel plots, Begg's test, and Egger's test were employed to assess publication bias.

Nine studies from eight articles, comprising a total of 862 urothelial carcinoma (UC) patients treated with immune checkpoint inhibitors (ICIs), were included in this meta-analysis. Seven studies investigated the association between baseline circulating tumor DNA (ctDNA) status and clinical outcomes. Compared to patients without detectable ctDNA, those with elevated baseline ctDNA levels exhibited significantly shorter progression-free survival/disease-free survival (PFS/DFS) (HR = 2.75, 95% CI = 1.36-5.58, P = 0.005), though no statistically significant difference was observed in overall survival (OS) (HR = 2.08, 95% CI = 0.83-5.24, P = 0.119). Additionally, we evaluated the prognostic value of ctDNA dynamics during ICI therapy. A decline or clearance of ctDNA levels was significantly associated with improved clinical outcomes (OS: HR = 0.10, 95% CI = 0.02-0.47, P = 0.004; PFS/DFS: HR = 0.27, 95% CI = 0.16-0.45, P < 0.001).

This meta-analysis demonstrates that detectable ctDNA is significantly associated with PFS or DFS in patients with UC undergoing ICI therapy. Moreover, dynamic changes in ctDNA are strongly correlated with OS and PFS/DFS. Therefore, ctDNA serves as a valuable tool for pre-treatment diagnostic assessment and patient stratification and plays a crucial role in monitoring treatment response and tracking disease progression throughout therapy.

www.inplasy.com, identifier INPLASY202520058.

Lutein and zeaxanthin are nutrients with antioxidant properties found in the macula of the eye and brain tissue. They have been reported to play a role in reducing oxidative damage, especially in the eyes and possibly in other organ systems. Oxygen free radicals are one of the agents postulated to cause tissue damage in preterm infants, which leads to morbidities such as retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), and necrotising enterocolitis (NEC). Supplementation with lutein and zeaxanthin may reduce oxidative damage, hence reducing morbidity and mortality in preterm infants.

To assess the effectiveness of lutein and zeaxanthin supplementation in reducing morbidity and mortality in preterm infants.

We conducted searches up to 17 December 2024 in CENTRAL, MEDLINE, Embase, and two trial registries. We also searched the reference lists of included studies, and related reviews and studies.

We included randomised controlled trials (RCTs), cluster-RCT, cross-over trials, and quasi-RCTs that compared lutein and zeaxanthin supplementation against placebo or no supplementation for preterm infants less than 37 completed weeks' postmenstrual age.

We used standard Cochrane methods. Our primary outcomes were the incidence of any stage of ROP, incidence of ROP stage 3 and above, incidence of visual impairment, and mortality assessed throughout the neonatal intensive care unit (NICU) stay. Secondary outcomes included the incidence of IVH, incidence of NEC, and any reported adverse effects. We used GRADE to assess the certainty of the evidence.

We included five studies (666 preterm infants) that compared lutein and zeaxanthin supplementation versus control (placebo or no supplementation). All five studies were conducted in high-income countries (Italy and the USA). We did not find any studies comparing lutein or zeaxanthin separately versus placebo or no supplementation. Most of the studies had a low risk of bias in most key domains, such as allocation concealment and blinding. The evidence suggests that lutein and zeaxanthin supplementation probably has little or no effect on ROP (any stage) when comparing infants who received lutein and zeaxanthin supplementation with those who did not (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.66 to 1.24; P = 0.53; I2 = 0%; 4 studies, 532 infants; moderate-certainty evidence). Lutein and zeaxanthin supplementation probably reduces the incidence of ROP stage 3 and above (RR 0.49, 95% CI 0.29 to 0.81; P = 0.005; I2 = 0%; 4 studies, 532 infants; moderate-certainty evidence). No studies assessed the incidence of visual impairment. Lutein and zeaxanthin supplementation may have little or no effect on mortality assessed throughout the NICU stay (RR 0.95, 95% CI 0.42 to 2.17; P = 0.91; I2 = 0%; 4 studies, 470 infants; low-certainty evidence), incidence of IVH (all grades) (RR 0.87, 95% CI 0.44 to 1.75; P = 0.70; I2 = 0%; 4 studies, 483 infants; low-certainty evidence), and incidence of NEC: Bell's stage II or greater (RR 0.87, 95% CI 0.43 to 1.76; P = 0.71; I2 = 0%; 5 studies, 666 infants; low-certainty evidence). No adverse effects were reported in either group.

While supplementation with lutein and zeaxanthin from day one of life in preterm infants until discharge probably reduces the incidence of ROP stage 3 and above, it may have little or no effect on the incidence of ROP at any stage, IVH or NEC, or mortality assessed throughout the NICU stay. However, the pooled estimates for these outcomes may change with further rigorously conducted trials. There were no adverse effects reported.

Chylothorax is defined by the accumulation of chyle in the pleural space, characterized by triglyceride levels exceeding 110 milligrams per deciliter. The clinical presentation of chylothorax varies depending on its acuity and underlying etiology. Mediastinal lymphangiomas are extremely rare and benign lesions that can affect both infants and adults. They may occur independently or in association with other lymphatic disorders and can lead to complications such as chylothorax.

A 60-year-old male patient presented with shortness of breath and was diagnosed with left-sided chylothorax secondary to mediastinal lymphangioma, accompanied by intestinal lymphangiomatosis. Conservative approach was unsuccessful, and surgical therapy was needed.

We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. The search parameters we used included the following Boolean terms: [("lymphangioma" OR "mediastinal lymphangioma" OR "cavernous lymphangiomas" OR "cystic hygromas" OR "capillary lymphangioma" OR "lymphangioma simplex") AND ("chylothorax" OR "chylous pleural effusion" OR "chylous effusion" OR "chylous lung")]. Our search yielded 166 articles in total, out of which we selected 17 articles for inclusion. We included patients who presented to the hospital with chylothorax secondary to mediastinal lymphangioma and those who developed chylothorax after the removal of mediastinal lymphangioma. The primary outcome was the total number of reported cases of chylothorax secondary to mediastinal lymphangioma. The secondary outcomes included patient characteristics, fluid characteristics, clinical manifestations, and therapeutic modalities.

The systematic review encompassed seventeen case reports. Most patients were male, spanning ages from six weeks to 82 years, with an average age of 28.35 years. Most pleural effusions were on the left side. Few cases were asymptomatic, while the most reported symptom was shortness of breath. The mean pleural triglyceride level was 708 mg/dl, with cystic hygroma being the most common subtype. The anterior mediastinum was the most frequent location. The primary treatment involved surgical removal of the lymphangioma along with thoracic duct ligation.

Mediastinal lymphangioma is an infrequent etiology of chylothorax and is scarcely documented in the literature. It may be present in isolation or may be associated with extra mediastinal lymphatic anomalies. The management of chylothorax in such cases is challenging with conservative measures often being ineffective, necessitating surgical intervention. The rarity of these conditions complicates the study of potential risk factors and genetic predispositions. Furthermore, there is no established consensus on the therapeutic modalities for patients with similar diagnoses which vary based on patient characteristics.

Sleep disturbances and their associated health issues are common among medical students. Despite this, the epidemiology of sleep disturbances among medical students in the Middle East and North Africa (MENA) region remains inadequately understood. Our objective was to synthesise the prevalence of sleep disturbances, including poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness (EDS), and their variation in relation to academic performance and stress levels.

We performed a systematic review and meta-analysis. Two independent reviewers searched PubMed, Web of Science, Google Scholar, and the reference lists of relevant studies and reviews up to May 2024. We assessed the quality of the included studies using a risk of bias tool. We performed meta-analyses using random-effects models and used Cochran's Q between-subgroups statistic to test for differences across subgroups. We used the I2 statistic to assess the statistical heterogeneity. Further, we assessed the publication bias using Doi plots.

We included 150 studies conducted in 16 MENA countries. We found that 59.1% of medical students suffer from poor sleep quality (Pittsburgh Sleep Quality Index mean (x̄) = 8.5; 95% confidence interval (CI) = 7.0-10.1), 59.8% have insufficient sleep duration (<7 hours per night) averaging 6.1 hours per night (95% CI = 5.4-6.9), and 38.4% experience EDS (Epworth Sleepiness Scale x̄ = 8.6; 95% CI = 8.0-9.1). Our results indicate a significantly higher prevalence of poor sleep quality among students with moderate or high stress levels during the preclinical training period and in low-income MENA countries. A significantly higher prevalence of insufficient sleep duration was found among students during preclinical academic years. A significantly higher prevalence of EDS was found among students in public medical schools and those in low-income MENA countries. We observed no differences in poor sleep quality and EDS between students with poor and good academic performance.

Our findings highlight the substantial prevalence of sleep disturbances among MENA medical students. Medical schools must address this critical issue with targeted, locally informed, and culturally appropriate interventions. Further research is needed to assess the association between sleep disturbances and identify factors for tailored interventions that mitigate the adverse consequences on medical students' health and well-being.

Open Science Framework BF2A6.

Trauma is a leading cause of morbidity and mortality worldwide. Research shows that haemorrhage and trauma-induced coagulopathy are reversible components of traumatic injury, if identified and treated early. Lack of consensus on definitions and transfusion strategies hinders the translation of this evidence into clinical practice.

To assess the beneficial and harmful effects of transfusion strategies started within 24 hours of traumatic injury in adults (aged 16 years and over) with major bleeding.

CENTRAL, MEDLINE, Embase, five other databases, and three trial registers were searched on 20 November 2023. We also checked reference lists of included studies to identify any additional studies.

We included randomised controlled trials (RCTs) of adults (aged 16 years and over) receiving blood products for the management of bleeding within 24 hours of traumatic injury.

We used standard Cochrane methodology to perform the review and assessed the certainty of the evidence using GRADE.

We included 18 RCTs with 5041 participants. Comparison 1: Prehospital transfusion strategies Five studies compared use of plasma (fresh frozen plasma (FFP) or lyophilised plasma) versus 'standard of care'. We are uncertain of the effect of plasma on all-cause mortality at 24 hours (risk ratio (RR) 1.05, 95% confidence interval (CI), 0.48 to 2.30; 3 studies, 279 participants; very low certainty evidence). There is probably no difference between plasma and standard of care in all-cause mortality at 30 days (RR 0.95, 95% CI 0.78 to 1.17; 3 studies, 664 participants; moderate-certainty evidence). However, the results of one cluster-RCT that could not be included in our meta-analysis suggested that plasma may be associated with a lower risk of death at 30 days (RR 0.54, 95% CI 0.42 to 0.70; 1 study, 481 participants; low-certainty evidence). There may be no difference between plasma and standard of care in the total number of thromboembolic events in 30 days (RR 1.23, 95% CI 0.67 to.2.27; 4 studies, 586 participants; low-certainty evidence). Comparison 2: In-hospital transfusion strategies Ten studies evaluated this comparison, seven providing usable data. The studies evaluated cryoprecitate (three studies); fixed-ratio blood component transfusion (three studies); fresh frozen plasma (FFP) (one study); lyophilised plasma (one study); leucoreduced red blood cells (one study); and a restrictive transfusion strategy (one study). All-cause mortality at 24 hours For all-cause mortality at 24 hours, there is probably no difference between: • cryoprecipitate plus a major haemorrhage protocol (MHP) versus MHP alone (RR 0.92, 95% CI 0.70 to 1.21; 1 study, 1577 participants; moderate-certainty evidence); and • blood products (plasma:platelets:red blood cells (RBCs)) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 0.75, 95% CI 0.52 to 1.08; 1 study, 680 participants; moderate-certainty evidence). We are uncertain of the effect on all-cause mortality at 24 hours for: • blood products (RBCs:FFP) transfused in 1:1 ratio versus transfusion according to coagulation and full blood count results (Peto odds ratio (POR) 0.45, 0.17 to 1.22; 1 study, 434 participants; very low certainty evidence); and • lyophilised (FlyP) plasma versus FFP (POR 1.04, 95% CI 0.06 to 17.23; 1 study, 47 participants; very low certainty evidence); All-cause mortality at 30 days For all-cause mortality at 30 days, there is probably no difference between blood products (plasma:platelets:RBCs) transfused in a 1:1:1 ratio versus a 1:1:2 ratio (RR 0.85, 95% CI 0.65 to 1.11; 1 study, 680 participants; moderate-certainty evidence). There may be little to no difference between the following interventions in all-cause mortality at 30 days: • cryoprecipitate plus MHP versus MHP alone (RR 0.77, 95% CI 0.33 to 1.78; 2 studies, 1572 participants; low-certainty evidence); and •leucoreduced RBCs versus standard RBCs (RR 1.20, 95% CI 0.74 to 1.95; 1 study,55 participants; low certainty evidence). We are uncertain of the effect on all-cause mortality at 30 days for: •lyophilised plasma versus FFP (RR 0.75, 95% CI 0.28 to 2.02; 1 study, 47 participants; very low certainty evidence); and • blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (RR 2.25, 95% CI 0.90 to 5.62; 1 study, 69 participants; very low certainty evidence). Total number of thromboembolic events at 30 days There may be little to no difference between the following interventions for total thromboembolic events at 30 days: • cryoprecipitate plus MHP versus MHP alone (RR 0.55, 95% CI 0.08 to 3.72; 2 studies, 1645 participants; low-certainty evidence); and • blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 1.03, 95% CI 0.75 to 1.42; 1 study, 680 participants; low-certainty evidence). We are uncertain of the effect on the total number of thromboembolic events at 30 days for: •blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (POR 6.83, 95% CI 0.68 to 68.35; 1 study, 69 participants; very low certainty evidence). Comparison 3: Whole blood versus individual blood products We are uncertain of the effect of modified (leucoreduced) whole blood versus blood products (RBCs:plasma) transfused in a 1:1 ratio on all-cause mortality at 24 hours (RR 1.13, 95% CI 0.37 to 3.49) or 30 days (RR 1.62, 95% CI 0.69 to 3.80) (1 study, 107 participants; very low certainty evidence). Comparison 4: Goal-directed blood transfusion strategy of viscoelastic haemostatic assay (VHA) versus conventional laboratory coagulation tests (CCT) to guide haemostatic therapy There may be little or no difference in all-cause mortality at 24 hours between VHA and CCT (RR 0.85, 95% CI 0.54 to 1.35; 1 study, 396 participants; low-certainty evidence). We are uncertain of the effects on all-cause mortality at 30 days (RR 0.75, 95% CI 0.48 to 1.17; 2 studies, 506 participants; very low certainty evidence). There is probably no difference between VHA and CCT in total thromboembolic events at 30 days (RR 0.65, 95% CI 0.35 to 1.18; 1 study 396 participants; moderate-certainty evidence).

Overall, there was little to no evidence of a difference between blood transfusion strategies for mortality or thromboembolic events. The studies covered a wide range of interventions, and the comparators and standard of care practice varied between trials, thereby limiting the pooling of data. Further research is needed.

Hereditary multiple osteochondromas (HMO) is a common pediatric condition defined by multiple cartilage-capped bony lesions. Spinal osteochondromas affect up to 68% of HMO patients. Although most are asymptomatic, intraspinal osteochondromas can cause significant neurological symptoms and morbidity. Limited guidelines exist regarding the use of advanced imaging to screen for spinal osteochondromas. This study evaluates the incidence of spinal osteochondromas detected through advanced imaging in pediatric HMO patients.

A systematic review and meta-analysis were conducted following the Cochrane Handbook for Systematic Reviews of Interventions. Included studies reported on the use of computed tomography (CT) or magnetic resonance imaging (MRI) in HMO patients under the age of 21. The primary outcome was spinal osteochondroma incidence. Secondary outcomes included imaging indication, symptoms, intraspinal lesion incidence, surgical intervention incidence, and postoperative outcomes. A meta-analysis of single proportions determined the pooled incidence of spinal osteochondromas, intraspinal lesions, and spinal surgery in HMO patients.

Of 415 eligible articles, seven met inclusion criteria, including 198 HMO patients with a weighted mean age of 12 ± 1.0 years. MRI was the primary imaging modality in 175 patients (99%) with 136 (69%) imaged only per institutional screening protocols. Neurological symptoms were present in 41 subjects (21%) at the time of imaging. The pooled spinal osteochondroma incidence was 36% (95% CI, 24%-51%, event rate 72/183). Of these, 109 lesions (43%) were in the cervical spine, 41 lesions (38%) in the thoracic spine, and 21 lesions (19%) in the lumbar spine. Among those with spinal osteochondromas, 49% (95% CI, 37%-61%, event rate 41/85) had intraspinal lesions, and 21% (95% CI, 13%-33%, event rate 15/70) underwent surgery. Postoperatively, 17 patients (55%) experienced symptom resolution with no long-term complications reported.

Although spinal osteochondromas are prevalent among HMO patients, standardized screening protocols remain limited. Nonetheless, initial and serial screening is needed to prevent irreversible neurological damage. As global guidelines evolve, large multicentre prospective studies are needed to identify and standardize optimal timing for spinal osteochondroma screening in HMO patients.

Level III.

This systematic review evaluates the diagnostic accuracy of circulating microRNAs (miRNAs) as potential biomarkers for detecting placenta accreta spectrum (PAS) disorders, a condition characterized by abnormal placental adherence with significant maternal health risks.

A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases up to October 30, 2024, using predefined keywords such as "miRNA" and "placenta accreta."

Studies investigating miRNA expression in PAS cases compared to controls, using either blood or placental tissue, were included. Articles were screened independently by two reviewers, with discrepancies resolved by consensus.

The methodological quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Extracted data were synthesized to identify miRNAs with diagnostic potential for PAS disorders. Due to significant variations in the comparisons conducted across studies and the diverse outcome measures reported, a meta-analysis of the included studies was not feasible.

Out of 82 articles identified, 14 met the inclusion criteria after duplicate removal and screening. The studies reported distinct differential expression patterns of miRNAs in PAS cases. Notably, a combination of miR-26a-5p and miR-17-5p demonstrated 100% sensitivity and 82% specificity for predicting PAS in the first-trimester of pregnancy.

PAS disorders are typically diagnosed during the third trimester through imaging techniques like ultrasonography. However, miRNAs exhibit promise as non-invasive, early biomarkers, potentially enabling earlier diagnosis and improved clinical management. These findings support the incorporation of miRNA analysis into diagnostic guidelines for PAS.

The optimal revascularization strategy for isolated left anterior descending (LAD) artery disease, minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI), remains a subject of debate. This updated meta-analysis aimed to compare the long-term outcomes of MIDCAB versus PCI for patients with isolated LAD artery disease. Three databases were systematically searched to identify randomized controlled trials (RCTs) and adjusted studies. Primary outcomes included long-term survival and repeat target vessel revascularization (TVR). The secondary endpoint was long-term major adverse cardiovascular events (MACEs). Hazards ratios (HR) and Confidence Intervals (CI) were calculated for long-term outcomes and a random effects model was used. Sensitivity analyses included subgroups analysis of stent-type. Nine articles, comprising 4 RCTs, totaling 2,168 patients (MIDCAB = 1,086 and PCI = 1,080) were included. The weighted mean follow-up was 4.35 ± 4.9 years. Long-term survival was comparable between MIDCAB and PCI (HR = 0.76; 95% CI, 0.58 to 1.00; p = 0.05). MIDCAB was associated with a significantly lower rate of repeat TVR (HR = 0.35; 95% CI, 0.25 to 0.49; p <0.0001) and a reduced risk of MACEs (HR = 0.59; 95% CI, 0.43 to 0.81; p <0.0001), although the difference was not evident in subgroup analysis comparing MIDCAB and PCI with drug-eluting stent (HR = 0.66; 95% CI, 0.46 to 1.06; p = 0.09). In conclusion, this meta-analysis of RCTs and adjusted studies shows that in patients with isolated LAD lesion, MIDCAB and PCI exhibit comparable long-term survival. However, MIDCAB is associated with a significantly reduced risk of long-term repeat TVR and MACEs compared to PCI.

Psychological and existential distress is prevalent among patients with life-threatening cancer, significantly impacting their quality of life. Psilocybin-assisted therapy has shown promise in alleviating these symptoms. This systematic review aims to synthesize the evidence on the efficacy and safety of psilocybin in reducing cancer-related distress.

We searched MEDLINE, APA PsycINFO, Cochrane database, Embase, and Scopus from inception to February 8, 2024, for randomized controlled trials (RCTs), open-label trials, qualitative studies, and single case reports that evaluated psilocybin for cancer-related distress. Data were extracted on study characteristics, participant demographics, psilocybin and psychotherapy intervention, outcome measures, and results. Two authors independently screened, selected, and extracted data from the studies. Cochrane Risk of Bias for RCTs and Methodological Index for Non-Randomized Studies criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42024511692).

Fourteen studies met the inclusion criteria, comprising three RCTs, five open-label trials, five qualitative studies, and one single case report. Psilocybin therapy consistently showed significant reductions in depression, anxiety, and existential distress, with improvements sustained over several months. Adverse effects were generally mild and transient.

This systematic review highlights the potential of psilocybin-assisted therapy as an effective treatment for reducing psychological and existential distress in cancer patients. Despite promising findings, further large-scale, well-designed RCTs are needed to confirm these results and address existing research gaps.

This meta-analysis was to assess the incidence and risk factors of sarcopenia in gastric cancer (GC) patients and to provide clinical implications for the prevention and improvement of sarcopenia in GC patients.

PubMed, Embase, Cochrane, Web of Science, CNKI, Wanfang, and VIP databases (language was limited to Chinese and English) were searched for observational studies. The random-effects model was used to analyze the incidence of GC combined with sarcopenia and the odd ratio (OR) and 95% confidence interval (CI) of risk factors.

1244 studies were retrieved and 20 eligible studies were included. The meta-analysis revealed that the incidence of sarcopenia in GC patients was 26.6% (95% CI: 21%~32%). Age (OR = 1.128, 95% CI: 1.056 ~ 1.204, P < 0.001), male (OR = 1.054, 95% CI: 0.620 ~ 1.791, P < 0.005), body mass index (OR = 1.117, 95% CI: 0.881 ~ 1.414, P < 0.001), nutritional risk screening 2002 (OR = 3.953, 95% CI: 2.038 ~ 7.668, P < 0.05), and tumor diameter > 3 cm (OR = 1.515, 95% CI: 1.021 ~ 2.248, P < 0.05) may be risk factors for sarcopenia in GC patients. In contrast, tumor stage (OR = 1.907, 95% CI: 0.967 ~ 3.763, P > 0.05), gastrectomy approach (OR = 1.837, 95% CI: 1.237 ~ 2.727, P > 0.05), differentiation type (OR = 0.586, 95%CI: 0.325 ~ 1.059, P > 0.05), and severe adverse reactions (NLR, HB, ALB) after chemotherapy (OR = 0.926, 95%CI: 0.793 ~ 1.082, P > 0.05) had no significant correlation with sarcopenia in GC patients.

This meta-analysis shows an increased prevalence of sarcopenia in GC patients. This analysis, which focused on Asian populations, suggested that high nutritional risk was a risk factor for sarcopenia in GC patients. Age over 65 years and tumor diameter over 3 cm may be risk factors for sarcopenia. Men may be prone to sarcopenia. Targeting these risk factors may be beneficial in the prevention of sarcopenia in GC patients.

Over decades, governments have enacted policies and legislation mandating strategies to reduce the incidence and severity of all-terrain vehicle (ATV)-related injuries. We performed a systematic review to determine the efficacy of laws and policies in reducing these injuries.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 articles from the peer-reviewed literature were systematically selected. Associations between legislation/policy and changes or differences in injury numbers, rates or severity were queried.

Data were available to examine age restrictions or child/youth-directed safety measures, use of helmets and vehicle-specific/engineering policies. Legislating age restrictions was associated with limited paediatric injury reduction in five of nine studies; sustained efficacy may require concurrent socialisation through media or regulated riding environments. Mandated helmet use was associated with reduced ATV-related mortality in five of six studies. However, the concurrent presence of other safety legislation precludes concluding the efficacy of helmet laws, alone. Legislation targeting vehicle design/engineering is limited, as are studies of their efficacy. A US federal decree for large-scale vehicle-related and industry-related changes was associated with a brief but dramatic decrease in ATV-related deaths; this reversed once the decree was lifted.

With the possible exception of helmet legislation, many laws aimed at reducing ATV-related injuries demonstrate little association with actual injury reduction. Most target changing individual behaviours and may be unsuccessful due to personal perceptions of low risk of injury. Enacting policies directed to industry, to address design and engineering interventions that can reduce risk during operation of these products, is more likely to result in substantive and sustained change.

Diabetic peripheral neuropathy (DPN) affects up to half of all patients with diabetes mellitus. Acupuncture is often used to manage chronic pain, but its' effects on DPN are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess the effectiveness of acupuncture for DPN.

We searched databases from inception to September 30, 2024. Paired reviewers independently extracted data and assessed risk of bias. We used random effects models for all meta-analyses and the GRADE approach to assess the certainty of evidence.

We included 14 RCTs (1,169 participants, 45% female). Low certainty evidence suggests that, compared to sham, acupuncture may reduce pain (weighted mean difference [WMD] -1.44 cm on a 10 cm VAS, 95%CI -1.72 to -1.15; modelled risk difference [RD] for achieving the minimally important difference [MID] of 1.5 cm: 45%, 95%CI 35-54%). Comparted to sham or usual care, low certainty evidence suggests that acupuncture may reduce overall neurological symptom severity (WMD - 1.22 [95%CI -1.85, -0.59] on the 19-point Toronto Clinical Scoring System [TCSS]), and provide little to no difference in physical functioning, mental functioning, or adverse events. Low certainty evidence suggests that, compared to amitriptyline or pregabalin, acupuncture may reduce pain associated with DPN.

Acupuncture for DPN may reduce pain when compared to sham acupuncture and may reduce neurologic symptom severity and result in little to no difference in physical functioning, mental functioning or adverse events, when compared with sham acupuncture or usual care.

To assess the effect of connective tissue graft (CTG) in the treatment of periodontal intrabony defects (IDs), focusing on changes in postoperative gingival recession (GR) depth and regenerative outcomes.

A systematic search was conducted across MEDLINE-PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for articles published through December 31, 2024. Randomized controlled trials (RCTs) comparing treatment outcomes in IDs treated with or without CTG were included in a meta-regression analysis. A mixed-effect linear regression model was employed to estimate the effect of CTG on postoperative GR depth, probing depth (PPD) reduction, clinical attachment level (CAL) gain, and bone fill (BF).

Twenty-three studies were selected, with five RCTs (176 IDs) included in the meta-regression. Of these, two RCTs compared bone graft (BG) + CTG to BG + resorbable membrane (MB), one compared periosteal vs. nonperiosteal CTG combined with BG, one compared open flap debridement (OFD) + CTG to OFD alone, and one compared BG + CTG to either OFD or MB. The use of CTG was significantly associated with a reduction in GR (mean effect size of 0.981 mm, 95% CI: 0.573 to 1.389, p = 0.001), PPD (mean effect size of 1.160 mm, 95% CI: 0.318 to 2.002, p = 0.010), as well as improvements in CAL (mean effect size of 1.105 mm, 95% CI: 0.420 to 1.790, p = 0.004) and BF (mean effect size of 1.382 mm, 95% CI: 0.595 to 2.169, p = 0.002).

Within the limitations of the study, the use of CTG in periodontal regenerative therapy for IDs appears beneficial in reducing postoperative GR and might further enhance regenerative outcomes compared to treatments without CTG.

To identify genetic biomarkers that may be used in the diagnosis, prevention or management of different forms of periodontal disease.

Following protocol registration and PICOTS (patient, intervention, comparison, outcome, time, studies) questions, a systematic search of the literature was conducted (PudMed, Ovid), resulting in 1592 papers screened by two reviewers. Diagnostic data were extracted or calculated from included papers and compared with clinically determined diagnoses, disease progression and/or response to treatment.

A total of 607 articles met the inclusion criteria, including 10 reporting data on gingivitis and 597 on periodontitis. Only two papers reported diagnostic performance data, while for 41 articles on large candidate gene studies, diagnostic performance could be calculated from the reported data. No study using chair-side tests was identified. Low to moderate values for sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were found.

No genetic diagnostic test of clinical value emerged for periodontal diagnosis, prevention or prediction of disease resolution. Thus, potential future applications of polygenic risk scores that encode susceptibility, as well as single-marker testing for monogenic or oligogenic forms of periodontal diseases, are discussed.

Background/Objectives: Necrotizing enterocolitis (NEC) is a severe, potentially fatal gastrointestinal disease that primarily affects preterm neonates, especially those with very low birth weight (<1500 g). Despite extensive research, its pathophysiology remains unclear, with NEC considered a spectrum of disorders driven by systemic inflammation, microbiota dysregulation, and intestinal hypoxic injury. Diagnosis is challenging due to its subtle presentation and reliance on clinical and radiographic findings, underscoring the urgent need for reliable early biomarkers. Complete blood count (CBC) is one of the most frequently performed laboratory tests in neonatal care, providing valuable insights associated with hematologic alterations associated with NEC. Given its cost-effectiveness, accessibility, and rapid turnaround time, CBC parameters have been increasingly investigated for their diagnostic and prognostic potential in NEC. This systematic review consolidates existing evidence on the diagnostic and prognostic utility of CBC parameters in NEC, examining their association with disease onset, progression, and outcomes. Methods: A systematic review of the literature in PubMed and Scopus databases was conducted, between February 25 and December 2024. Results: Following a PRISMA-compliant search strategy, 77 eligible studies were included, analyzing data from 295,195 neonates, of whom 14,570 had NEC. Among the 77 studies, 17 examined NEC-associated mortality as a primary outcome, while 13 studies focused on the development of predictive models incorporating CBC parameters alongside other clinical and laboratory data to assess NEC severity and prognosis in neonates. The findings highlight the potential of CBC-derived markers to facilitate early NEC detection and risk stratification. However, variations in study design and diagnostic criteria highlight the need for prospective studies to validate their clinical use. Conclusions: Despite advancements in understanding NEC, its diagnosis remains challenging due to the absence of fully reliable biomarkers. CBC parameters show promise in offering early diagnostic and prognostic insights. However, further validation is needed for their routine integration into NICU practice. Given the persistent challenges in NEC diagnosis and management, our findings highlight the necessity for integrated scoring systems that combine hematologic, clinical, and radiologic data to enhance early detection and optimize neonatal care. Further research is essential to refine these predictive models, enabling timely interventions and improving survival rates in NEC-affected neonates.

Background: Teclistamab (TEC) is the first B-cell maturation antigen-directed bispecific antibody approved in 2022 by the European Medicines Agency and Food and Drug Administration for triple-class exposed relapsed/refractory multiple myeloma (RRMM). Objectives: As TEC is increasingly used in real-world (RW) settings, this study seeks to gather existing RW evidence on effectiveness, safety, healthcare resource utilization, and clinical practices associated with TEC. Methods: A systematic literature review was performed to identify RW observational studies of TEC-treated adults with RRMM from 2023 to June 2024. Results: Sixty-one records representing 41 unique studies were included; sample sizes ranged from 8 to 572 patients. Where reported, median follow-up ranged from 2.3 to 33.6 months, and >65% of the patients would have been ineligible for the pivotal trial of TEC (MajesTEC-1) in all but one study. In eight studies with ≥50 patients and ≥3 months follow-up, overall response rates were 59-66% and cytokine release syndrome (CRS) rates were 18-64%. Tocilizumab use for CRS management was reported in 14 studies, with two indicating CRS rates of 13% and 26% when used prophylactically. Survival and infection outcomes showed wide variability due to short follow-up in most studies. Conclusions: Overall, early RW effectiveness and safety outcomes of TEC were comparable to findings from MajesTEC-1.