This study aimed to evaluate and rank the effectiveness of pharmacological and non-pharmacological interventions for managing dyspnea severity, anxiety, exercise capacity, and health-related quality of life (HRQoL) in patients with advanced cancer.

A comprehensive search of PUBMED, HINARI, CENTRAL, and ResearchGate was conducted to identify randomized controlled trials (RCTs) published up to March 2024. Network meta-analysis was performed to compare interventions, calculating mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI). P-scores were used to rank the interventions. Risk of bias was assessed using the Cochrane tool, and the quality of evidence (QOE) was evaluated using the GRADE framework.

A total of 42 RCTs, encompassing 3,832 patients, were included in the analysis. Among the evaluated interventions, high-flow nasal cannula (HFNC) demonstrated the most significant improvement in dyspnea relief (SMD = -1.91; 95% CI: -3.32 to -0.49; QOE: moderate), followed by acupressure/reflexology (SMD = -1.04; 95% CI: -2.02 to -0.06; QOE: very low). Activity rehabilitation was the only intervention that significantly reduced anxiety compared to the control group (SMD = -0.64; 95% CI: -0.97 to -0.32; QOE: very low). While all interventions showed trends of improving exercise capacity, none reached statistical significance. Notably, acupressure/reflexology significantly enhanced HRQoL (SMD = 1.55; 95% CI: 0.22 to 2.88; QOE: moderate).

Non-pharmacological interventions, particularly HFNC and acupressure/reflexology, were more effective than pharmacological approaches in improving dyspnea relief and HRQoL. However, the low quality of evidence underscores the need for high-quality, large-scale trials to confirm these findings and refine treatment strategies for dyspnea management in advanced cancer patients.

PROSPERO CRD42023479041.

Glofitamab is a T-cell engaging bispecific monoclonal antibody that was granted accelerated approval from the United States Food and Drug Administration for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified or large B-cell lymphoma arising from follicular lymphoma, after ≥2 lines of systemic therapy (3L+).

A budget impact model was developed for a hypothetical blended commercial/Medicare health plan with 1,000,000 members. Comparators were axicabtagene ciloleucel (Axi-cel), lisocabtagene maraleucel (Liso-cel), tisagenlecleucel (Tisa-cel), loncastuximab tesirine, polatuzumab vedotin + bendamustine + rituximab, rituximab + gemcitabine + oxaliplatin, tafasitamab + lenalidomide, and epcoritamab (Epcor). Total costs included those for drugs, wastage, administration, grade ≥3 adverse reactions, and all-grade cytokine release syndrome) and routine care. Market shares were based on internal projections and expert opinions. Total and per-member per-month (PMPM) net budget impacts over 3 years were calculated.

Approximately nine patients were projected to be eligible for 3L + DLBCL treatment in a health plan of 1,000,000 members. The introduction of glofitamab as a treatment option resulted in estimated total and PMPM cost savings of $728,697 and -$0.0202, respectively, over 3 years. Costs were reduced across all cost categories but particularly in drug costs. Among the newer therapies, total 3-year cost per treated patient was lowest for glofitamab: $226,658 versus Tisa-cel = $564,113; Axi-cel = $540,002; Liso-cel = $516,272; and Epcor = $335,293. Across all sensitivity analyses, the inclusion of glofitamab had minimal PMPM budget impact, ranging from -$0.0256 to -$0.0108.

With the lowest 3-year total cost per treated patient among the newer therapies, glofitamab being an available option in the 3L + DLBCL market is estimated to save a hypothetical 1,000,000-member health plan $728,697 in cumulative total costs and $0.0202 in PMPM costs over 3 years.

There is an increase in the application data of Extracorporeal Membrane Oxygenation (ECMO) in perinatal women, particularly since the outbreak of coronavirus disease 2019. Therefore, we reviewed publications on the use of ECMO in pregnant and postpartum women and analyzed the maternal and fetal outcomes, updated the progress of ECMO in perinatal women.

We conducted a systematic literature search across PubMed, EMBASE, Cochrane Library, and the International Clinical Trials Registry (ICTRP), yielding 30 eligible clinical studies that investigated the application of ECMO during pregnancy. A comprehensive data extraction process was implemented to retrieve information from these selected studies. A single rate analysis on material survival, material harmonic compilations, and fetus survival were performed by R software.

Of the 1460 women included, our primary outcome was maternal survival: 74.4% (95% confidence interval [CI]: 67.8%-81.1%). Among them, the survival rate of VV ECMO patients was 83.6% (95% confidence interval [CI]: 76.4%-90.8%); the survival rate of VA ECMO patients was 62.8% (95% confidence interval [CI]: 48.7%-76.8%). The secondary outcomes were maternal hemorrhagic complications: 34.8% (95% [CI]: 24.1%-45.5%), and fetal survival: 73.2% (95% [CI]: 62.0%-84.4%).

Our analysis revealed that the outcomes of ECMO (both type) use in pregnant patients may be comparable or superior to those observed in non-pregnant cohorts. Moreover, patients treated with VV ECMO exhibited a significantly higher survival rate compared to those on VA ECMO.

The protocol for this systematic review was registered on INPLASY (2022110036) in 11 November 2022.

Spinal cord injury (SCI) is a debilitating neurological condition that causes physical dependency, psychological distress, and financial burden. Pain is a common consequence of SCI, significantly impacting quality of life. Effective pain management in SCI is challenging and requires multifaceted approaches. Among rehabilitation methods, non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS), transcranial direct current stimulation (tDCS), transcutaneous electrical nerve stimulation (TENS), and virtual reality (VR) have been explored. This study aims to evaluate the efficacy of rehabilitation and non-invasive brain stimulation techniques on pain relief in SCI patients.

A systematic review of the literature was conducted using PubMed, Scopus, and ScienceDirect with the formula ("spinal cord injury") AND ("pain"). Risk of bias was assessed using the Cochrane Risk of Bias Tool.

Sixteen studies involving 319 patients were included. Patients in the control groups received: rTMS in seven trials, tDCS in seven trials, TBS in one trial, and TENS combined with VR in one trial. The trials analyzed were of poor methodological quality, characterized by small sample sizes, weak power analyses, varying clinical scores, and non-comparable follow-up periods. No major complications or serious adverse events were reported.

Results were inconsistent, with no solid evidence supporting the superiority of rehabilitation techniques over comparator treatments. However, the favorable safety profile and positive outcomes in some measures suggest potential benefits for pain management and quality of life. Further studies are necessary to better understand SCI-related pain and optimize treatment strategies.

Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.

In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.

A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).

We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).

RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.

Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P  < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.

PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.

Tranexamic acid (TXA) use has become the gold standard in total joint arthroplasty to limit intraoperative blood loss and transfusion rates. More recently, the indications for TXA have expanded to knee and shoulder arthroscopy with promising early results. However, the effectiveness of TXA during arthroscopic rotator cuff repair (RCR) is unclear. Therefore, the purpose of this study was to investigate perioperative outcomes following the use of TXA during RCR.

A systematic review was performed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, MEDLINE, Embase, and Cochrane databases in November 2024. Studies were assessed for quality of visual clarity, operative time, mean arterial pressure (MAP), volume of arthroscopy irrigation used, arthroscopic pump pressure, and clinical outcomes.

A total of 12 clinical trials involving 999 patients were included. 9 studies reported on visual clarity and 6 of these reported improvements in visual clarity with TXA administration. Four studies reported improvements in postoperative pain, however outcomes varied greatly depending on when follow-up assessment occurred. A majority of studies did not report differences in operative time, irrigation volume, or postoperative swelling. There were no venous thromboembolism events reported in the included studies.

TXA dosing during RCR surgery may improve visual clarity, however its effect on other perioperative outcomes remains unclear.

Level I.

Pain management in elderly patients with hip fractures has received more and more attention, which is crucial for promoting recovery and reducing complications. At present, there are various and controversial analgesic methods for this population. This meta-analysis evaluated the analgesic effects and side effects of intravenous analgesia compared to different nerve block techniques, including femoral nerve block, fascia iliaca block or pericapsular nerve group block, in this patient group. The study was conducted following the PRISMA 2020 guidelines. A search was performed in October 2024 across PubMed, Web of Science, Cochrane Library, and Embase. Pain scores at different time points, supplemental analgesic morphine consumption, and adverse reactions were compared between intravenous analgesia and nerve blocks. Data were collected from 12 studies and 1157 elderly patients using intravenous analgesia and nerve block after hip fracture, with no differences in sample size, mean age, or percentage of females between the two groups at baseline. Compared to intravenous analgesia, nerve blocks showed significant advantages in the pain score of 2 h after block (SMD-0.80; 95% CI: -1.23 to -0.38; I2 = 90%) and the supplemental analgesic morphine consumption (SMD = -0.46; 95% CI: -0.73 to -0.19; I2 = 59%). The incidence of adverse reactions and the pain scores at various time points also demonstrated significant differences between the two groups. The application of nerve blocks in elderly patients with hip fractures demonstrates significant clinical advantages, particularly in postoperative pain management, decreasing opioid use, and reducing postoperative complications.

The purpose of this study was to evaluate the effect of del Nido cardioplegia versus conventional cardioplegic solutions on early outcomes of isolated coronary artery bypass grafting (CABG). PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched through July 2024 to conduct a meta-analysis for a comparison between del Nido and other cardioplegic solutions in isolated CABG. Major end points of the study included operative mortality and morbidities. A random effects model was used to estimate the pooled effect size. For subgroup analyses, meta-analyses were conducted for outcomes derived from either randomized controlled-trials, propensity score analysis, or multivariable analysis. Twenty-four studies met our eligibility criteria, including 4 randomized controlled trials and 5 propensity score-matched studies with a total of 34,737 patients. Operative mortality was not significantly associated with cardioplegic solutions (del Nido vs other solutions; p = 0.262). The incidence of postoperative stroke, reoperation, deep wound infection, and atrial fibrillation was also comparable between the 2 groups. The incidence of postoperative myocardial infarction and renal failure was significantly lower in the del Nido group with a pooled odds ratio of 0.43 (95% confidence interval, 0.24-0.77) and 0.61 (95% confidence interval, 0.45-0.81), respectively. Subgroup analyses also demonstrated these significant differences. In patients undergoing isolated CABG, del Nido cardioplegia provides comparable mortality compared with other cardioplegic solutions. Del Nido solution was significantly protective against myocardial infarction and renal failure.

This study aimed to evaluate the effectiveness of various formulas and the ability of breastfeeding with the exclusion of cow milk protein to reduce the Scoring Atopic Dermatitis (SCORAD) index and promote growth in infants with cow milk protein allergy.

We conducted a systematic search of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, Weipu, and the China Biomedical Literature Database. The search period ranged from the inception of each database to December 2023 (with an update until January 15, 2025). We included randomized controlled trials (RCTs) comparing formulas and breastfeeding for cow's milk protein allergy in infants. Two independent reviewers extracted data via standardized methods and assessed the risk of bias via the revised Cochrane risk-of-bias 2.0 tool. We performed a network meta-analysis (NMA) via a Bayesian fixed-effects model in RStudio and assessed the certainty of the evidence via the Confidence in Network Meta-Analysis (CINeMA) online application. The protocol for this NMA was preregistered in PROSPERO (No. CRD42024504707).

This analysis included 23 RCTs involving 1997 children and assessed 12 interventions. Compared with the regular formula, the pectin-thickened amino acid formula (TAAF) might reduce the SCORAD index (-12.49, 95% confidence interval [CI] -20.38 to -4.48, low certainty). At ≤6 months of follow-up, compared with rice-hydrolyzed formula (RHF), breastfeeding might improve the length-for-age Z score (LAZ) (0.47, 95% CI 0.13-0.81, moderate certainty), and breastfeeding (0.39, 95% CI 0.02-0.77, low certainty) and extensively hydrolyzed formula (EHF) with probiotics (0.38, 95% CI 0.00-0.77, low certainty) might respectively improve the weight-for-age Z score (WAZ) and weight-for-length Z score (WLZ). At the 12-month follow-up, EHF might improve the LAZ (0.41, 95% CI 0.11-0.71, low certainty) and WLZ (0.37, 95% CI 0.18-0.56, low certainty) compared with RHF, whereas the amino acid formula (AAF) may improve the WAZ (0.33, 95% CI 0.02-0.63, low certainty).

Low-certainty evidence suggested that TAAF might reduce the SCORAD index. Moderate or low certainty evidence indicated that, at ≤6 months of follow-up, breastfeeding might improve the LAZ and WAZ, whereas EHF with probiotics might improve the WLZ. At the 12-month follow-up, EHF might improve the LAZ and WLZ, whereas AAF might improve the WAZ. However, further high-quality studies would be needed to confirm these findings and assess their safety and cost-effectiveness.

Primary Angiitis of Central Nervous System (PACNS) is a rare disease featured by transmural inflammation in vessels pertaining to brain, leptomeninges and spinal cord. It is a rare disease and the involvement of the spinal cord represents a rarer and not yet completely investigated subtype.

We performed a systematic search of the available literature on Pubmed and Embase, adding backward and forward citations, in order to retrieve the reported cases of PACNS i9nvolvimeng the spinal cord without time limitations. The main aim is to retrieve information about clinical and demographic features, pathological and neuroradiological findings on brain and spinal cord, and, finally, treatment and outcome.  RESULTS: The search provided 33 papers (mainly individual case reports) and 38 patients, with a large age frame (from 12 to 70 years of age), mainly adults. Among these ones 36/38 received a pathological diagnosis and granulomatous pattern was the main reported one. The description of spinal cord involvement in MRI is variable form extensive tumefactive lesions to spinal roots prominent involvement. The mortality is high (29% at the end of the individual follow-up).   DISCUSSION: As in non-spinal involvement, the main limitation of the retrieved cases is the inhomogeneity of the diagnostic and therapeutic pathway with underusing and underreporting of neuroradiolgoical techniques relevant for the diagnosis according with the available diagnostic criteria. Spinal cord involvement confirms its rarity, but it has been associated to a high disability and mortality and the diagnosis of PACNS has therapeutic consequences.  CONCLUSIONS: Spinal cord involvement is present in a minority of PACNS cases with a variety of neuroradiological and pathological findings. The standardization of the diagnostic pathway could help to improve the quality of information in prospective studies.

This bibliometrix and meta-analysis aimed to evaluate the efficacy of perioperative dexmedetomidine (DEX) on postoperative delirium (POD) in adult patients undergoing cardiac surgery. A comprehensive search of electronic databases identified 21 randomized controlled trials involving 5210 patients. The primary outcome was the incidence of POD from the first day to seven days post-surgery. The meta-analysis revealed that DEX significantly reduced POD incidence compared to various controls (RR 0.70; 95 % CI 0.54-0.89; P = 0.004). Subgroup analyses showed that DEX was particularly effective when compared to propofol (RR 0.48; 95 % CI 0.30-0.78; P = 0.003). However, no significant differences were observed in the duration of anesthesia, surgery, or ICU/hospital stay. Notably, DEX was associated with a higher incidence of hypotension (RR 1.90; 95 % CI 1.16-3.10; P = 0.01). The study highlights the potential neuroprotective benefits of DEX but underscores the need for careful monitoring of hemodynamic stability. Future research should focus on optimizing DEX dosing protocols and exploring its broader impact on postoperative recovery and patient outcomes.

A recent systematic review reported very high pooled estimates of blood lead levels (BLLs) for Indian children. Current study aimed at systematically pooling the BLLs of Indian children (aged ≤ 14 years). Further, explore the time trend of BLLs with respect to implementing the ban on the use of Pb-petrol (i.e.2000) and a decade later (2010). Observational studies documenting the BLL in Indian children (aged ≤ 14 years) from PubMed-Medline, Scopus, and Embase digital databases from inception to August 2024 were systematically reviewed. Detailed protocol is available at PROSPERO (ID: CRD42022382835). Pooled mean BLL was estimated using the random-effects model and conventional-I 2 statistics to assess the heterogeneity, while the Newcastle Ottawa Scale for bias assessment. Sub-group, sensitivity, and meta-regression analyses were performed where data permitted. Observations from 65 reports (51 original studies) revealed pooled BLL of 10.4 (95 % CI: 9.55-11.2) µg/dL with a trend of gradual reduction during the last 3 decades. Subgroup analysis revealed the high risk (with known Pb exposure) children had BLL of 14.3 (12.3-16.2) µg/dL, while that of the low risk (no known Pb exposure) is 8.71 (7.71-9.71) µg/dL. Only the low risk group exhibited a time trend of a gradual reduction in BLL. Notably, the review observed high heterogeneity. A progressive decline in Pb burden with respect to the national ban on leaded petrol was observed. However, present observations emphasize remedial actions toward non-occupational Pb exposure particularly among high risk Pb group, such as periodic BLL surveys.

Anemia is a common comorbidity in heart failure (HF) patients, often leading to worsened outcomes. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors represent a novel approach for anemia management, yet their efficacy and safety in HF patients remain unclear. We aimed to conduct a systematic review and meta-analysis of studies on the effects of HIF-PH inhibitors on hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), or estimated glomerular filtration rate (eGFR) in HF patients with chronic kidney disease (CKD).

The search of electronic databases identified four studies including 98 patients. Among the included studies, two were conducted prospectively, while two were retrospective in design. No studies were identified that compared HIF-PH inhibitors with erythropoiesis-stimulating agents or placebo. In cases of significant heterogeneity (I2 > 50 %), data were pooled using a random-effects model; otherwise, a fixed-effects model was used. In pooled analyses, hemoglobin levels increased at one (weighted mean difference [WMD]: 0.697 [0.473, 0.920] g/dL; Pfix < 0.001; I2 = 24 %) and three months (WMD: 0.760 [0.443, 1.076] g/dL; Pfix < 0.001; I2 = 31 %) after the use of HIF-PH inhibitors. NT-proBNP levels showed a modest decrease at one month but no significant changes at three months. eGFR remained unchanged, and no severe adverse events were reported.

This meta-analysis suggests that HIF-PH inhibitors effectively improve anemia in HF patients with CKD without notable changes in renal or HF-related biomarkers. However, the small number of included studies and the absence of a comparator group underscore the need for cautious interpretation of the findings.

To analyze the efficacy of supervised exercise (SE) compared with control protocols on sleep parameters of women who survived breast cancer.

This systematic review with meta-analysis searched studies using the following electronic databases: PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Library, and EMBASE. The PEDro scale assessed the bias risk, and the study protocol was registered in the PROSPERO (no. CRD42023420894).

Of 3,566 identified studies, 13 randomized clinical trials involving 847 women diagnosed with breast cancer were included. Interventions consisted of SE in an outpatient setting (62%) or combined protocols with supervised and home exercises. Most interventions (85%) used multicomponent protocols with aerobic and resistance exercises. Usual care and health education were the most reported controls. SE decreased the sleep disturbance score (- 31.61 [95% confidence interval =  - 39.40 to - 23.83]) of the European Organisation for Research and Treatment of Cancer quality of life questionnaire and daytime dysfunction score (- 0.41 [95% confidence interval =  - 0.73 to - 0.09]) of the Pittsburgh Sleep Quality Index (PSQI). Also, SE presented a tendency to improve the self-reported sleep quality score of the PSQI (p = 0.06).

SE increased the subjective sleep quality and immobility time and decreased sleep disturbance and daytime dysfunction symptoms in women who survived breast cancer. Most SE protocols were multicomponent, with aerobic and resistance exercises ranging from moderate to high intensity.

Supervised exercise may improve sleep quality and reduce symptoms of sleep disorders, contributing to survival outcomes.

We conducted a systematic review and meta-analysis of comparative studies to analyze intra- and postoperative outcomes of robot-assisted radical prostatectomy (RARP) using either DaVinci (DV-RARP) or Hugo™RAS (H-RARP) platforms.

The study was registered in PROSPERO (CRD42024562326) and followed PRISMA guidelines. Literature search was conducted in June 2024 using academic databases, focusing on articles from 2021 to 2024. Research question focused on men with PCa (P) undergoing H-RARP (I) versus DV-RARP (C) to evaluate surgical, pathology, and functional outcomes (O), across comparative studies. Continuous variables were summarized using mean difference (MD) and categorical variables using odds ratio with 95% confidence intervals (CI). Heterogeneity was assessed using Cochran's Q test and I2 statistics. Publication bias was evaluated with Egger's and Begg's tests. Statistical analysis was performed with Stata®17.0, with significance set at p < 0.05. Risk of bias was assessed using the ROBINS-I tool. Methodological quality was evaluated with AMSTAR 2.

Eight studies (three prospective, five retrospective) with 1114 patients (454 H-RARP vs. 660 DV-RARP) were included. Baseline characteristics were comparable between groups. No significant differences were found in overall operative time, console time, blood loss, nerve-sparing, or lymphadenectomy. Docking time was significantly longer for Hugo™RAS (MD:6 min,95% CI 4.2;7.8). Postoperative outcomes, including complications, length of stay, and catheterization time, were similar. Pathological outcomes showed no significant differences in positive surgical margins or staging, but lower node yield was observed with H-RARP (MD:-2,95% CI -3.3;-0.6). Urinary continence recovery was comparable. Risk of bias was moderate to serious.

The meta-analysis suggests H-RARP and DV-RARP perform not statistically different across most of analyzed outcomes, except for docking time and lymph-node yield. The longer docking time associated with the Hugo™RAS suggests demanding setup but does not translate into significantly longer operative time. Although statistically significant, the observed difference in lymph-node yield might be clinically negligible.

We performed a systematic review and meta-analysis to examine the associations between telomere length and telomerase activity in subjects with and without metabolic syndrome (MetS).

The meta-analysis protocol was registered in the PROSPERO database. The PubMed, Embase, Cochrane Library, and LILACS databases were searched for studies reporting telomere length or telomerase activity in adult men and non-pregnant women with and without MetS. The risk of bias was assessed with the Newcastle-Ottawa Scale. Random effects and inverse variance methods were used to meta-analyze associations. We conducted a bootstrapped analysis to test the accuracy of clinical results.

Five studies reported telomere length and two studies telomerase activity. There was no significant difference in telomere length (standardized mean difference [SMD]: 0.10, 95% confidence interval [CI]: -0.07, 0.28, I 2: 54%), between subjects of similar age (mean difference: 2.68, 95%CI: -0.04, 5.40 years) with and without the MetS. Subjects with MetS displayed significantly higher body mass index, triglycerides, and blood pressure, and lower HDL-cholesterol values than subjects without the syndrome. A bootstrapping mediation analysis of telomere length confirmed the clinical results. There was no significant difference in telomerase activity (SMD: 1.19, 95% CI -0.17, 2.55, I 2: 93%) between subjects with and without the MetS.

There were no significant differences of telomere length and telomerase activity in patients with MetS and subjects of similar age without the syndrome.

The online version contains supplementary material available at 10.1007/s40200-024-01513-4.

This meta-analysis aimed to compare the efficacy and safety of iGlarLixi with those of insulin glargine for treating type 2 diabetes (T2D).

A systematic search of PubMed, the Cochrane Library, and EMBASE was conducted to identify randomized controlled trials (RCTs) that compared the use of iGlarLixi with the use of insulin glargine in patients with T2D. The meta-analysis protocol was registered at PROSPERO. The primary outcomes of interest were changes in hemoglobin A1c (HbA1c) and body weight. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models.

We included 7 RCTs comprising 2229 men and 1926 women, of whom 2075 (49.94%) were randomized to iGlarLixi. Compared with insulin glargine, iGlarLixi decreased HbA1c (MD: -0.50%; 95% CI: -0.65% to -0.35%; p < 0.00001) and body weight (MD: -1.17 kg; 95% CI: -1.36 kg to -0.98 kg; p < 0.00001) and self-measured plasma glucose (MD: -0.97 mmol/L; 95% CI: -1.27 mmol/L to -0.68 mmol/L; p < 0.00001) and increased the percentage of patients achieving HbA1c < 7% (RR: 1.66; 95% CI: 1.31 to 2.11; p < 0.0001), the percentage of patients achieving HbA1c < 6.5% (RR: 2.11; 95% CI: 1.53 to 2.92; p < 0.00001), and HbA1c < 7.0% without weight gain and/or without severe or blood glucose-confirmed hypoglycemic episodes (RR: 2.18; 95% CI: 1.76 to 2.69; p < 0.00001). However, a higher incidence of gastrointestinal adverse events (RR: 2.02; 95% CI: 1.61 to 2.54; p < 0.00001) and adverse events (RR: 1.08; 95% CI: 1.02 to 1.14; p = 0.008) was associated with iGlarLixi than with insulin glargine.

Compared with insulin glargine, iGlarLixi is superior in reducing blood glucose levels and facilitating weight loss. Nevertheless, its administration is also linked to a heightened occurrence of gastrointestinal and adverse events.

To compare patient-reported outcome measures (PROMs) at 1-year and 2-year follow-up after treatment for anterior shoulder instability.

Randomized controlled trials and prospective studies that evaluated and reported PROMs after a capsulolabral repair (with or without remplissage), bone augmentation, or nonoperative treatment to treat anterior shoulder instability at both 1-year and 2-year follow-up were included. PROMs were compared between 1-year and 2-year follow-up; forest plots with mean difference were created to compare baseline, 1-year, and 2-year follow-up; and scatterplots were created to visualize clinical improvement over time.

Fourteen studies, comprising 923 patients, with levels of evidence Level I and II were included. Nine PROMs, of which predominantly were the Western Ontario Shoulder Instability Index (WOSI; 11 studies; 79%), were evaluated. Minimal to no statistically significant change in WOSI, Oxford Shoulder Instability Score, American Shoulder and Elbow Surgeons (ASES), Subjective Shoulder Value, Simple Shoulder Test, Disabilities of Arm, Shoulder, and Hand (DASH), Quick DASH, Single Assessment Numeric Evaluation, or visual analog scale was observed between 1-year and 2-year follow-up. Pooling of the WOSI, Oxford Shoulder Instability Score, ASES, and Single Assessment Numeric Evaluation demonstrated improvement from baseline to 1-year follow-up and minimal to no change between 1-year and 2-year follow-up. Scatterplots of the WOSI and ASES demonstrated the most improvement within 6 months and no clear improvement after 1-year follow-up. Recurrence rates increased with time but varied between studies.

In contrast to recurrence rates, which have been shown to increase with time, minimal to no statistically significant change was observed for any of the included PROMs between 1-year and 2-year follow-up. This finding raises the question as to whether it is necessary to evaluate PROMs in long-term follow-up of patients after shoulder stabilization treatment.

Level II, systematic review of Level I and II studies.

Rapid sequence intubation (RSI) is a critical procedure in emergency and intensive care settings. Etomidate has been favored for its hemodynamic stability; however, concerns about adrenal insufficiency have prompted interest in ketamine as an alternative induction agent. This systematic review and meta-analysis aimed to compare the effects of etomidate vs ketamine on 30-day survival and other clinical outcomes in critically ill patients undergoing in-hospital RSI. A comprehensive literature search was conducted until 1 November 2024, across PubMed, Embase, Web of Science, Cochrane databases, and clinical trial registries. Eligible studies included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing etomidate vs ketamine for RSI. The primary outcome was 30-day survival. Secondary outcomes encompassed intubation difficulty, post-intubation vasopressor use, cardiovascular collapse, Sequential Organ Failure Assessment score, systemic steroid use, organ support-free days, and adrenal insufficiency. Fourteen studies comprising 23 926 patients (19 288 receiving etomidate; 4638 receiving ketamine) met the inclusion criteria. Pooled analyses of RCTs and CCTs revealed no significant difference in 30-day survival between the two agents [RCTs: odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.68-1.24, P  = 0.58; CCTs: OR = 1.16, 95% CI: 0.92-1.45, P  = 0.58]. Ketamine was associated with a higher requirement for post-intubation vasopressor support (OR = 0.71, 95% CI: 0.53-0.96, P  = 0.03) and an increase in ICU-free days. Etomidate use correlated with a significantly higher incidence of adrenal insufficiency (OR = 2.43, 95% CI: 1.67-3.53, P  < 0.001). No significant differences were observed in intubation difficulty, cardiovascular collapse, or systemic steroid use between the groups. Ketamine and etomidate showed no significant difference in 30-day survival among critically ill patients undergoing RSI. However, etomidate was associated with a higher incidence of adrenal insufficiency, while ketamine required more post-intubation vasopressor support. Provenance and peer review: Not commissioned, externally peer-reviewed.

Endothelial dysfunction is associated with increased cardiovascular risk in individuals with autoimmune diseases. This systematic review and meta-analysis included studies assessing endothelial function with functional methods in children with rheumatic diseases versus controls.

Literature search involved PubMed and Scopus databases (from inception to February 2024) and manual reference screening. Studies assessing endothelial function by all available functional methods were eligible. Study quality was evaluated via Newcastle-Ottawa scale.

Twenty-four studies (880 children with rheumatic diseases, 784 controls) were included in meta-analysis. Pooled analysis showed significantly impaired endothelial function in patients versus controls (SMD: -0.74, 95%CI -1.10 to -0.39) but with high heterogeneity (I2 = 91%, p < 0.001); sensitivity analysis including only high-quality studies confirmed this finding (SMD: -0.83, 95%CI -1.20 to -0.46). In subgroup analyses according to type of rheumatic disease, significantly impaired endothelial function was showed for patients with juvenile idiopathic arthritis (SMD: -1.05, 95%CI -1.84 to -0.25), vasculitis (SMD: -0.74, 95%CI -1.11 to -0.37) and juvenile systemic sclerosis (SMD -2.48, 95%CI -4.34 to -0.61).

Children with rheumatic diseases show impaired endothelial function. Future studies are needed to elucidate whether endothelial dysfunction is involved in high cardiovascular risk of these patients.

CRD42023413799.

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.

A significant number of patients encounter weight gain (WG) or inadequate weight loss (IWL) following bariatric surgery for obesity. Recent studies have explored the role of semaglutide in addressing weight management challenges in patients who have inadequate weight loss or weight gain after bariatric surgery. Despite such studies, a systematic review and meta-analysis evaluating the efficacy, safety and tolerability of semaglutide in this specific clinical context remains absent. Therefore, this study was undertaken to address this knowledge gap.

Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of semaglutide in the intervention arm post-bariatric surgery. Outcome was weight loss post-bariatric surgery.

A total of six studies (300 participants) demonstrated significant weight reduction following semaglutide administration after bariatric surgery (WMD: - 15.730, 95% CI: - 22.140, - 9.320, p < 0.001). This effect remained robust in sensitivity analysis.

The current data encourages the use of semaglutide for managing WG or IWL post-bariatric surgery.

Around 50% of people aged 60 years and above are affected by diverticular disease, and 25% of these individuals will require surgical intervention. Our objective is to compare the results of left colonic resection for sigmoid diverticular disease using both robotic and laparoscopic approaches. Our primary aim is to conduct a meta-analysis while investigating the rates of conversion to open surgery, stoma and complications between the two methods.

A systematic review was conducted following the PRISMA guidelines. A meta-analysis was performed using RevMan Version 5.4 software. The random-effect model was employed to pool dichotomous outcomes and estimate risk and odds ratios (OR).

Eight studies were thought to fulfil the eligibility criteria: 1892 patients (49.2%) had robotic surgery, and 1952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group (P < 0.00001), a lower rate of postoperative ileus (P = 0.005), shorter length of stay (mean difference (MD) 0.18 P = 0.003) and fewer morbidities (P = 0.002). There were similar rates of stoma formation (4.7%, P = 1.00), anastomotic leak (2.6%, P = 0.85) and mortality (0.3% vs 0.2%, P = 0.59). The operative time was shorter in the robotic approach, although the difference was not significant (P = 0.47).

Robotic surgery is feasible for diverticular disease compared to laparoscopic left colectomy. Our study observed a reduction in the conversion to open rate, reduced morbidity, and less ileus while demonstrating similar rates of stoma formation, anastomotic leak, and mortality. However, more high-quality research needs to be conducted to investigate this further. The study is registered in Prospero (reg # CRD42023440509).

Preventing postpartum haemorrhage remains a high priority worldwide. We aimed to provide all available evidence comparing maternal and neonatal outcomes of different prophylactic endovascular procedures in patients with abnormal placentation.

Pubmed, Embase and ClinicalTrials.gov databases were searched from inception to Nov, 2024, using relevant key words. Studies comparing outcomes of women undergoing or not prophylactic endovascular procedures in planned cesarean delivery in patients with antenatally suspected or confirmed PAS, placenta previa or both were included. An arm-based random effect frequentist network meta-analysis was performed. All available maternal and neonatal outcomes were evaluated.

Three randomized controlled trials and 59 observational studies were eligible reporting on 6973 women (42.9% did not undergo any endovascular procedure, 26.7% underwent aortic balloon occlusion, REBOA, 16.6%, internal iliac balloon occlusion, PBO-IIA, 5.8%, common iliac artery occlusion, PBO-CIA, placement, and 7.8% underwent uterine artery embolization, UAE). The pooled network analysis showed that all prophylactic endovascular procedures were associated with reduced perioperative blood loss, with proximal balloon occlusion (REBOA) having the strongest effect (SMD -1.80 L, 95%CI -2.38;-1.21; I2 = 97.2%). Also, peripartum hysterectomy rates were significantly lower in women undergoing prophylactic UAE and REBOA compared to the control group; moreover, patients with placenta previa without any prophylactic endovascular procedure had a 4 to fivefold increased risk of peripartum hysterectomy compared to the REBOA group (I2 = 20.6%). REBOA was associated with a significant decrease in massive transfusion rates (I2 = 0%), surgery-related complications (I2 = 0%), ICU admissions (I2 = 40.3%), and units of red blood cells transfused (I2 = 92.8%), compared to PBO-IIA and control groups. The control group versus women undergoing prophylactic UAE showed a significant increase in total operative time (I2 = 96.5%) and Clavien-Dindo grade IV post-operative complications (I2 = 26%), compared to REBOA. All prophylactic endovascular procedures had a comparable risk ratio in terms of units of platelets transfused, maternal mortality, and use of additional post-operative bilateral uterine artery embolization among the treatment groups. As for neonatal outcomes, no significant differences were detected.

Although the preponderance of observational studies suggests caution in interpreting the results of this meta-analysis, our findings suggest that prophylactic endovascular interventional procedures, particularly aortic balloon occlusion, may substantially improve clinical outcomes in women with PAS, placenta previa or both.

CRD4202457398.

Cancer patients frequently experience insomnia, adversely affecting their quality of life. This study aimed to systematically review and analyse the effectiveness and safety of acupressure and acupuncture in improving sleep quality among cancer patients suffering from insomnia, providing evidence for non-pharmacological treatment options.

Several digital databases (Scopus, PubMed, Embase, Web of Science, Medline, Cochrane library, PsycINFO, CINAHL complete, and Google Scholar) were examined for English-language records. Inclusion criteria involved randomized controlled trials assessing the impact of acupressure or acupuncture on cancer patients with insomnia. The Cochrane Collaboration's instrument was employed to evaluate the quality of the encompassed studies. For meta-analysis, a model that accounts for variability among studies was favoured, and statistical analysis was conducted using Stata software version 17.

This review analysed 13 randomized controlled trials involving 806 cancer patients. The analysis indicated that sleep quality didn't differ significantly between treatment and control groups. However, sleep efficacy was significantly higher in the treatment group (SMD [95 % CI] = 0.43 [0.21, 0.65]). Additionally, total sleep time showed a significantly higher extent in the treatment group (SMD [95 % CI] = 0.58 [0.24, 0.92]). No significant differences were found for depression or sleep onset latency between groups, while anxiety levels were lower in the treatment group (SMD [95 % CI] = -0.52 [-0.90, -0.15]).

The review suggests that acupressure and acupuncture enhance sleep quality in cancer patients suffering from insomnia, showing notable benefits during follow-up, especially among Asian participants.

To perform a systematic review and meta-analysis of randomized and comparative studies comparing mesenchymal stromal cells other orthobiological injections for patients with knee osteoarthritis.

Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1-3 from 2014 to 2024. Validated scores (VAS, KOOS, Lysholm, IKDC) were included as outcome measures. Risk of bias was assessed using the Cochrane Collaboration's tools. The GRADE system was used to assess the quality of the body of evidence and the modified Coleman Methodology score was used to assess study quality. Heterogeneity was assessed using χ2 and I2 statistics.

Ten studies were included; all published in English between 2019 and 2023, encompassing a total of 563 cases (281 treated with MSCs and 282 with other biologics). Two studies had a high risk of bias, one had some bias, and seven had a low risk of bias. Publication bias was detected (Egger's test 3.26447; p = 0.007). The pooled estimates revealed significant differences favoring MSCs for VAS scores at 3, 6, and 12 months. For KOOS pain and symptoms, significant differences were observed at 3 and 6 months.

The results of this meta-analysis demonstrated a significant effect of adipose and bone marrow-derived stromal cell injections on pain reduction at all assessed time points, and showed superiority over other non-surgical treatment options. These differences were not reflected in clinical and functional outcomes, indicating that the observed reduction in pain did not correspond to substantial improvements in knee functionality.

Over the past years, there has been an upward trend in the total number of spinal fusion procedures worldwide. There are many different strategies to perform the lumbar fusion, each with some advantages. Hospital charges for lumbar spinal surgeries also have increased significantly, with great variation in the costs and recommendations of different surgical procedures. There has also been a trend increase in the rate of the use of interbody fusion implants compared to that of traditional decompression surgery, even though the former is known to incur higher costs. Access through the anterior route gained many followers after studies on sagittal balance, and its indication has also increased worldwide. However, this technique presents different patterns of complications from those observed in traditional posterior approaches.

This study aims to determine the safety and efficacy of surgery in managing patients with symptomatic lumbar degenerative diseases by comparing the effectiveness of posterior and anterior approach techniques to treat this condition on patient-related outcomes. We also aimed to investigate the safety of these surgical interventions by including perioperative complication data.

A systematic search of multiple online databases was conducted up to August 2024 to identify randomized controlled trials (RCTs) and other high-quality retrospective studies comparing outcomes of anterior lumbar interbody fusion (ALIF) versus posterior fusion techniques (PLF, PLIF, TLIF) in the treatment of degenerative lumbar diseases. The primary outcomes assessed included the Oswestry Disability Index, Visual Analogue Scale, and overall clinical improvement. Secondary outcomes encompassed complications such as mortality, infections, gastrointestinal complications, deep vein thrombosis (DVT), surgical site infections, and the need for blood transfusions, as well as length of hospital stay and operative duration. Pooled effect estimates were calculated and presented as mean differences (MD) with 95% confidence intervals (CI) at the two-year follow-up.

Regarding VAS and ODI, anterior and posterior approaches were similar in analyzing five RCTs. Including retrospective studies, we also found that the length of hospital stay and duration of surgery were comparable between the two approaches. Anterior approaches had a lower rate of patients requiring blood transfusions OR 0,69[0.60,0,80]. Anterior approaches showed higher rates of mortality (0,21%) OR1,33[1.10,1.62], deep vein thrombosis (0,65%) 1.73 [1.35, 2.20], and gastrointestinal complications (4,9%) OR 2.19 [1.73, 2.78].

Clinical outcomes measured by VAS and ODI were comparable between anterior and posterior approaches, demonstrating similar efficacy in treating lumbar degenerative diseases. However, the safety profiles varied significantly. Anterior approaches carried higher rates of severe complications, including mortality, DVT, and gastrointestinal events, while posterior techniques were linked to increased blood transfusion needs. Given the elevated risk of severe complications with ALIF, posterior approaches should be prioritized as the first-line option for lumbar degenerative disease.

Ependymomas, rare malignant central nervous system (CNS) lesions (2-6% of primary CNS tumors), are typically treated with maximal safe resection followed by fractionated radiation therapy. Stereotactic radiosurgery (SRS) has emerged as an alternative, particularly in recurrent or residual cases. This study evaluates the safety and efficacy of SRS for CNS ependymomas, while also identifying key prognostic factors.

A systematic search was conducted to identify studies that evaluated the efficacy and safety of SRS in WHO Grade 2/3 CNS ependymoma patients. Random-effect meta-analysis was employed.

Fourteen studies with 298 patients and 496 lesions were included. Our meta-analysis demonstrated an overall local tumor control (LTC) rate of 72% (95% CI: 65-79%). LTC rates at 1, 3, and 5 years were 83% (95% CI: 76-88%), 72% (95% CI: 64-78%), and 69% (95% CI: 61-76%), respectively. Progression-free survival (PFS) rates at 1, 3, and 5 years were estimated at 67% (95% CI: 50-80%), 56% (95% CI: 48-64%), and 51% (95% CI: 39-63%), respectively. Additionally, the 5-year overall survival (OS) rate was 58% (95% CI: 48-67%). The incidence of adverse radiation events (ARE) was 20% (95% CI: 12-31%). Meta-regression showed older age correlated with improved tumor control (P = 0.02) and lower ARE (P = 0.06) and radionecrosis rates (P < 0.01), while larger tumor volumes (P = 0.03) and anaplastic histology (P = 0.01) were associated with poorer PFS.

SRS is a reasonably valuable therapeutic option in the multimodal management of WHO Grade 2/3 CNS ependymomas, especially for individuals with inoperable, recurrent, or residual lesions. Key patient and tumor characteristics have been analyzed to determine factors potentially impacting treatment outcomes.

Acute ischemic stroke (AIS) is a major cause of disability and mortality worldwide. While antiplatelet therapy is standard for secondary prevention, many patients still experience early neurological deterioration (END). Argatroban, a direct thrombin inhibitor, can potentially limit thrombus progression and improve AIS's functional outcomes. This meta-analysis assessed the efficacy and safety of argatroban in combination with single (SAPT) or dual antiplatelet therapy (DAPT) compared to antiplatelets alone. Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted until January 2025. Randomized controlled trials (RCTs) and cohort studies evaluating argatroban plus antiplatelets versus antiplatelets alone in AIS patients were included. The primary outcome was a 90-day modified Rankin Score (mRS) of 0-2. Secondary outcomes included mRS 0-1 and mRS 3-5 at 90 days, END, and National Institutes of Health Stroke Scale (NIHSS) improvement, stroke recurrence, intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), and mortality. We used the mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous ones at 95% confidence intervals (CI) and a P-value of 0.05. A total of 14 studies (four RCTs and 10 cohort studies) were included. Compared to antiplatelets alone, argatroban significantly improved functional outcomes, increasing the incidence of mRS 0-2 (OR = 1.36 [95%CI: 1.05, 1.76, P = 0.02]) and mRS 0-1 (OR = 1.54 [95%CI: 1.08, 2.2, P = 0.02]) while reducing END (OR = 0.42 [95%CI: 0.21, 0.85, P = 0.02]). Argatroban was also associated with greater NIHSS score improvement (MD =  - 0.52 [95%CI: - 0.89, - 0.15, P = 0.005]). No significant differences were observed in mRS 3-5, stroke recurrence, ICH, sICH, or mortality. Subgroup analysis indicated that argatroban combined with DAPT showed the greatest benefits. Argatroban combined with antiplatelet therapy improves functional recovery and reduces END without increasing bleeding risks. These findings support its use, particularly with DAPT, in mild to moderate AIS management. Further large-scale RCTs are needed to optimize dosing strategies and patient selection.

Vigilant clinical assessment is the key to preventing complications, including death, in infants at risk of neonatal withdrawal syndrome. The eat, sleep and console (ESC) is proposed as an alternative to usual care with Finnegan's Neonatal Abstinence Scoring System (FNASS), but whether ESC improves infant outcomes is uncertain.

To conduct a meta-analysis and systematic review of outcomes of studies comparing ESC to FNASS.

PubMed, Embase, CINAHL and Cochrane were searched. There was no date restriction.

Published data from observational studies published in English were included. Randomised controlled trials, reviews and abstracts were excluded. Data was required to be converted to mean and SD to be included.

Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used, and data were independently extracted by multiple observers. Data was pooled using a random-effects model.

Length of stay (LOS) in days, number of days medicated and proportion of infants medicated were the primary outcomes assessed. It was hypothesised prior to data collection that ESC would be associated with shorter LOS and a lower proportion of infants medicated, given key differences in infant assessment compared with the FNASS.

12 studies, all from the USA, were published between 2018 and 2024. 10 quality improvement studies and two cohort studies compared ESC (n=1877) with historical controls using FNASS (n=2199). ESC decreased hospitalisation days (MD -4.11 days, 95% CI -6.04 to -2.19 days; p<0.0001; I2=95%; 10 studies; 3703 participants) and the proportion treated with withdrawal medications (OR 0.36, 95% CI 0.22 to 0.60; I2=89%; RD -0.22; 95% CI -0.34 to -0.10; p<0.0001; I2=93%; 12 studies; 4076 participants). One study assessed physical health up to 1 week after discharge (n=1), three assessed weight loss (n=3) and one assessed cost (n=1).

The majority of evidence for a reduction in hospitalisation and need for withdrawal medication with ESC compared with FNASS is derived from quality improvement and cohort studies with almost no health information beyond 1 week after discharge. High-quality trials incorporating physiological measurements of infant stress and longer-term outcomes are needed.

CRD42024532169.

Dietary interventions are a potential alternative treatment of depression and anxiety.

To evaluate the effects of dietary interventions on depression and anxiety.

PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and PsycINFO searched from inception until 12 December 2024. Trial registries and forward and backward citation analysis done on 3 January 2025.

Randomized controlled trials (RCTs) evaluated the effect of dietary advice with or without food provision compared with no specific dietary advice or active interventions for 3 months or longer on depression and/or anxiety.

Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes included depression and anxiety symptoms at 3 months or longer. Random-effects meta-analyses were done, and the certainty of evidence was assessed.

Twenty-five RCTs were included. Compared with no specific dietary advice, depressive symptoms might be improved in adults with elevated cardiometabolic risk by dietary advice on calorie restriction (standardized mean difference [SMD], -0.23 [95% CI, -0.38 to -0.09]; low certainty). Low-fat diets may also have very small effects on depressive symptoms in adults with elevated cardiometabolic risk (SMD, -0.03 [CI, -0.04 to -0.01]; low certainty). Evidence on other diets, comparing diets with active comparisons, and on anxiety was limited by study limitations and clinical or methodological heterogeneity.

Limited studies did not allow for adequate exploration of heterogeneity.

Calorie restrictions and low-fat diets might reduce depressive symptoms among adults with elevated cardiometabolic risk, but the differences were small and confidence in the findings was low. Evidence on other diets, comparisons to active interventions, and other outcomes is limited.

None. (PROSPERO: CRD42023485953).

Parkinson's disease (PD), a progressive neurodegenerative disorder, often involves sleep disturbances, affecting 88-98% of patients. Melatonin, a sleep-regulating neurohormone, shows the potential to improve sleep quality and non-motor symptoms in PD.

To evaluate melatonin's efficacy and safety in PD patients with sleep disorders.

We systematically searched PubMed, Scopus, Web of Science, and Cochrane till January 2025. The risk of bias in the included studies was evaluated using the Cochrane risk-of-bias tool. Dichotomous outcomes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs), while continuous outcomes were reported as mean differences (MDs) with 95% CIs.

We retrieved 2537 records. Five double-blinded RCTs were finally included. The meta-analysis revealed a significant improvement in sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), in the melatonin group compared to placebo (MD= -1.88, 95% CI: [-3.07, -0.68], P = 0.002). However, no significant differences were observed for the Epworth Sleepiness Scale (MD= -1.04 CI: [-2.81, 0.73], P = 0.25), total sleep time (MD = 14.85 min CI: [-5.45, 35.16], P = 0.15), sleep efficiency, sleep latency, REM sleep latency, frequency of arousals, or REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ; MD = 0.74, P = 0.50). For Parkinson's disease-related outcomes, melatonin significantly improved Non-Motor Symptom Scale (NMSS) scores but showed no significant effects on UPDRS Part III scores or Parkinson's Disease Quality of Life.

Melatonin improves subjective sleep quality and non-motor symptoms in PD patients with a favorable safety profile, but effects on objective measures and motor symptoms remain inconclusive.

This meta-analysis was registered on PROSPERO.

CRD42024619496.

Visual location recognition encompasses place recognition (PR) and anomaly detection (AD). These are crucial tasks for autonomous robots to accurately determine the location and the occupied place. To accelerate research in this area, we introduce a multi-domain dataset for indoor visual place recognition and anomaly detection by mobile robots. The dataset includes 89,550 RGB images captured in nine rooms. The data collection process involved both manual recordings and recordings captured by mobile robots. The images depict a wide range of scenarios, including variations in lighting, robot vision, and human activity. Additionally, we provide an analysis of other available datasets referenced in the literature. This article presents a freely available dataset for research on place recognition and presents an example application in the field of anomaly detection. The baseline methods were thoroughly tested and achieved an 80.18% accuracy in anomaly detection for single images and 80.63%-84.18% for image sequences. The article includes a comprehensive presentation of the characteristics of individual image sequences and the most significant conclusions drawn from the research.

Policosanol, a compound generated from sugar cane, consists of alcohols such as octacosanol, hexacosanol, and triacontanol, which possess antioxidant properties. Evaluating the impact of this antioxidant on serum creatinine in clinical settings is essential because of the contradictory findings. This comprehensive review and dose-response meta-analysis attempts to evaluate the impact of policosanol supplementation on creatinine levels.

A comprehensive search was performed in bibliographic databases such as Cochrane, PubMed, Google Scholar, Scopus, and Web of Science, covering the period from inception to November 2023. The necessary data was retrieved, and pertinent randomized controlled trials (RCTs) that satisfied the inclusion criteria were included. Weighted mean differences (WMDs) were the reported measure of the pooled effects. To find between-study heterogeneities, the I-squared test was employed.

A total of 2427 participants were involved in the twenty-one RCTs that were included. A meta-analysis showed that policosanol had no significant change in creatinine levels in participants consuming policosanol compared to placebo consumers (WMD = 0.21 µmol/l; 95% CI = - 0.85 to 1.26; P = 0.70). Policosanol consumption for durations ≥ 24 weeks significantly decreased creatinine, according to subgroup studies. There was a non-linear correlation between changes in creatinine levels and the dosage of prescription policosanol (P non_linearity = 0.002). However, the treatment time did not have a significant impact on creatinine levels in a non-linear manner (P non_linearity = 0.24).

Policosanol supplementation has no significant effect on creatinine levels.

Africa bears the highest double burden of HIV and malaria worldwide. In 2023, an estimated 25.9 million people were living with HIV (PLHIV), and 246 million malaria cases were diagnosed in Africa. Malaria patients co-infected with HIV are considered at a higher risk of failing malaria treatment, according to the World Health Organization (WHO) guidelines. This systematic literature review aims to assess the treatment outcomes following artemisinin-based combination therapy (ACT) in PLHIV.

The literature search was conducted up to April 2022 in the following databases: MEDLINE, EMBASE, Web of Science, Cochrane Central, WHO Global Index Medicus, Clinicaltrials.gov, and the WorldWide Antimalarial Resistance Network (WWARN) Clinical Trial Library. Studies describing any malaria treatment outcomes or anti-malarial drug exposure in PLHIV treated for uncomplicated Plasmodium falciparum malaria infection were eligible for inclusion.

A total of 26 articles describing 19 studies conducted between 2003 and 2017 in six countries were included in this review; it represented 2850 malaria episodes in PLHIV across various transmission settings. The most studied artemisinin-based combination was artemether-lumefantrine (in 16 studies). PLHIV were treated with various antiretroviral therapy (ART) regimens, namely efavirenz (EFV), nevirapine (NVP), atazanavir-ritonavir (ATVr), lopinavir-ritonavir (LPV/r), and/or on prophylaxis with trimethoprim-sulfamethoxazole (TS), or were untreated (in 3 studies). There was no evidence of an increased risk of recrudescence in PLHIV compared to those without HIV. When treated with artemether-lumefantrine, PLHIV receiving LPV/r had a lower risk of malaria recurrence compared to PLHIV on NVP-based or EFV-based ART, or those without HIV. LPV/r increased lumefantrine exposure and EFV-treated patients had a reduced exposure to both artemether and lumefantrine; NVP reduced artemether exposure only.

Limited data on ACT outcomes or drug exposure in PLHIV in Africa remains a reality to date, and the effect of antivirals appears inconsistent in the literature. Considering the heterogeneity in study designs, these review's findings support conducting an individual patient data meta-analysis to explore the impact of antiretroviral therapy on anti-malarial treatment.

The protocol for the original search was published on PROSPERO with registration number CRD42018089860.

Recurrent pregnancy loss (RPL) affects 1-2 % of fertile couples, with immunological factors increasingly implicated in unexplained cases. Currently, no convincing treatment exists. Intravenous immunoglobulin (IVIg) has been explored as a potential treatment, but results have been inconsistent. This study evaluates whether IVIg affects live birth rates in women with RPL in subsequent pregnancies. We searched PubMed, Embase, and Cochrane libraries for relevant randomized controlled trials up to March 20, 2023, and contacted authors for individual patient data. Trials involving women with two or more consecutive pregnancy losses who received IVIg or placebo before or during the first trimester were included. Primary outcomes were live birth and clinical pregnancy rates, with secondary outcomes including pregnancy loss rate, side effects, adverse events, and perinatal outcomes. Risk of bias and certainty of evidence (GRADE) were evaluated. Ten studies involving 662 women were included. The intention-to-treat analysis showed no significant difference in live birth rates between IVIg and placebo groups (RR: 1.02, 95 % CI: 0.86-1.22, p = 0.78, GRADE: moderate). However, per-protocol analysis indicated an increased live birth rate with IVIg (RR: 1.23, 95 % CI: 1.00-1.50, GRADE: low). Live birth rates after IVIg improved with the number of previous losses, especially in patients with ≥ 6 losses (RR: 5.26 (1.58-17.53)). While IVIg therapy did not show a significant improvement in live birth rates overall, future research should focus on identifying specific patient subgroups, such as those with multiple prior losses, who may benefit most from this treatment.

The lung magnetic resonance longitudinal relaxation rate R 1 varies with disease but reported values in healthy subjects (HS) also differ markedly between studies.

To evaluate the reported values and variances of observed R 1 accounting for field strength B 0 , acquisition method, and disease.

A systematic literature search was performed to identify studies quantifying R 1 or its reciprocal T 1 . The relationship between field strength and observed R1 was analysed in all healthy subject data. Data were fit to the heuristic equationR 1 = B ∗ ( B 0 A ) . The variances between-study bs , within-study-between-subject wsbs , and within-study-within-subject wsws , in HS were assessed. Linear correlation between observed R1 and TE was also investigated.

Fifty-nine papers were selected, 50 quantifying R1 in HS and 20 in disease, representing 1559 human and non-human subjects, with B 0 ranging from 0.2 T to 9.4 T. In HS, the result of the fit on all healthy subjects was A = -0.227 ± 0.020 s-1 T-1, B = 0.923 ± 0.014 s-1 with variance components b s > w s b s > w s w s . The reference values for R1 at B 0 between 0.55 T and 7 T were derived. For inversion recovery with gradient echo readout at 1.5 T, a previously observed negative relationship between R 1 and TE was confirmed.

We provide reference values for lung R 1 across all commonly used field strengths. The variation in HS lung observed R 1 reported in different studies in different centres likely reflects methodological differences. Investigators wishing to compare lung R 1 values with previous reports should take account of this irreproducibility, and multicentre projects should standardise to minimise between-centre variance.

Objective: To develop and validate the China Dietary Inflammatory Index (CHINA-DII) for Chinese adults. Methods: A systematic literature search was conducted to identify studies published between 2009 and 2024 reporting dietary intake levels among Chinese adults. After applying inclusion and exclusion criteria and evaluating study quality, a dietary intake database for Chinese adults was established. Following the methodology of the original Dietary Inflammatory Index (DII), the CHINA-DII was constructed and validated. A total of 256 newly diagnosed gastric cancer patients who visited the Union Hospital of Fujian Medical University between June 2023 and November 2024 were recruited. Demographic information, clinical data, and dietary data based on a food frequency questionnaire (FFQ) were collected. Spearman rank correlation was used to assess the relationship between CHINA-DII scores and high-sensitivity C-reactive protein (hs-CRP) levels. Results: A total of 33 eligible studies were included to develop a dietary intake database encompassing 27 dietary components. Among the 256 gastric cancer patients, the average CHINA-DII score was -1.91 ± 0.35, and the mean hs-CRP level was 3.68 ± 2.35 mg/L. CHINA-DII scores were positively correlated with hs-CRP levels (r = 0.20, p ≤ 0.001). Multivariate logistic regression analysis showed that individuals with higher CHINA-DII scores had a 1.90-fold increased risk of hs-CRP ≥ 3 mg/L compared to those with lower scores (odds ratio, OR = 1.90; 95% confidence interval, 95%CI: 1.01-3.55). For each 1-standard-deviation (SD) increase in CHINA-DII score, the risk of hs-CRP ≥ 3 mg/L increased by 1.50 times (OR = 1.50, 95% CI: 1.10-2.06). Conclusions: The CHINA-DII developed in this study effectively reflects the potential inflammatory impact of dietary intake in Chinese adults and is significantly positively associated with the inflammatory marker hs-CRP, indicating good validity and applicability.

The association between the microbiota and obstructive sleep apnea (OSA) remains understudied. In this study, we conducted a comprehensive systematic review and meta-analysis of studies investigating the diversity and relative abundance of microbiota in the gut, respiratory tracts and oral cavity of patients with OSA, aiming to provide an in-depth characterization of the microbial communities associated with OSA.

A comprehensive literature search across PubMed, the Cochrane Library, Web of Science, and Embase databases were conducted to include studies published prior to Dec 2024 that compared the gut, respiratory and oral microbiota between individuals with and without OSA. The findings regarding alpha-diversity, beta-diversity, and relative abundance of microbiota extracted from the included studies were summarized. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO (CRD42024525114).

We identified a total of 753 articles, out of which 27 studies were ultimately included in the systematic review, involving 1,381 patients with OSA and 692 non-OSA populations, including 1,215 OSA patients and 537 non-OSA populations in adults and 166 OSA patients and 155 non-OSA populations in children. The results of alpha diversity revealed a reduction in the Chao1 index (SMD = -0.40, 95% CI = -0.76 to -0.05), Observed species (SMD = -0.50, 95% CI = -0.89 to -0.12) and Shannon index (SMD = -0.27, 95% CI = -0.47 to -0.08) of the gut microbiota in patients with OSA. Beta diversity analysis indicated significant differences in the gut, respiratory and oral microbial community structure between individuals with OSA and those without in more than half of the included studies. Furthermore, in comparison to the non-OSA individuals, the gut environment of patients with OSA exhibited an increased relative abundance of phylum Firmicutes, along with elevated levels of genera Lachnospira; conversely, there was a decreased relative abundance of phylum Bacteroidetes and genus Ruminococcus and Faecalibacterium. Similarly, within the oral environment of OSA patients, there was an elevated relative abundance of phylum Actinobacteria and genera Neisseria, Rothia, and Actinomyces.

Patients with OSA exhibit reduced diversity, changes in bacterial abundance, and altered structure in the microbiota, especially in the gut microbiota. The results of this study provide basic evidence for further exploration of microbiome diagnostic markers and potential intervention strategies for OSA.

This work elucidates Evans-Polanyi-like (EPL) relations to rapidly estimate the standard activation enthalpy of three ubiquitous reaction classes playing a central role in hemicellulose pyrolysis: ring-opening, ring contraction, and elimination. These models bypass computing the reaction enthalpy by leveraging computationally cheap local and global electron-density-based chemical reactivity descriptors, such as Fukui's functions (f), electron population of C-O bonds (N), and the gross intrinsic strength bond index (Δgpair), evaluated for reactants solely. More than 270 reactions observed in twenty-eight functionalized β-d-xylopyranoses, the hemicellulose building block, are used under the 20-80% partition scheme for validating-deriving purposes. By using multilinear regression analysis, four EPL equations are proposed for informing barriers at the M06-2X/6-311++G(d,p), CBS-QB3, G4, and DLPNO-CCSD(T)-F12/cc-pVTZ-F12//M06-2X/6-311++G(d,p) levels. An adjusted coefficient of determination of 0.80 characterizes these parametric polynomials. Moreover, MAE and RMSE of ≈3.3 and ≈4.1 kcal mol-1 describe the performance of the best-fitting models at DFT and G4. Conversely, the highest values, MAE = 3.6 and RMSE = 4.7 kcal mol-1, are associated with the CBS-QB3 level. The benchmarking of the computed activation enthalpies at 298 K yields simple functions for high-level estimations from low levels of theory with R2 ranging from 0.94 to 0.98. Extrapolating the DPLNO barriers to the complete basis set limit tends to lower them by 0.63 kcal mol-1. EPL expressions are tailored to facilitate the development of chemical kinetic models for hemicellulose pyrolysis, as the reactant structure is the only input required.

Navigation, the ability to find one's way from one place to another, is an important cognitive skill for maintaining autonomy in daily life. Several findings indicate that navigational ability can be impaired after stroke. However, navigation is rarely assessed in clinical practice, and evidence-based recommendations for suitable diagnostic tools are lacking. Furthermore, the scientific literature does not provide a meta-analytic estimation of the prevalence of post-stroke navigational impairments. This systematic review aims to provide an overview of the tools to assess navigational difficulties after stroke, including their psychometric properties, and determine the prevalence of post-stroke navigational difficulties.

Three investigators independently and systematically searched publications performing assessments of navigation in the stroke population, with a fourth independent investigator consulted when discrepancies were present. References of the retrieved articles were hand searched for relevant articles.

The systematic review included 19 studies, reporting on 19 different approaches to assess objective and/or subjective navigation skills, each with different psychometric properties. The pooled effect size, using a random-effects model including data from a subset of 8 out of the 19 included studies, demonstrated a prevalence of post-stroke navigation impairments of 35% (95% CI: 0.29-0.42). However, this model was significantly heterogeneous.

Navigational difficulties are a common neuropsychological deficit after stroke. However, navigation is a broad construct and a subdivision to reduce heterogeneity in navigation ability is recommended, e.g. by categorizing navigation into landmark-, location-, and path-based navigation impairment. The inclusion of objective and subjective assessments of navigation is recommended in clinical practice.

The protocol was registered at the PROSPERO international prospective register of systematic reviews (PROSPERO ID: CRD42023491346).

Minimally invasive techniques such as vertebroplasty, kyphoplasty, radiofrequency ablation, and stereotactic body radiotherapy have been widely used to manage spinal metastases. Among these, percutaneous cryoablation (PCA) has emerged as a promising option for local tumor control and pain management, offering targeted treatment with minimal damage to surrounding tissues. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCA for spinal metastases.

A systematic review was conducted using PubMed and Embase databases to identify studies that reported outcomes of PCA for spinal metastases. The reported radiologic, clinical, and complication outcomes were then combined and analyzed using meta-analytic methods including the calculation of pooled means and proportions, subgroup analysis, and meta-regression.

Eleven studies, including 229 patients, met inclusion criteria and were analyzed. Patients had a mean age of 61.8 years, with 60.6% being female. Breast (18.6%), lung (16.0%), and thyroid (8.0%) were the most common primary cancer sites. PCA was primarily conducted under general anesthesia (47.5%) and with CT/MRI guidance (93.9%). Local tumor control was achieved in 70.5% of cases over a mean follow-up of 12.6 months. Pain severity significantly decreased postoperatively, with a mean reduction of 4.5 points (P < 0.0001). Major and minor complication rates were 2.0% and 4.8%, respectively.

PCA is an effective alternative treatment for spinal metastases, offering pain relief and local tumor control with low complication rates in appropriately selected patients. However, tumor location and patient age may influence treatment outcomes, underscoring the need for individualized treatment planning.

Mental health disorders affect 15% of youth aged 10-19 years globally, typically emerging before age 15. While school-based peer-led programs show promise in improving physical health behaviours by leveraging existing social networks, reducing stigma, and demonstrating high implementation feasibility, their effectiveness for mental health outcomes remains unclear. This systematic review examined controlled trials of school-based, peer-led lifestyle interventions (physical activity, diet, or sleep) reporting mental health outcomes in adolescents aged 10-19 years. Six electronic databases were searched up to March 28, 2024. Seven studies met inclusion criteria, encompassing 7,060 adolescents from 151 schools across the UK, USA, Canada, and Norway. Interventions varied in frequency and duration, with six focusing on physical activity and one on diet. Meta-analyses revealed no significant effects for psychological difficulties (MD = 0.60, 95% CI -3.52 to 4.72; p = 0.32, k = 2), self-efficacy for physical activity (SMD = 0.18, 95% CI -3.08 to 3.44; p = 0.61, k = 2), or wellbeing (SMD = 0.0, 95% CI -2.94 to 2.94; p = 1.0, k = 2). These findings, while requiring cautious interpretation, highlight the pressing need for more comprehensive and rigorous research to better understand the impact of peer-led interventions on mental health outcomes.

C-reactive protein (CRP) is one of the most important markers for assessing inflammation status and its increased concentration in blood is associated with many chronic diseases in humans. The aim of this study was to reveal the effect of soy isoflavones containing soy protein on serum levels of CRP in adult population with chronic inflammatory diseases.

We searched databases including PubMed, Cochrane Library, ISI Web of Science, Scopus, and clinicalTrials.gov up to March 2025. We used random effects model to calculate the heterogeneity and the overall effects.

Twenty-seven articles were involved in the systematic review and twenty-two articles with thirty-four effect sizes were considered for meta-analysis. The overall estimates revealed that soy isoflavones containing soy protein significantly decreased serum levels of CRP in comparison with control group (weighted mean difference (WMD)= -0.49 mg/L; 95% confidence interval (CI): -0.74, -0.25; P = 0 < 0.001).

Although our results clearly showed soy isoflavones containing soy protein can have decreasing effect on inflammation in participants with chronic inflammatory disease, more large-scale and high quality interventional studies still need to be done to clarify our results.