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.

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.

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.

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 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.

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.

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).

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.

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).

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.

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.

Although intraperitoneal local anesthetics are commonly used following intra-abdominal surgical procedures, the level of evidence supporting their use for postoperative pain management remains uncertain.

To evaluate the effect of intraperitoneal local anesthetics on postoperative pain following intra-abdominal surgery.

Medline (PubMed), Embase (Embase.com), CENTRAL, Web of science and ClinicalTrials.gov databases were searched from their inception to July 15th, 2022.

Randomized controlled trials comparing IPLA to placebo, usual care or other analgesic regimens among patients of any age undergoing any type of surgery.

Trial selection, data extraction, risk of bias assessment and the certainty of evidence were conducted in duplicate independently. Meta-analyses were performed using random effect models.

The co-primary outcomes were abdominal pain intensity at 6, 12, 24, 48, and 72 h after surgery. Secondary outcomes included postoperative nausea and vomiting, opioid use, recovery of gastrointestinal transit, length of hospital stay, postoperative chronic pain, persistent postoperative opioid use, quality of recovery and adverse events.

A total of 150 trials (n = 11,821 participants were included in our systematic review (97% of trials among adults). Intraperitoneal local anesthetics reduced postoperative pain intensity at 6 h (-0.86 point [95%CI -1.02 to -0.70]), 12 h (-0.74 point [95%CI -0.93 to -0.55]), 24 h (-0.65 point [95%CI -0.82 to -0.48]), and 48 h (-0.51 point [95%CI -0.70 to -0.31]), but not at 72 h (-0.38 point [95%CI -1.04 to 0.27]), with very low to low certainty of evidence. Modelled risk difference for achieving the clinically important effect and subgroup analyses among participants with moderate or high pain showed potential clinically significant effect from IPLA. Opioid use at 24 h (-10.4 mg of oral morphine equivalent [95% CI -13.1 to -7.6]), postoperative nausea and vomiting (RR 0.79 [95% CI -0.71 to 0.88]), and time to gastrointestinal transit recovery (-3.80 h [95% CI -7.54 to -0.07]) were also reduced. We found no association for other outcomes.

Intraperitoneal local anesthetics may be associated with a small analgesic effect following intra-abdominal surgery. Considering the low to very low level of evidence supporting these findings, along with the limited data on adverse effects and long-term outcomes, their adoption as a standard of care intervention cannot be recommended at this stage.

CRD42018115062.

To verify the influence of glucagon-like peptide-1 receptor agonists (GLP-1 RA) on renal function parameters in type 2 diabetes based on well-known randomized controlled trials (RCTs).

PubMed, Cochrane, Web of Science, Embase, and grey literature were searched for RCTs published until December 24, 2024. The quality of the RCTs was assessed using the Cochrane risk-of-bias tool. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated for continuous variables using meta-analysis. The primary outcomes were composite renal function parameters, including serum creatinine (Cr) levels, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and urinary albumin-to-creatinine ratio (UACR).

Pooled data from 24 studies revealed that GLP-1 RA positively influenced renal outcomes in the type 2 diabetes group to some extent compared with that in the control group. GLP- 1 RA decreased serum creatinine levels (WMD=-0.10, 95%CI -0.19 to -0.01, I2 = 33%, P < 0.05), eGFR(WMD = 0.54, 95% CI 0.19 to 0.90, I2 = 27%, P < 0.05), UAE (WMD=-11.92, 95% CI - 23.50 to - 0.33, I2 = 0%, P < 0.05) and UACR (WMD: -1.01 mg/g, 95% CI:-1.68, -0.34, I2 = 15%, P < 0.05) in the type 2 diabetes group.

GLP-1 RA treatment significantly elevated eGFR, decreased the UACR, and positively influenced renal function outcomes in the type 2 diabetes group.

Not applicable.

The aim of this study was to compare postoperative complications between pre- and subpectoral implant-based breast reconstruction in non-irradiated patients.

This systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Literature search was performed using the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Meta-analysis assessed implant loss, while odds ratios (OR) were used to compare other postoperative complications, such as dehiscence, seroma, infection, necrosis, and re-operation. The Clavien-Dindo system was applied to standardize the comparison of complication severity.

The literature search identified 1087 studies. Eighteen met the inclusion criteria. A meta-analysis of 11 studies showed no significant difference in implant loss between the pre- (1045 cases) and subpectoral (1485 cases) groups (OR = 1.00, p > 0.99). Furthermore, the application of the Clavien-Dindo classification of postoperative complications revealed no significant differences in the severity or frequency of complications between the 2 implant placements. No significant differences were found for other postoperative outcomes including seroma, dehiscence, hematoma, infection, necrosis, and re-operation.

Pre- and subpectoral implant-based breast reconstruction have comparable outcomes for implant loss. There were no significant differences in the severity or frequency of complications when standardized using the Clavien-Dindo classification system. These findings suggest that prepectoral placement is as safe as subpectoral placement in appropriately selected patients. Future studies should focus on standardizing the reporting of complications to enhance comparability between sub- and prepectoral implant placement across studies, thereby improving surgical decision-making.

The German Registry of Acute Aortic Dissection Type A (GERAADA) score is a risk score for predicting 30-day mortality after an operation for type A acute aortic dissection (TAAAD). This meta-analysis sought to assess the performance of the GERAADA model and compare it to the performance of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).

A systematic search of 3 online databases was conducted to identify studies that externally validated the GERAADA score. A random-effect meta-analysis was conducted, pooling area under the curve (AUC) data, operative mortality observed/expected (O/E) ratios and observed-expected (O-E) differences-of the GERAADA model in all studies and of the EuroSCORE II when available.

Eleven studies were selected, including a total of 10 360 patients. The observed in-hospital mortality rate was 12.2%. Pooled expected mortality rates estimated by the GERAADA score and the EuroSCORE II were 18.4% and 5.8%, respectively. The pooled analyses for the GERAADA scores showed moderate discrimination [AUC 0.70, 95% confidence interval (CI) 0.66-0.73] and good calibration [observed-expected (O-E) differences -12.3, 95% CI -27.1 to 2.58; O/E ratio 0.81, 95% CI 0.57-1.05]. Results from 5 studies (2133 patients) investigating both scores simultaneously revealed similar AUC results (P = 0.50), significantly lower O-E differences (P = 0.03) and a trend towards O/E ratios closer to 1 (P = 0.08) with the GERAADA score compared to the EuroSCORE II.

The GERAADA score seemed to offer a better calibration for predicting 30-day postoperative death following TAAAD operations, even though further studies are needed to confirm these findings. The moderate discriminatory capacity of both scores highlights the challenges of predicting outcomes in complex cardiovascular conditions like TAAAD.

In this systematic review and meta-analysis, the impact of green tea supplementation on measurement/indices of adiposity was investigated.

Using predefined keywords, online databases (PubMed, Scopus, Web of Science Core Collection, and Google Scholar) were searched for relevant studies, published from inception up to February 2024. Data were extracted and registered. Subgroup analyses and the investigation of linear and non-linear associations were carried out.

Green tea supplementation reduced BW (WMD: -0.74 kg; 95% CI: -0.97, -0.51), BMI (WMD: -0.29 kg/m2; 95% CI: -0.38, -0.19), WC (WMD: -1.04 cm; 95% CI: -1.55, -0.53), BFP (WMD: -0.65%; 95% CI: -1.03, -0.27), and leptin (WMD: -0.92 ng/ml; 95% CI: -1.71, -0.14), but did not change adiponectin levels (WMD: 0.20 µg/ml; 95% CI: -0.17, 0.57).

Supplementation with green tea seems to be effective in reducing excess adiposity.

This study aims to compare laparoscopic versus open in ileostomy reversal techniques from multiple perspectives and to gain insight into the potential advantages and limitations of laparoscopic techniques and provide guidance on finding the best anastomosis for ileostomy reversal.

This systematic review and meta-analysis has been pre-registered with PROSPERO. The registration number is CRD42025640754. A rigorous literature search was conducted across multiple databases, including Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure. The primary outcome measure was the incidence of overall postoperative complications, and the secondary outcomes included operative time, estimated blood loss, and the length hospital stay.

This research included 11 studies with a total of 867 cases, showing that the laparoscopic surgery group had a significantly lower overall complication rate compared to the open surgery group (OR = 0.40, 95% CI: 0.27-0.59, P < 0.00001). Further investigation of specific postoperative complications revealed that laparoscopic surgery significantly reduced the risk of bowel obstruction (OR = 0.39, 95% CI: 0.18-0.83, P = 0.01) and wound infection (OR = 0.41, 95% CI: 0.23-0.73, P = 0.003), with no significant difference observed for anastomotic leaks (OR = 0.40, 95% CI: 0.11-1.43, P = 0.16). Although laparoscopic surgery required a longer operative time (P = 0.002), it resulted in significantly shorter hospital stays (P < 0.00001) and did not increase estimated blood loss (P = 0.50). In addition, both extracorporeal laparoscopic surgery and intracorporeal laparoscopic surgery can effectively reduce the occurrence of postoperative complications and shorten the length of hospital stay compared with open surgery.

Laparoscopic-assisted ileostomy closure (both intracorporeal and extracorporeal techniques) demonstrates significant clinical benefits, including reduced postoperative complication rates, shortened hospitalization duration, and optimized recovery trajectories.

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.

Therapeutic exercise (TE) is the only intervention with strong recommendation for fibromyalgia. However, there is controversy as to which type of exercise is the most beneficial.

To determine which TE approach is the most effective in reducing pain intensity in women with fibromyalgia.

A systematic review was performed with a network meta-analysis (NMA). Six databases were searched from inception until January 2024. Randomized controlled trials (RCTs) evaluating the effects of TE on pain intensity were included in women with fibromyalgia. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The size of the effect and the clinically important difference were determined in the short-term (≤3 months) and long-term (>3 months).

Sixty-one studies were identified, of which 51 were included in the quantitative synthesis (n = 2873). Fifteen TE interventions and eight comparison interventions (comparators) were identified. Aquatic exercise (p-score: 0.8713) was found to provide best benefits in the short-term and resistance training in the long-term (p-score: 0.9749). Statistically significant differences were found in favor of aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise, and aerobic exercise (in the short-term) and in favor of resistance training, dance, functional training, aquatic exercise, virtual reality, and aerobic exercise (in the long-term) compared to usual care.

With a moderate level of evidence, our NMA shows that, in the short-term, aquatic exercise is the most effective TE intervention to reduce pain intensity in women with fibromyalgia, while resistance training is the most effective in the long-term. More RCTs are needed to strengthen these findings.

Sub-Tenon's and topical anesthesia are the most common anesthetic techniques employed for cataract surgery. The objectives were to compare the effectiveness of intraoperative analgesia between the two techniques.

A systematic review was performed of three databases (MEDLINE, EMBASE, CENTRAL) from inception until August 2023. Included were adult patients undergoing routine cataract surgery with sub-Tenon's or topical anesthesia. Excluded were studies using systemic medications and complicated surgeries. The primary outcome was intraoperative analgesia assessed by patient reported pain scores. Secondary outcomes were post-operative pain at 30 minutes and 24 hours, patient satisfaction, surgeon satisfaction and complications. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Outcomes were statistically assessed with meta-analyses where able.

Twelve studies with 1370 patients were included in the meta-analysis. Sub-Tenon's block provided better intraoperative analgesia with lower pain scores (SMD -0.53, 95% CI -0.70 to -0.36; p < 0.001) which remained significant on subgroup analysis of six studies with uniform pain scales (MD -0.84, 95% CI -1.22 to -0.47; p < 0.001). Instances of severe intraoperative discomfort requiring rescue regional anesthesia were reported with topical anesthesia. While there was no difference in pain scores at 30 minutes or 24 hours post-operatively, higher patient and surgeon satisfaction was found with sub-Tenon's anesthesia. Serious complications were rare, with a higher reported rate of posterior capsule rupture with topical anesthesia. Only two of fourteen studies were considered an overall low risk-of-bias.

Sub-Tenon's block provides marginally better intraoperative analgesia during cataract surgery over topical anesthesia. Both can be considered effective for uncomplicated cataract surgery.

Endometrial cancer (EC) is the leading gynecologic cancer in developed nations. Recent studies suggest that trace elements like zinc and copper may be involved in cancer development due to their involvement in essential biological processes. However, there is inconsistency regarding their serum levels in EC patients. This review sought to systematically analyze and quantify the differences in serum concentrations of zinc and copper between patients with EC and healthy controls through a meta-analysis. A comprehensive search in PubMed, Embase, Scopus, and Google Scholar was performed. Studies comparing serum zinc and/or copper concentrations between confirmed EC patients and healthy controls were included. The quality of the papers was appraised using Newcastle-Ottawa Scale. Synthesis of data was done using standardized mean differences (SMD) at 95% confidence intervals (CIs) employing RevMan software. Five studies, including 433 patients with EC and 448 healthy controls, were analyzed. Meta-analysis showed a substantial decrease in serum zinc concentrations in EC patients against controls (SMD, - 0.91; 95% CI, [- 1.73, - 0.08]; p = 0.03). Serum copper levels were slightly higher in EC patients (SMD, 0.27; 95% CI, [- 0.66, 1.20]), but the difference was not statistically substantial (p = 0.57). The analysis showed reduced serum zinc levels in EC patients, suggesting the potential of zinc as a biomarker. The non-significant trend of higher copper levels requires further investigation to conclusively determine copper's role in EC. Future studies should explore the mechanisms underlying trace element imbalances.

Diabetes self-management education (DSME) and support (DSME/S) delivered via mobile health (mHealth) is potentially cost-effective, if proven effective.

To assess the effectiveness of DSME, DSMS or DSME/S delivered by mHealth interventions compared to usual care (UC) or attention placebo control (APC) in adults with type 2 diabetes.

We searched (1) MEDLINE, (2) Embase, (3) PsycINFO, (4) Cochrane Central Register of Controlled Trials via the Cochrane Register of Studies Online, (5) ClinicalTrials.gov, and (6) World Health Organization International Clinical Trials Registry Platform from the year 2000 to January 31, 2023. We included RCTs comparing DSME/S delivered via mHealth versus UC or APC. Four authors independently selected trials, assessed risk of bias and extracted data. Primary outcome was HbA1c, outher outcomes secundairy. Meta-analysed with random-effects model was used.

We included 43 trials involving 9328 participants; sample sizes ranging from 20 to 1119. Pooled effects on HbA1c were for DSME: mean difference (MD) of -4 mmol/mol (-0.3%), 95% CI -6 mmol/mol (-0.6%) to -1 mmol/mol (-0.1); p = 0.002; DSMS MD -4 mmol/mol (-0.4%), 95% CI 7 mmol/mol (-0.6%) to -2 mmol/mol (-0.2); p < 0.001; and DSME/S MD of -2 mmol/mol (-0.2%) for HbA1c, 95% CI -3 mmol/mol (-0.3%) to -0 mmol/mol (-0.0%); p < 0.001. We found uncertain effects on other outcomes.

mHealth interventions delivering self management education with or without support to adults with type 2 diabetes appear to have a modest beneficial effect on HbA1c. Only a few trials investigated patient-reported outcomes.

Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.

Fungal growth is common in intraoperative cultures of patients with perforated peptic ulcer (PPU) leading to the common use of empiric antifungal therapy, with current evidence not clearly supporting this practice. The goal of this updated systematic review and meta-analysis was to synthesize the effect of empiric antifungals in patients with PPU. Eligible studies were identified through a comprehensive literature search in the MEDLINE (PubMed) and EMBASE databases, following the PRISMA 2020 statement. A total of eight studies were identified reporting on 1802 patients. The population consisted of 67.3% males (n = 121/1802), with a mean age of 59.1 ± 13.2 years. Most of the population underwent surgery (n = 1763/1802, 97.8%), which was most frequently omental patch (n = 1169/1411, 82.8%), while 12.8% (n = 140/1096) underwent laparoscopic repair. Intraoperative cultures were obtained in 73.7% (n = 1262/1713); blood cultures were obtained in 54.5% (n = 467/857) and were positive for fungus in 44.1% (n = 558/1262) and in 5.6% (n = 26/467), respectively. Empiric antifungal treatment was administered in 19.6% (n = 353/1802). The most common agent was fluconazole reported in 6 studies. At a mean follow-up of 34.4 ± 9.9 days, 191/1787 (10.7%) patients died. Patients with fungus-positive intraoperative cultures had significantly increased odds of having diabetes mellitus (OR: 1.55; 95% CI: 1.05-2.30), history of malignancy (OR: 2.80; 95% CI: 1.22-6.45), being on steroids (OR: 5.13; 95% CI: 1.37-19.3), and increased mortality (OR: 2.49; 95% CI: 1.67-3.70). Empiric antifungal therapy did not significantly decrease the odds for death (OR: 1.45; 95% CI: 0.33-6.41). The presence of fungi in the peritoneal fluid is associated with increased risk of death, that is not affected by administration of empiric antifungal therapy.