Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I2). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I2 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I2 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I2 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I2 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I2 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I2 43%), LBW (RR 0.78, CI:0.64-0.95, I2 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I2 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

There are suboptimal levels of HPV vaccine uptake among gay, bisexual and men who have sex with men (GBMSM), despite the prevalence and incidence rates of HPV infection among GBMSM being higher than heterosexual males. This systematic review provides a thematic synthesis of qualitative research which examined the perceptions and experiences of GBMSM to HPV vaccine acceptability and explored the barriers and facilitators to participating in HPV vaccination. This review offers new insights about GBMSM understandings of HPV and how they are shaped by a complex relationship between limited knowledge and information of HPV, feminization of HPV with the focus on cervical cancer and women, and the socio-political governmentality of health services in meeting their health needs. Public health communication is required that focuses on the risks of HPV for anal, penile and oropharyngeal cancers and is culturally congruent to tailor and work with GBMSM more effectively for HPV vaccination. Healthcare providers need training around sexual health stigma and should proactively offer the HPV vaccination outside sexual health clinics for this vulnerable group.

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

Previous studies have explored whether soluble programmed cell death ligand-1 (sPD-L1) can be used to predict the prognosis of patients with peripheral T-cell lymphoma (PTCL); however, no consistent results have been obtained. Consequently, we conducted the present meta-analysis to identify the precise significance of sPD-L1 in predicting the prognosis of PTCL.

We searched PubMed, Embase, Web of Science, and the Cochrane Library until July 31, 2024. The value of sPD-L1 in predicting PTCL prognosis was examined by combining the hazard ratios (HRs) with 95% confidence intervals (CIs).

Seven articles involving 445 patients were included in this study. Based on our pooled findings, increased sPD-L1 was associated with dismal overall survival (OS) (HR = 4.22, 95%CI = 1.89-9.43, p < 0.001) and worse progression-free survival (PFS) (HR = 2.57, 95%CI = 1.35-4.90, p = 0.004) in PTCL. Furthermore, higher sPD-L1 levels were correlated with male sex (OR = 1.80, 95%CI = 1.06-3.03, p = 0.029), International Prognostic Index (IPI) score ≥2 (OR = 4.32, 95%CI = 2.10-8.89, p < 0.001), elevated lactate dehydrogenase (LDH) level (OR = 5.15, 95%CI = 1.94-13.71, p = 0.001), presence of B symptoms (OR = 2.56, 95%CI = 1.45-4.52, p = 0.001), and ECOG PS ≥2 (OR = 7.41, 95%CI = 1.49-36.92, p = 0.015) in PTCL.

According to the present meta-analysis, higher sPD-L1 levels were significantly correlated with poor OS and inferior PFS in patients with PTCL. Additionally, high sPD-L1 levels were also associated with clinical features representing the development of PTCL.

Pediatric cancer patients often struggle to adhere to vaccination schedules, requiring personalized catch-up immunization after treatment. Currently, healthcare professionals create these schedules manually, which is time-consuming, error-prone, and limited in accessibility. We developed and validated an automated clinical decision support system to optimize this process through algorithmic schedule generation.

Following PRISMA guidelines, we systematically reviewed vaccination recommendations for pediatric cancer patients to develop comprehensive scheduling algorithms. The system implements multi-step optimization modeling incorporating age-dependent dosing, minimum intervals, and treatment-related timing rules for 27 vaccines. We validated the tool through a technical evaluation comparing algorithm-generated schedules against those created by experts for representative pediatric cancer cases and through clinical assessments by healthcare professionals in real-world settings.

Technical validation revealed high agreement between algorithm-generated and expert-created schedules, with only minor acceptable variations. Clinical evaluation demonstrated strong user acceptance, with 70% (95% CI: 58.1%-81.9%) of professionals using the system for schedule validation, 61% (95% CI: 48.3%-73.7%) for schedule creation, and 47% (95% CI: 34.0%-60.0%) for vaccination history verification. Users reported median time savings of 20 min per schedule and rated the tool's quality highly (median 4.5/5).

Our clinical decision support system demonstrates technical accuracy and clinical usefulness. It offers an effective solution for managing post-cancer treatment immunizations while alleviating healthcare professionals' workloads, particularly in resource-limited settings.

The landscape of digital health technologies is evolving rapidly, with clinical artificial intelligence increasingly integrated into primary care. Successfully adopting these technologies depends on the users' knowledge, attitude, and practice.

This systematic review and meta-analysis aims to assess primary care physicians' knowledge, attitude, and practice toward clinical artificial intelligence and to uncover the key determinants influencing its implementation in primary care.

PubMed, Web of Science, Scopus, and Institute of Electrical and Electronics Engineers (IEEE) were searched on 18.10.2023 and 03.05.2024 to systematically review quantitative and qualitative relevant primary studies. Three authors independently reviewed and appraised the studies using the Mixed Methods Appraisal Tool. Thematic analysis and proportion meta-analysis of the addressed domains were performed, with results aligned with a recent integration framework.

24 publications, including 4074 primary care physicians, suggested that knowledge levels were generally low, with passive opportunistic learning (pooled proportion 0·33, 95 % Confidence Interval (CI) 0·16-0·50, n = 6 studies, 2358 physicians). Attitudes varied, with concerns about losing jobs and rejecting new technologies (0·53, 95 %CI 0·42-0·64, n = 11, 2988). Practice experience was positive with AI simulation/prior training or negative with infrastructure and electronic medical records limitations (0·52, 95 %CI 0·36-0·68, n = 12, 3459). The risk of bias was low in 14 studies and moderate-high in ten, with significant heterogeneity between studies.

This review underscores the importance of effectively integrating clinical artificial intelligence-assisted digital health technologies within primary care. Acknowledging the current knowledge, attitude, and practice state and identifying gaps and opportunities, a physician-driven artificial intelligence implementation process with sustainable adoption might be possible. More attention is needed to counterbalance the concerns hindering the effectiveness of advanced tools in primary care practice.

The association between diet and the onset and treatment of depression is unclear. This study aims to estimate the evidence for the prospective association between diet quality and depression.

Systematic searches in PubMed, Web of Science and Embase up to 2024/01/04 of propective studies on the potential relationship between diet quality and depression identified 21 randomized clinical trials (RCT) and 92 prospective cohorts (PC) (>700,000 participants), that were pooled in random-effects frequentist and Bayesian meta-analyses.

Treatment-RCT yielded anecdotal-to-moderately strong support for the hypothesis that dietary interventions improve depression (d = -0.80, 95 % CI = -1.46 to -0.14), though their internal validity was low. Interventional effects were observed in nonpatient samples (d = -0.17, -0.29 to -0.08). Prevention-RCT yielded strong evidence indicating no association. Data from PC showed that adherence to some dietary patterns/food groups was associated with depression, e.g., adherence to the Mediterranean-diet was associated to fewer self-reported symptoms (OR = 0.91, 95%CI = 0.88-0.96), with anecdotal-to-moderate strength of evidence but no dose-response relationship. For most dietary patterns and food-groups (e.g., fish), data supported the null-hypothesis of no effect. Effect moderation was present: associations were evident when depression was self-reported but not when diagnosed. Postpartum-depression studies yielded evidence showing dose-response associations between fish (OR = 0.84, 95%CI = 0.78-0.91) and dietary DHA/EPA/Omega3 consumption (OR = 0.84, 95%CI = 0.77-0.92) with self-reported depression-scores.

The strength of the current evidence on the hypothesis that dietary quality influences depression outcome is very low, due to reverse causation and low internal and construct validity. The clinical significance of fish/dietary DHA/EPA/Omega3 intake to reduce the risk of postpartum-depression should be further investigated.

Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.

On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.

The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.

The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.

Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.

Multiple databases were screened using the keywords: "kyphoplasty", "vertebroplasty", "unipedicular", "bipedicular", "osteoporotic fracture", and "compression fracture", and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.

We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.

Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.

We performed a comprehensive systematic review and network meta-analysis (NMA) to assess the efficacy of pharmacological agents for the treatment of proliferative vitreoretinopathy (PVR) following retinal detachment (RD) surgery. A systematic search was performed across PubMed, Scopus, Web of Science, and Embase. Randomized and non-randomized controlled trials and comparative observational studies evaluating the effect of pharmacological agents in a clinical setting were included. The primary outcome was retinal reattachment rate, and secondary outcomes were PVR recurrence, reoperation, intraocular pressure (IOP), epiretinal membrane (ERM), and macular edema. A total of 23 studies with 1749 eyes were included. Twelve different drugs or drug combinations were assessed. The NMA was performed for retinal reattachment, PVR recurrence, and reoperation rate outcomes. Among the pharmacological agents analyzed, adjunctive therapy with 13-cis-retinoic acid (13-cis-RA) demonstrated a statistically significant improvement in retinal reattachment rates (RR=1.36, 95 % CI: 1-1.84) and a reduction in reoperation rates (RR=0.23, 95 % CI: 0.07-0.69) compared to the control group, while none of the other drugs had statistically significant results. Additionally, adjunctive therapy did not yield significant improvements in IOP, ERM, or macular edema, except for a reduction in macular edema associated with dexamethasone in one study. This systematic review and NMA indicate that most pharmacological agents could not significantly improve retinal reattachment, reduce PVR recurrence, or lower reoperation rates following RD surgery. 13-cis-RA was the only drug that showed a significant impact on lowering retinal detachment and reoperation rates. Further high-quality clinical trials are warranted to confirm these findings.

Road safety measures, e.g., speed limits, are widely used globally to prevent and reduce the number of road crashes, injuries, and fatalities. However, implementing such preventive measures has long-term and complex social, environmental, and economic interdependencies and impacts. Therefore, socio-economic appraisals of road safety measures are crucial for identifying such complex interdependencies and impacts on the well-being of individuals, society, the economy, and the environment. The study carries out a comprehensive review of the scientific literature dealing with socio-economic appraisal methodologies of road safety measures. The study comprehensively reviewed the scientific literature on socio-economic appraisal methodologies for road safety interventions. The review follows PRISMA guidelines for selecting scientific articles across Google Scholar, Scopus, and Web of Science. From 535 records identified on 18 January 2025, 80 studies (including grey and peer-reviewed articles in English) were selected. These studies are reviewed based on six themes, namely: (a) methodological frameworks of the methodologies, (b) classification, (c) key indicators, (d) datasets, (e) strengths, limitations, and biases, (f) stakeholders' involvement and impacts on policymaking. The review indicates that the existing socio-economic appraisal methodologies for road safety measures effectively capture specific dimensions, e.g., crash rate reduction, willingness-to-pay for road safety and improved social well-being. However, these methodologies also exhibit inconsistencies while accounting for factors like price inflation and replicability. The review identifies six methodological limitations that accentuate significant future research and innovation opportunities. The review also presents recommendations for future research to address the identified limitations.

Patient safety is a global concern, and nurses, as the largest group of healthcare professionals, play a critical role in ensuring patient safety. This study aimed to systematically review and analyze the effects of patient safety education programs on nursing students' knowledge, attitudes, and competencies by synthesizing existing research and identifying key factors contributing to program effectiveness.

Systematic review and meta-analysis.

Ovid-EMBASE, MEDLINE, CINAHL, and PubMed were selected for their comprehensive coverage of healthcare and nursing literature. Articles published between January 2000 and July 2024 were included, as the year 2000 marked the beginning of global efforts to prioritize patient safety in healthcare systems.

This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of Ovid-EMBASE, MEDLINE, CINAHL, and PubMed (2000-2024) identified interventional studies on patient safety education for nursing students. Eligible studies underwent quality appraisal using the weight of evidence framework.

The meta-analysis showed significant improvements in nursing students' knowledge (Z = 5.315, p < .001), attitudes (Z = 2.727, p = .006), and competencies (Z = 4.870, p < .001). Effect sizes ranged from medium to very large (g = 0.684-2.461). Meta-regression analysis indicated that participants' grades (β = -3.29, p < .001) influenced attitudes, while both grades (β = -2.04, p = .007) and education methods (β = 0.85, p = .042) affected competency.

Patient safety education programs significantly enhance nursing students' knowledge, attitudes, and competencies. Structured, long-term education and interactive methods, such as simulation and virtual reality, enhance competency development. Integrating these approaches into nursing curricula can help bridge the gap between theory and practice, ultimately improving patient safety.

Improving the safety of cyclists, who are considered vulnerable road users, is essential. Implementing a warning system that alerts cyclists to nearby hazards is an effective method to improve their safety. Nevertheless, the literature needs a comprehensive and detailed review of cyclist warning systems. This paper presents a systematic review of existing studies about warning technologies and systems developed to improve cyclist safety, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (n = 78). Based on the review, it was found that the most used cyclist warning technologies were cameras with artificial intelligence (AI), ultrasonic sensors, lidar, and radar. Furthermore, there were some insights from the studies that conducted cycling experiments with the use of a warning system: (1) most participating cyclists responded positively to the warning technologies/systems, (2) most cyclists preferred auditory signals over visual or haptic signals as warning modalities, (3) warning technologies/systems influenced some cyclists' behaviour during critical situations, such as early braking, faster reactions, increased focus, maintaining a safer distance, and temporarily reducing speed, and (4) only two studies tried to explore how warning systems affect crash risk. Future research should focus on developing warning systems that are compact, lightweight, and affordable. More studies are also needed to demonstrate the impact of the cyclist warning system on cyclists' crash risk. This review identifies gaps in the current literature and offers a solid foundation for future studies to enhance cyclist safety.

This study provides a focused review on the use of saliva biomarkers, particularly salivary cortisol, for measuring cognitive fatigue. Through a systematic review and analysis of 25 articles sourced from five academic databases, we examine the relationship between cognitive fatigue and saliva biomarkers. The findings highlight the potential of salivary cortisol as an effective marker of cognitive fatigue, while also identifying limitations in current methodologies, including inconsistent saliva collection and analysis procedures. Although prior reviews have explored saliva biomarkers, our analysis focuses on gaps related to the empirical connection between cognitive fatigue and biomarkers. This review further meta-analysis reveals that cortisol and alpha-amylase levels significantly increased after completing cognitive fatigue-inducing tasks. Moreover, this review emphasizes the need for updated, standardized protocols and real-time detection methods. Future research should aim to conduct more focused empirical investigations to advance the field.

This systematic review investigates the integration of automatic segmentation techniques of magnetic resonance imaging (MRI) with neuropsychological assessments for early diagnosis and prognosis of Alzheimer's Disease (AD).

Focus on studies that utilise automated MRI segmentation and neuropsychological evaluations across the AD spectrum.

A literature search was conducted on the PubMed database on 7 November 2024, using key terms related to MRI, segmentation, brain structures, AD, and cognitive decline.

Studies including individuals with AD, mild cognitive impairment (MCI), or subjective cognitive decline (SCD), utilising structural MRI, focusing on grey matter and automatic segmentation, and reporting cognitive assessments were included.

Data were extracted and synthesised focusing on associations between MRI measures and cognitive tests, and discriminative values for diagnosis or prognosis.

Seven studies were included, showing a significant association between structural changes in the medial temporal lobe and cognitive decline. The combination of MRI volumetric measures and neuropsychological scores enhanced diagnostic accuracy. Neuropsychological measures demonstrated superiority in the identification of patients with MCI and mild AD in comparison to MRI measures alone.

Heterogeneity across studies, selection and measurement bias, and lack of non-response data were noted.

This review emphasises the necessity of integrating automated MRI segmentation with neuropsychological assessments for the diagnosis and prognosis of AD. While MRI is valuable, neuropsychological testing remains essential for early detection. Future studies should focus on developing integrated predictive models and refining neuroimaging techniques.

Childhood brain tumor and leukemia (CBTL) and their treatments can have negative effects on development, including communication and swallowing. Clinical practice guideline recommendations for managing communication and swallowing difficulties in children diagnosed with CBTL were informed by (i) a systematic review using the GRADE approach to rate certainty of evidence; (ii) GRADE Evidence to Decision Framework involving an international panel of experts; and (iii) a Health Professional and Consumer survey. To improve outcomes and quality of life, children with CBLT should have access to communication and swallowing assessment and intervention from cancer diagnosis, throughout and after treatment, and across survivorship.

Research on metal nanoparticles is crucial for their application in diverse fields, requiring detailed assessments of their effects and potential. Galleria mellonella larvae have emerged as a valuable model for studying the impacts of metal nanoparticles, offering ethical and logistical advantages over traditional models. This systematic review synthesizes evidence on the application of Galleria mellonella in evaluating the toxicity, distribution, and therapeutic potential of metal nanoparticles. Adhering to PRISMA guidelines, a comprehensive database search (MEDLINE, Embase, Cochrane, Scopus, Google Scholar, Science Citation Index Expanded) was conducted using keywords related to Galleria mellonella and metal nanoparticles. The SYRCLE's risk of bias tool (adapted for G. mellonella) was used for risk of bias assessment. Out of 1696 initially identified studies, 31 met the inclusion criteria, encompassing research from 2011 to 2024. The included studies effectively demonstrate G. mellonella's capacity to model the toxicity of metal nanoparticles, their therapeutic potential in treating infections, and the impact on the innate immune response, bridging the gap between simpler in vitro assays and more complex mammalian models. Galleria mellonella stands out as a critical model for the early-stage development and evaluation of metal nanoparticles, particularly in assessing toxicity, therapeutic efficacy in infection treatment, and interaction with immune systems. This review underscores the larvae's role in metal nanoparticle research, advocating for its broader use to streamline development processes while minimizing ethical concerns.

Temporomandibular joint (TMJ) osteoarthritis (OA) leads to pain, limited jaw function, and bite changes. When non-invasive treatments fail, minimally invasive procedures like TMJ arthrocentesis with saline and hyaluronic acid (HA) injections are commonly used. Orthobiologics, including platelet-rich plasma (PRP) and cell-derived products, have gained attention for their potential to enhance tissue healing. This review aimed to compare the outcomes of orthobiologic injections with HA injections following arthrocentesis in TMJ-OA treatment. A systematic search, following PRISMA guidelines, identified nine studies (403 patients). Risk of bias was assessed using the Cochrane Risk of Bias Tool. PRP and cell-derived products showed potential benefits in reducing TMJ pain and improving maximum mouth opening (MMO). However, three of four studies comparing PRP with HA found no significant difference between the two. In contrast, cell-derived orthobiologics demonstrated significantly greater improvements in TMJ pain and MMO compared to HA. Risk of bias varied, with some studies showing moderate to high levels. This review highlights the potential but inconsistent benefits of orthobiologics in treating TMJ-OA. While cell-derived orthobiologics appear promising, PRP did not demonstrate superiority over HA. Further high-quality studies are needed to validate these findings.

Alzheimer's disease (AD) is an age-associated disorder characterized by cognitive decline, with dementia representing the final stage of a complex clinical-biological process rather than simply a more severe form of cognitive decline. Circular RNAs (circRNAs), novel non-coding RNAs, have emerged as key regulators of brain function and associated disorders. This study explores the role of circRNAs in AD by reviewing experimentally validated circRNAs in human and animal models. We identified 10 human (seven pathogenic, three protective) and six animal (three pathogenic, three protective) AD-related circRNAs. Experimental studies have confirmed that human protective circRNAs are predominantly downregulated in AD, where they function by sequestering specific miRNAs within cells, particularly miR-7, miR-142-5p, and miR-217, which have well-recognized neuroinflammatory functions. In-silico analysis revealed that circLPAR1 (pathogenic), circHUWE1 (pathogenic), and circHOMER1 (protective) interact with miRNAs that mainly control AD-related genes. Notably, circHOMER1 plays a key role in regulating multiple AD-related pathways, including autophagy, apoptosis, and PI3K-AKT and amyloid fiber formation. Furthermore, circRNA/protein interaction analysis revealed that circHUWE1 predominantly associates with RNA transport proteins, whereas circHOMER1 interacts with proteins involved in mRNA surveillance pathways. Remarkably, docking analysis demonstrated that circAβ-a (pathogenic) exhibits a strong affinity for eukaryotic translation initiation factor 4A3 protein, while circHOMER1 shows a higher binding affinity for DGCR8 microprocessor complex subunit protein. Our study presents a concise list of circRNAs as potential key targets for further investigation in AD research. Future experimental research is essential to uncover their precise mechanisms and assess their potential as biomarkers, offering promising avenues for developing interventions to alleviate cognitive decline in AD.

Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.

The correlation between air pollution and cancer incidence has been a longstanding concern, understanding the need to elucidate the specifics of this relationship. Thus, this study aimed to assess the association between exposure to air pollution and cancer incidence, and to identify the possible biological links between the two. We examined global cohort studies investigating the association between air pollution and cancer and performed a univariate Mendelian randomization (MR) analysis. Our analysis revealed that the presence of particulate matter (PM)2.5, PM10, NO2, and NOx substantially impacted the risk of developing cancer. MR analysis identified 130 CpGs sites associated with three ambient air pollutants that have significant casual effects on the risk of 14 cancer sites (false discovery rate<0.05). Gene annotation was conducted using g-Profiler by screening for single nucleotide polymorphisms significantly associated with outcome, followed by analysis of the gene interaction network using GeneMANIA, and visualization using igraph. In conclusion, this study demonstrates that air pollution has a significant impact on cancer incidence, provides strong evidence for an epigenetic causal link between the two, and provides new insights into the molecular mechanisms by which air pollution affects cancer development.

Fascioliasis is a zoonotic disease of public health and economic importance. It is caused by trematodes species Fasciola hepatica, and Fasciola gigantica. The parasites infest the liver particularly the bile ducts, and cause harm to the host. The economic loss to both dairy and meat industry is attributed to emaciation, reduction in milk production, death, infertility, and losses to liver condemnation. However, fascioliasis remains poorly studied and limited data is available to guide appropriate interventions especially in low- and middle-income countries. This paper aimed to review the prevalence and risk factors of animal fascioliasis in Eastern and Southern Africa between 2000 and 2023. Globally recognized databases including Science Direct, PubMed and Google scholar were used to search the related studies on fascioliasis conducted between 2000 and 2023 in accordance with PRISMA guidelines. A review of papers was done for risk factors of fascioliasis, and data was extracted. A total of 106 articles met the inclusion criteria, data was extracted, analyzed using meta package in R software (version 4.21), and presented both quantitatively and qualitatively. Forest plots at a 95 % confidence interval were generated to show the prevalence estimate of different subgroups and Cochran's Q statistic was used to measure the level of heterogeneity between studies. The prevalence estimates for different animal species in Eastern and Southern Africa were 47.5 % (95 % CI: 38.0-57.2 %) in mules, 23.3 % (95 % CI: 17.0-31.1 %) in sheep, 23.4 % (95 % CI: 19.2-28.2 %) in cattle, 23.2 % (95 % CI: 19.3-27.6 %) in donkeys, 12.2 % (95 % CI: 9.9-14.8 %) in horses, and 7.9 % (95 % CI: 5.4-11.5 %) in goats. These findings clearly demonstrate the high prevalence of fascioliasis in animals in Eastern and Southern Africa. We therefore recommend enhanced awareness and promotion of effective prevention measures for the Fasciola infection control to maximize benefits from livestock production.

Recent research underscores the significance of meniscal extrusion in knee osteoarthritis progression. Centralization of the meniscus has emerged as a potential intervention, yet comprehensive literature on this is limited. This systematic review aims to synthesize evidence on meniscus centralization's impact on extrusion and knee biomechanics. A search of PubMed Central and Scopus yielded 14 relevant articles until June 1, 2023. Included were 3 case series, 9 cadaveric studies, and 2 involving animals or patients. Biomechanical effects on both medial and lateral menisci were explored, alongside implications for anterior cruciate ligament reconstruction. Findings suggest centralization may mitigate extrusion and improve knee biomechanics, potentially benefiting clinical outcomes. However, further high-quality studies are warranted to validate these observations and ascertain optimal centralization techniques.

The aim of this review was to summarize the effectiveness of respiratory muscle training (RMT) in athletes in muscle strength, lung function and performance of athletes. Searches without date limits or language restrictions, in the databases: Medline via PubMed, Lilacs via Virtual Health Library, CENTRAL through the Cochrane Library, PEDro, EMBASE, ClinicalTrials.gov, reference lists of retrieved articles and gray literature. The selection of studies and data extraction was performed in duplicate by two independent reviewers. Twenty-five articles (involving 522 athletes) provided sufficient information to be included in the meta-analyzes. Most studies included swimmers and soccer players. The RMT was most commonly performed between 30 and 90% of MIP and/or MEP. Furthermore, in a meta-analysis involving 18 studies (different sports), RMT was favorable to increase MIP values (DM = 27.90cmH2O 95% CI: 16.18cmH2O to 39.62cmH2O, p = 0.00001) and in the meta-analysis involving soccer players, MEP values increased significantly (MD = 31.77cmH2O 95% CI: 22.49cmH2O to 41.05cmH2O, p = 0.00001). We conclude that the TMR favors the improvement of pulmonary function: MIP, FEV1, FVC, Tiffenau Index in athletes, mainly soccer players, who also improved their physical performance. However, these results are based on very low to low quality evidence.

Cervicogenic dizziness appears in 35-40 % of patients affected with neck pain. Conservative physical therapy treatment for this pathology is increasingly present in the scientific literature, However, there is limited evidence regarding the long-term effects of manual therapy on dizziness intensity and cervical range of motion (ROM). This research aims to address these gaps by analyzing the existing evidence to determine the efficacy of manual therapy for patients with cervicogenic dizziness.

To determine the effect of manual therapy in dizziness intensity and cervical range of motion in patients affected with cervicogenic dizziness.

A bibliographic search was carried out in the following databases: Pubmed, PEDro, WOS, Scopus and CINAHL from February to March 2022 and an update was carried out during March 2024. Randomized clinical trials were included with a minimum sample of 20 subjects, published in English, conducted on human subjects, with the presence of a group diagnosed with cervicogenic dizziness (CD) that received manual therapy treatment, and required to have a score on the PEDro scale ≥7. For the evaluation of the methodological quality, PEDro scale was used. For risk of bias assessment, the Cochrane RoB 2.0 tool was applied. The main outcomes studied were: dizziness intensity and cervical range of motion (ROM). Pain intensity, frequency of dizziness and functionality were also studied as secondary outcomes.

After applying the inclusion and exclusion criteria, a total of 8 articles were included for qualitative analysis. The mean score on the PEDro scale was 8.12 points. Most articles reflected a decrease in the intensity of dizziness and an increase in ROM in the short term, describing inconsistencies in the long term.

Scientific evidence supports the effect of manual therapy in patients with cervicogenic dizziness in terms of modifying the intensity of dizziness and cervical ROM, at least in the short term. While short-term benefits are consistent, long-term effects remain uncertain. Further research is recommended to explore lasting outcomes and optimize treatment approaches.

Odontogenic Keratocystic (OKC) and Ameloblastoma (AB) are pathological entities characterized by aggressive behavior, slow growth, local invasiveness, and high recurrence rates. The aim of this systematic review with meta-analysis and trial sequential analysis (TSA) is to assess the prognostic role of extracting involved teeth during the surgical enucleation of OKCs and ABs in terms of recurrence risk.

A search was conducted in PubMed/Medline, Scopus, and Web of Science databases for studies reporting data on teeth extraction and recurrence rates. This systematic review was performed according to guidelines in the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Meta-analysis was performed using the Mantel-Haenszel method with a random-effects model due to heterogeneity. The TSA was conducted to control and reduce for type I and II errors of statistical analysis.

Six studies were identified and analyzed qualitatively and quantitatively. A total of 737 lesions (674 OKCs and 64 ABs) were included, of which 508 had involved teeth. The meta-analysis included 451 OKCs; 367 lesions were treated with teeth extraction, and in 141 cases, the teeth were preserved. The overall Risk Ratio was 0.17 (95% CI: [0.04, 0.74]; P < .0001) for OKCs. Quantitative analysis could not be performed for ABs.

The analysis revealed that tooth extraction contextually to the enucleation of the lesion reduces the risk of recurrence by approximately 83% in the OKCs; this appears to have the same trend for ABs, but more evidence is needed.

Efforts to promote adaptation among smallholder farmers in Ghana have yielded a substantial body of research. Despite the growing body of research on climate adaptation in Ghana, existing studies remain fragmented, lacking a comprehensive synthesis of smallholder farmers' adaptation strategies and barriers. This study makes a novel contribution by providing the first agroecology-specific synthesis of climate change adaptation strategies among Ghanaian smallholder farmers. By disaggregating findings across six ecological zones, it reveals context-specific patterns and barriers, offering an evidence base for locally tailored and transformative adaptation planning within Ghana's agricultural sector. A systematic literature review was performed to assess Ghanaian smallholder farmers' adaptation strategies and identify any existing gaps for future research. From the 497 records reviewed, we identified 61 adaptation strategies employed by smallholder farmers. These strategies were organised into two categories: on-farm strategies-agricultural intensification and extensification-and off-farm strategies-livelihood diversification and migration. Additionally, several significant gaps were identified, including limited research on the effectiveness of adaptation strategies, the role of institutions in enhancing adaptive capacity, and how different livelihood capitals are mobilized, transformed, and combined to reduce livelihood sensitivity. Further gaps include the lack of integrated vulnerability analyses of crop-livestock farming systems and insufficient multi-scale research to examine how climatic and non-climatic stressors vary and interact across scales to exacerbate the vulnerability of farming households. Our findings emphasise the need for all stakeholders to increase investment in contemporary research and sustainable development initiatives to foster transformational adaptation in Ghana's agricultural sector.

Increasing evidence supports the use of neoadjuvant chemotherapy (NAC) prior to surgery for breast cancer. However, the optimal timing between NAC and surgery had yet to be fully elucidated. This meta-analysis aims to assess how the optimal interval time (OTT) between NAC and surgery affects outcomes in breast cancer, providing additional evidence for clinical practice and future research.

PubMed, Web of Science and Cochrane Library databases in English were systematically searched for this systematic review. All included studies investigated the variations in surgical timing following NAC and their effects on breast cancer outcomes. The endpoints included the rate of pathological complete response (pCR), overall survival (OS), recurrence free survival (RFS), and disease-free survival (DFS). This study has been registered with PROSPERQ.

Eleven eligible studies were identified, encompassing a total of 10,834 cases, all of which received surgery post-NAC. All studies were retrospective in nature. Ultimately, compared to intervals within 4 weeks, patients who underwent surgery>8weeks post-NAC demonstrated a statistically significant worse OS (HR = 1.21, 95 % CI: 1.06-1.40, p = 0.333 for heterogeneity). No significant difference of OS was observed between patients with OTT of 4-8 weeks vs < 4 weeks. Notably, patients with an OTT of 4-8 weeks (HR = 1.18, 95 % CI: 1.10-1.26, I2 = 0.0 %, p = 0.931 for heterogeneity) and>8weeks (HR = 1.21, 95 % CI: 1.13-1.29, I2 = 36.2 %, p = 0.195 for heterogeneity) exhibited decreasing RFS, compared with those with OTTs of<4 weeks. DFS and pCR rates were similar in>8weeks vs < 4 weeks and 4-8weeks vs < 4 weeks.

Our systematic review and meta-analysis indicate that the optimal interval following NAC for breast cancer patients might be within four weeks, as delays exceeding eight weeks could be associated with poorer clinical outcomes. However, additional research is necessary to validate these preliminary findings.

A systematic literature search and meta-analysis were performed to evaluate the variability in biomechanical testing of murine long bones, specifically focused on point-bending tests of mice femora. Due to the lack of standardized protocols for these tests, the assessment quantifies the heterogeneity in reported mechanical properties across existing literature. This study followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) and strengthening the reporting of observational studies in epidemiology (STROBE) guidelines to search publicly available databases for relevant studies. After title and abstract screening, full-text reviews identified 73 articles meeting the inclusion criteria. Data was extracted from these studies, including stiffness, maximum load, modulus, and ultimate stress values for both three-point and four-point bending tests. The data were analyzed through ANOVA and metaregression to assess variability caused by age, sex, and genetic strain. The reviewers also assessed the quality of the included studies. The meta-analysis revealed significant heterogeneity in reported mechanical properties, with I2 values ranging from 72% to 100% in the three point-bend tests of pooled genetic strains. This heterogeneity persisted even after accounting for age, sex, and genetic strain differences. The review concludes that nonstandardized testing setups are the likely major source of the observed variability in reported data more than the population characteristics of the mice, highlighting the need for more consistent testing methodologies in future studies.

ObjectiveThe current mixed-methods systematic review evaluated available literature to find out which attachment-based interventions have been implemented for people with intellectual disability and whether they are efficacious and acceptable.MethodsFive databases were searched (in July 2023 and April 2024), using terms related to intellectual disability and attachment-based interventions. The search yielded 793 papers; 15 papers (13 studies) met inclusion criteria. Relevant data was extracted from each study. Paper quality was appraised using the Mixed Methods Appraisal Tool. Findings were synthesised in an integrative review.ResultsOf the included studies, 7 had people with intellectual disability as participants and 6 had their caregivers. Interventions included education, psychotherapy, technology assisted therapy, video interaction guidance/feedback and circle of security. Research methods varied.ConclusionsEvidence for efficacy and acceptability of interventions was mixed but promising. Most studies had limited generalisability. Therefore, further research is required. Pre-registration with PROSPERO [351287].

Pregnancy requires a careful immune balance between tolerance for the semi-allogenic fetus and protection against pathogens. Women with immune-mediated inflammatory diseases (IMIDs), where the interleukin (IL)-23/IL-17 axis plays an important role, often experience changes in disease severity during pregnancy. These changes and the association between disease flares and pregnancy complications, suggests a role for IL-17 and IL-23 in pregnancy.

We systemically searched PubMed, EMBASE, and Web of Science (March 2024), to assess the role of IL-17 and IL-23 in pregnancy-related in vitro assays, animal or human studies.

Eighty articles (8 in vitro, 11 animal and 61 human studies) were included. Seventy-one studies reported on IL-17 and 16 studies on IL-23. In vitro trophoblast proliferation, migration and invasion was increased in the presence of IL-17, but impaired with IL-23. IL-17 levels were increased in animal models for pregnancy complications. In humans, IL-17 levels seemed to be increased in pregnant women versus non-pregnant women. Additionally, elevated IL-17 levels were associated with pregnancy complications. Although similar trends were found for IL-23, data were limited.

We identified a large, but heterogenic, body of evidence for a significant role of IL-17 in all stages of pregnancy: while an excessive increase seemed to be associated with complications. The limited number of studies prevents firm conclusions on the role of IL-23. Future research is needed to find biomarkers for patients with IMIDs to predict the effect of possible disease flares on pregnancy, and the effect of therapeutic inhibition of IL-17 or IL-23.

West Nile Virus (WNV) exemplifies the complexities of managing vector-borne diseases, expanding globally due to human activities and ecological changes. Originating from Africa and transmitted by Culex mosquitoes, WNV is now reported across multiple continents. The aim of this study was to identify the environmental, ecological, and individual factors influencing WNV transmission.

An umbrella review was conducted. Comprehensive searches were performed in PubMed, Scopus, Web of Science, Embase, and LILACS. Inclusion criteria were reviews involving WNV transmission agents (reservoirs, vectors, hosts) and associative analyses between environmental, ecological, or individual factors and WNV transmission. Data extraction and quality appraisal were performed using templates and the AMSTAR 2 tool.

From 404 retrieved studies, 23 systematic reviews and meta-analyses were included. Almost 70 % were low or critically low quality. The co-occurrence network highlighted emerging research on climate change and environmental factors. Temperature, precipitation, and land use significantly influence WNV transmission. Warmer temperatures enhance mosquito populations and viral replication, while extreme weather events like droughts increase mosquito-human contact. Climate change significantly contributes to WNV dynamics by altering temperature and precipitation patterns, enhancing vector proliferation, and extending transmission seasons. Ecological factors such as higher avian diversity, vegetation indexes, and distribution of mosquito species can impact WNV transmission significantly. Education and income levels influence preventive behaviors and infection risk, with lower socioeconomic status linked to higher WNV risk. Certain occupational groups are also at elevated risk of WNV infection.

Environmental factors like temperature and precipitation critically affect WNV transmission by influencing mosquito behavior and avian reservoir dynamics. Socio-economic status and education levels significantly impact individual preventive behaviors and infection risk. Multifactorial influences on infection risk make necessary integrated surveillance systems and public health strategies. Longitudinal studies with One Health approaches are necessary to better understand WNV dynamics and reduce WNV transmission.

Sewer-associated rodents inhabiting urban and peri-urban areas constitute a potential infection source for many zoonotic pathogens at a global scale. However, there is a lack of scientific information about the implications of these micromammals in regions with fragile sanitary services, low economic resources and weak educational systems. Consequently, this study aimed to review the scientific knowledge about rodent-borne zoonoses in sewer-related environments from countries with lower Human Development Index (HDI). Our results revealed a low number of publications (n = 13) evaluating the epidemiology of sewer-associated rodents in countries with lower HDI, which were distributed across Central/South America (69.2 %; 9/13), Africa (23.1 %; 3/13) and Asia (7.7 %; 1/13). The most evaluated rodents were Rattus norvegicus -brown rat- (present in 10/13 articles), followed by Rattus rattus -black rat- (6/13) and Mus musculus -house mouse- (5/13). Fourteen zoonotic pathogens were assessed, specifically bacteria (n = 6 publications) and parasites (n = 7), with the highest prevalence described for Bartonella spp. (85.0 %), Calodium hepaticum (83.8 %), Rickettsia spp. (75.0 %), Leptospira spp. (68.0 %) and Hymenolepis nana (60.0 %). Most reviewed publications described the use of molecular methods and direct examination of samples to identify the pathogens studied (46.2 %; 6/13 each), followed by the MALDI-TOF technique (15.4 %; 2/13). The four clusters building the semantic network reinforced the pivotal role of sewer-associated rodents as reservoirs of both vector-borne pathogens and directly transmitted zoonoses. Our findings evidence a severe gap of knowledge in lower-resource areas about the role of sewer-associated rodents in the epidemiology of zoonotic diseases, which could impact on the sanitary system of not only the evaluated countries, but also in other developed and non-developed regions worldwide.

Binge eating is defined as eating abnormally large amounts in a brief period of time. Many animal studies have examined the behavioural and physiological effects of binge eating of high-fat, high-sugar foods to model the consequences of human binge eating. The present systematic review of 199 rodent studies sought to identify the behavioural and physiological consequences of binge eating and determine whether changes were specific to binge eating or to general effects of exposure to a palatable diet. A meta-analysis of 18 rodent studies revealed that binge eating produces greater anxiety-like behaviour on the Elevated Plus-Maze with a small effect size and significant funnel plot asymmetry, suggesting that the true effect size is overestimated. A history of binge-like access generally increases progressive ratio breakpoint for the binged food, without altering 'liking' as measured by lick microstructure, suggesting that dissociable effects on 'wanting' but not 'liking' accompany binge eating behaviour and contribute to its persistence. Binge eating appears to enhance compulsive food-seeking behaviour and prevent stress-induced reductions in intake but does not appear to alter depression-like behaviour or locomotor activity. Notably, binge eating may produce comparable metabolic impairments to those observed after extended continuous exposure to a palatable diet despite no overall effects on body weight outcomes in most studies.

The increasing use of remote patient care for individuals with scoliosis has created opportunities for the development and utilization of different tools and methods of evaluation. The aim of this study was to determine the clinical postural variables evaluated in patients with scoliosis through telehealth.

Systematic searches were conducted by two independent reviewers in the PubMed, Scopus, EMBASE, and IEEE databases using the MeSH terms "scoliosis" and "telemedicine" and their synonyms. This study followed the MOOSE guideline (Meta-analysis of Observational Studies in Epidemiology). The methodological quality assessment was performed using the Critical Appraisal Skills Program (CASP).

136 studies were found in the databases, and 20 were found through manual search of references. After removing duplicates (n = 41), 81 studies were excluded, leaving 14 for full-text reading. Of these, six studies were included for qualitative synthesis, with a total of 1002 subjects. Were identified: angle of trunk rotation (ATR), angle between body segments (in development), movement - oscillations per second (Hz/s), impedance (Ohms/mm), synchronous postural observation, and aesthetic deformity. Only two studies provided validity and reproducibility coefficients, however, it was not possible to conduct a meta-analysis because the presented coefficients were different.

The angle of trunk rotation, angle between body segments, movement - oscillations per second (Hz/s), impedance (Ohms/mm), synchronous postural observation, and aesthetic deformity were the clinical postural variables evaluated through telehealth. Further research is needed to focus on the development, validation, and reproducibility of assessment instruments for patients with scoliosis through telehealth.

BackgroundMixed reality (MR) is an emerging technology that has been employed in medicine, providing a holographic representation of patient anatomy.PurposeThe aim of this review is to examine the use of imaging-derived holograms in the management of musculoskeletal conditions.Research DesingA literature search was performed on PubMed, Embase, Web of Science, Scopus, and Google Scholar up to June 2023, a total of 31 studies were included. A random-effects model was employed for the meta-analysis.ResultsMR has been extensively used in orthopedic surgery, spinal surgery, and interventional procedures for pain management. A 3D model is derived from DICOM images and superimposed on the surgical field. The procedure's accuracy has yielded remarkable results, especially for operators with less surgical experience. Furthermore, this technology minimises the need for intra-procedure imaging, thus reducing radiation exposure.ConclusionThe meta-analysis showed an impact of MR in reducing operatory time and improving inexperienced surgeons' accuracy.

Animal models investigating sevoflurane or compound A and renal function serve as the initial basis for concerns regarding renal injury following sevoflurane anesthesia and subsequent recommendations of minimum fresh gas flow, but this evidence basis has not been critically appraised. Primary literature searches were performed in MEDLINE OVID, PubMed, EMBASE, the Cochrane Library), the Cochrane Central Register of Controlled Trials, the International HTA Database, CINAHL, and Web of Science to identify randomized controlled trials and quasi-experimental studies in animals utilizing sevoflurane or compound A. The primary outcomes included renal function as determined by blood urea nitrogen, serum creatinine, creatinine clearance, and urine volume. The secondary outcomes included the serum fluoride concentration and histopathological findings. A total of 2537 records were screened, and 21 randomized controlled trials and 9 quasi-experimental animal studies were identified. No associations between sevoflurane exposure and subsequent changes in renal function (blood urea nitrogen, serum creatinine or changes in urine volume) were noted. A similar effect on renal function was observed following compound A exposure, but urine volume was elevated following compound A exposure. In addition, the histopathological damage following compound A exposure was observed only at concentrations that are unachievable in clinical practice. Our review of evidence from animal models revealed that sevoflurane usage was not associated with changes in renal function tests or urine volume. Histopathologic changes after sevoflurane exposure were either nonexistent or minor. Studies on compound A did not reveal an alteration in renal function, although histopathological evidence of injury was present when compound A was administered at very high, unphysiologic concentrations. In light of the existing evidence, the initial concerns of sevoflurane-related nephrotoxicity based on animal studies that leads to minimum fresh gas flow recommendations are called into question.

Direct oral anticoagulant (DOAC) agents are established as the anticoagulation strategy of choice for a variety of clinical risks. Despite this, uncertainty still exists with regard to their efficacy and safety for the prevention of stroke and systemic embolism in some patient populations; most notably those with low body weight (LBW) (<60 kg or body mass index [BMI] <18 kg/m2). Currently, there is a paucity of trial and non-trial data to support a prescriptive recommendation for their use in these patient cohorts. We have carried out a pooled systematic review of the most up to date published data of patients stabilized on various DOAC analogs with the view to ascertaining the exact matrices of their efficacy and safety in these cohorts of patients.

We initially carried out a comprehensive search of databases from inception to June 2023 for eligible studies exploring the efficacy and safety of various analogs of direct oral anticoagulants in patients with atrial fibrillation who had low body weight. Databases accessed include PubMed, EMBASE, the Science Citation Index, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effectiveness. We carried out a weighted comparison of derived pooled odd ratios (with their corresponding confidence intervals) of mortality outcomes between various DOACs using the random effects model.

Thirteen studies (n = 165,205 patients) were included in our meta-analysis. DOAC analogs were associated with increased stroke-related events, composite outcome, and mortality in low body weight patients compared to non-low body weight patients (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.17-1.92), (OR 1.55, 95% CI 1.29-1.86), (OR 2.92, 95% CI 1.87-4.58), respectively. There was no significant difference in the safety outcome (major bleeding events) between the DOAC analogs (OR 1.19, 95% CI 0.93-1.52).

In this meta-analytical review comprising both real-world and randomized controlled studies, the use of DOAC analogs in low body weight patients (body weight of <60 kg or BMI<18 kg/m2) with atrial fibrillation was associated with increased risks of stroke-related events, composite outcomes, and mortality compared to non-low body weight cohorts patients. At the same time, there was no significant difference in terms of major bleeding events. This finding has provided the first resolution of pervading uncertainty surrounding the use of DOAC analogs in these patient cohorts and suggests the need for follow-up confirmatory systematic studies in this group of patients.

Continuous deep sedation until death (CDS) is a procedure commonly used in palliative care to alleviate refractory symptoms in terminally ill patients. This systematic review aims to explore the experiences of both healthcare providers (HCPs) and relatives regarding the use of CDS, highlighting emotional, ethical, and practical implications.

A systematic search was conducted in six electronic databases (Embase, PsycINFO, PubMed, Scopus, Web of Science, Cairn). Studies were included if they focused on the experiences of HCPs and/or relatives related to CDS in terminally ill adults. The Crowe Critical Appraisal Tool (CCAT) was used to assess the quality in the included studies.

A total of 40 studies were included, comprising 9260 HCPs and 1062 relatives. The review identified four main themes: decision-making processes, emotional and psychological adjustment, ethical concerns regarding the distinction between CDS and medical assistance in dying and communication challenges. CDS was found to contribute to a "good death" from the perspective of many relatives, though concerns about hastening death were noted. Healthcare providers reported mixed emotions, including ethical dilemmas and emotional burden when administering CDS. Communication issues between families and healthcare teams were highlighted as key challenges.

CDS can alleviate suffering but raises ethical and communication challenges for both families and healthcare providers. Clearer guidelines, enhanced support systems, and improved communication strategies are essential for better CDS practices.

 Duodenal atresia is one of significant causes of neonatal intestinal obstruction. It often co-occurs with Down syndrome. This study is conducted to estimate the global prevalence of duodenal atresia in Down syndrome patients and to investigate associated factors.

 Conducting a systematic review with meta-analysis of 18 eligible studies reporting duodenal atresia prevalence in pediatric Down syndrome patients. Study quality is assessed using the Newcastle-Ottawa Scale. The subgroup analysis on region, study quality, publication year, and design is addressed. Gender-specific prevalence rates are examined.

 The pooled prevalence of duodenal atresia in Down syndrome is 3.0%, with significant heterogeneity. The Middle East reports a higher prevalence of 6.0%, while Latin America, India, and Canada exhibit a lower prevalence of 1.0%. High-quality studies demonstrate 2% prevalence, while moderate-quality studies report 4.0%. Gender analysis indicates a similar incidence for females and males at 3.0%. Prevalence varies with study design: case-control studies report 4.0%, cross-sectional studies report 2.0%, and prospective cohort studies report 2.0%.

 Duodenal atresia is common in Down syndrome patients, affecting 3.0% of the patients worldwide. Regional variations exist, necessitating further investigation. Gender does not significantly impact prevalence. This study highlights the need for region-specific research to enhance clinical decision-making for individuals with Down syndrome and duodenal atresia.

The association between periodontitis and dementia remains controversial. Therefore, we analyzed this association focusing on the severity of periodontitis and type of dementia.

We searched the PubMed, Embase, Web of Science, and gray literature (OpenGrey, ProQuest) databases from inception to June 30, 2021, and pooled the data for meta-analysis. Fixed- or random-effects models were employed to calculate odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) to evaluate the strength of the associations between periodontitis and dementia.

Thirteen case-control and 11 cohort studies were selected. The analysis of entire studies indicated an association between periodontitis and dementia, with an OR of 2.26 (95% CI, 1.65-3.09; P < .0001) and HR of 1.15 (95% CI, 1.04-1.27; P = .0006). According to periodontitis severity, the risk of dementia was significantly associated with severe periodontitis (OR = 2.85; 95% CI, 2.16-3.74; P = .038), but not with less-than-moderate periodontitis (OR = 0.94; 95% CI, 0.64-1.40; P = .66). In particular, patients with severe periodontitis had a 6.87-fold higher risk of Alzheimer's dementia (OR = 6.87; 95% CI, 2.55-18.54; P = .04) and 2.92-fold higher risk of cognitive impairment (OR = 2.92, 95% CI, 2.15-3.96; P = .36).

We found a strong association between periodontitis and dementia, with severe periodontitis identified as a potential risk factor for Alzheimer's dementia. Therefore, timely management of periodontitis to prevent its progression may help prevent dementia.

Inborn errors of immunity (IEI) are congenital disorders of the immune system. Due to impaired immune system, they are at a higher risk to develop a more severe COVID-19 course compared to general population.

Herein, we aimed to systematically review various aspects of IEI patients infected with SARS-CoV-2. Moreover, we performed a meta-analysis to determine the frequency of COVID-19 in patients with different IEI.

Embase, Web of Science, PubMed, and Scopus were searched introducing terms related to IEI and COVID-19.

3646 IEI cases with a history of COVID-19 infection were enrolled. The majority of patients had critical infections (1013 cases, 27.8%). The highest frequency of critical and severe cases was observed in phenocopies of IEI (95.2%), defects in intrinsic and innate immunity (69.4%) and immune dysregulation (23.9%). 446 cases (12.2%) succumbed to the disease and the highest mortality was observed in IEI phenocopies (34.6%). COVID-19 frequency in immunodeficient patients was 11.9% (95% CI: 8.3 to 15.5%) with innate immunodeficiency having the highest COVID-19 frequency [34.1% (12.1 to 56.0%)]. COVID-19 case fatality rate among IEI patients was estimated as 5.4% (95% CI: 3.5-8.3%, n = 8 studies, I2 = 17.5%).

IEI with underlying defects in specific branches of the immune system responding to RNA virus infection experience a higher frequency and mortality of COVID-19 infection. Increasing awareness about these entities and underlying genetic defects, adherence to prophylactic strategies and allocating more clinical attention to these patients could lead to a decrease in COVID-19 frequency and mortality in these patients.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce major cardiovascular events among individuals with heart failure regardless the ejection fraction. The effect of SGLT2 inhibitors on health-related quality of life (HRQoL) and physical capacity are still unclear.

To investigate the effects of SGLT2 inhibitors on HRQoL and physical capacity in patients with heart failure.

We systematically searched PubMed, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing SGLT2 inhibitors to placebo in this population. The outcomes analyzed were mean changes in Kansas City Cardiomyopathy Questionnaire (KCCQ) score and its domains: total symptoms score (TSS), physical limitations score (PLS), clinical summary score (CSS) and overall summary score (OSS), as well as the six-minute walk test (6MWT) and peak oxygen uptake (peak VO2).

Eighteen RCTs with 23,848 participants were included. There was a statistical significant improvement in KCCQ TSS (MD: 3.33; 95% CI 1.84 to 4.81; p < 0.001) in HFrEF, HFpEF and non-diabetic subgroups. Consistent findings were found in KCCQ PLS, KCCQ CSS, and KCCQ OSS. The distance covered in the 6MWT was significant higher (MD: 12.8; 95% CI 1.06 to 24.54; p = 0.03) and peak VO2 was increased (MD: 1.06; 95% CI 0.57 to 1.55; p < 0.001).

SGLT2 inhibitors improve HRQoL and functional capacity in patients with HF regardless the ejection fraction and co-diagnosis of diabetes.

This meta-analysis evaluates and compares the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) with conventional microbiological tests (CMTs) in diagnosing pediatric pneumonia using bronchoalveolar lavage fluid (BALF).

Data were sourced from Embase, PubMed, Web of Science, and the Cochrane Library. The pooled positive detection rate (PDR) of pathogens was estimated using fixed-effects or random-effects models. Subgroup analyses explored factors influencing mNGS diagnostic performance. Data analysis was conducted using Review Manager (RevMan) 5.4 and Stata version 16.0.

The pooled PDR of mNGS was 85.83 %, which is higher than the pooled PDR of 49.97 % for CMTs. A random-effects model indicated that, compared to CMTs, mNGS has a significantly higher PDR in pediatric pneumonia (OR = 3.99, 95 %CI: 2.12-7.50, P < 0.0001, I2 = 81 %). Subgroup analysis indicated that mNGS exhibited greater advantages in the group using the QIAamp kit (OR = 5.55, 95 % CI: 3.03-10.16, P < 0.00001), the group using the Illumina Nextseq platform (OR = 4.87, 95 % CI: 2.97-7.99, P < 0.00001), the DNA-only mNGS group (OR = 4.54, 95 % CI: 2.73-7.54, P < 0.00001), and the non-severe pneumonia group (OR = 4.76, 95 % CI: 3.51-6.46, P < 0.00001). However, when the subgroups were categorized as mixed infections or single-pathogen infections, no statistically significant differences were observed (Mixed: OR = 1.77, 95 % CI: 0.30-10.56, P = 0.53; Single: OR = 3.97, 95 % CI: 0.42-37.87, P = 0.23) CONCLUSION: mNGS demonstrates high diagnostic efficacy in detecting pathogens in BALF from pediatric patients with pneumonia. The diagnostic stability of mNGS is influenced by sample extraction, sequencing platforms, positive interpretation criteria, and disease status. Standardized procedures and technologies can enhance mNGS diagnostic performance.