This study aims to compare the efficacy and safety of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) for pancreatic neoplasms. A meta-analysis following PRISMA guidelines, registered on PROSPERO, included randomized controlled trials (RCTs) and propensity-score matched studies. Data from Cochrane Central, PubMed, and Embase were analyzed, focusing on procedure efficacy (e.g., length of hospital stay and reoperations), oncologic outcomes (e.g., R0 resections), surgical outcomes (e.g., blood loss and operative time), and postoperative outcomes (e.g., 90-day mortality, severe complications, pancreatic fistula). Among 23 studies, MIDP showed significantly reduced 90-day mortality (OR: 0.57, p = 0.03), severe (CDC ≥ III) complications (OR: 0.81, p = 0.04), hospital stay (MD: 2.38 days, p < 0.01), reoperations (OR: 0.65, p < 0.01) and blood loss (MD: 137.66 mL, p < 0.01) compared to ODP. No significant differences were found in postoperative pancreatic fistula (OR: 1.06, p = 0.74) or operative time (MD: 1.95 min, p = 0.87). ODP showed a significantly lower incidence of R0 resections (OR: 1.57, p < 0.01). Subgroup analyses of RCTs favored MIDP for 90-day mortality, severe complications, and hospital stay, but found no differences in pancreatic fistula or operative time. Meta-regression identified age and tumor size as influential covariates. MIDP offers superior outcomes in procedure efficacy, surgical and postoperative outcomes compared to ODP. These findings highlight MIDP as a safe and effective alternative for pancreatic surgery, supported by robust subgroup and sensitivity analyses.

In this meta-analysis, we provide the findings of randomized controlled trials on the levels of inflammatory markers in patients with obstructive sleep apnea (OSA) receiving continuous positive airway pressure (CPAP).

Literature published in the PubMed, Web of Science, Embase and Cochrane databases up to May 21, 2024, was comprehensively searched, and inclusion and exclusion criteria were developed. Pooled estimates of CPAP therapy were analyzed via the standardized mean difference (SMD). This meta-analysis follows the PRISMA 2020 guidelines and is registered with PROSPERO (ID CRD42024548588).

A total of 15 studies were included, each reporting data on one or more inflammatory markers, as follows: 10 studies on C-reactive protein (CRP), 12 studies on interleukin-6 (IL-6), 3 studies on interleukin-8 (IL-8), and 9 studies on tumor necrosis factor-α (TNF-α). The results revealed that the SMDs (95% confidence intervals [CIs]) for CRP, IL-6, IL-8 and TNF-α levels before and after CPAP treatment were 0.88 (95% CI 0.28-1.48), 0.58 (95% CI 0.12-1.05), 0.20 (95% CI 0.39-0.80) and 0.17 (95% CI 0.05-0.29), separately.

CPAP therapy used for a certain duration can lower CRP, IL-6 and TNF-α levels in OSA patients, and there are substantial differences observed in the various inflammatory indicators. To confirm the usefulness of these biomarkers in evaluating CPAP therapy for cardiovascular risk reduction among OSA patients, more randomized controlled trials (RCTs) have to be carried out in the future.

The fertility effects of antiseizure medications (ASMs) have been highlighted in females of reproductive age; however, the effects in males have not been extensively analyzed. This review aims to summarize the existing evidence of how ASMs affect sexual hormones and functions in males with epilepsy. We searched the Embase, PubMed, and MEDLINE databases in January 2024 to identify studies measuring sexual hormones, sexual function, or sperm parameters of males with epilepsy taking any ASM except valproic acid who were compared to a control group. A systematic review summarizing the effects of valproic acid on sexual function was published in 2018; therefore, we excluded valproic acid to avoid duplicating existing evidence. Risk of bias assessments were specific to the study type and included the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, NIH Quality Assessment Tool for Before-After (Pre-Post) Studies, and Cochrane Risk of Bias-2 tool for randomized trials. The systematic review included 32 studies, and the meta-analysis included 22 studies. Using random effect models, we calculated mean differences or rate ratios for studies assessing the association between ASMs and male sexual hormones or functions. Analyses were run for each combination of individual ASM or ASM characteristic, outcome, and comparison group. Males taking oxcarbazepine had significantly higher levels of testosterone, luteinizing hormone, and follicle-stimulating hormone compared to healthy controls. Conversely, there was no evidence of differences in any outcomes between levetiracetam or lamotrigine and comparison groups. Analyses that included untreated males with epilepsy rarely differed from males taking ASMs, highlighting the potential importance of epilepsy on altered sex hormones and functions. However, results should be interpreted cautiously, as many analyses included only a few studies and had high heterogeneity.

Steatotic liver disease (SLD) affects ~30% of adults worldwide. The global population is continuously threatened by epidemic and endemic viral diseases. This study aims to thoroughly examine the interaction between SLD and major viral diseases.

We systematically searched databases from inception to April 2, 2024, for observational studies recording viral-infected adult patients with eligible data on the presence of hepatic steatosis.

Six hundred thirty-six eligible studies were included in the analysis of SLD prevalence. Among patients with monoinfections, the highest SLD prevalence was observed in those infected with HCV at 49% (95% CI: 47%-51%), followed by SARS-CoV-2 (39%, 95% CI [34%-44%]), HIV (39%, 95% CI [33%-44%]), and HBV (36%, 95% CI [32%-40%]). Additionally, co-infections, such as HCV-HIV and HBV-HCV, exhibit even higher SLD prevalence. The prevalence of steatohepatitis is particularly high in HIV-infected (24%, 95% CI: 17%-30%) and HCV-infected (18%, 95% CI: 13%-24%) populations. The co-existence of SLD with viral infections was associated not only with the progression of liver disease but also with more severe outcomes of the infections and poorer responses to antiviral treatment. The combination of cardiometabolic risk factors and viral-associated and host factors contributes to the higher risk of SLD in viral-infected populations.

SLD is highly prevalent in viral-infected populations, and the reciprocal interactions between SLD and viral diseases exacerbate both conditions, leading to poorer patient outcomes in general.

While the outcomes of patients with cancer have improved, the prognosis for those requiring invasive mechanical ventilation (IMV) remains poor. High-flow nasal cannula (HFNC) can be used as a management strategy to avoid IMV.

To determine the efficacy and safety of HFNC compared to other non-invasive oxygenation techniques among patients with cancer.

This systematic review was prospectively registered and followed PRISMA guidelines. Literature searches were conducted from inception to May 17th, 2023, across MEDLINE, EMBASE, CINAHL, CENTRAL, and Web of Science. We included observational studies and randomized controlled trials enrolling adults (≥18 years of age) with an underlying cancer diagnosis that compared HFNC to at least one other form of non-invasive oxygenation.

Seven (n = 501) medical and 4 (n = 379) post-esophagectomy studies were included. There were no significant differences in all-cause mortality (n = 573; RR 0.81; 95 % CI: 0.48 to 1.36; I2 = 9 %) or invasive mechanical ventilation (IMV) (n = 540; RR 0.89; 95 % CI: 0.62 to 1.28; I2 = 47 %). HFNC was associated with lower nose/mouth dryness overall (n = 398; RR 0.37; 95 % CI: 0.24 to 0.58; I2 = 20 %). Across post-esophagectomy studies, HFNC was associated with shorter hospital length of stay (LOS) (n = 309; MD -88.73 h; 95 % CI: 108.94 to -68.52 h; I2 = 0 %). Among medical studies, one study reported a shorter hospital LOS.

Among hospitalized patients with cancer, there were no significant differences in mortality, IMV use, ICU LOS, or skin damage. Across both cohorts, HFNC was associated with shorter hospital LOS and lower rates of nose/mouth dryness compared to other non-invasive oxygen techniques.

CRD42022303621.

Transfemoral access (TFA) is the standard for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Transradial access (TRA) is a feasible alternative. Despite advances, no recent systematic review or meta-analysis exists, highlighting the need for updated evidence.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases were searched up to February 2024 for articles comparing TRA with TFA for MT in AIS. Studies were included if they reported at least one outcome, with at least 10 patients per group. Random-effects models were applied, with odds ratios (ORs) used for dichotomous outcomes and mean differences (MDs) for continuous outcomes.

Our analysis included 763 TRA patients and 3527 TFA patients, with one randomized study and nine observational studies. We found no significant differences in successful recanalization (OR 0.88, 95% CI: 0.59-1.32), complete recanalization (OR 1.15, 95% CI: 0.92-1.43), first pass effect (OR 0.83, 95% CI: 0.68-1.01), puncture-to-recanalization time (MD -1.67, 95% CI: -7.48 to 4.13), access site complications (OR 0.70, 95% CI: 0.28-1.76), symptomatic intracranial hemorrhage (OR 0.93, 95% CI: 0.62-1.39), crossover (OR 1.71, 95% CI: 0.75-3.92), number of passes (MD 0.17, 95% CI: -0.08-0.41), length of hospitalization (MD -0.59, 95% CI: -1.28-0.09), and favorable outcomes at 3 months (OR 0.85, 95% CI: 0.58-1.23). Trial sequential analysis showed that successful recanalization, puncture-to-recanalization time, and first pass effect did not reach the required information size, indicating inconclusive results, whereas access complications analysis suggested a high probability of similarity between the two treatments.

TRA is a viable alternative to TFA for MT in AIS, with comparable safety and efficacy. Although current evidence does not support widespread adoption, the introduction of radial-specific devices and advancements in operator training could improve outcomes. Further randomized trials with larger sample sizes are needed to clarify TRA's role and optimize neurointerventional practices compared with TFA.

Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.

We conducted a systematic search from database inception until October 2024. The primary effectiveness outcome was complete occlusion rate defined by the Raymond-Roy and/or O'Kelly-Marotta scales. Primary safety outcomes included thromboembolic event rates following implantation. Secondary outcomes included procedure-related mortality, good functional outcome (GFO), and retreatment. Pool estimates were calculated using a random-effect model. Subgroup analysis based on morphology and study design was also conducted.

A total of 42 studies met our inclusion criteria. A total of 1698 patients were treated with FDs for 1760 PC aneurysms. Among these cases, 47.6% were in the vertebral artery. Our pooled overall analysis of complete occlusion rates was 72.73% (P<0.0001; I2=67.2%), and the pooled thromboembolic events rate following implantation was 11.70% (P<0.0046; I2=70.5%). Additionally, the pooled mortality rate was 8.07% (P<0.0001; I2=61.5%), the retreatment rate was 6.59% (P<0.4260; I2=1%), and the pooled GFO rate was 83.99% (P<0.0001; I2=76%). Subgroup analysis revealed that fusiform-dolichoectatic had a complete occlusion rate of 48.29% (P<0.3223; I2=11.7%).

FDs for PC aneurysms achieve generally adequate occlusion rates, except in dolichoectatic-fusiform subtypes. Despite achieving adequate occlusion rates, FD use was associated with higher thromboembolic events, mortality, and retreatment rates, which necessitates careful patient selection.

Objectives: This systematic review with meta-analysis compared cardiometabolic syndrome (CMS) in adults with chronic (≥1 year) spinal cord injury (SCI) to non-SCI individuals (controls) and athletes, analyzing the effect of specific injury characteristics and exploring temporal and geographical trends. Methods: Ovid Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from inception to September 2024. Adults with chronic SCI were included based on observational and baseline data derived from experimental studies. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields assessed quality. Weighted means with 95% bootstrapped confidence intervals (CI) were computed for risk stratification. Group differences were assessed using random effects meta-analysis, calculating weighted mean differences with 95% bootstrapped CI. Temporal and geographical trends were evaluated with linear regression based on sample-size-weighted distributions and relevant covariates. Results: Of 31,163 identified records, 471 studies were included (n ≤ 31,782 SCI participants). CMS was present in men with SCI, paraplegia, tetraplegia, and injuries above T6; men with complete SCI (AIS A); and men and women with motor-complete SCI (AIS A-B). Compared to controls, adults with SCI had a lower body mass index (BMI), higher total and visceral fat, and worse lipid and carbohydrate profiles, including increased insulin resistance (IR). Tetraplegia was associated with greater visceral fat, poorer glycemic control, and lower BMI, insulin sensitivity, high-density lipoprotein-cholesterol (HDL-C), and triglycerides than paraplegia. Motor-complete SCI had lower BMI, HDL-C, and fasting glucose than motor-incomplete injuries. Injuries above T6 had lower blood pressure and higher fasting insulin levels than those below T6. Athletes with SCI had a lower BMI, fat mass, and fasting glucose, and higher systolic blood pressure than non-athletes with SCI, but frequently presented with obesity and carbohydrate dysfunction. Temporal analysis revealed increasing obesity trends and improved systolic blood pressure, while other CMS risk factors remained unchanged. We also identified global variations in obesity, lipids, blood pressure, and carbohydrate patterns. Conclusions: With a large sample, we revealed a widespread cardiometabolic burden in chronic SCI, even among athletes. Specifically, obesity, IR, and hypoalphalipoproteinemia worsened with increasing injury severity, alongside rising obesity trends and geographic disparities in risk profiles. These patterns highlight the evolution of what was deemed an epidemic into a global cardiometabolic pandemic.

In an unselected obstructive sleep apnoea (OSA) population, continuous positive airway pressure (CPAP) slightly lowers blood pressure (BP). The aim was to investigate the differential effects of CPAP on BP in different OSA severities. Medline was searched through December 2023 for randomised controlled trials (RCTs) on the effect of CPAP compared to an inactive control on office, 24 h, diurnal and nocturnal systolic and diastolic BP in OSA. A random-effects meta-analysis was performed at the study level for the different BP measures; meta-regression and subgroup analyses were used to examine the effects of OSA characteristics and CPAP use. Seventy-five RCTs (10,025 patients) were included. CPAP lowered office, 24 h, diurnal and nocturnal systolic BP (SBP) by -2.5 (95% CI -3.8 to -1.2; nRCTs = 40), -2.6 (95% CI -3.6 to -1.6; n = 29), -2.2 (95% CI -3.2 to -1.3; n = 32) and - 3.5 (95% CI -4.4 to -2.5; n = 32) mmHg, respectively. In the meta-regressions, higher 24 h and diurnal SBP and longer nocturnal CPAP use were significantly associated with greater BP reduction (all p < 0.05). In subgroup analyses, the reduction in 24 h, diurnal, and nocturnal SBP was greater in studies with an apnoea-hypopnoea index ≥ 30/h compared to mild OSA. CPAP use ≥ 5 h/night had a greater impact on lowering 24 h and nocturnal SBP (-4.2 vs. -2.1, p = 0.05, and -4.2 vs. -1.6 mmHg, p = 0.01). CPAP has the strongest BP-lowering effect on nocturnal blood pressure, which is, particularly, relevant prognostically and the effect is stronger at higher baseline BP and with CPAP use of ≥ 5 h. Study Registration: The systematic review and meta-analysis has been registered on PROSPERO: CRD42023477227.

Postoperative voice changes is a common complication following thyroidectomy, which usually decrease patient quality of life. Perioperative dexamethasone is hypothesized to mitigate these effects by reducing inflammation and edema. However, the evidence supporting its efficacy remains inconclusive. This study aims to evaluate the effectiveness of perioperative dexamethasone in reducing postoperative voice changes in patients undergoing thyroidectomy through a systematic review and meta-analysis.

Systematic review and meta-analysis of randomized controlled trials.

The current study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. This study systematically reviewed the MEDLINE, Cochrane, and EMBASE databases in September 2022, using keywords relevant to the study outcome.

Eight randomized controlled trials encompassing 1244 participants were included. Subjective outcomes revealed that dexamethasone significantly reduced voice dysfunction scores within the first 48 hours postoperatively (SMD: -0.55, 95% CI: -0.82 to -0.28, P < 0.001), with no significant differences observed after day 7. Objective outcomes, reported in two trials (n = 639), showed no significant improvement in fundamental voice frequency (MD: 11.18, 95% CI: -17.36 to 39.71, P = 0.44).

Our meta-analysis concluded that perioperative dexamethasone significantly reduces subjective voice dysfunction in the immediate postoperative period following thyroidectomy. However, no objective improvement was observed, and its effects deplete beyond 7 days. Future studies should focus on evaluating objective measures to confirm its clinical utility.

Kidney transplant (KT) patients have higher risks of developing de novo colorectal cancer (CRC) compared to the general population. However, there is still a knowledge gap in their clinical characteristics, as most single- or multi-center efforts are underpowered and lack generalizability.

PubMed, Web of Science, Cochrane CENTRAL, and Scopus databases were queried for studies published until July 22nd, 2024. Studies reporting the clinicopathologic characteristics and outcomes of de novo CRC among KT recipients were included.

There were 49 articles included involving 1855 KT patients who developed CRC. The mean time from transplantation to CRC diagnosis was 8·7 years (95%CI 7·2, 10·3 years; I2 = 98·3%). De novo CRC was most commonly located in the ascending colon (43·6%; 95%CI 29·5%, 58·9%; I2 = 55·3%), and 37·1% had advanced CRC at diagnosis (95%CI 22·3%, 54·8%; I2 = 64·1%). Although 68·8% underwent curative intent treatment (95%CI 45·4%, 85·4%; I2 = 65·4%), pooled 5-year survival rate was 31·8% (95%CI 10·5%, 65·1%; I2 = 82·5%).

De novo CRC was diagnosed in under 10 years after KT, and nearly 40% of patients already have advanced stage disease at diagnosis. The pooled rate of 5-year survival was 31.8%. However, there was wide heterogeneity between studies and further research is required. PROSPERO Registration: CRD42023415767.

The value of neurofilament light chain (NfL) levels as a biomarker for the diagnosis and differential diagnosis in patients with Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) remains controversial. Furthermore, few studies have directly compared NfL levels among specific APS categories. This study aimed to compare cerebrospinal fluid (CSF) and blood NfL levels among PD, APS, other PD-related disorders, and controls, as well as rank NfL levels across these groups.

PubMed, Embase, Web of Science, and the Cochrane Library were searched from the inception up to November 1st, 2024, to identify eligible studies reporting CSF or blood NfL concentrations in PD, PD dementia (PDD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), corticobasal syndrome (CBS), vascular parkinsonism (VP), essential tremor (ET), idiopathic rapid eye movement sleep behavior disorder (iRBD), and controls. The Bayesian approach was utilized to estimate the standardized mean difference (SMD) and the associated 95% credible intervals (CrIs) of NfL levels. The surface under the cumulative ranking curve (SUCRA) was employed to evaluate the ranking probabilities of NfL levels. Subgroup analysis and meta-regression were conducted to explore the sources of heterogeneity.

The present network meta-analysis (NMA) included 78 studies with 13,120 participants (4050 controls, 5021 PD, 191 PDD, 1173 MSA, 887 PSP, 1254 DLB, 319 CBS, 160 ET, 65 iRBD, and 0 VP). Of these, the NMA of CSF NfL included 34 studies with 6,013 participants, while the NMA of blood NfL included 49 studies with 7,787 participants. Both CSF and blood NfL levels were significantly elevated in patients with PD and APS compared to controls. Compared to PD patients, CSF NfL levels were significantly elevated in MSA (SMD 1.85; 95% CrI 1.55-2.15), CBS (1.42; 1.08-1.75), PSP (1.35; 1.06-1.64), and DLB 0.52; 0.20-0.85) patients. Similarly, blood NfL levels were significantly higher in patients with MSA (1.36; 1.02-1.71), PDD (1.19; 0.65-1.72), PSP (1.15; 0.77-1.54), CBS (0.92; 0.11-1.72), and DLB (0.63; 0.14-1.12) compared to PD. Among APS, CSF NfL levels in MSA patients were significantly higher than those in PSP, DLB, and CBS patients, while blood NfL levels in MSA patients were significantly higher only compared to DLB. In both CSF and blood NfL, MSA patients exhibited the highest probability of ranking first for NfL level elevations (CSF: SUCRA = 0.998; blood: SUCRA = 0.925). Age significantly influenced the SMD of the comparison between MSA and PD in CSF NfL (β = -0.15; p = 0.016).

CSF and blood NfL levels in PD and APS are higher than those in controls, and all APS categories show higher levels than PD, suggesting that NfL levels may serve as a potential biomarker for the differential diagnosis between PD and APS. However, caution is warranted when using NfL as a diagnostic biomarker for PD. Significant differences in NfL levels are also observed between certain APS categories. Patients with MSA exhibit the highest NfL levels among PD and related disorders.

Tracheal decellularization is one of the main processes to provide tracheal substitutes for tracheal replacement. Recently, studies have been held for agents and combinations of processes for tracheal decellularization with different outcomes. This study aimed to evaluate the efficacy of tracheal decellularization by the immunogenic cellular elements using residual deoxyribonucleic acid (DNA) contents (ng/mg) and the preservation of biomechanical integrity by glycosaminoglycan (GAG) content (μg/mg), modulus tensile strength (MPa), ultimate tensile strength (MPa), and stress loading of 50% deformation (N).

We conducted a meta-analysis based on PRISMA criteria. Data from experimental studies in MEDLINE, Scopus, and ScienceDirect from inception to August 21, 2023, were sought and computed using RevMan 5.4. The outcomes of tracheal decellularization were evaluated through effect size estimates based on pooled Standardized Mean Difference (SMD) with 95% CI.

Tracheal decellularization has significantly reduced the DNA and GAG content after the process (SMD: -11.77, 95% CI [-13.92, -8.62], p < 0.00001; SMD: -6.70, 95% CI [-9.55, -3.85], p < 0.00001). No significant outcomes were observed in modulus and ultimate tensile strength result (SMD: -0.14, 95% CI [-0.64, 0.36], p = 0.58; SMD: 0.11, 95% CI [-0.57, 0.80], p = 0.75). The stress loading of 50% deformation was observed to significantly lower (SMD: -1.61, 95% CI [-2.49, -0.72], p = 0.0004).

Tracheal decellularization has been proven to effectively remove immunogenic cells. However, extracellular matrix integrity and biomechanical properties vary among different decellularization techniques, indicating a need for further refinement to achieve better preservation.

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

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

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

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

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

Apixaban and rivaroxaban are activated factor X (FXa) inhibitors commonly used for treatment of venous thromboembolism and stroke prevention in patients with atrial fibrillation. While routine monitoring of their concentrations is not recommended, but it may be beneficial in certain situations. Expected peak and trough concentrations remain poorly understood, with most data derived from small studies.

To establish the average peak and trough concentrations of apixaban and rivaroxaban from real-world studies.

PubMed, Scopus, and Web of Science were searched until October 2023 for observational studies reporting apixaban and rivaroxaban concentrations. Meta-regression was used to examine factors influencing these concentrations.

Sixteen studies involving 1054 apixaban and 1321 rivaroxaban patients were pooled using random-effects model. Mean apixaban peak concentrations were 157 ng/mL (95% CI, 127-187) for 2.5 mg and 228 ng/mL (95% CI, 204-252) for 5 mg, with trough concentrations of 77 ng/mL (95% CI, 56-98) and 113 ng/mL (95% CI, 101-124), respectively. Mean rivaroxaban peak concentrations were 168 ng/mL (95% CI, 104-232) for 10 mg, 225 ng/mL (95% CI, 192-257) for 15 mg, and 229 ng/mL (95% CI, 193-264) for 20 mg, with trough concentrations of 23 ng/mL (95% CI, 13-32), 31 ng/mL (95% CI, 26-36), and 36 ng/mL (95% CI, 25-47), respectively. Meta-regression revealed age and creatinine clearance correlated with apixaban peak concentrations. Creatinine clearance correlated with apixaban and rivaroxaban trough concentrations.

The pooled mean concentrations align with expected concentration ranges reported in different pharmacokinetic studies.

Clinical trials often report medians and quartiles due to skewed data distributions. We sought to evaluate the methods currently used in meta-analyses in anesthesiology to estimate means and standard deviations (SDs) from medians and quartiles.

We simulated sample sizes (n = 15, 27, 51) and coefficients of variation (CV = 0.15, 0.3, 0.5), representative scenarios in anesthesiology studies, generating data that have a log-normal distribution with zero log-scale means. We calculated generalized confidence intervals for the ratios of means and ratios of SDs using means and SDs estimated from three quartiles in time scale, using Luo et al.'s and Wan et al.'s methods, McGrath et al.'s quantile estimation and Box-Cox transformation, and Cai et al.'s maximum likelihood estimation method.

The method by Luo et al. and Wan et al. produced 95% confidence intervals for the ratio of means with coverage ranging from 92.4% to 93.6%, and for SDs from 79.2 to 89.6. McGrath et al.'s quantile estimation method yielded coverage for mean ratios between 88.5% and 91.5% and SDs between 78.0 and 82.7. McGrath et al.'s Box-Cox transformation method showed coverage for mean ratios from 86.6% to 94.4% and SDs from 67.1 to 83.1. The maximum likelihood estimation method by Cai et al. for nonnormal distributions showed coverage for mean ratios from 78.9% to 86.4% and SDs from 67.6 to 78.0.

All evaluated methods of estimating means and standard deviations from quartiles of log-normal distributed data result in confidence interval coverages below the expected 95%. Because these methods are widely used in meta-analyses of anesthesiology data, P values reported as < 0.05 cannot be trusted. Anesthesiology journals and investigators should revise reporting requirements for continuous skewed variables. We advise reporting the quartiles, mean, and SD, or the quartiles and including the raw data for the relevant variables as supplemental content. This holistic approach could improve the reliability of statistical inferences in meta-analyses of anesthesiology research, particularly when skewed distributions are involved.

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

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

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

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

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

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

Eight online databases were searched up until 12 January 2024.

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

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

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

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

Systematic review with random effects meta-analysis.

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

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

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

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

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

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

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

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

CRD42022359282.

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

Systematic review with random effects meta-analysis.

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

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

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

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

CRD42022359282.

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

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

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

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

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

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

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

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

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

Postpartum sleep interventions reduced the severity of depression symptoms.

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

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

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

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

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

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

Understanding how ecosystems respond to ubiquitous microplastic (MP) pollution is crucial for ensuring global food security. Here, we conduct a multiecosystem meta-analysis of 3,286 data points and reveal that MP exposure leads to a global reduction in photosynthesis of 7.05 to 12.12% in terrestrial plants, marine algae, and freshwater algae. These reductions align with those estimated by a constructed machine learning model using current MP pollution levels, showing that MP exposure reduces the chlorophyll content of photoautotrophs by 10.96 to 12.84%. Model estimates based on the identified MP-photosynthesis nexus indicate annual global losses of 4.11 to 13.52% (109.73 to 360.87 MT·y-1) for main crops and 0.31 to 7.24% (147.52 to 3415.11 MT C·y-1) for global aquatic net primary productivity induced by MPs. Under scenarios of efficient plastic mitigation, e.g., a ~13% global reduction in environmental MP levels, the MP-induced photosynthesis losses are estimated to decrease by ~30%, avoiding a global loss of 22.15 to 115.73 MT·y-1 in main crop production and 0.32 to 7.39 MT·y-1 in seafood production. These findings underscore the urgency of integrating plastic mitigation into global hunger and sustainability initiatives.

Myeloperoxidase (MPO) contributes to the progression of ischemic damage. To fully understand MPO biology, highly sensitive and specific probes that can trace the activity of endogenous MPO fluxes are indispensable. Here, we developed two hypochlorous acid (HClO)-activated near-infrared probes to image MPO activity in a noninvasive manner. The probe MPO-NIR-II could track MPO-induced HClO in real time and in situ upon various stimuli with high sensitivity and specificity. Furthermore, MPO-NIR-II could monitor the MPO activity by in vivo fluorescence imaging and confocal laser scanning microscopy in mice with ischemic stroke. Moreover, a high-content screening system for MPO inhibitors was established by combining MPO-NIR-II with MPO-overexpressed cells and mouse brain slices with ischemic stroke, and the candidate compound AZD5904 was found to effectively attenuate ischemic brain injury. Overall, this work provides a versatile fluorescence tool that holds great promise for visualizing endogenous MPO fluxes of brain ischemia.

Surgical resection is the primary treatment modality for colorectal cancer. Prehabilitation is about enhancing the patient's physiological capacity preoperatively to reduce the risk of treatment-related complications. Clear definitions of the modality, content, and duration of prehabilitation, including its components such as nutrition, exercise, and psychological support, are lacking. Some review articles have proposed that a multimodal approach may yield the best overall outcomes, but the clinical efficacy of such an approach requires further exploration.

This study consisted of a systematic review and meta-analysis to investigate the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery.

We searched PubMed, Embase, CINAHL, and the Cochrane Library from inception to August 5, 2023, without language or publication period restrictions. The included studies were randomized controlled trials, prospective studies, or retrospective studies that examined the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery. A random-effects model was used for data analysis.

This study included 14 articles that analyzed data from 2314 patients who underwent colorectal cancer surgery. In comparisons against a control group, multimodal prehabilitation significantly reduced the length of hospital stay ([mean difference; MD] = -2.47 days, 95% confidence interval [CI] [-3.56, -1.39]), postoperative complication rate (odds ratio; [OR] = 0.74, 95% CI [0.59, 0.94]), and time to the first passage of flatus (MD = -0.43 days, 95% CI [-0.66, -0.20]).

Multimodal prehabilitation interventions before colorectal cancer surgery reduce hospital stay lengths, lower complication rates, and promote bowel recovery, particularly in older populations.

To summarize the existing evidence from double-blind randomized controlled trials (RCTs) and cohort studies regarding the effects of biologic agents for the treatment of large vessel vasculitis (LVV).

A systematic review and meta-analysis was conducted using MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, and ClinicalTrials.gov covering the period from database inception to May 3rd, 2023. Double-blind RCTs and cohort studies reporting biologic therapies' effects on LVV including giant cell arteritis (GCA) and Takayasu's arteritis (TAK) with outcomes of interest in English were included. The primary outcome of interest was relapse rates during glucocorticoid tapering. The Cochrane Risk of Bias tool 2.0 and the Risk of Bias In Non-randomized Studies of Interventions tool were used for the quality assessment. Random-effects models were used for meta-analysis.

Of the 4599 references retrieved, 10 RCTs regarding GCA, 6 cohort studies, and 2 RCTs regarding TAK were included, comprising 997 participants in total. All the included RCTs were of low risk of bias, while the 6 cohort studies were of moderate to serious risk of bias. Meta-analysis suggested a significant superiority of biologic agents in prolonging relapse-free survival, increasing glucocorticoid taper rate, and decreasing cumulative glucocorticoids dose for both GCA and TAK. Additionally, GCA patients using biologic agents had significantly lower relapse rates and ESR levels with higher remission rates. Trends of favoring biologic agents in reducing relapse rate, ITAS-2010, ITAS-A, ESR, and CRP along with increased remission rate for TAK were also observed.

Biologic agents significantly improved clinical outcomes in LVV by reducing relapse rates, enhancing remission, and enabling safer glucocorticoid tapering, offering an important therapeutic advantage for managing both GCA and TAK. Further well-designed studies and corresponding meta-analyses are needed to validate their long-term efficacy and safety.

This review and meta-analysis evaluates the short-term surgical results of robot-assisted gastrectomy compared to 3D laparoscopic gastrectomy in individuals with gastric cancer. This study used scholarly articles from peer-reviewed articles of PubMed. Further, this study uses other sources, such as, Embase, CNKI, and the Cochrane Library, to gather relevant studies on gastrectomy for gastric cancer which are made public from the inception of these databases up to July 15, 2024. This study seeks to primarily draw similarities between the therapeutic efficacy of robot-assisted gastrectomy (RG) and the 3D laparoscopic gastrectomy (3D-LG). Similarly, this study will strictly adhere to the inclusion and exclusion guidelines, focusing on randomized controlled trials (RCTs) and cohort research. A total of 1231 gastric cancer patients were involved in incorporating seven retrospective cohort studies as the final analysis in the study with 533 undergoing robot-assisted gastrectomy and 698 undergoing 3D-LG. The results showed that patients who received robotic-assisted gastrectomy experienced superior outcomes regarding EBL and time-to-first postoperative exhaust compared to those who underwent 3D-LG. However, the robotic-assisted approach was related to a reduced number of LNY. Besides, there were similarities between the two surgical techniques in relation to OT, LOHS, and post-surgery complications. In summary, robot-assisted gastrectomy is acknowledged as a secure and efficient treatment option for individuals with stomach cancer. This approach demonstrated notable benefits compared to 3D-LG, particularly with regard to estimated intraoperative blood loss and the timing of the first postoperative exhaust.

Goal-directed haemodynamic therapy (GDHT) aims to optimize haemodynamic variables. However, its effectiveness in reducing postoperative complications in major abdominal surgery, particularly when targeting both arterial pressure and flow variables, remains unclear. This meta-analysis addresses this by evaluating GDHT using uncalibrated pulse contour (uPC) methods.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) in adult patients undergoing major abdominal surgery who received GDHT using uncalibrated pulse contour (uPC) methods for cardiac output monitoring, with predefined targets for both blood flow and blood pressure. The primary outcome was postoperative complications; secondary outcomes included postoperative acute kidney injury (AKI), hospital length of stay (EH), intraoperative fluid administration and mortality.

Initial search retrieved 860 reports, with 12 RCTs (1367 patients) meeting the inclusion criteria. Our meta-analysis showed a significant reduction in postoperative complications (RR 0.78, 95% CI 0.68-0.90), AKI (RR 0.7, 95% CI 0.51-0.97), and hospital LOS (SMD -0.30, 95% CI -0.54 to -0.06) with uPC-guided GDHT. No significant differences were observed in intraoperative fluid volume and mortality.

Implementing GDHT in major abdominal surgery with predefined arterial pressure and blood flow targets significantly reduces postoperative morbidity and hospital EH without increasing intraoperative fluid administration.

Postpartum depression (PPD) is a prevalent and debilitating disorder that occurs in 14% of women after giving birth.

We aimed to assess the efficacy and safety of perioperative esketamine for preventing PPD in women undergoing cesarean section.

We performed a systematic literature search in five medical databases - MEDLINE, Cochrane Library, Embase, Scopus, and Web of Science on the 12th of January 2025.

We searched for trials on the efficacy and safety of esketamine for preventing PPD.

We collected data on rates of PPD, Edinburgh Postnatal Depression Scale (EPDS) scores, and adverse effects. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.

Our systematic search provided 2681 records; we screened 1336 duplicate-free records. A total of 17 eligible studies were identified after title, abstract, and full-text selection. Esketamine administration was associated with a lower rate of PPD at postpartum days 3-7 and 28-42 (OR = 0.43; 95% CI: 0.31-0.59 and OR = 0.59; 95% CI: 0.39-0.87, respectively). Esketamine administration was associated with significantly lower EPDS scores at postpartum days 3-7 (MD = -1.32; 95% CI: 1.84 to -0.80).

Our findings suggest that perioperative administration of esketamine was associated with lower PPD rates and lower scores on the EPDS questionnaire and was considered safe compared to placebo/standard care.

The aim of our study was to investigate whether sublobar resection is non-inferior to lobar resection in early-stage non-small cell lung cancer less than 2 ​cm.

This is a meta-analysis for randomized controlled trials. Databases including PubMed, Web of Science, EMBASE and Cochrane Central Register were searched up to June 3, 2023. The primary outcome was 5-year survival, and the secondary outcomes were 5-year disease-free survival, cancer-related mortality, recurrence rate, postoperative lung function and perioperative events.

A total of 5 studies enrolling 2035 patients were included. Sublobar resection was found to be non-inferior to lobar resection concerning the 5-year survival rate, 5-year disease-free survival rate and cancer-related mortality. However, sublobar resection was associated with higher recurrence rate and less reduction of postoperative lung function.

Sublobar resection was non-inferior to lobar resection in terms of survival outcomes and was associated with better postoperative lung function.

To explore the effects of exercise interventions on cognition, physical function, and quality of life among older adults with cognitive frailty.

A systematic review and meta-analysis were conducted (PROSPERO [CRD42024532608]). PubMed, Web of Science, Cochrane Library, Embase, CNKI, WanFang, VIP, and SinoMed databases were searched from inception until December 18, 2023.

We found exercise improved overall cognition, physical frailty, walking ability, gait speed, and so on among older adults with cognitive frailty, but the effect on physical fitness and quality of life was insignificant. Subgroup analysis revealed exercise conducted ≥3 times per week, each session lasting ≤45 min and cycle≤12 weeks, had better-improved cognition. Traditional mind-body exercises like Baduanjin were more effective than resistance training for enhancing cognition.

Exercise intervention benefits overall cognition and most physical functions, but its impact on physical fitness and quality of life remains to be confirmed by future studies.

Gut bacteria that potential produce short-chain fatty acids (SCFAs) influences the recovery of motor function in the host in patients with spinal cord injury (SCI). We aimed to conduct a review and meta-analysis of the literature on gut microbiota in SCI patients. Following the Preferred Reporting Project for Systematic Review and Meta-Analysis (PRISMA), we searched Embase, PubMed, Cochrane Library, Web of Science (WOS) and ClinicalTrials.gov. The search period was from inception to March 31, 2024. We reported standardized mean differences (d) with 95% confidence intervals (CI) and used funnel plots and Egger tests to assess publication bias. The subacute of SCI data set revealed the microflora changes in the subacute phase, and meta-analysis summarized the changes in the chronic phase. Eleven studies (720 participants) were included, 2 phyla, 1 order, and 14 genus meta-analyses performed. No substantial heterogeneity was observed, and significant publication bias was not found among the studies included. In the subacute phase of spinal cord injury, the relative abundance of Bacteroidetes, Clostridiales, Faecalbacterium, Ruminococcus, Coprococcus, Lachnospira, Dorea, Prevotella, Roseburia, Atopobium, Bifidobacterium, Bacteroides, and Blautia increased. Firmicutes and Lactobacillus decreased. In the chronic phase, Firmicutes decreased in the SCI group. Bifidobacterium, Bacteroides, Blautia, and Eubacterium were found to have a higher average proportion of abundance in patients with SCI compared to non-SCI persons, and Clostridiales, Ruminococcus, Faecalbacterium, Coprococcus, and Lachnospira showed a lower relative abundance in SCI. The genus of potential SCFAs-producing bacteria is lower in the chronic phase of spinal cord injury than in the subacute phase, and gut dysbiosis is present in both the subacute and chronic phases.

Background/Objectives: Zygomaticomaxillary complex (ZMC) fractures are the second most common of all facial bone fractures, and conventional treatment represents a challenge even for experienced surgeons. The aim of this systematic review and meta-analysis was to compare Intraoperative Surgical Navigation (ISN) with conventional surgery in the treatment of ZMC fractures. Methods: We reported our systematic review and meta-analysis based on the recommendation of the PRISMA 2020 guideline. The electronic search was conducted on 9 February 2025 in two search engines (PubMed and Web of Science) and two databases (Embase and the Cochrane Library). Randomized controlled trials and observational studies were included. The outcome variables were accuracy, operative time, maximum mouth opening, postoperative stay, amount of bleeding, and cheek numbness. The random-effects model was used for the analysis, and the results were given as mean differences and odds ratios with 95% confidence intervals (CI). After duplicate removal, 1961 articles were found. After the selection procedure, five studies were found to be eligible for qualitative and quantitative analysis. Results: There were no statistically significant differences between ISN and conventional surgery regarding the outcomes investigated, except in postoperative average deviation of the zygomatic bone. Our results showed an improvement of 0.64 mm [CI: 0.32, 0.92] zygomatic bone deviation when ISN was used. Conclusions: The results suggest that ISN is as effective as the conventional technique in the treatment of ZMC fractures. However, because of the low number of eligible studies, further randomized controlled trials are necessary to strengthen the level of evidence on this matter.

Background/Objectives: The mental foramen (MF) constitutes a passage for mental nerves and vessels, and it is a crucial anatomical landmark in the body of the mandible. The accessory mental foramen (AMF) is a small, addable foramen proximate to the MF, and it is mainly located posteriorly. The AMF is a rare anatomical variation in human mandibles that must be taken into consideration throughout dental and surgical operations. We aimed to assess the incidence and perform morphological and morphometric analyses of AMFs in the human dry mandibles of the Greek population, in addition to a relevant systematic review and meta-analysis of global data. Methods: We studied 114 human adult dry mandibles of unknown gender and age available from the Laboratory of Anatomy, Medical School, Democritus University of Thrace, Greece. We used the search term "accessory mental foramen" in the PubMed, Scopus, and Google Scholar databases to detect all publications of the last 50 years reporting the prevalence and morphology of AMFs in dry mandibles; the search ended on 13 January 2025. Quality assessments were performed using the relevant Joanna Briggs Institute tool. Data were synthesized with the random-effects REML model after Freeman-Tukey double arcsine transformationusing STATA 18. No external funding was received. The PROSPERO CRD is 42025638135. Results: According to our data, the MF was present in all observed mandibles, and it was bilateral. Nine AMFs (five right/four left; five round/four oval; six posterior/three anterior to the MF) were found in seven mandibles (five single and two double), and all were unilateral. AMFs presented a mean diameter of 0.96 ± 0.43 mm and mean distances of 4.12 ± 2.15 mm from the MF, 12.68 ± 4.10 mm from the alveolar ridge, and 11.92 ± 1.57 mm from the lower border of the mandible. Furthermore, 27 publications were included in the meta-analysis; the combined AMF prevalence was 6.1% (95% CI: 4.8-7.6%; I2 60%), the combined mean vertical axis was 1.18 ± 0.61 mm, and the combined mean distance from the MF was 3.64 ± 2.29 mm. Bilateral AMFs were detected in 2.1% of AMF cases. An oval shape was described in 37.3% of AMFs. No publication bias was detected. Conclusions: AMFs are not considered rare, and they are occasionally bilateral or even multiple in number. Moreover, they demonstrate considerable variation regarding their size, shape, anddistance from the MF, alveolar ridge, and lower border of the mandible. Dental surgeons must be aware of AMFs' anatomical variations during surgical and anesthetic planning in order to effectively prevent or mitigate the risk of postoperative complications, such as pain, anesthesia, injury, and other adverse outcomes.

Sepsis-associated hypotension or shock is a critical stage of sepsis, and a current clinical emergency that has high mortality and multiple complications. A new restrictive fluid resuscitation therapy has been applied, and its influence on patients' renal function remains unclear. The purpose of this study is to evaluate the influence of restrictive fluid resuscitation on incidence of severe acute kidney injury (AKI) in adult patients with sepsis hypotension and shock compared with usual care.

Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

PubMed, Embase, Web of Science and Cochrane Library were searched through 1 November 2024.

We included randomised controlled trials that compared restrictive fluid resuscitation with liberal fluid therapy on patients with sepsis-associated hypotension and shock, to find out their effect on the incidence of severe AKI. Severe AKI was defined as the AKI network score 2-3 or Kidney Disease Improving Global Outcomes stages 2 and 3.

Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed using the Cochrane Systematic Review Handbook for randomised clinical trials. Meta-analysis was conducted using random effects models. Sensitivity and subgroup analyses, trial sequential analysis (TSA), Egger's test and the trim-and-fill method were performed. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

Nine trials (3718 participants) were included in this research and the analysis was conducted in random effects model. There was a significant difference in the incidence of severe AKI (risk ratio 0.87, 95% CI 0.79 to 0.96, p=0.006; I2=0%) and the duration of mechanical ventilation (mean difference -41.14, 95% CI -68.80 to -13.48; p=0.004; I2=74%) between patients receiving restrictive fluid resuscitation and patients receiving liberal fluid resuscitation. TSA showed that the cumulative amount of participants met the required information size, the positive conclusion had been confirmed. The GRADE assessment results demonstrated moderate confidence in the incidence of severe AKI, as well as the results of all second outcomes except the Intensive Care Unit length of stay (ICU LOS), which received limited confidence. The result of incidence of worse AKI was rated as of high certainty.

It is conclusive that fluid restriction strategy is superior to usual care when it comes to reducing the incidence of severe AKI in sepsis-associated hypotension and shock. Shorter duration of ventilation is concerned with fluid restriction as well, but the heterogeneity is substantial. GRADE assessments confirmed moderate and above certainty. Traditional fluid resuscitation therapy has the potential to be further explored for improvements to be more precise and appropriate for a better prognosis.

CRD42023449239.

An increasing number of studies indicate that the gut, cervical, and vaginal microbiota may play crucial roles in the development of cervical cancer (CC). However, the interactions between the microbiota and the host are yet unknown. To address this gap, a systematic review and meta-analysis were conducted to assess the microbiota alterations in a variety of body locations, including the gut and genital tract.

Electronic searches of PubMed, Embase, Web of Science, and the Cochrane Library were conducted to retrieve eligible papers published from January 1, 2014, to January 1, 2024 (PROSPERO: CRD42024554433). This study was restricted to English-language studies reporting on alpha diversity, beta diversity, and relative abundance, as well as on patients with CC whose microbiota had been analyzed via next-generation sequencing technologies. To assess the risk of bias (RoB), we utilized the Newcastle‒Ottawa Quality Assessment Scale (NOS) and the ROBINS-I tool. For the meta-analysis, we employed Review Manager 5.4.

Thirty-six eligible studies were included in this review. The Chao1 index (SMD = 0.96, [95% CI: 0.71, 1.21], I2 = 0%) and the Shannon index (SMD = 1.02, [95% CI: 0.53, 1.50], I2 = 85%) values from vaginal samples were significantly greater in patients than in the controls. In the cervical samples, the Shannon index value (SMD = 1.29, [95% CI: 0.61, 1.97], I2 = 93%) significantly increased, whereas the Chao1 index value did not significantly differ (SMD = 0.50, [95% CI: -0.46, 1.46], I2 = 89%). The Shannon index value (SMD = 0.25, [95% CI: -0.22, 0.72], I2 = 38%) did not significantly differ across the gut samples. The majority of studies (19/25) indicated that the patients and noncancer controls differed significantly in terms of beta diversity. Cancer-associated changes were observed, with a dramatic decrease in the Lactobacillus genus and significant increases in pathogenic bacteria, including the Anaerococcus, Peptostreptococcus, Porphyromonas, Prevotella, and Sneathia genera. Additionally, the impact of antineoplastic therapies on microbial diversity was inconsistently reported across several studies.

This systematic review elucidates the microbiota alterations associated with the prevalence of CC and its response to anti-tumor therapies, aiming to provide insights for future research directions and precision medicine strategies to enhance women's quality of life.

CRD42024554433.