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Rocha Fernandes Y, Visconti TADC, Dall'Agnol MK, Ardengh AO, Veras MDO, Valentim ESDS, Lera dos Santos ME, Matuguma SE, Bernardo WM, de Moura EGH. Covered Self-Expanding Metal Stents Versus Multiple Plastic Stents in Treating Biliary Strictures Post-Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. DEN OPEN 2026; 6:e70143. [PMID: 40416587 PMCID: PMC12101909 DOI: 10.1002/deo2.70143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 04/24/2025] [Accepted: 04/30/2025] [Indexed: 05/27/2025]
Abstract
Objectives Anastomotic biliary strictures are a common complication following orthotopic liver transplantation (post-OLT), impacting morbidity and graft survival. This meta-analysis evaluates the efficacy, safety, and cost-effectiveness of covered self-expanding metal stents (cSEMS) versus multiple plastic stents (MPS) for treating post-OLT strictures. Methods A systematic review was conducted in PubMed, Cochrane Central, Embase, Scholar, and SciELO. We analyzed randomized controlled trials (RCTs) comparing cSEMS and MPS in post-OLT biliary strictures. Outcomes included stricture resolution, recurrence, endoscopic retrograde cholangiopancreatography sessions, adverse events, and cost. Standardized mean differences (SMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CIs). Cost-effectiveness analysis covered direct and indirect expenses. Results Five RCTs with 269 patients were analyzed. No significant differences were found between cSEMS and MPS in terms of stricture resolution (RR = 1.01; 95% CI [0.90, 1.13]; p = 0.91), recurrence rates (RR = 2.23; 95% CI [0.74, 6.75]; p = 0.15), adverse events (RR = 0.80; 95% CI [0.41, 1.54]; p = 0.50), stent migration (RR = 1.55; 95% CI [0.69, 3.50]; p = 0.29), number of endoscopic retrograde cholangiopancreatography sessions (SMD = -2.18; 95% CI [-5.28, 0.91]; p = 0.12), number of stents (SMD = -2.33; 95% CI [-22.26, 17.59]; p = 0.38), treatment time (SMD = -1.60; 95% CI [-4.24, 1.05]; p = 0.15), and cost ($10,344 vs. $18,003; p = 0.19). Conclusion cSEMS and MPS demonstrate similar efficacy and safety for post-OLT biliary strictures. Both strategies are viable, with selection based on cost, anatomy, and institutional resources.
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Affiliation(s)
- Ygor Rocha Fernandes
- Department of GastroenterologyHospital das ClínicasUniversity of São Paulo Medical School (HCFMUSP)Sao PauloBrazil
| | | | - Marcelo Klotz Dall'Agnol
- Department of GastroenterologyHospital das ClínicasUniversity of São Paulo Medical School (HCFMUSP)Sao PauloBrazil
| | - André Orsini Ardengh
- Department of GastroenterologyHospital das ClínicasUniversity of São Paulo Medical School (HCFMUSP)Sao PauloBrazil
| | - Matheus de Oliveira Veras
- Department of GastroenterologyHospital das ClínicasUniversity of São Paulo Medical School (HCFMUSP)Sao PauloBrazil
| | | | | | - Sergio Eiji Matuguma
- Department of GastroenterologyHospital das ClínicasUniversity of São Paulo Medical School (HCFMUSP)Sao PauloBrazil
| | - Wanderley Marques Bernardo
- Faculty of MedicineUniversity of São PauloSao PauloBrazil
- Medical Guidelines Program, Brazilian Medical AssociationSao PauloBrazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy UnitClinical Hospital of Faculty of Medicine of the University of São PauloSao PauloBrazil
- Graduate Program in GastroenterologyFaculty of Medicine of the University of São PauloSao PauloBrazil
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Mukhopadhyay D, Cocco P, Orrù S, Cherchi R, De Matteis S. The role of MicroRNAs as early biomarkers of asbestos-related lung cancer: A systematic review and meta-analysis. Pulmonology 2025; 31:2416792. [PMID: 38402124 DOI: 10.1016/j.pulmoe.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Asbestos is still the leading cause of occupational cancer mortality worldwide. Asbestos-related lung cancer (LC) and malignant pleural mesothelioma (MPM) prognosis is still poor especially at advanced stage, so early diagnosis biomarkers are needed. MicroRNAs (miRNAs) have been proposed as potential early diagnostic biomarkers of asbestos-related LC and MPM. AIM To evaluate the role of miRNAs as diagnostic and prognostic biomarkers of asbestos-related LC and MPM by performing a literature systematic review and meta-analysis. METHODS MEDLINE, EMBASE via Ovid, PUBMED and Cochrane library databases were systematically searched up to April 2023 to identify relevant articles. A grey literature search was also conducted using the Google Scholar platform. MeSH and free text terms for 'asbestos', 'occupational exposure', 'lung cancer', 'mesothelioma' and 'miRNAs' were used to search the literature. Our systematic review protocol was registered in the PROSPERO database. Study quality was assessed via the Newcastle-Ottawa Scale. RESULTS From the search, 331 articles were retrieved, and, after applying our selection criteria, and exclusion of one study for poor quality, 27 studies were included in the review. Most of the studies were hospital-based case-control, conducted in Europe, and evaluated MPM among men only. MiRNAs expression was measured mainly in plasma or serum. MiR-126, miR-132-3p, and miR-103a-3p were the most promising diagnostic biomarkers for MPM, and we estimated a pooled area under the curve (AUC) of 85 %, 73 %, and 50 %, respectively. In relation to MPM prognosis, miR-197‑3p resulted associated with increased survival time. MiR-126, alone and combined with miR-222, was confirmed associated also to LC diagnosis, together with miR-1254 and miR-574-5p; no miRNA was found associated to LC prognosis. CONCLUSION Based on our systematic literature review there is suggestive evidence that the expression of specific miRNAs in the blood serum or plasma are associated with asbestos-related LC and MPM diagnosis and prognosis. Further large longitudinal studies are urgently needed to validate these findings and elucidate the underlying mechanisms given the potential important implications for patients' survival.
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Affiliation(s)
- D Mukhopadhyay
- Molecular and Translational Medicine, Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Cagliari, Italy
| | - P Cocco
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - S Orrù
- Operative Unit of Medical Genetics, Health Agency of Sardinia, Hospital Binaghi, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Cagliari, Italy
| | - R Cherchi
- Operative Unit of Thoracic Surgery, Hospital G. Brotzu, Cagliari, Italy
| | - S De Matteis
- Department of Health Sciences, University of Milan, Milan, Italy
- NHLI, Imperial College London, United Knigdom
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Fernández-Alonso AM, López-Baena MT, García-Alfaro P, Pérez-López FR. Systematic review and meta-analysis on the association of metabolic syndrome in women with overactive bladder. Gynecol Endocrinol 2025; 41:2445682. [PMID: 39743909 DOI: 10.1080/09513590.2024.2445682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 01/04/2025] Open
Abstract
AIMS A systematic review and meta-analysis were performed to determine the association of metabolic syndrome (METS) in women with and without overactive bladder (OAB). METHODS PRISMA guidelines were followed and the protocol was registered at PROSPERO (CRD42024606398). We searched PubMed, Embase, Cochrane Library, and LILACS databases to obtain relevant articles for studies reporting METS outcomes related to OAB published through October 2024. A meta-analysis was performed of available studies using random effect models. Results are reported as mean difference (MD), standardized MD (SMD), or odds ratio (OR) and their 95% confidence interval (CI). Heterogeneity was described with the I2 statistic. The quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS Of the 108 non-duplicated retrieved citations, after successive selection, four case-control studies with low or moderate risk of bias reported information about the association of METS in women assessed with the 8-item OAB Symptom Bother Scale. OAB patients displayed higher body mass index (BMI, MD: 3.27, 95% CI: 2.12, 4.43), waist circumference (MD: 7.96, 95% CI: 4.41, 11.52), fasting blood glucose (SMD: 1.26, 95% CI: 0.18, 2.34), triglycerides (SMD: 0.24, 95% CI: 0.01, 0.47), and LDL-cholesterol (SMD: 0.30, 95%CI: 0.06, 0.54) levels. In addition to low HDL-cholesterol levels (SMD: -0.40, 95% CI: -0.74, -0.06) compared to the control group. There were no significant differences in circulating total cholesterol levels and rates of hypertension, hysterectomy, postmenopausal status, and constipation in women with and without OAB. CONCLUSION Women with OAB display associations with age, BMI, waist circumference, and METS factors.
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Affiliation(s)
- Ana M Fernández-Alonso
- Department of Obstetrics and Gynecology, Torrecárdenas University Hospital, Almería, Spain
| | - María T López-Baena
- Aragón Health Sciences Research Institute, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Pascual García-Alfaro
- Department of Obstetrics and Gynecology, Dexeus University Hospital, Barcelona, Spain
| | - Faustino R Pérez-López
- Aragón Health Sciences Research Institute, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
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Chang H, Sun L, Wang X, Wang H, Shi Y. Comparative efficacy of non-pharmacological interventions on depression in people with multiple sclerosis: A systematic review and network meta-analysis. J Affect Disord 2025; 383:207-213. [PMID: 40288459 DOI: 10.1016/j.jad.2025.04.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 04/08/2025] [Accepted: 04/19/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Depression, a common psychological problem in multiple sclerosis (MS) patients, can exacerbate the deterioration of the disease and have an impact on the quality of life of MS. Non-pharmacological therapies are effective alternatives to pharmacological treatments. It is not clear which non-pharmacological therapies are most effective in improving depression in MS at present. AIMS To compare the effectiveness of non-pharmacological interventions in enhancing depression in people with MS. METHODS A total of seven databases were searched from the establishment of the database to June 2024. After literature screening and data extraction, the Cochrane Bias Assessment Tool 2.0 version of randomized controlled trials (RCTs) was used to evaluate the quality of the literature. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on depression. Statistical analysis was performed using R (version 4.3.2) and STATA 17.0 software. RESULTS A total of 33 RCTs involving seven non-pharmacological interventions (cognitive behavioral therapy, mindfulness therapy, acceptance of commitment therapy, exercise therapy, relaxation therapy, education, and computer-assisted cognitive rehabilitation) were included. The results of the network meta-analysis showed that cognitive-behavioral therapy (SMD = -4.04, 95%CrI = -6.80 to -1.45), exercise therapy (SMD= = -3.62, 95 % CrI= = -6.55 to -0.85), and education (SMD = -2.94, 95 % CrI = -5.69 to -0.25) were effective in improving depression in multiple sclerosis patients relative to the control group. CONCLUSION This study confirms that non-pharmacological interventions can improve depression in MS patients. Healthcare professionals can choose non-pharmacological therapies according to the specific conditions of MS patients to improve the depression of them and thus enhance their quality of life in future.
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Affiliation(s)
- Hui Chang
- Department of Nursing, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Lili Sun
- Department of Neurology Intensive Care Unit, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xuexue Wang
- Department of Neurology Intensive Care Unit, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China..
| | - Yanru Shi
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China..
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da Cruz VF, Machinski E, da Silva Oliveira Filho AR, Conde RA, Varone BB, Gobbi RG, Helito CP, Leal DP. Effectiveness of intra-articular vancomycin in preventing prosthetic joint infections in hip and knee arthroplasty: A systematic review and meta-analysis of RCT's. J Orthop 2025; 66:25-33. [PMID: 39872993 PMCID: PMC11763160 DOI: 10.1016/j.jor.2024.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 12/23/2024] [Indexed: 01/30/2025] Open
Abstract
Introduction This study aimed to evaluate the effectiveness and safety of intra-articular vancomycin powder in reducing prosthetic joint infections (PJIs) in primary hip and knee arthroplasty through a meta-analysis of randomized controlled trials (RCTs). Methods A research in Pubmed, Embase and Cochrane databases was performed to identify randomized clinical trials comparing intra-articular vancomycin use to conventional antibiotic prophylaxis in total hip or knee arthroplasty patients, assessing postoperative infection rates, adverse drug reactions, and venous thrombotic events. Statistical analysis was performed using R (RStudio 2024.04.2), and heterogeneity was assessed with the I2 test. Results A total of 1485 patients from five randomized clinical trials were included, with 737 receiving intra-articular vancomycin. The infection rate was 0.54 % in the intervention group and 1.73 % in the control group (RR 0.37; 95 % CI 0.02-8.95; p = 0.369; I2 = 49 %), showing no statistically significant difference between the groups. Adverse reactions to the glycopeptide were reported in six cases (0.8 %) in the intervention group compared to four cases (0.5 %) in the control group (RR 1.50; 95 % CI 1.50-150; p = 0.001; I2 = 0 %). Regarding thrombotic events, there was one case in 647 patients in the intervention group and three cases in 660 patients in the control group (RR 0.45; 95 % CI 0.03-7.02; p = 0.169; I2 = 0 %). Conclusion Although no significant difference was found, the intervention group showed a trend toward lower infection rates. Additional RCTs with larger sample sizes are required to confirm these findings. Trial registration The prospective registration of the meta-analysis was conducted on PROSPERO in July 2024 with the protocol number 565988.
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Affiliation(s)
| | - Elcio Machinski
- Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, Brazil
| | | | - Rodrigo Arruda Conde
- Fundación Barceló - Instituto Universitario de Ciencias de la Salud, Buenos Aires, Argentina
| | - Bruno Butturi Varone
- Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Riccardo Gomes Gobbi
- Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- HCor, Hospital do Coração, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Peixoto Leal
- Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Pourrajab B, Fotros D, Asghari P, Shidfar F. Effect of the Mediterranean Diet Supplemented With Olive Oil Versus the Low-Fat Diet on Serum Inflammatory and Endothelial Indexes Among Adults: A Systematic Review and Meta-analysis of Clinical Controlled Trials. Nutr Rev 2025; 83:e1421-e1440. [PMID: 39530776 DOI: 10.1093/nutrit/nuae166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
CONTEXT Inflammation and endothelial dysfunction are important risk factors for chronic diseases, including cardiovascular diseases and related mortality. OBJECTIVE This systematic review and meta-analysis aimed to assess the effects of 2 popular dietary patterns-a Mediterranean (MED) diet supplemented with olive oil and a low-fat diet (LFD)-on factors related to inflammation and endothelial function in adults. DATA SOURCES AND DATA EXTRACTION The following online databases were searched for related studies published until August 7, 2024: PubMed/Medline, Scopus, Clarivate Analytics Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. Two independent researchers selected the studies based on the eligibility criteria. DATA ANALYSIS The effect sizes were expressed as Hedges' g with 95% CIs. A total of 16 eligible trials with 20 effect sizes were included in the analyses. This meta-analysis revealed that the MED diet supplemented with olive oil significantly improved all of the indicators of the study compared with the LFD, except in the case of E-selectin, in which a low and nonsignificant decrease was reported. CONCLUSION Available evidence suggests that a MED diet supplemented with olive oil compared with the LFD significantly improves inflammation and serum endothelial function in adults. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023485718.
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Affiliation(s)
- Behnaz Pourrajab
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Danial Fotros
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Parastoo Asghari
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177899191, Iran
| | - Farzad Shidfar
- Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Department of Nutritional Sciences, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran
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Pellegrini L, Giobelli S, Burato S, di Salvo G, Maina G, Albert U. Meta-analysis of age at help-seeking and duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD): The need for early interventions. J Affect Disord 2025; 380:212-225. [PMID: 40118279 DOI: 10.1016/j.jad.2025.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 03/12/2025] [Accepted: 03/14/2025] [Indexed: 03/23/2025]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that often begins early in childhood. Patients with OCD are known to seek help late after disorder onset, and therefore have a long duration of untreated illness (DUI), which is found to correlate with negative clinical outcomes. No meta-analysis has previously investigated this issue. METHODS Our protocol was pre-registered with PROSPERO (CRD42020165226). We followed PRISMA-guidelines and searched for relevant articles in four electronic databases. Meta-analyses of means based on random-effects (Der-Simonian-and-Laird-method) were used to derive the pooled estimates. Subgroup-analyses and meta-regressions were conducted to explore possible factors affecting help-seeking and DUI. RESULTS We included N = 31 studies in the quantitative synthesis, with 16 studies proving data for age at help-seeking and 16 studies providing data for duration of untreated illness. The pooled mean age at help-seeking was 28.66 years (95 % CI: 27.34-29.98), while the pooled mean interval between age at disorder onset and help-seeking was 6.97 (95 % CI: 5.69-8.24), and the pooled mean duration of untreated illness was 80.23 months (68.72-91.75), around 6.69 years, all with p < 0.001. Specific OCD-related factors affected help-seeking and duration of untreated illness. CONCLUSIONS Patients with OCD seek for help late in the course of the disorder and have a long duration of untreated illness, which is associated with more negative prognosis. This meta-analysis confirms the long duration of untreated illness in OCD and proposes possible factors associated with the length of the help-seeking process and DUI.
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Affiliation(s)
- Luca Pellegrini
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy; Department of Mental Health, Psychiatric Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, Trieste, Italy; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Centre for Psychedelic Research and Neuropsychopharmacology, Imperial College London, London, UK.
| | - Sofia Giobelli
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Sofia Burato
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gabriele di Salvo
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy; Department of Mental Health, Psychiatric Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, Trieste, Italy
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Ifzaal M, Bughio SA, Rizvi SAFA, Muzaffar M, Ali R, Ikram M, Murtaza M, Mirza AMW, Ans HH, Bucataru L, Ans AH, Ahmed R, Ahmed M, Ayyan M, Rehman MAU. Efficacy and safety of tenecteplase administration in extended time window for acute ischemic stroke: An updated meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis 2025; 34:108338. [PMID: 40324546 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 05/02/2025] [Accepted: 05/02/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Data regarding the efficacy and safety of tenecteplase (TNK) in patients with acute ischemic stroke (AIS) who present outside the standard treatment window are limited. This study aims to evaluate the role of TNK at a dose of 0.25 mg/kg, in treating AIS patients in an extended time window. METHODS Searches were performed up to February 15, 2025 in PubMed, Embase, and Cochrane Library to include randomized-controlled trials (RCTs) comparing TNK (0.25 mg/kg) to no thrombolysis in AIS patients presenting after 4.5 hours of symptom onset or wake-up AIS. The primary efficacy outcomes included a 3-month excellent functional outcome (mRS ⩽1), and a good functional outcome (mRS ⩽2). Secondary safety outcomes assessed included symptomatic intracranial hemorrhage (sICH), any ICH, and 3-month all-cause death. A random-effects model was used to calculate summary estimates. RESULTS 6 RCTs were included (n = 1,955 patients) in the meta-analysis. The pooled analysis demonstrated a significantly improved excellent functional outcome on 90 days (OR = 1.35, 95 % CI: 1.12 to 1.64) with TNK administration compared to control. No statistically significant association was observed for the two groups regarding good functional outcome (OR = 1.16, 95 % CI: 0.94 to 1.44), all-cause death (OR = 1.11, 95 % CI: 0.82 to 1.49), sICH (OR = 1.79, 95 % CI: 0.94 to 3.39), and any ICH (OR = 1.21, 95 % CI: 0.96 to 1.53). CONCLUSION TNK administration in an extended time window for AIS patients leads to favorable neurological outcomes with a good safety profile.
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Affiliation(s)
- Moazzma Ifzaal
- Acute Medicine Unit, University Hospital of North Midlands, UK
| | | | | | | | - Rubia Ali
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Moeen Ikram
- Department of Medicine, Frontier Medical and Dental College, Abbottabad, Pakistan
| | - Meer Murtaza
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | | | | | - Armghan Haider Ans
- Department of Vascular Neurology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Raheel Ahmed
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Ayyan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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de Campos Martin Berber G, de Sarges KML, da Cruz TCD, Roma EH, Miyajima F, Almeida JR, de Souza CF, da Silva AA, Vallinoto IMVC, Vallinoto ACR, Queiroz MAF, Baccin TG, de Castro AC, Vieira AT, de Azevedo FKS, da Costa Pereira A, Falcão LFM, Quaresma JAS, Kehdy F, Santos ET, Siqueira MM, Garcia CC, Dos Santos EJM, Slhessarenko RD. Polymorphisms in HLA genes among Brazilian patients hospitalized with COVID-19: Insights from a multicentric study. Microb Pathog 2025; 204:107542. [PMID: 40188974 DOI: 10.1016/j.micpath.2025.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 04/02/2025] [Accepted: 04/03/2025] [Indexed: 04/14/2025]
Abstract
Immunogenetic factors such as human leukocyte antigen (HLA) alleles, have yielded contrasting associations with protection or increased chances of hospitalization due to COVID-19 worldwide. This case-control study included 834 patients with confirmed COVID-19 diagnosis from five Brazilian states: Ceará (n = 110), Mato Grosso (n = 192), Pará (n = 209), Rio de Janeiro (n = 211) and Rio Grande do Sul (n = 112). Genotyping was performed using the Axiom™ Human Genotyping SARS-CoV-2 array, targeting single nucleotide polymorphisms in HLA class I and II genes; HLA alleles were imputed for eight loci. Among the 15 preselected candidate alleles, only DQA1∗05:01 (p = 0.015) in the state of Ceará remained significantly associated with hospitalization. The meta-analysis of the most frequent alleles in all states revealed that HLA-DPA1∗01:03 (p = 0.0229, OR = 0.76, 95 % CI = 0.60-0.96) and HLA-DPB1∗04:01 (p = 0.0474, OR = 0.78, 95 % CI = 0.611.00) were associated with protection against hospitalization, whereas HLA-DPA1∗02:01 (p = 0.0259, OR = 1.37, 95 % CI = 1.04-1.80), HLA-DQA1∗05:01 (p = 0.0133, OR = 1.40, 95 % CI = 1.07-1.82), and HLA-DRB1∗03:01 (p = 0.0276, OR: 1.59, 95 % CI: 1.05-2.40) associated with increased risk of hospitalization. HLA evolutionary divergence (HED) scores were significantly higher among the non-hospitalized group for the HLA-A locus, which has been shown to be a protective factor for the most severe forms and consequently hospitalization due to COVID-19.
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Affiliation(s)
| | - Kevin Matheus Lima de Sarges
- Post-graduation Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belém, PA, Brazil
| | - Thais Campos Dias da Cruz
- Post-graduation Program in Health Sciences, Federal University of Mato Grosso School of Medicine, Cuiabá, MT, Brazil
| | - Eric Henrique Roma
- Laboratory of Immunology and Imunogenetics in Infectious Diseases, Evandro Chagas National Infectology Institute, Rio de Janeiro, RJ, Brazil
| | - Fábio Miyajima
- Analytical Competence Molecular Epidemiology Laboratory, Fiocruz Genomic Surveillance Network, Fiocruz Ceará, Eusebio, CE, Brazil
| | - Jorge Reis Almeida
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Cíntia Fernandes de Souza
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil; Laboratory of Respiratory, Exanthematic, Enteric Viruses and Viral Emergencies, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Andrea Alice da Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Izaura Maria Vieira Cayres Vallinoto
- Post-graduation Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belém, PA, Brazil; Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Antônio Carlos Rosário Vallinoto
- Post-graduation Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belém, PA, Brazil; Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Maria Alice Freitas Queiroz
- Post-graduation Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belém, PA, Brazil; Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | | | | | - Angélica Thomaz Vieira
- Laboratory of Microbiota and Immunomodulation, Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Alexandre da Costa Pereira
- Laboratory of Molecular Genetics and Cardiology, InCor - Hospital das Clínicas - FMUSP, University of São Paulo, SP, Brazil
| | | | | | - Fernanda Kehdy
- Laboratory of Leprosy, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Eduardo Tarazona Santos
- Laboratory of Human Genetic Diversity, Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marilda Mendonça Siqueira
- Laboratory of Respiratory, Exanthematic, Enteric Viruses and Viral Emergencies, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Cristiana Couto Garcia
- Laboratory of Respiratory, Exanthematic, Enteric Viruses and Viral Emergencies, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil; Integrated Research Group on Biomarkers, René Rachou Institute, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | - Eduardo José Melo Dos Santos
- Post-graduation Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belém, PA, Brazil.
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Sharif A, Reilly A, Bhagra O, Papisetty K, Magableh H, Dominari A, Nathani KR, Delawan M, Bydon M. Impact of perioperative nutritional supplementation on outcomes of spine surgery: A systematic review and meta-analysis. Clin Neurol Neurosurg 2025; 254:108916. [PMID: 40288287 DOI: 10.1016/j.clineuro.2025.108916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 04/15/2025] [Accepted: 04/19/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVE Malnutrition, characterized by a total serum lymphocyte count less than 1500 cells/mm³ and serum albumin levels below 3.5 g/dL, is linked to delayed wound healing and a higher incidence of surgical site infections (SSIs). This meta-analysis evaluates the impact of perioperative nutritional supplementation on clinical outcomes in spine surgery. METHODS A systematic review of the published literature was conducted. Outcomes of interest included postoperative complications such as wound complications, SSI, and deep vein thrombosis (DVT). Estimated blood loss, operative time, and duration of hospital stay were also investigated. RESULTS Five studies with 554 patients were included. A total of 221 patients (39.90 %) were in the intervention group, compared to 333 patients (60.10 %) in the control group. The intervention groups received nutritional supplementation at different timeframes, including preoperatively or postoperatively. A significantly lower rate of total complications (OR: 0.32, CI: [0.12, 0.89], p = 0.04) and wound-related complications (OR: 0.34, CI: [0.20, 0.60], p < 0.01) was observed in the intervention group when compared to the control group. A trend towards fewer SSIs was observed (OR: 0.35, CI: [0.02, 7.19], p = 0.39). There were also fewer DVT events in the intervention group (OR: 0.62, CI: [0.04, 8.90], p = 0.52). CONCLUSIONS Patients receiving perioperative nutritional supplementation had significantly lower overall and wound-related complication rates compared to patients who did not receive nutritional supplementation perioperatively. This analysis highlights the value of nutritional supplementation as part of the perioperative care and optimization efforts in patients undergoing spine surgery.
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Affiliation(s)
- Ahmad Sharif
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Alison Reilly
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, USA
| | - Ojas Bhagra
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Vanderbilt University, Nashville, TN, USA
| | - Karthik Papisetty
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hamzah Magableh
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Asimina Dominari
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karim Rizwan Nathani
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maliya Delawan
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatic Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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Franco IL, de Carvalho Palhano Travassos L, Cavalcanti RVA, de Araujo CM, Taveira KVM, Pernambuco L. Prevalence of Self-Assessed Masticatory Disorders in Community-Dwelling Older Adults: A Systematic Review With Meta-Analysis. J Oral Rehabil 2025; 52:1124-1138. [PMID: 40346735 PMCID: PMC12162414 DOI: 10.1111/joor.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 02/06/2025] [Accepted: 04/21/2025] [Indexed: 05/12/2025]
Abstract
BACKGROUND Aging leads to changes that affect the functionality of the stomatognathic system, which can result in masticatory disorders. The loss or reduction in masticatory efficiency is often reported as one of the main complaints among healthy older adults. Due to variability and imprecision in prevalence estimates, there is a gap in specific knowledge about the true severity of masticatory issues in this population. OBJECTIVE To determine the prevalence of masticatory disorders in community-dwelling older adults. METHODS The prevalence of self-assessed masticatory disorders in community-dwelling older adults was investigated. A search was conducted in the electronic databases Cinahl, Embase, Lilacs, Livivo, PubMed/Medline, Scopus, Web of Science, Google Scholar, OpenGrey and Proquest. The search strategy was adapted for each database using specific terms and keywords. Population-based cross-sectional/ecological studies that used questionnaires to identify masticatory disorders in individuals aged 60 years or older, living in the community were included. Of the 7008 articles identified in the databases and grey literature, 22 articles were included for data extraction and analysis. RESULTS High heterogeneity was observed among the prevalence estimates (I2 = 100%) for the different studies included in the analysis, which was not explained by the mean age of the study population or sample size when evaluated using a meta-regression model (p < 0.05). The pooled prevalence of masticatory disorders was 36% (95% CI = 0.28-0.43; I2 = 100%), with individual study estimates ranging from 4.3% to 61.7%. CONCLUSION The prevalence of self-assessed masticatory disorders in community-dwelling older adults is approximately 36%.
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Affiliation(s)
| | | | | | | | | | - Leandro Pernambuco
- Programa de Pós‐Graduação em Saúde da Comunicação Humana, Universidade Federal de PernambucoRecifeBrazil
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Amiri Khosroshahi R, Zare M, Zeraattalab-Motlagh S, Kiany F, Talebi S, Mohammadi H. Effects of a Low-Protein Diet on Kidney Function in Patients With Chronic Kidney Disease: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Controlled Trials. Nutr Rev 2025; 83:e2127-e2138. [PMID: 39657217 DOI: 10.1093/nutrit/nuae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2024] Open
Abstract
CONTEXT Chronic kidney disease (CKD) stands out as one of the most widespread diseases globally. Dietary interventions, such as adopting a low-protein diet (LPD), play a crucial role as a key approach in impeding the advancement of CKD. OBJECTIVE The objective of this umbrella review was to provide understanding into the effects of an LPD on kidney function among individuals with CKD, along with evaluating the certainty of the available evidence. DATA SOURCES Searches for relevant studies were conducted without limitations through databases such as PubMed, Scopus, Web of Science, and Google Scholar, encompassing findings up to June 2023. DATA EXTRACTION The effect sizes for each meta-analysis were recalibrated using a random-effects model. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DATA ANALYSIS Twenty-five meta-analyses including 47 randomized controlled trials were included in this study. Moderate certainty of the evidence suggests that LPDs may reduce glycated hemoglobin (HbA1c) and phosphorus levels, and the risk of progressing to end-stage renal disease in patients with CKD. Moreover, notable outcomes include increased glomerular filtration rate and decreased levels of serum albumin, blood urea nitrogen, and bicarbonate, although the certainty of evidence is low. In addition, LPDs can substantially decrease proteinuria, urine urea, and parathyroid hormone (PTH), although with very low certainty. The effects on serum creatinine, calcium, systolic blood pressure, and diastolic blood pressure are statistically nonsignificant, with the certainty of evidence ranging from low to moderate. CONCLUSION LPDs demonstrated beneficial effects on renal function in patients with CKD, which is supported by moderate to very low certainty evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023473647.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Marzieh Zare
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 1417613151, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Health and Human Performance, University of Houston, Houston, TX 77204-6015, United States
| | - Fatemeh Kiany
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz 1417613151, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 1417613151, Iran
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Krynicki CR, Jones CA, Hacker DA. A meta-analytic review examining the validity of executive functioning tests to predict functional outcomes in individuals with a traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2025; 32:1205-1222. [PMID: 37358236 DOI: 10.1080/23279095.2023.2225666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Deficits in executive functioning are a common consequence of Traumatic Brain Injury (TBI) and the severity of TBI is known to predict functional outcomes. In this review, the authors examine the ability of three commonly used tests of executive functioning [The Trail Making Test (TMT-B), The Wisconsin Card Sorting Test (WCST), and Verbal Fluency (VF)] to predict domains of function. METHODS Seven hundred and twenty articles were identified and twenty-four met inclusion criteria (original articles published in English examining an adult TBI population). Data were subject to a study quality analysis and then meta-analyzed to assess whether tests of executive functioning (TMT-B, WCST, and VF) can predict functional, employment, and driving outcomes following a TBI. RESULTS The TMT-B (r = 0.29; 95% CI 0.17-0.41) and the WCST (r = 0.20; 95% CI 0.02-0.37) were significantly associated with functional outcomes. The TMT-B was also associated with a person's ability to return to driving (r = 0.3890; 95% CI 0.2678-0.5103). No test of executive functioning was associated with employment outcomes following a TBI. CONCLUSION These findings are important to guide rehabilitation strategies and future planning. This review has also highlighted the scarcity of research on specific outcomes.
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Affiliation(s)
- Carl R Krynicki
- School of Psychology, The University of Birmingham, Birmingham, UK
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Christopher A Jones
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- Clinical Neuropsychology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David A Hacker
- Clinical Neuropsychology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Guo A, Ludvigsson J, Hård Af Segerstad EM, Brantsæter AL, Andersson B, Størdal K, Mårild K. Early-Life Diet Diversity and the Subsequent Risk of Inflammatory Bowel Disease: Findings From Two Scandinavian Birth Cohorts. Inflamm Bowel Dis 2025; 31:1493-1501. [PMID: 39276084 DOI: 10.1093/ibd/izae210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND Diet diversity in early childhood promotes microbial diversity, influences the developing immune system, and has been linked to a reduced risk of immune-mediated diseases. This study aimed to determine the association between childhood diet diversity and later inflammatory bowel disease (IBD), for which data are limited. METHODS Questionnaire data from the population-based birth cohorts All Babies in Southeast Sweden (ABIS) and the Norwegian Mother, Father, and Child Cohort (MoBa), including participants from Southeast Sweden and Norway, were used to estimate a diet diversity score at ages 1 and 3 years. This score represents the diversity of intakes across 5 food groups comprising 11 subgroups. A higher score signifies higher diet diversity. We used linked health registry data to identify IBD diagnoses up to the year 2021. Cox regression and random-effect models were used to estimate pooled hazard ratios (aHRs) adjusted for sociodemographics, breastfeeding, and early-life antibiotic use. RESULTS Among 81 272 children with 1 304 325 person-years of follow-up, 307 developed IBD. Diet diversity at ages 1 and 3 years was in pooled analyses not associated with later IBD (per one-unit increase, aHR = 0.96 [95% CI = 0.81-1.14] and aHR = 0.96 [95% CI = 0.83-1.11]). In MoBa, but not ABIS, a higher diet diversity at 1 and 3 years of age was inversely associated with ulcerative colitis (UC) (per one-unit increase, aHR = 0.78 [95% CI = 0.66-0.94] and aHR = 0.78 [95% CI = 0.65-0.95]). Still, pooled aHRs for UC as well as Crohn's disease approximated one. CONCLUSIONS In this prospective study of 2 Scandinavian birth cohorts, no association was observed between early-life diet diversity and the subsequent risk of IBD.
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Affiliation(s)
- Annie Guo
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Region Östergötland, Linköping, Sweden
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Anne Lise Brantsæter
- Department of Food Safety and Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
| | - Björn Andersson
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ketil Størdal
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
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15
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Roy R, Babu A, Song Z, Vinjamuri S, Anyagwa OE, Kasmirski J, Chaudhary I, Lindeman B, Fazendin J, Gillis A, Chen H. Outcomes in Pediatric Thyroid Surgery Across Multiple Institutions. J Surg Res 2025; 312:55-67. [PMID: 40516151 DOI: 10.1016/j.jss.2025.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Revised: 04/28/2025] [Accepted: 05/12/2025] [Indexed: 06/16/2025]
Abstract
INTRODUCTION Surgical management plays a crucial role in managing thyroid disease in the pediatric population as evidenced by the increasing volume of such cases over the years. This study aims to evaluate the outcomes of thyroid surgery in children, adolescents, and young adults by meta-analyzing outcomes across several institutions. METHODS A comprehensive literature search for single institutional studies was performed across PubMed, Science Direct, Embase, Scopus, and Google Scholar. Key variables like mean hospital stay and both transient and permanent complications were recorded. Transient hypocalcemia or hypoparathyroidism was defined as a drop in serum calcium below laboratory reference range postthyroidectomy that resolved within 6 mo. Transient laryngeal nerve injury was characterized by hoarseness or dysphonia arising from neuropraxia or trauma to the nerve that resolved within 6 mos postsurgery. Complications persisting beyond 6 mo were classified as permanent. We performed meta-analysis on complication rates using the metaprop library on R studio. RESULTS A total of 2339 studies were retrieved through our search strategy across five databases. Excluding duplicates, the remaining studies were screened resulting in 88 studies being selected for a full text review. Fifty-six studies were excluded due to a lack of outcome specific data leaving a total of thirty-two studies that were included, amounting to 2747 patients with a mean of 86 patients per study. The overall weighted mean age of patients in our study pool was 12.9 ± 4.1 (95% confidence interval [CI]: 12.8-13.1) years. Mean hospital stay was 2.6 ± 1.9 (95% CI: 2.5-2.7) days. Common complications like transient hypocalcemia or hypoparathyroidism was found in 24% (95% CI: 0.2-0.3, I2 = 91%) and transient laryngeal nerve injury was 2% (95% CI: 0.01-0.02, I2 = 35%) of patients. Permanent hypocalcemia or hypoparathyroidism was found in 3% (95% CI: 0.02-0.04, I2 = 65%) patients. Rare complications included permanent laryngeal nerve injury in 1% (95% CI: 0.00-0.01) and hematoma formation in 1% (95% CI: 0.00-0.01). CONCLUSIONS Pediatric thyroid surgery, although safe, has a high risk of transient hypocalcemia or hypoparathyroidism. Other complications remain under 3%.
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Affiliation(s)
- Raj Roy
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Abhirami Babu
- Our Lady of Fatima University, College of Medicine, Valenzuela City, Philippines
| | - Zhixing Song
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Julia Kasmirski
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isha Chaudhary
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Fazendin
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea Gillis
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Moffatt J, Webster KE, Dwan K, Frost JA, Morrison J. Lymphadenectomy or sentinel node biopsy for the management of endometrial cancer. Cochrane Database Syst Rev 2025; 6:CD015786. [PMID: 40492478 DOI: 10.1002/14651858.cd015786.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2025]
Abstract
RATIONALE Endometrial cancer, which affects the lining of the uterus, is the most common form of uterine cancer (96%), and the sixth most common cancer in females worldwide, accounting for 4.5% of all cancers in females. In 2022, there were 420,242 cases of uterine cancer and 97,704 deaths from the disease worldwide. Most women have early-stage endometrial cancer at diagnosis. Traditionally, surgical staging included removal of all lymph nodes (lymphadenectomy) in the pelvis (pelvic lymphadenectomy) with or without para-aortic areas (pelvic/para-aortic lymphadenectomy), to determine the need for further treatment. However, rates of lymph node involvement are relatively low and may be predicted by uterine histopathology and molecular markers. Lymphadenectomy carries a significant risk of long-term morbidity from lymphoedema and previous studies comparing pelvic lymphadenectomy with no lymphadenectomy found no survival benefit. Detecting the first draining lymph node(s) from each side of the uterus, called sentinel lymph node biopsy, can replace lymphadenectomy in terms of accuracy of detecting nodes, but no studies have shown whether sentinel lymph node biopsy is beneficial to women, despite its wide use. OBJECTIVES To evaluate the benefits and harms of lymphadenectomy and sentinel lymph node biopsy for the management of endometrial cancer comparing different head-to-head comparisons in a network meta-analysis allowing ranking of treatment strategies. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the WHO ICTRP for studies up to 22 March 2024. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) of women with early-stage endometrial cancer, comparing combinations of no lymphadenectomy, pelvic lymphadenectomy, pelvic/para-aortic lymphadenectomy and sentinel lymph node biopsy. We excluded non-randomised studies and studies assessing diagnostic test accuracy of lymph node sampling. OUTCOMES Overall survival; progression-free survival; morbidity and mortality related to surgery; early and late adverse events, including lymphoedema and lymphocyst formation; and quality of life. RISK OF BIAS We used RoB 2 to assess risk of bias. SYNTHESIS METHODS We conducted meta-analyses using random-effects models to calculate hazard ratios (HR) for time-to-event data and risk ratios (RR) and mean difference (MD) for other outcomes, with 95% confidence intervals (CI). We used GRADE to summarise the certainty of evidence. We intended to compare treatments in a network meta-analysis. INCLUDED STUDIES We included five RCTs (one remains ongoing) with 2074 women. Studies were conducted in the UK, South Africa, Poland, New Zealand, Chile, Italy, Egypt and Brazil, and published between 2008 and 2023. Another 10 studies are ongoing. Three studies (1955 participants) compared no lymphadenectomy with pelvic lymphadenectomy, one study (50 participants) compared no lymphadenectomy with pelvic/para-aortic lymphadenectomy, and one study (69 participants - ongoing) compared sentinel lymph node biopsy with pelvic/para-aortic lymphadenectomy. SYNTHESIS OF RESULTS No lymphadenectomy versus pelvic lymphadenectomy No lymphadenectomy probably results in little to no difference in overall survival (HR 0.85, 95% CI 0.66 to 1.10; 2 studies, 1922 participants; moderate-certainty evidence) and improves progression-free survival (HR 0.78, 95% CI 0.63 to 0.96; 2 studies, 1922 participants; high-certainty evidence) compared to pelvic lymphadenectomy. No lymphadenectomy may reduce early adverse effects from direct surgical morbidity slightly (RR 0.68, 95% CI 0.27 to 1.71; 3 studies, 1955 participants; low-certainty evidence) and probably reduces early adverse effects due to surgically related systemic morbidity (RR 0.28, 95% CI 0.09 to 0.93; 3 studies, 1955 participants; moderate-certainty evidence). No lymphadenectomy probably results in a large reduction in lymphoedema (RR 0.12, 95% CI 0.05 to 0.26; 3 studies, 1955 participants; moderate-certainty evidence) and likely reduces lymphocyst formation (RR 0.20, 95% CI 0.04 to 0.91; 1 study, 1403 participants; moderate-certainty evidence). There were no quality of life data. Sentinel lymph node biopsy versus pelvic/para-aortic lymphadenectomy One study shared unpublished data and the evidence is very uncertain about the effect of sentinel lymph node biopsy on overall survival, progression-free survival, early adverse events, lymphocyst formation and quality of life at 12 months. Sentinel lymph node biopsy compared with pelvic/para-aortic lymphadenectomy probably reduces the development of lymphoedema (RR 0.30, 95% CI 0.09 to 0.97; 1 study, 69 participants; moderate-certainty evidence). No lymphadenectomy versus pelvic/para-aortic lymphadenectomy One study closed after the recruitment of 50 participants due to slow uptake, and we were unable to extract data for use in the meta-analysis. Because of this, we were unable to form a linked network for meta-analysis. Other comparisons Studies of other comparisons are ongoing or results are yet to be published. AUTHORS' CONCLUSIONS Data suggest 'less is probably more' in terms of surgical staging for women with presumed endometrial cancer, as no lymphadenectomy is favoured over pelvic lymphadenectomy in terms of important outcomes, with overall moderate certainty. Preliminary results for sentinel lymph node biopsy versus pelvic/para-aortic lymphadenectomy have a similar direction of effect, but the evidence is very uncertain. Data from several studies are ongoing. However, given the weight of evidence that supports no lymphadenectomy over lymphadenectomy, our ability to make adjuvant treatment decisions based on uterine factors, and the advent of molecular profiling, it is disappointing that only one study compared no lymphadenectomy with sentinel lymph node biopsy, potentially putting many women at continued risk of short- and significant long-term consequences of extensive lymphadenectomy. FUNDING This Cochrane review had no dedicated funding. REGISTRATION This review is based on an updated protocol including network meta-analysis methods and new RoB 2 assessment of a previously published review. Updated protocol 2023 available via https://doi.org/10.1002/14651858.CD015786.
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Affiliation(s)
- Joanne Moffatt
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Katie E Webster
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Kerry Dwan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jonathan A Frost
- Department of Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Probst P, Hüttner FJ, Klaiber U, Knebel P, Ulrich A, Büchler MW, Diener MK. Stapler versus scalpel resection followed by handsewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev 2025; 6:CD008688. [PMID: 40492489 DOI: 10.1002/14651858.cd008688.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2025]
Abstract
BACKGROUND Resections of the pancreatic body and tail reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are elective treatments for chronic pancreatitis, benign or malignant diseases, and they have high morbidity rates of up to 40%. Pancreatic fistula formation is the main source of postoperative morbidity, and is associated with numerous further complications. Researchers have proposed several surgical resection and closure techniques of the pancreatic remnant in an attempt to reduce these complications. The two most common techniques are scalpel resection followed by handsewn closure of the pancreatic remnant and stapler resection and closure. OBJECTIVES To assess the effects of stapler resection and closure compared to scalpel resection followed by handsewn closure of the pancreatic remnant in people undergoing distal pancreatectomy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from database inception to October 2023, and the ISGPS Evidence Map of Pancreatic Surgery to 9 April 2025. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing stapler versus scalpel resection followed by handsewn closure of the pancreatic remnant for open distal pancreatectomy (irrespective of language or publication status). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and performed data extraction. Our outcomes of interest were postoperative mortality and morbidity, especially postoperative pancreatic fistula. Taking into account the clinical heterogeneity between trials (e.g. different endpoint definitions), we analysed data using a random-effects model in RevMan, calculating risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. MAIN RESULTS In three trials, a total of 515 participants underwent distal pancreatic resection and were randomised to closure of the pancreatic remnant either with stapler (n = 259) or scalpel resection followed by handsewn closure (n = 256). One study was a single-centre pilot RCT, and two studies were multicentre RCTs. The single-centre pilot RCT evaluated 69 participants in five intervention arms (stapler, handsewn, fibrin glue, mesh, and pancreaticojejunostomy), although we only assessed the stapler and handsewn closure groups (14 and 15 participants, respectively). The two multicentre RCTs had two interventional arms: stapler (n = 177 and 68) and handsewn closure (n = 175 and 66). Stapler may have similar effects on postoperative mortality compared to scalpel resection followed by handsewn closure, although the CI is wide (4 deaths per 1000 compared with 8 per 1000; RR 0.49, 95% CI 0.05 to 5.40; 3 RCTs; 515 participants; low-certainty evidence). Stapler likely results in little to no difference in postoperative pancreatic fistula according to the International Study Group of Pancreatic Surgery (ISGPS) definition compared to scalpel resection followed by handsewn closure (26% versus 29%; RR 1.11, 95% CI 0.84 to 1.47; 2 RCTs; 486 participants; moderate-certainty evidence). Stapler likely results in little to no difference in overall postoperative morbidity compared to scalpel resection followed by handsewn closure (63% versus 59%; RR 1.06, 95% CI 0.87 to 1.30; 2 RCTs; 486 participants; moderate-certainty evidence). We downgraded the certainty of evidence for all outcomes by one level due to potential selection bias alone or in combination with performance and detection bias, and for postoperative mortality by a further level for imprecision. AUTHORS' CONCLUSIONS The evidence is mainly based on the results of two multicentre RCTs. There is no ongoing RCT on this topic. We did not find evidence to indicate that either stapler or scalpel resection followed by handsewn closure of the pancreatic remnant for distal pancreatectomy is superior in terms of postoperative pancreatic fistula, overall postoperative mortality, or operation time. Currently, the choice of closure is left to the preference of the individual surgeon and the anatomical characteristics of the patient. Future trials stratifying for pancreatic texture (soft versus hard) could add valuable information to inform surgical approaches when considering different pancreatic textures. Future trials assessing novel methods of stump closure should compare them either with stapler or handsewn closure as a control group to ensure comparability of results.
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Affiliation(s)
- Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
| | - Felix J Hüttner
- Department of General, Visceral and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
| | - Ulla Klaiber
- Department of General and Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Phillip Knebel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral, Thoracic and Vascular Surgery, Lukas Hospital Neuss , Neuss, Germany
| | - Markus W Büchler
- Botton-Champalimaus Pancreatic Cancer Center, Champalimaud Foundation, Lisbon, Portugal
| | - Markus K Diener
- Department of General, Visceral and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
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Agrawal A, Sharma S, Janjua D, Jadon G, Chanchlani R, Dsouza V. Impact of nutritional status on the mortality and clinical outcomes of children admitted to the pediatric intensive care unit: A systematic review and meta-analysis. Clin Nutr 2025; 51:28-39. [PMID: 40516325 DOI: 10.1016/j.clnu.2025.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 05/31/2025] [Accepted: 06/02/2025] [Indexed: 06/16/2025]
Abstract
BACKGROUND AND AIMS Malnutrition has been associated with poor outcomes in hospitalized patients; however, previous studies reported variable results due to different periods, height and weight standards, interventions, and possible confounding factors. We aimed to evaluate the association of nutritional status with the clinical outcomes in children admitted to the Pediatric Intensive Care Unit (PICU). METHODS We searched PubMed, Scopus, Web of Science, and Cochrane Library from inception to May 2024 using keywords and MeSH related to critically ill children, outcome, and nutritional status or malnutrition in different combinations. Studies reporting the association of undernutrition (UN), over-nutrition (ON), or both with outcomes of patients admitted to PICU aged 1 month to 18 years were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to collect studies and extract relevant data. After removing duplicates, title, and abstract screening was done for 6560 studies, 121 full-text studies were reviewed, and 52 studies were finally included. The outcome measures were to assess risk difference (RD) and standardized mean difference (SMD) among UN, ON, and normal nutrition groups for mortality (primary), PICU length of stay (LOS), hospital LOS, duration, or need of mechanical ventilation (MV), and hospital-acquired infections (secondary). The protocol of this study is registered with the Open Science Framework (https://osf.io/ywmvz). RESULTS We included 52 studies comprising 34,795 patients (4843 undernourished, 18,373 normally nourished, and 6552 overnourished). The male-to-female ratio was 1.13, with a mean age of 3.66 years. Meta-analysis showed a significantly increased risk of mortality in the UN group (RD = 0.02; 95%CI = 0.01-0.04, P < 0.0001) but not in the ON group (RD = 0.00; 95%CI = -0.01-0.01, P = 0.78). The need for MV (RD = 0.04; P = 0.0004) and duration of MV (SMD = 0.23; P < 0.00001) were significantly greater in the UN children but not in the ON group (P = 0.13, P = 0.43, respectively). UN significantly prolonged hospital LOS (SMD = 0.26; P < 0.00001) and PICU LOS (SMD = 0.27; P < 0.00001). CONCLUSION Undernutrition is independently associated with poor outcomes, including a higher risk of mortality, need for MV, longer MV duration, PICU, and hospital LOS. However, overnutrition did not show such associations with poor outcomes in critically ill children. Timely recognition of malnutrition is important for enhancing pediatric critical care and optimizing outcomes through planned nutritional interventions.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India.
| | - Shweta Sharma
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India.
| | - Dalwinder Janjua
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
| | - Gaurav Jadon
- NMC Speciality Hospital, Dubai, United Arab Emirates.
| | - Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, MP, India.
| | - Viola Dsouza
- Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands.
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Campara K, Rodrigues P, Viero FT, da Silva B, Trevisan G. A systematic review and meta-analysis of advanced oxidative protein products levels (AOPP) levels in endometriosis: Association with disease stage and clinical implications. Eur J Pharmacol 2025; 996:177434. [PMID: 40024324 DOI: 10.1016/j.ejphar.2025.177434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 11/22/2024] [Accepted: 02/25/2025] [Indexed: 03/04/2025]
Abstract
Endometriosis is a common cause of chronic pelvic pain and lacks precise pathophysiological mechanisms. Advanced oxidation protein products (AOPPs), markers of oxidative stress and inflammation, are implicated in pain-related diseases and have been suggested to play a crucial role in endometriosis pathophysiology. We aim to assess the significance of AOPP in endometriosis by analyzing their levels across serum, follicular fluid, peritoneal fluid, and ovarian endometrioma tissue, and their association with different disease stages. A systematic review of articles published up to Nov 2024 examining AOPP levels in endometriosis patients compared to controls was conducted (PROSPERO: CRD42022343714). Using the Newcastle-Ottawa Scale (NOS), the quality and risk of bias of included studies were assessed, and publication bias was evaluated using Egger's and Begg's tests. The analysis 12 studies involving 561 control patients without endometriosis and 670 patients with endometriosis. Compared to controls, elevated AOPP levels were observed in endometriosis patients' serum and peritoneal fluid. Patients with type III/IV endometriosis exhibited higher AOPP levels in serum and plasma compared to control patients, suggesting a potential association with disease severity. The study underscores the potential of AOPP levels as biomarkers for endometriosis severity and proposes them as pharmacological targets for disease management, including pelvic pain treatment.
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Affiliation(s)
- Kelly Campara
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria (RS)97105-900, Brazil
| | - Patrícia Rodrigues
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria (RS)97105-900, Brazil
| | - Fernanda Tibolla Viero
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria (RS)97105-900, Brazil
| | - Brenda da Silva
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria (RS)97105-900, Brazil
| | - Gabriela Trevisan
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria (RS)97105-900, Brazil.
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Jalili C, Moosavian SP, Awlqadr FH, Mehrabani S, Bagheri R, Sedighy M, Hodder S, Jalili F, Ali Hojjati Kermani M, Zamir Nasta M, Moradi S, Dutheil F. The Association of Food Insecurity and Risk of Mortality: A Systematic Review and Meta-Analysis of Large-Scale Cohorts. Nutrients 2025; 17:1937. [PMID: 40507207 PMCID: PMC12158141 DOI: 10.3390/nu17111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2025] [Revised: 05/22/2025] [Accepted: 06/01/2025] [Indexed: 06/16/2025] Open
Abstract
Objectives: Food insecurity (FI) represents a significant global public health issue, yet existing literature presents inconsistent findings regarding its association with mortality risk. This systematic review and meta-analysis aimed to synthesize available evidence to evaluate the relationship between FI and mortality. Setting: A systematic search was conducted using the ISI Web of Science, PubMed/MEDLINE, and Embase databases without any date limitation until February 18, 2025. Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using a random-effects model, while validated methods examined quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests, respectively. Results: Findings from 19 studies demonstrated a significant association between FI and increased risk of mortality (HR = 1.23; 95% CI: 1.16, 1.30; I2 = 83.1%; p < 0.001; n = 19). Subgroup analyses indicated a dose-response relationship, with mortality risk increasing by FI severity: mild (HR = 1.16; 95% CI: 1.10, 1.22; I2 = 0.0%; p < 0.001; n = 9), moderate (HR = 1.19; 95% CI: 1.07, 1.31; I2 = 83.2%; p = 0.001; n = 10) and severe (HR = 1.52; 95% CI: 1.25, 1.86; I2 = 94.9%; p < 0.001; n = 10). Additional subgroup analyses revealed a significant association between FI and both all-cause mortality (HR = 1.26; 95% CI: 1.18, 1.35; I2 = 82.0%; p < 0.001; n = 16), and cardiovascular-related mortality (HR = 1.24; 95% CI: 1.11, 1.39; I2 = 42.8%; p < 0.001; n = 7), but not cancer-related mortality. Conclusions: Persistent FI appears to contribute to an increased risk of mortality. Hence, it is important to maintain continuity and strengthen current programs aimed at combating FI, which may help reduce FI-related mortality.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah 6714686698, Iran; (C.J.); (M.Z.N.)
| | - Seyedeh Parisa Moosavian
- Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran;
| | - Farhang Hameed Awlqadr
- Department of Food Science and Quality Control, Halabja Technical College, Sulaimani Polytechnic University, Halabja 46001, Iraq;
| | - Sanaz Mehrabani
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan 8174673441, Iran;
| | - Matin Sedighy
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Shirley Hodder
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.H.); (F.J.)
| | - Faramarz Jalili
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.H.); (F.J.)
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran;
| | - Maryam Zamir Nasta
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah 6714686698, Iran; (C.J.); (M.Z.N.)
| | - Sajjad Moradi
- Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh 5518654511, Iran
- Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh 5518654511, Iran
| | - Fred Dutheil
- Preventive and Occupational Medicine, Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Witty Fit, F-63000 Clermont-Ferrand, France;
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21
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Atem TD, Singh R, Newbury-Birch D, Pal B, Chaudhary V. Prevalence and associated factors of self-medication with antibiotics among pediatric population in India: a systematic review and meta-analysis. BMC Pediatr 2025; 25:451. [PMID: 40468262 PMCID: PMC12135438 DOI: 10.1186/s12887-025-05676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 04/08/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND Antibiotic resistance presents a substantial threat to global public health. One of the primary contributors to antibiotic resistance is the irrational use of antibiotics. This study aimed to comprehensively assess the prevalence and associated factors of antibiotic self-medication (ASM) practices among the pediatric population in India. METHODS A comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar to identify relevant articles published up to December 2024. Inclusion criteria included studies reporting the prevalence rate of ASM practices among the pediatric population in India. Quality assessment of the included studies was conducted using the JBI tool for prevalence studies. Data were extracted using a standardized form and analyzed using R software with a random-effects model. RESULTS Seventeen studies involving 7847 children were analyzed. The pooled prevalence of pediatric ASM in India was 19.8% (95% CI: 13.5; 28.2; I2 = 98.2%; p < 0.01). Regional disparities were observed (p < 0.01), with the northern region exhibiting the highest prevalence at 30.7%. No significant difference in prevalence was found between studies that recruited participants from hospital and community settings (p = 0.0552). Key factors associated with pediatric ASM included financial constraints, time constraints, perceptions of mild illness, and limited healthcare access. Common sources for procuring antibiotics were local pharmacies, leftover medications, and friends/family members. Information sources regarding the use of antibiotics included previous prescriptions, friends/family members, media, past experiences, and pharmacists. The mean duration of antibiotic consumption was 2.5 days. CONCLUSION Self-medication with antibiotics was prevalent among the pediatric population in India. Therefore, government and policymakers should take necessary measures to promote the responsible use of antibiotics.
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Affiliation(s)
- Tambe Daniel Atem
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India.
- Department of Pharmacology, Lovely Professional University, Punjab, 144411, India.
| | - Ruby Singh
- Department of Pediatrics, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India.
- Department of Pharmacology, Lovely Professional University, Punjab, 144411, India.
| | - Vaibhav Chaudhary
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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22
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von Bartheld CS, Chand A, Wang L. Prevalence and Etiology of Strabismus in Down Syndrome: A Systematic Review and Meta-Analysis with a Focus on Ethnic Differences in the Esotropia/Exotropia Ratio. Ophthalmic Epidemiol 2025:1-19. [PMID: 40458862 DOI: 10.1080/09286586.2025.2500018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Revised: 03/27/2025] [Accepted: 04/27/2025] [Indexed: 06/11/2025]
Abstract
PURPOSE We sought to determine the prevalence of strabismus and the esotropia/exotropia ratio in Down syndrome. Wide ranges of an increased strabismus prevalence have been reported and it is unclear by how much esotropia exceeds exotropia in people with Down syndrome. METHODS We compiled in a systematic review and meta-analysis results of over 100 studies that report the strabismus prevalence and ratio of esotropia/exotropia in cohorts of Down syndrome. We calculated the pooled global prevalence and established the geographical distribution of the strabismus prevalence and the esotropia/exotropia ratio. RESULTS The ethnically-adjusted global prevalence of strabismus in Down syndrome is 30.2%. In subjects 15 years and older, the global prevalence is 53.2%, and the lifetime prevalence is 51.0%. In populations which normally have more esotropia than exotropia (e.g. Caucasians), Down syndrome subjects have a further increased bias towards esotropia. In populations which normally have more exotropia (e.g. West Africans, Asians and Hispanics), Down syndrome subjects have a significantly lower esotropia/exotropia ratio (3.21) than reported in Caucasians with Down syndrome (9.98). CONCLUSION Worldwide, about 1.81 million people with Down syndrome have strabismus: 1.42 million of them have esotropia, and 0.37 million have exotropia. Differences in the esotropia/exotropia ratio between ethnicities point to the orbital anatomy as a major contributing factor to the etiology of strabismus in Down syndrome. The narrow-set eyes (reduced orbital width) in Down syndrome favor esotropia over exotropia, especially in Caucasians, thus explaining why Down syndrome patients from different ethnicities have different prevalences of esotropia and exotropia.
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Affiliation(s)
- Christopher S von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Avishay Chand
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Lingchen Wang
- School of Public Health, University of Nevada, Reno, NV, USA
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23
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Lee YH, Song GG. Association between chemokine genes polymorphisms and susceptibility to Parkinson's disease: a meta-analysis and systematic review. Acta Neurol Belg 2025; 125:599-607. [PMID: 39066886 DOI: 10.1007/s13760-024-02615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE This study aimed to investigate the potential association between polymorphisms in monocyte chemoattractant protein-1 (MCP-1), chemokine receptor type 2 (CCR2), type 5 (CCR5), regulated on activation, normal T cell expressed, and secreted (RANTES) and susceptibility to Parkinson's disease (PD). METHODS The MEDLINE, EMBASE, and Web of Science databases were searched for relevant articles, and a meta-analysis was conducted to assess the associations between the MCP-1 -2518 G/A, CCR2 V64I, CCR5-Δ32, RANTES - 405 G/A, -28 G/A polymorphisms and the risk of PD. RESULTS Six studies with 1,416 patients with PD and 1,715 controls that met the inclusion criteria were identified. Meta-analysis of all study participants demonstrated no association between PD and the MCP-1 -2518 G allele (odds ratio [OR] = 1.089, 95% confidence interval [CI] = 0.980-1.211, p = 0.114). Stratification by ethnicity indicated no association between the MCP-1 -2518 G allele and PD in the European and Asian populations. Meta-analysis demonstrated no association between PD and the MCP-1-2518 A/G polymorphism in recessive and dominant models and homozygote contrast. However, meta-analysis revealed a significant association between the risk of PD and the CCR2-V64I AA + GG genotype in all study participants (OR = 0.418, 95% CI = 0.232-0.753, p = 0.004). Stratification based on ethnicity validated this association between the CCR2-V64I AA + GG genotype and PD in the Asian population (OR = 0.460, 95% CI = 0.243-0.870, p = 0.017), but not in European populations. Analysis using the homozygous contrast model revealed the same pattern for the CCR2-V64I AA + GG genotype. Meta-analysis revealed no association between the CCR5-Δ32 allele and the risk of PD (OR = 0.972, 95% CI = 0.377-2.501, p = 0.952). Moreover, the meta-analysis demonstrated no allelic association between RANTES - 405 G/A and - 28 G/A polymorphisms and the risk of PD. CONCLUSIONS Our meta-analysis showed that the CCR2 V64I polymorphism is associated with PD, especially in Asian populations.
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Affiliation(s)
- Young Ho Lee
- Department of Rheumatology, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Korea.
| | - Gwan Gyu Song
- Department of Rheumatology, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Korea
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24
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Khezri M, Kimball S, McKnight C, Rouhani S, Bunting AM, Karamouzian M, Ompad DC, Des Jarlais D. Harms associated with injecting in public spaces: a global systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 140:104819. [PMID: 40294496 DOI: 10.1016/j.drugpo.2025.104819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 04/14/2025] [Accepted: 04/17/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Despite increasing backlash against harm reduction efforts and the need to understand the risk environments encountered by people who inject drugs (PWID), a quantitative systematic review on public injecting and associated health and drug-related outcomes is lacking. We aimed to summarize the global evidence on the prevalence and harms associated with injecting in public spaces. METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Global Health, and Web of Science from inception to March 21, 2024. We pooled data from included studies using random-effects meta-analyses to quantify the associations between recent (i.e., current or within the last year) public injecting and associated outcomes. Public injecting was defined as injecting in public or semi-public spaces, including streets, parks, and abandoned buildings. Risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tool. RESULTS Of the 6144 initial records, 84 studies were eligible for inclusion. The pooled prevalence of recent public injecting was 48.85 % (95 % confidence intervals [CI] 43.87, 53.85). Public injecting was associated with increased odds of recent non-fatal overdose (odds ratio [OR] 2.51, 95 % CI 2.01, 3.13), HCV infection (OR 1.55, 95 % CI 1.18, 2.02), recent needle/syringe sharing (OR 2.41, 95 % CI 1.97, 2.94), recent sex work (OR 1.75, 95 % CI 1.03, 2.97), recent incarceration (OR 2.10, 95 % CI 1.78, 2.47), and recent unstable housing/homelessness (OR 4.23, 95 % CI 3.17, 5.65). Public injecting showed a statistically non-significant association with HIV infection (OR 1.41, 95 % CI 0.80, 2.46). Public injecting was also associated with a higher willingness to use supervised injection facilities (OR 2.66, 95 % CI 1.86, 3.80). CONCLUSION Public injecting is prevalent among PWID and associated with various adverse drug- and health-related outcomes, highlighting the need for increased access to safe injection spaces. Findings support developing interventions to reduce harms from public injecting, such as addressing structural risks from law enforcement, expanding naloxone programs, and establishing overdose prevention centers. Housing interventions, in particular, could serve as an effective upstream strategy to reduce public injecting and related harms.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sarah Kimball
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States
| | - Courtney McKnight
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States
| | - Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States
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25
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Rodrigues ALSDO, Salomão IFA, Scabello IF, Vieira CM, Cavalcante DVS, de Melo Neto GJ, de Lima DP, de Carvalho RLC. Intrapleural Fibrinolytics Versus Thoracic Surgery for Complicated Pleural Infections: A Systematic Review and Meta-Analysis. Heart Lung Circ 2025; 34:627-638. [PMID: 40050212 DOI: 10.1016/j.hlc.2024.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 11/04/2024] [Accepted: 11/06/2024] [Indexed: 06/11/2025]
Abstract
BACKGROUND Intrapleural fibrinolytic therapy (IPFT) is an option for complicated pleural effusion (CPE). However, concerns remain about its use compared with thoracic surgery (TS). Therefore, we conducted a systematic review and meta-analysis to assess the length of stay associated with IPFT compared to TS in treating CPE. METHOD We searched PubMed, Embase, and Cochrane Library databases for studies that compared TS with IPFT in patients with complicated pleural infections. We used a random-effects model with a 95% confidence interval (CI) to pool the data. R version 4.4.1 was used for statistical analysis and heterogeneity was examined using I2 statistics. RESULTS A total of 16 studies, including 13 randomised controlled trials, involving a total of 764 were analysed. Of whom, 40% underwent IPFT. The success rate was higher in the TS group (odds ratio 0.3; 95% CI 0.11-0.78; p=0.014; I2=47%), and had a significantly shorter length of stay (mean difference 2.76; 95% CI 1.40-4.13; p<0.001; I2=92%) compared with the IPFT group. There were no statistical differences between groups in the mortality endpoint. Considering only the paediatric population, there were also no statistically significant differences for length of stay (mean difference 1.32; 95% CI -2.37 to 5.01; p=0.08; I2=91%) or success rates (odds ratio 0.86; 95% CI 0.27-2.74; p=0.74; I2=0%). CONCLUSIONS Our findings suggest that TS is an effective treatment for pleural infections. There is no significant increase in adverse events, and both treatments are equally effective and safe.
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Affiliation(s)
| | | | | | | | | | | | - David Paes de Lima
- University Center of João Pessoa (UNIPÊ), João Pessoa, Paraíba, Brazil; Department of Thoracic Surgery, Hospital Metropolitano Dom José Maria Pires João Pessoa, Paraíba, Brazil
| | - Rafael Lucas Costa de Carvalho
- University Center of João Pessoa (UNIPÊ), João Pessoa, Paraíba, Brazil; Department of Thoracic Surgery, Hospital Metropolitano Dom José Maria Pires João Pessoa, Paraíba, Brazil
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Demeco A, Renzi F, Frizziero A, Palermi S, Salerno A, Foresti R, Martini C, Costantino C. Imaging Derived Holograms Improve Surgical Outcome in Inexperienced Surgeons: A Meta-Analysis. Surg Innov 2025; 32:270-300. [PMID: 40100916 DOI: 10.1177/15533506251325351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
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.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Renzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Frizziero
- Department of Medicine and Surgery, ASST "Gaetano Pini" CTO, Milano, Italy
| | - Stefano Palermi
- Public Health Department-Human Anatomy and Sport Medicine Division, University of Naples Federico II (UNINA), Naples, Italy
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, Parma, Italy
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Fernández‐Elorriaga M, Fifield J, Semrau KEA, Lipsitz S, Tuller DE, Mita C, Cho C, Scott H, Taha A, Dhingra‐Kumar N, Moran A, Molina RL. Impact of the WHO safe childbirth checklist on birth attendant behavior and maternal-newborn outcomes: A systematic review and meta-analysis. Int J Gynaecol Obstet 2025; 169:984-998. [PMID: 39840819 PMCID: PMC12093921 DOI: 10.1002/ijgo.16123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/04/2024] [Accepted: 12/16/2024] [Indexed: 01/23/2025]
Abstract
BACKGROUND The intrapartum period is critical for reducing maternal and perinatal morbidity and mortality. The WHO's Safe Childbirth Checklist (SCC) was designed as a reminder of the most critical, evidence-based practices (EBPs) to improve quality care and reduce preventable complications and deaths. OBJECTIVE To assess the impact of SCC on birth attendant behavior and maternal and newborn health outcomes. SEARCH STRATEGY A systematic review and meta-analysis was performed searching across five databases from 2009 to 2023. SELECTION CRITERIA We included randomized controlled trials, quasi-experimental studies, and pre/post studies. DATA ANALYSIS A meta-analysis yielded a pooled estimate of relative risk (RR) for adherence to and effectiveness of the SCC. MAIN RESULTS Of 1070 articles identified, 16 were included. Use of the SCC increased adherence to EBPs by 65% (RR 1.65; 95% confidence interval [CI] 1.34-2.02). The behaviors that improved the most were danger sign counseling (RR 12.37; 95% CI 1.95-78.52; P = 0.008) and pre-eclampsia management (RR 3.43; 95% CI 1.33-8.88; P = 0.011). There was moderate evidence for stillbirth reduction (RR 0.89; 95% CI 0.80-0.99; P = 0.034). CONCLUSION There is moderate evidence demonstrating the effectiveness of the SCC in reducing stillbirths and improving adherence to EBPs.
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Affiliation(s)
- María Fernández‐Elorriaga
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
- Nursing DepartmentMedical School at Autonomous University of MadridMadridSpain
| | - Jocelyn Fifield
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
| | - Katherine E. A. Semrau
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
| | - Stuart Lipsitz
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
| | - Danielle E. Tuller
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
| | - Carol Mita
- Countway LibraryHarvard Medical SchoolBostonMassachusettsUSA
| | - Chelsea Cho
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
| | - Heather Scott
- Maternal, Newborn, Child and Adolescent Health and Ageing DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Ayda Taha
- WHO Patient Safety Flagship World Health OrganizationGenevaSwitzerland
| | | | - Allisyn Moran
- Maternal, Newborn, Child and Adolescent Health and Ageing DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Rose L. Molina
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T H Chan School of Public HealthBostonMassachusettsUSA
- Department of Obstetrics and GynecologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Fernández-Fernández R, Ibias J, Del Toro-Pérez C, Lahera G, Gasca-Salas C. Alexithymia in Parkinson's Disease: A Meta-analysis. Am J Geriatr Psychiatry 2025; 33:638-653. [PMID: 39732593 DOI: 10.1016/j.jagp.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/26/2024] [Accepted: 11/04/2024] [Indexed: 12/30/2024]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor manifestations, including alexithymia. This condition is defined by difficulty in recognizing, articulating, and expressing one's emotional states. In this study, we conducted a systematic review and meta-analysis to compare the prevalence of alexithymia in PD patients and a healthy population, and to identify associated demographic and clinical factors. We identified 16 observational studies through Pubmed, EMBASE, PsycINFO, and SCOPUS, selecting articles published since 2002. Data were analyzed using a random-effects model. We conducted additional prevalence meta-analyses and correlation meta-analyses. We found that PD patients exhibit higher levels of alexithymia compared to the general population (combined effect size 0.65 [95% CI = 0.49-0.81; P <0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, P <0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, P <0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, P<0.05]), after adjusting for covariates. The additional meta-analysis reported higher prevalence of alexithymia in PD and a pooled correlation coefficient of 0.496 (95% CI = 0.40-0.59, P <0.05) when we analyzed alexithymia and depression scores. To our knowledge, there are no previous meta-analysis applied to alexithymia in PD patients. Even though we could not determine whether alexithymia is a primary characteristic of PD, we found an association of higher levels of alexithymia with depression and higher levodopa equivalent daily dose. Furthermore, there are not enough studies to draw clear conclusions about the influence of cognitive status.
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Affiliation(s)
- Roberto Fernández-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain; Hospital Universitario Infanta Cristina (RFF), Madrid. Spain; PhD Program in Health Sciences (RFF), University of Alcalá de Henares, Madrid, Spain
| | - Javier Ibias
- Department of Behavioral Sciences and Methodology (JI), Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain
| | - Cristina Del Toro-Pérez
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities (GL), University of Alcala, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS) (GL), Madrid, Spain; Psychiatry Service (GL, CGS), Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Carmen Gasca-Salas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain; Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED) (CGS), Instituto Carlos III, Madrid, Spain; University CEU-San Pablo (CGS), Madrid, Spain.
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Martínez-Hortelano JA, Saz-Lara A, González JLG, Cristóbal-Aguado S, Iglesias-Rus L, Martínez-Vizcaíno V, Garrido-Miguel M. Skin-to-skin contact and breastfeeding after caesarean section: A systematic review and meta-analysis of intervention studies. Int J Nurs Stud 2025; 166:105038. [PMID: 40086104 DOI: 10.1016/j.ijnurstu.2025.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 02/14/2025] [Accepted: 02/25/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Breastfeeding has been widely studied as a factor that improves maternal and newborn health outcomes. Immediate or early skin-to-skin contact interventions have been proposed in health care services to increase breastfeeding or exclusive breastfeeding rates following caesarean births although the findings are inconclusive. OBJECTIVE This systematic review and meta-analysis aimed to synthesize the available evidence on early or immediate skin-to-skin contact and breastfeeding in women and newborns following caesarean birth. METHODS A systematic search was performed using in the MEDLINE, EMBASE, Cochrane Library and Web of Science databases from inception to June 2024. The effects of early or immediate skin-to-skin contact were reported as relative risks (RRs) with 95 % confidence intervals (CIs) provided by the original articles. Pooled estimates were calculated using the DerSimonan and Laird methods. The intervention groups received early or immediate skin-to-skin contact and the control group received standard care after caesarean birth. The risk of the bias of the randomized controlled trials was assessed using the Cochrane risk of bias tool for randomized controlled trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) assessment tool for nonrandomized studies. Publication bias was assessed with funnel plot asymmetry and Egger's test. Zotero reference manager and Stata 17 software were used. RESULTS Eight randomized controlled trials and three quasiexperimental studies involving a total of 1.990 participants were included. The findings indicate that skin-to-skin contact decreased the time to first attachment by 51.73 min (95 % CI: -68.54 to -34.91; I2: 85.3), increased the breastfeeding rates in the first 2 h after birth (RR: 4.86; 95 % CI: 2.71 to 7.01; I2: 44.1) and the exclusive breastfeeding rate at discharge (RR: 1.69; 95 % CI 1.36 to 2.01; I2: 13.7), but not the exclusive breastfeeding rate at one month from birth or later (RR: 1.13; 95 % CI 0.73 to 1.54; I2: 0.0). CONCLUSION This study revealed that early or immediate skin-to-skin contact after caesarean birth improved breastfeeding rates and exclusive breastfeeding rates during the health care stay. Trials with longer follow-up times are needed to assess whether interventions based on early or immediate skin-to-skin contact maintain their effectiveness over time and to clarify whether early or immediate skin-to-skin contact is safe for preterm newborns or women with certain health conditions.
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Affiliation(s)
- José Alberto Martínez-Hortelano
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain; University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain
| | - Alicia Saz-Lara
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Luis Gómez González
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain.
| | - Soledad Cristóbal-Aguado
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain
| | - Laura Iglesias-Rus
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain
| | - Vicente Martínez-Vizcaíno
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Facultad de Enfermería de Albacete, Albacete, Spain
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Falagario UG, Pellegrino F, Fanelli A, Guzzi F, Bartoletti R, Cash H, Pavlovich C, Emberton M, Carrieri G, Giannarini G. Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies. Prostate Cancer Prostatic Dis 2025; 28:270-279. [PMID: 38580833 DOI: 10.1038/s41391-024-00827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Three primary strategies for MRI-targeted biopsies (TB) are available: Cognitive TB (COG-TB), MRI-US Fusion TB (FUS-TB), and In Bore TB (IB-TB). Despite nearly a decade of practice, a consensus on the preferred approach is lacking, with previous studies showing comparable PCa detection rates among the three methods. METHODS We conducted a search of PubMed, EMBASE, PubMed, Web of Science, and Scopus databases from 2014 to 2023, to identify studies comparing at least two of the three methods and reporting clinically significant PCa (csPCa) detection rates. The primary and secondary outcomes were to compare the csPCa and insignificant prostate cancer (iPCa, ISUP GG 1) detection rates between TB techniques. The tertiary outcome was to compare the complication rate between TB techniques. Detection rates were pooled using random-effect models. Planned sensitivity analyses included subgroup analysis according to the definition of csPCa and positive MRI, previous biopsy status, biopsy route, prostate volume, and lesion characteristics. RESULTS A total of twenty studies, involving 4928 patients, were included in the quantitative synthesis. The meta-analysis unveiled comparable csPCa detection rates among COG-TB (0.37), FUS-TB (0.39), and IB-TB (0.47). iPCa detection rate was also similar between TB techniques (COG-TB: 0.12, FUS-TB: 0.17, IB-TB: 0.18). All preplanned sensitivity analyses were conducted and did not show any statistically significant difference in the detection of csPCa between TB methods. Complication rates, however, were infrequently reported, and when available, no statistically significant differences were observed among the techniques. CONCLUSIONS This unique study, exclusively focusing on comparative research, indicates no significant differences in csPCa and iPCa detection rates between COG-TB, FUS-TB, and IB-TB. Decisions between these techniques may extend beyond diagnostic accuracy, considering factors such as resource availability and operator preferences. Well-designed prospective studies are warranted to refine our understanding of the optimal approach for TB in diverse clinical scenarios.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, (Solna), Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy.
| | - Francesco Pellegrino
- Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Fanelli
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Francesco Guzzi
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- PROURO, Berlin, Germany
| | - Christian Pavlovich
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Giuseppe Carrieri
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria Della Misericordia University Hospital, Udine, Italy
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Ogata Y, Hatta W, Kanno T, Hatayama Y, Saito M, Jin X, Koike T, Imatani A, Yuan Y, Masamune A. Prevalence and risk factors for lymph node metastasis in duodenal neuroendocrine tumors: a systematic review and meta-analysis. J Gastroenterol 2025; 60:673-682. [PMID: 40178634 PMCID: PMC12095403 DOI: 10.1007/s00535-025-02247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 03/24/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Although the status of lymph node metastasis (LNM) is crucial in determining treatment strategy for duodenal neuroendocrine tumors (D-NETs), robust evidence for their potential LNM risk remains lacking. This systematic review aimed to summarize the prevalence and risk factors of LNM in D-NETs. METHODS This systematic review of electronic databases identified eligible case-control and cohort studies for D-NET resected either endoscopically or surgically, published from 1990 to 2023. The primary outcome was the pooled prevalence of LNM in D-NETs. Secondary outcomes included the pooled prevalence of LNM according to tumor location and functionality, as well as identifying pathological risk factors for LNM. Meta-analysis was performed. RESULTS We identified 36 studies that involved 1,396 patients with D-NETs, including 326 with LNM. The pooled prevalence of LNM in D-NETs was 22.7% (95% confidence interval [CI] 17.3-29.2%). The prevalence was high in ampullary/peri-ampullary D-NETs and functional D-NETs (46.8 and 53.3%, respectively), whereas it was low in non-functional, non-ampullary D-NETs (NAD-NETs) (9.5%). Pathological risk factors for LNM in NAD-NETs included tumor size > 10 mm (odds ratio [OR] 7.31 [95% CI 3.28-16.31]), tumor invasion into the muscularis propria or deeper (OR 7.79 [3.65-16.61]), lymphovascular invasion (OR 5.67 [2.29-14.06]), and World Health Organization grading of G2 (OR 2.47 [1.03-5.92]). CONCLUSION Approximately one-fourth of the patients with D-NETs had LNM. Endoscopic resection might be acceptable for non-functional NAD-NETs with diameters of 10 mm or less, but additional surgical resection with lymphadenectomy may be recommended for cases exhibiting pathological risk factors.
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Affiliation(s)
- Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yutaka Hatayama
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Patel KR, Spratt DE, Tran PT, Krauss DJ, D'Amico AV, Nguyen PL. The Benefit of Short-Term Androgen Deprivation Therapy with Radiation Therapy for Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2025; 122:407-415. [PMID: 39922318 DOI: 10.1016/j.ijrobp.2025.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 01/06/2025] [Accepted: 01/25/2025] [Indexed: 02/10/2025]
Abstract
PURPOSE A previous, individual patient-level meta-analysis of randomized controlled trials (RCTs) demonstrated the overall survival (OS) benefit of short-term androgen deprivation therapy (ST-ADT) when delivered with radiation therapy (RT) for the subset of patients with intermediate-risk prostate cancer (IR-PCa). However, because of inclusion criteria, several studies such as NRG/RTOG 0815, GETUG-14, and DFCI 95-096 were excluded. Thus, we conducted the present analysis, inclusive of all studies to define the current role of ST-ADT in IR-PCa. METHODS AND MATERIALS A systematic review was conducted of phase 3 RCTs published or presented between January 1980 and October 2024 which profiled the comparative efficacy of radiation therapy ± ST-ADT in patients with IR-PCa. A study-level, random-effects meta-analysis was performed. The primary endpoint of this meta-analysis was OS, with secondary endpoints of time-to-biochemical failure (BF) ± biochemical-progress-free survival (bPFS). Meta-regression was used to explore trial-level factors associated with treatment effects. Synthetic individual patient-level OS data were pooled for confirmation and used to estimate the relative and absolute survival benefit. RESULTS Seven RCTs (NRG/RTOG 9408, DFCI 95-096, TROG 96.01, PCS III, EORTC 22991, NRG/RTOG 0815, and GETUG-14) reporting outcomes of 6179 patients were identified. The pooled hazard ratios (HRs) for HROS, HRBF, and HRBF+bPFS were 0.88 (95% confidence interval [CI], 0.79-0.97; P = .01), 0.50 (95% CI, 0.37-0.68; P < .001), and 0.54 (95% CI, 0.46-0.65; P < .001), respectively. ST-ADT duration, RT dose, and Gleason score trial population composition were each associated with an increased benefit of ST-ADT for biochemical disease control (all P < .05) but not for OS (all P > .05). Pooling of simulated, patient-level data confirmed the presence of a survival benefit (HROS, 0.85 [95% CI, 0.76-0.96], log-rank P = .021), corresponding to an absolute survival benefit of 5% benefit at 10 years. CONCLUSIONS The present analysis confirms current knowledge that ST-ADT improves both OS and prostate-specific antigen-based outcomes for unselected patients with IR-PCa to a clinically significant degree.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland.
| | - Daniel E Spratt
- UH Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Phuoc T Tran
- Department of Radiation Oncology, University of Maryland/Greenebaum Cancer Cancer, Baltimore, Maryland
| | - Daniel J Krauss
- Department of Radiation Oncology, Corewell Health Baumont University Hospital, Royal Oak, Michigan
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Woman's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Woman's Hospital, Harvard Medical School, Boston, Massachusetts
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Fleming SA, Fleming RAF, Peregoy J. The non-cariogenic effects of aspartame: A systematic review and meta-analysis. J Dent 2025; 157:105715. [PMID: 40157710 DOI: 10.1016/j.jdent.2025.105715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/30/2025] [Accepted: 03/21/2025] [Indexed: 04/01/2025] Open
Abstract
OBJECTIVES This systematic review and meta-analysis evaluated the cariogenicity of aspartame and explored mechanisms of action. DATA, SOURCES, AND STUDY SELECTION A literature search was conducted across PubMed, Web of Science, Scopus, and CENTRAL on February 16th, 2024 (registered with PROSPERO CRD42024513463). Eligible studies evaluated the cariogenicity of aspartame in humans, animals, and dental samples compared to sucrose or other controls. Random effects meta-analysis was conducted on caries incidence, acidogenicity, oral bacterial composition, and mineralization for preclinical and clinical trials. Certainty was assessed using the GRADE framework. CONCLUSION Four studies in bovine blocks, seven preclinical trials in rats, and two clinical studies were identified. In clinical studies aspartame was less acidogenic than sucrose (standardized mean difference [95 % confidence interval]: 3.07 [-0.97, 7.10], very low certainty), and similar to water (-0.51 [-1.51, 0.48], low certainty). Preclinical studies indicated aspartame did not promote caries development (-0.01 [-0.31, 0.30], low certainty), reduced caries compared to sucrose (-2.51 [-3.50, -1.52], moderate certainty), but had minimal impact when added to sucrose (-0.53 [-1.29, 0.23], very low certainty), except when assessed in sulcal caries (-0.86 [-1.70, -0.02]). Aspartame had minimal effect on bacterial composition. Studies on bovine blocks indicated aspartame was less acidogenic and erosive than sucrose. While aspartame is a non-cariogenic alternative to sucrose, there is limited evidence supporting anti-cariogenicity. The reduction in caries observed with aspartame use is likely due to its role in minimizing sugar intake rather than biological activity. More long-term studies in humans are needed to fully assess aspartame's impact on oral health. CLINICAL SIGNIFICANCE Replacement of sugar with aspartame may help maintain healthy oral pH in humans. Animals fed aspartame instead of sugar consistently develop fewer caries, and lab tests indicate aspartame lessens oral acids and dental erosion compared to sugar.
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Stamp LK, Frampton C, Newcomb JA, O'Dell JR, Mikuls TR, Dalbeth N. Gout Flares After Stopping Anti-Inflammatory Prophylaxis: A Rapid Literature Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2025; 77:720-726. [PMID: 39711080 DOI: 10.1002/acr.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 12/08/2024] [Accepted: 12/12/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE The aim of this research was to determine how common gout flares are after ceasing anti-inflammatory prophylaxis. METHODS A rapid literature review and meta-analysis were undertaken. PubMed was searched from inception to February 2024. Eligibility criteria included any clinical trial of people with gout with at least one arm starting or intensifying urate-lowering therapy (ULT) with coprescription of anti-inflammatory prophylaxis and that had the percentage of participants experiencing one or more gout flares reported during and after the period of prophylaxis. Random effects meta-analyses were used to generate pooled estimates of the percentage of participants experiencing one or more flares in each period. RESULTS Six trials were included, together with aggregated, unpublished data from the VA STOP Gout trial (2,972 participants). Pooled random effects estimates of the percentage of participants having one or more gout flares were 14.7% (95% confidence interval [CI] 11.3-18.5%) during prophylaxis, 29.7% (95% CI 22.9-37.0%) in the three-month period after ceasing prophylaxis, and 12.2% (95% CI 6.8-19.0%) during the last study period. The mean difference in the percentage of participants having one or more gout flare while taking prophylaxis and immediately after ceasing prophylaxis was -14.8.0% (95% CI -21.2% to -8.5%; P < 0.0001). The mean difference from the period immediately following prophylaxis discontinuation compared to the last study period was 16.0% (P < 0.001). Sensitivity analyses indicated no material effects of prophylaxis duration, trial duration, ULT class, or placebo arms. CONCLUSION Gout flares are common after stopping anti-inflammatory prophylaxis but return to levels seen during prophylaxis. Patients should be cautioned about the risk of gout flares and have a plan for effective gout flare management in the three months after stopping anti-inflammatory prophylaxis.
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Affiliation(s)
- Lisa K Stamp
- University of Otago, Christchurch and Health New Zealand, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | | | | | - James R O'Dell
- VA Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center, Omaha
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center, Omaha
| | - Nicola Dalbeth
- Health New Zealand, Te Whatu Ora Te Toka Tumai, and the University of Auckland, Auckland, New Zealand
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Ali A, Ali MA, Khattak AI, Khattak F, Afridi A, Azeem T, Shabbar Banatwala US, Alam U, Khan A, Jalal U, Moeez A, Khan MW, Collins P, Ahmed R. Outcomes of transcatheter vs surgical aortic valve replacement in pre-existing chronic liver disease patients: A meta-analysis of observational studies. IJC HEART & VASCULATURE 2025; 58:101651. [PMID: 40230501 PMCID: PMC11994331 DOI: 10.1016/j.ijcha.2025.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 03/06/2025] [Accepted: 03/10/2025] [Indexed: 04/16/2025]
Abstract
Aortic valve stenosis in patients with chronic liver diseases, particularly liver cirrhosis and End-Stage Liver Disease, poses significant management challenges due to the interplay between cardiovascular and hepatic dysfunction. This systematic review and meta-analysis compared the safety and efficacy of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this high-risk population. An extensive search of PubMed, Embase, and Web of Science (inception to January 5, 2025) identified 11 retrospective studies comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals, were calculated using random-effects models. The analysis revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 % CI: 0.30-0.42; I2 = 7.6 %), acute kidney injury (RR 0.51, 95 % CI: 0.33-0.78; I2 = 57.2 %), bleeding (RR 0.33, 95 % CI: 0.28-0.39; I2 = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23-0.51; I2 = 6.1 %), and blood transfusion (RR 0.48, 95 % CI: 0.40-0.57; I2 = 7.6 %). TAVR was also associated with shorter hospital stays (MD -6.77 days, 95 % CI: -9.17 to -4.38; I2 = 97.5 %). No significant differences were observed in vascular complications requiring surgery or hospital charges and post-operative infections. These findings suggest TAVR offers significant advantages over SAVR in reducing complications such as mortality, acute kidney injury, and bleeding in patients with liver disease. However, further randomized trials are necessary to confirm long-term outcomes and establish optimal treatment strategies for this high-risk population.
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Affiliation(s)
- Aizaz Ali
- Khyber Medical College, Peshawar, Pakistan
| | | | | | | | | | | | | | - Umama Alam
- Khyber Medical College, Peshawar, Pakistan
| | | | | | | | | | - Peter Collins
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Raheel Ahmed
- National Heart and Lung Institute, Imperial College London, United Kingdom
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Bailey AJM, Luo OD, Zhou SQ, Wells PS. The incidence and risk of venous thromboembolism in patients with active malignancy and isolated superficial venous thrombosis: a systematic review and meta-analysis (the IROVAM-iSVT review). J Thromb Haemost 2025; 23:1824-1837. [PMID: 40154793 DOI: 10.1016/j.jtha.2025.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 02/13/2025] [Accepted: 03/13/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND The management of cancer-associated isolated superficial venous thrombosis (iSVT) remains controversial as cancer patients are at higher risk of bleeding and venous thromboembolism (VTE). OBJECTIVES We performed a systematic review and meta-analysis to determine the incidence and risk of VTE in patients with iSVT and active malignancy. METHODS Medline, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2, 2024, to identify studies investigating VTE rates in adult patients with iSVT and active malignancy. The incidence of VTE in patients with active malignancy and iSVT was pooled by meta-analysis and compared to patients with iSVT without active malignancy. Secondary outcomes included the incidence of major bleeding, clinically relevant nonmajor bleeding, hospitalization, and all-cause death. RESULTS Eight full-text studies were included, comprising 5998 iSVT patients and 448 with active malignancy. Patients with cancer-associated iSVT had an overall incidence of VTE of 18.2 events per 100 patient years (95% CI, 5.2-31.2; I2 = 76%) and a higher rate of VTE compared to patients with iSVT without active malignancy (risk ratio, 2.57; 95% CI, 1.78-3.71; I2 = 0%; P < .001). There were 2 major bleeding events per 100 patient years (95% CI, 0-6.7; I2 = 59%) and 22.8 deaths per 100 patient years (95% CI, 0-58.7; I2 = 73%) for cancer-associated iSVT. Only 1 study reported on clinically relevant nonmajor bleeding and hospitalization rates, respectively. CONCLUSION Patients with iSVT and active malignancy have high rates of VTE despite treatment. Future studies should investigate the role of extended duration anticoagulation on VTE rates in this population.
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Affiliation(s)
| | - Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
| | - Shi Qi Zhou
- Faculty of Science, McGill University, Montréal, Quebec, Canada
| | - Philip Steven Wells
- Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Khasawneh M, Mokhtare M, Moayyedi P, Black CJ, Ford AC. Efficacy of gut-brain neuromodulators in irritable bowel syndrome: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2025; 10:537-549. [PMID: 40258375 DOI: 10.1016/s2468-1253(25)00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/08/2025] [Accepted: 02/11/2025] [Indexed: 04/23/2025]
Abstract
BACKGROUND Gut-brain neuromodulators might be efficacious for irritable bowel syndrome (IBS), but there has been no synthesis of evidence from randomised controlled trials (RCTs) of some drug classes, and whether they have pain-modifying properties in IBS is unclear. We updated a previous systematic review and meta-analysis of RCTs examining these questions. METHODS We searched MEDLINE (from Jan 1, 1946, to Jan 1, 2025), Embase and Embase Classic (from Jan 1, 1947, to Jan 1, 2025), and the Cochrane Central Register of Controlled Trials (from database inception to Jan 1, 2025). Trials recruiting adults with IBS and that compared gut-brain neuromodulators versus placebo over at least 4 weeks of treatment were eligible. Dichotomous symptom data were pooled using a random effects model to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI. FINDINGS The search strategy identified 3625 citations. 28 RCTs were eligible containing 2475 patients. Ten RCTs were identified since our previous meta-analysis, containing 1348 patients. The RR of global IBS symptoms not improving with gut-brain neuromodulators versus placebo in 22 RCTs (2222 patients) was 0·77 (95% CI 0·69-0·87). The best evidence in terms of persistence of global IBS symptoms was for tricyclic antidepressants (TCAs) in 11 trials (1144 patients; RR 0·70, 0·62-0·80). The RR of abdominal pain not improving with gut-brain neuromodulators versus placebo in 19 RCTs (1792 patients) was 0·72 (95% CI 0·62-0·83). The best evidence was for TCAs in seven trials (708 patients; RR 0·69, 0·54-0·87), but there was also a benefit of selective serotonin reuptake inhibitors in seven RCTs (324 patients; RR 0·74, 0·56-0·99), and serotonin and norepinephrine reuptake inhibitors in two trials (94 patients; RR 0·22, 0·08-0·59). Adverse events were not significantly more common with gut-brain neuromodulators, although rates of withdrawal due to adverse events were significantly higher. The certainty in the evidence for tricyclic antidepressants for global IBS symptoms was moderate, but it was low to very low for all other endpoints and drug classes studied. INTERPRETATION Some gut-brain neuromodulators are efficacious in reducing global symptoms and abdominal pain in IBS. The findings support guidelines that recommend use of tricyclic antidepressants for ongoing global symptoms or abdominal pain but also highlight a potential for SSRIs to be modestly effective for abdominal pain. More data for SNRIs, azapirones, and tetracyclic antidepressants in IBS are required. FUNDING None.
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Affiliation(s)
- Mais Khasawneh
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Marjan Mokhtare
- Department of Internal Medicine, School of Medicine Colorectal Research Center, Iran; University of Medical Sciences, Tehran, Iran
| | - Paul Moayyedi
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
| | - Christopher J Black
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
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Kakos NJ, Lufler RS, Cyr B, Zwirner C, Hurley E, Heinrich C, Wilson AB. Unlocking knowledge: a meta-analysis assessing the efficacy of educational escape rooms in health sciences education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2025; 30:837-857. [PMID: 39266886 DOI: 10.1007/s10459-024-10373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024]
Abstract
Educational escape rooms within health sciences education are gaining traction as a unique and engaging game-based strategy for reviewing instructional content. Educational escape rooms cultivate valuable skills such as teamwork, communication, creativity, attention to detail, and the ability to apply knowledge under time pressures. While several studies have independently assessed learners' knowledge gains after educational escape room interventions, the present work meta-analyzes the efficacy of educational escape rooms across studies and student learners within health sciences education. A systematic search across seven databases was performed by a health sciences librarian from inception to March 24, 2023. Record screenings, full-text reviews, and data extractions were managed within Covidence. MERSQI criteria were used to assess study quality. Pooled effect sizes (Standardized Mean Differences = SMD) were estimated through meta-analysis to summarize learner performance outcomes after educational escape room interventions. Eleven studies followed a longitudinal pretest-posttest design, and five studies followed a control-treatment group design. Learners' posttest scores after participating in an educational escape room were statistically higher than their pretest scores as indicated by a large positive summary effect size (SMD ≥ 0.893; p <0.001). Educational escape rooms were also effective for treatment group participants (n = 508), who significantly outperformed (SMD = 0.616; p <0.001) control group participants (n = 555). Most escape rooms were employed as a mechanism for reviewing educational content. This meta-analytic review suggests escape rooms are effective educational interventions for increasing knowledge gains among health sciences learners and highlights common implementation practices to help guide educators interested in this game-based learning approach.
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Affiliation(s)
| | - Rebecca S Lufler
- Department of Medical Education, Tufts University School of Medicine, Boston, MA, USA
| | - Brendan Cyr
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Erin Hurley
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Adam B Wilson
- Department of Anatomy and Cell Biology, Rush University, Chicago, IL, 60612, USA.
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Fernández Alonso AM, Varikasuvu SR, Pérez-López FR. Telomere length and telomerase activity in men and non-pregnant women with and without metabolic syndrome: a systematic review and bootstrapped meta-analysis. J Diabetes Metab Disord 2025; 24:24. [PMID: 39735175 PMCID: PMC11671447 DOI: 10.1007/s40200-024-01513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 11/19/2024] [Indexed: 12/31/2024]
Abstract
Purpose We performed a systematic review and meta-analysis to examine the associations between telomere length and telomerase activity in subjects with and without metabolic syndrome (MetS). Methods The meta-analysis protocol was registered in the PROSPERO database. The PubMed, Embase, Cochrane Library, and LILACS databases were searched for studies reporting telomere length or telomerase activity in adult men and non-pregnant women with and without MetS. The risk of bias was assessed with the Newcastle-Ottawa Scale. Random effects and inverse variance methods were used to meta-analyze associations. We conducted a bootstrapped analysis to test the accuracy of clinical results. Results Five studies reported telomere length and two studies telomerase activity. There was no significant difference in telomere length (standardized mean difference [SMD]: 0.10, 95% confidence interval [CI]: -0.07, 0.28, I 2: 54%), between subjects of similar age (mean difference: 2.68, 95%CI: -0.04, 5.40 years) with and without the MetS. Subjects with MetS displayed significantly higher body mass index, triglycerides, and blood pressure, and lower HDL-cholesterol values than subjects without the syndrome. A bootstrapping mediation analysis of telomere length confirmed the clinical results. There was no significant difference in telomerase activity (SMD: 1.19, 95% CI -0.17, 2.55, I 2: 93%) between subjects with and without the MetS. Conclusion There were no significant differences of telomere length and telomerase activity in patients with MetS and subjects of similar age without the syndrome. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01513-4.
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Affiliation(s)
- Ana Maria Fernández Alonso
- Department of Obstetrics and Gynecology, Torrecárdenas University Hospital, Almería, Paraje Torrecárdenas s/n 04009 Spain
| | | | - Faustino R. Pérez-López
- Aragón Health Research Institute, University of Zaragoza Faculty of Medicine, Domingo Miral s/n, Zaragoza, 50009 Spain
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Vastrad SJ, Saraswathy GR, Dasari JB, Nair G, Madarakhandi A, Augustine D, Sowmya S. A comprehensive transcriptome based meta-analysis to unveil the aggression nexus of oral squamous cell carcinoma. Biochem Biophys Rep 2025; 42:102001. [PMID: 40271514 PMCID: PMC12016861 DOI: 10.1016/j.bbrep.2025.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 03/21/2025] [Accepted: 03/31/2025] [Indexed: 04/25/2025] Open
Abstract
Lymph node metastasis in oral cancer (OC) complicates management due to its aggressive nature and high risk of recurrence, underscoring the need for biomarkers for early detection and targeted therapies. However, the drivers of this aggressive phenotype remain unclear due to the variability in gene expression patterns. To address this, an integrative meta-analysis of six publicly available transcriptomic profiles, categorized by lymph nodal status, is conducted. Key determinants of disease progression are identified through functional characterization and the TopConfects ranking approach of nodal associated differentially expressed genes (DEGs). To explore the critical nexus between lymph node metastasis and OC recurrence, significant metastatic genes were cross-analysed with literature-derived genes exhibiting aberrant methylation patterns in OC recurrence. Their clinical relevance and expression patterns were then validated in an external dataset from the TCGA head and neck cancer cohort. The analysis identified elevated expression of genes involved in extracellular matrix remodelling and immune response, while the expression of genes related to cellular differentiation and barrier functions was reduced, driving the transition to nodal positivity. The highest-ranked gene, MMP1, showed a log-fold change (LFC) of 4.946 (95 % CI: 3.71, 6.18) in nodal-negative samples, which increased to 5.899 (95 % CI: 4.80, 6.99) in nodal-positive samples, indicating consistent elevation across disease stages. In contrast, TMPRSS11B was significantly downregulated, with an LFC of -5.512 (95 % CI: -6.63, -4.38) in nodal-negative samples and -5.898 (95 % CI: -7.15, -4.64) in nodal-positive samples. Furthermore, MEIS1, down-regulated in nodal-positive status, was found to exhibit hypermethylation at CpG sites associated with OC recurrence. This study represents the first transcriptomic meta-analysis to explore the intersection of lymph node metastasis and OC recurrence, identifying MEIS1 as a potential key contributor. These comprehensive insights into disease trajectories offer potential biomarkers and therapeutic targets for future treatment strategies.
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Affiliation(s)
- Soujanya J. Vastrad
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, New BEL Road, M.S.R. Nagar, Bengaluru, India
| | - Ganesan Rajalekshmi Saraswathy
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, New BEL Road, M.S.R. Nagar, Bengaluru, India
| | | | - Gouri Nair
- Department of Pharmacology, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - Ashok Madarakhandi
- Department of Pharmaceutical Chemistry, KLE College of Pharmacy, (A Constituent Unit of KAHER-Belagavi), 2nd Block, Rajajinagar, Bangalore, India
| | - Dominic Augustine
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, New BEL Road, M.S.R. Nagar, Bengaluru, India
| | - S.V. Sowmya
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, New BEL Road, M.S.R. Nagar, Bengaluru, India
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Okoli GN, Grossman Moon A, Soos AE, Neilson CJ, Kimmel Supron H, Etsell K, Grewal A, Van Caeseele P, Richardson C, Harper DM. Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis. PUBLIC HEALTH IN PRACTICE 2025; 9:100562. [PMID: 39802391 PMCID: PMC11721234 DOI: 10.1016/j.puhip.2024.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 11/07/2024] [Accepted: 11/07/2024] [Indexed: 01/16/2025] Open
Abstract
Objectives To systematically identify, appraise, and summarise published evidence on individual socioeconomic and health-related factors associated with human papillomavirus (HPV) vaccination initiation and completion among females of paediatric age. Study design A global systematic review with meta-analysis (PROSPERO: CRD42023445721). Methods We performed a literature search in December 2022 and supplemented the search on August 1, 2023. Appropriate data were pooled using an inverse variance, random-effects model and the results were expressed as odds ratios, with 95 % confidence intervals. A statistically significant point pooled increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥70 % was very strongly associated. Results We included 83 cross-sectional studies. Among several significantly associated factors, being an older girl: 1.67 (1.44-1.93), having health insurance: 1.41 (1.16-1.72), and being in a public school: 1.54 (1.05-2.26) strongly increased the odds of vaccination initiation, and nativity in the country of study: 1.82 (1.33-2.50), use of contraception: 2.00 (1.16-3.46), receipt of influenza vaccination: 1.75 (1.54-2.00) and having visited a healthcare provider: 1.85 (1.51-2.28) in the preceding year very strongly increased the odds of vaccination initiation. Likewise, being an older girl: 1.36 (1.23-1.49) and having visited a healthcare provider in the preceding year: 1.46 (1.05-2.04) strongly increased the odds of vaccination series completion, and school-based vaccination: 3.08 (1.05-9.07), having health insurance: 1.72 (1.27-2.33), and receipt of influenza vaccination in the preceding year: 1.72 (1.62-1.83) very strongly increased the odds of vaccination series completion. We made similar observations when the studies were limited to the United States. Conclusions Several individual socioeconomic/health-related factors may determine initiating and completing the HPV vaccination series among paediatric females. These factors provide insights that may be key to identifying girls at increased risk of not being vaccinated and may aid targeted public health messaging.
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Affiliation(s)
- George N. Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Alexandra E. Soos
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | | | | | - Katharine Etsell
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Avneet Grewal
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Diane M. Harper
- Departments of Family Medicine and Obstetrics & Gynecology, University of Michigan, Michigan, USA
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Gecici NN, Hameed NUF, Habib A, Deng H, Lunsford LD, Zinn PO. Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis. Oper Neurosurg (Hagerstown) 2025; 28:749-761. [PMID: 40062857 DOI: 10.1227/ons.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/14/2024] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND AND OBJECTIVES For 50 years, frame-based stereotactic brain biopsy has been the "gold standard" for its high diagnostic yield and safety, especially for complex or deep-seated lesions. Over the past decade, frameless and robotic alternatives have emerged. This report evaluates and compares the outcomes, diagnostic yield, and safety of these methods. METHODS Major databases were screened for studies reporting data on diagnostic yield, postoperative hemorrhage, neurological deficits, and mortality after frame-based, robot-assisted or neuronavigation-assisted frameless biopsies. Meta-analysis with random-effect modeling was performed to compare diagnostic yield, operative duration, length of stay, complications, and mortality. RESULTS A total of 92 studies were included with 9801 patients in the frame-based group, 2665 in the robot-assisted group, and 1862 in the frameless group. Pooled diagnostic yield rates were 97% (96%-98%, I 2 = 49%) in robot-assisted, 95% (94%-96%, I 2 = 74%) in frame-based, and 94% (91%-96%, I 2 = 55%) frameless groups with a statistically significant difference ( P < .01, I 2 = 71%). The mean total operative duration including anesthesia, system setup, patient registration, trajectory planning, and skin incision to closure was significantly shorter in the robot-assisted group (76.6 vs 132.7 vs 97.3 minutes, P < .01). The duration from skin incision to closure was comparable between the groups (robot-assisted: 37.8 mins, frame-based: 42.6 minutes, frameless: 58.2 minutes; P = .23). Pooled rates of symptomatic hemorrhage (0.005% vs 0.009% vs 0.007, P = .71, I 2 = 34%), asymptomatic hemorrhage (4% vs 3% vs 3%, P = .64, I 2 = 93%), transient neurological deficit (3% vs 2% vs 2%, P = .5, I 2 = 72%), permanent neurological deficit (0.001% vs 0.001% vs 0.0002, P = .78, I 2 = 47%), and mortality (0% vs 0.001% vs 0.006%, P < .01, I 2 = 10%) were similar between groups. Deaths were mainly due to postprocedural hemorrhage (robotic: 46%, frame-based: 48%, frameless: 72%). CONCLUSION Robot-assisted biopsy is not inferior in diagnostic yield and safety to the gold standard frame-based and neuronavigation-assisted frameless biopsy methods.
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Affiliation(s)
- Neslihan Nisa Gecici
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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D’Antonio A, Assante R, Zampella E, Cantoni V, Green R, Gaudieri V, Mannarino T, Falzarano M, Volpicelli F, Cutillo P, Matrisciano F, Buongiorno P, Panico M, Nappi C, Cozzolino D, Petretta M, Cuocolo A, Acampa W. Prognostic value of myocardial flow reserve by PET imaging in patients with suspected coronary artery disease: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2025; 58:101677. [PMID: 40291825 PMCID: PMC12023774 DOI: 10.1016/j.ijcha.2025.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/27/2025] [Accepted: 03/31/2025] [Indexed: 04/30/2025]
Abstract
Purpose We performed a systematic review and meta-analysis of published studies evaluating the value of myocardial flow reserve (MFR) assessed by positron emission tomography (PET) imaging in predicting adverse cardiovascular events in patients with suspected coronary artery disease (CAD). Material and methods Studies published until December 2024 were identified by database search. We included studies evaluating MFR by PET imaging with data on adjusted hazard ratio (HR) for the occurrence of adverse cardiovascular events. Results We identified 8 eligible articles including 12.087 patients with a mean follow-up of 2.98 ± 0.69 years. The pooled HR for the occurrence of events was 2.19 (95 % CI 1.80-2.68) and no heterogeneity was observed. The pooled incidence rate ratio (IRR) was 3.26 (95 % CI 2.43-4.37) and the heterogeneity was 37.7 %. At meta-regression analysis no significant association was found between HR for adverse events and demographic and clinical variables considered. Conclusion MFR assessed by PET imaging is a valuable noninvasive prognostic indicator in the evaluation of patients with suspected CAD.
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Affiliation(s)
- Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Falzarano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Volpicelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Paolo Cutillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Matrisciano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Domenico Cozzolino
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Srinivasan M, Kamnoedboon P, Nantanapiboon D, Papi P, Romeo U. Non-surgical management of peri-implantitis with photodynamic therapy: A systematic review and meta-analysis of clinical parameters and biomarkers. J Dent 2025; 157:105680. [PMID: 40081730 DOI: 10.1016/j.jdent.2025.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 03/07/2025] [Accepted: 03/08/2025] [Indexed: 03/16/2025] Open
Abstract
OBJECTIVE To evaluate the clinical and biomarker outcomes of photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (MD) in the management of peri‑implantitis, and to compare its efficacy to MD alone or other non-surgical treatment modalities. DATA AND SOURCES Electronic searches in PubMed, Web of Science, and CENTRAL were conducted. 4675 studies published until November 2023 were screened. Clinical studies reporting on non-surgical treatments involving PDT were selected. Meta-analyses assessed clinical parameters (bleeding on probing [BOP], probing depth [PD], plaque index [PI], crestal bone loss [CBL], clinical attachment level [CAL]) and biomarkers. STUDY SELECTION A total of 25 studies were included. The meta-analysis of randomized controlled trials revealed that both MD alone and MD+PDT significantly improved clinical and biomarker outcomes compared to baseline. The addition of PDT provided greater improvements at 3 months for BOP (SMD:0.90; 95 % CI:1.53 to -0.28; p = 0.005), PD (SMD:1.15; 95 % CI:1.72 to -0.58; p < 0.0001), PI (SMD:0.74; 95 % CI:1.15 to -0.33; p = 0.0004) and CBL (SMD:0.38; 95 % CI:0.73 to -0.03; p = 0.04). The additional benefits of PDT were less pronounced on CAL, mucosal recession, and inflammatory biomarkers. No significant changes were observed over extended follow-up periods. CONCLUSIONS Adjunct PDT significantly enhanced clinical outcomes, particularly for the short-term, with the most notable benefits observed in BOP, PD, PI, and CBL reductions. However, additional benefits in CAL, mucosal recession, and inflammatory biomarkers outcomes remain limited. Standardized protocols and long-term studies are warranted. CLINICAL SIGNIFICANCE PDT as an adjunct in non-surgical peri-implantitis management improves short-term clinical outcomes, particularly for BOP, PD, PI, and CBL. The benefits of adjunctive use with mechanical debridement offer a promising and minimally invasive approach. Further long-term research is needed to establish its role in routine clinical practice.
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Affiliation(s)
- Murali Srinivasan
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Porawit Kamnoedboon
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Dusit Nantanapiboon
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Piero Papi
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy.
| | - Umberto Romeo
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
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Hwang JH, Kim B. Postoperative Urinary Complications in Minimally Invasive Versus Abdominal Radical Hysterectomy: A Meta-Analysis With a Focus on Ureterovaginal Fistula. J Minim Invasive Gynecol 2025; 32:502-511. [PMID: 39710105 DOI: 10.1016/j.jmig.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 11/03/2024] [Accepted: 12/18/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE This study aims to perform a systematic review and meta-analysis to compare the incidence of specific postoperative urologic complications, such as vesicovaginal fistula and ureterovaginal fistula, in patients undergoing minimally invasive radical hysterectomy (MIRH) vs abdominal radical hysterectomy (ARH) for early-stage cervical cancer. DATA SOURCES A comprehensive literature search was conducted in PubMed, the Cochrane Library, Web of Science, ScienceDirect, and Google Scholar up to April 2024. METHOD Comparative studies evaluating postoperative urologic complications following MIRH and ARH were included. Meta-analyses were conducted using fixed- and random-effects models, with subgroup analyses based on publication year, study quality, BMI, and geographical region. TABULATION, INTEGRATION, AND RESULTS The meta-analysis included 35 studies. Overall, MIRH (N = 17,957) was associated with a significantly higher odds ratio (OR) of 3.189 (95% CI: 2.637-3.856, p <.001) for postoperative urologic complications compared to ARH (N = 31,878). Ureterovaginal fistula was the most frequently reported complication, with an OR of 4.440 (95% CI: 3.398-5.804, p <.001). Subgroup analysis showed a higher OR for studies published between 2016 and 2024 (OR: 3.637, 95% CI: 2.965-4.462, p <.001) and in low-quality studies (OR: 3.981, 95% CI: 3.237-4.897, p <.001). CONCLUSION MIRH is associated with a higher incidence of postoperative urologic complications compared to ARH, particularly ureterovaginal fistula. These findings underscore the importance of careful patient selection and the potential need for improved surgical techniques or training to reduce these risks. (CRD42024553756).
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital (Hwang), Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.
| | - Bitnarae Kim
- Department of Obstetrics and Gynecology (Kim), Dongwon Cancer Specialized Care Hospital, Goyang-si, Gyeonggi-Do, Republic of Korea
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Sheraz M, Asif N, Khan A, Khubaib Khan M, Maaz Bin Rehan M, Tayyab Amer Ch M, Sadain Khalid A, Oriana Alfieri C, Bouyarden E, Amine Ghenai M, Alareed A, Ahmed R, Ahmed M, Ehsan M. Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis 2025; 34:108300. [PMID: 40157656 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 03/22/2025] [Accepted: 03/26/2025] [Indexed: 04/01/2025] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase. METHODS A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs). RESULTS A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14). CONCLUSION In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.
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Affiliation(s)
- Maheen Sheraz
- Department of Medicine, Continental Medical College, Lahore, Pakistan
| | - Nawal Asif
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ariba Khan
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | | | | | | | | | | | | | | | - Ahmad Alareed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Raheel Ahmed
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Ehsan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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Panettieri RA, Kraft M, Castro M, Bober M, Lindsley AW, Shelkrot M, Ambrose CS. Efficacy of Biologics in Reducing Exacerbations Requiring Hospitalization or an Emergency Department Visit in Patients with Moderate or Severe, Uncontrolled Asthma. Adv Ther 2025; 42:2679-2689. [PMID: 40261563 PMCID: PMC12085395 DOI: 10.1007/s12325-025-03184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 03/19/2025] [Indexed: 04/24/2025]
Abstract
INTRODUCTION Patients with moderate or severe, uncontrolled asthma are often prescribed biologic therapies to improve disease control and reduce asthma exacerbations. The efficacy of different biologics in reducing asthma exacerbations associated with hospitalization or an emergency department (ED) visit has varied across randomized controlled trials (RCTs). This study summarizes published US Food and Drug Administration-approved biologic efficacy data for exacerbations that required hospitalization or an ED visit in patients with moderate or severe, uncontrolled asthma. METHODS A PubMed literature search (24 May 2024) identified phase 2b/3 RCTs of omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, or tezepelumab. Annualized asthma exacerbation rate (AAER) ratios for exacerbations that required hospitalization or an ED visit, or hospitalization regardless of an ED visit, were extracted. A pooled efficacy estimate of the AAER ratio for exacerbations that required hospitalization or an ED visit across the RCTs was assessed using a meta-analysis based on a random effects model. The percentage of total variation across all included RCTs that was due to heterogeneity was calculated (I2). RESULTS Among 308 articles identified, nine publications describing 10 RCTs reported relevant AAER ratio data. No suitable omalizumab data were identified. In all trials, biologic treatment showed a reduction versus placebo in the AAER for exacerbations that required hospitalization or an ED visit, except in one of two benralizumab studies and both reslizumab studies. The pooled efficacy estimate showed a 56% reduction (95% CI 37-69) in the AAER for exacerbations requiring hospitalization or an ED visit (I2, 59.93%; p = 0.0075). One of three mepolizumab trials and both tezepelumab trials showed a reduction versus placebo in the AAER for exacerbations that required hospitalization regardless of an ED visit. CONCLUSION These findings suggest that there may be differential effects of biologics in reducing exacerbations that require hospitalization or an ED visit in patients with moderate or severe, uncontrolled asthma.
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Affiliation(s)
- Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Monica Kraft
- Department of Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Magdalena Bober
- Biometrics, Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | | | - Max Shelkrot
- US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Christopher S Ambrose
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
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Edjimbi JAC, Shah N, Kwaah PA, Grimshaw AA, Regan C, Nagpal S, Attaran R, Chaar CIO, Romain G, Smolderen KG, Mena-Hurtado C. Effect of diabetes on clinical outcomes in patients with peripheral arterial disease undergoing lower extremity revascularization: A systematic review and meta-analysis. J Vasc Surg 2025; 81:1518-1528.e13. [PMID: 40015609 DOI: 10.1016/j.jvs.2025.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/28/2025] [Accepted: 02/15/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND Peripheral arterial disease is highly prevalent and has a well-established association with diabetes mellitus (DM). However, it remains unclear whether DM worsens clinical outcomes after lower extremity revascularization (LER). METHODS We performed a systematic search of six databases (Cochrane Library, Embase, Google Scholar, Medline, Scopus, and Web of Science) through February 2024, including studies that reported a risk estimate for the association of DM with 30-day all-cause mortality, hospital readmission, major amputation, and wound infection for patients following LER. For each outcome, a random-effect meta-analysis was applied to pool the relative risk (RR) estimates across studies. I2 statistics were used to examine heterogeneity. RESULTS Of the 3079 articles screened, 11 observational studies with 139,497 patients were included. A total of 44.8% of patients had DM. DM was associated with an increased risk of 30-day hospital readmission (RR, 1.28; 95% confidence interval (CI), 1.20-1.37; I2 = 28%; P < .001), 30-day major limb amputation (RR, 1.31; 95% CI, 1.14-1.50; I2 = 86%; P < .001), and 30-day wound infection (RR, 1.32; 95% CI, 1.11-1.56; I2 = 81%; P = .001). There was no significant association between DM and 30-day mortality (RR, 1.08; 95% CI, 0.93-1.24; I2 = 65%; P = .33). CONCLUSIONS Our findings suggest that DM is associated with an increased risk of major amputation, readmission, and wound infection risk, but does not affect mortality risk in patients 30 days after LER.
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Affiliation(s)
- Johann A C Edjimbi
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Nisarg Shah
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Patrick A Kwaah
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, Yale-Waterbury Internal Medicine, Waterbury, CT
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT
| | - Christopher Regan
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Sameer Nagpal
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Robert Attaran
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | | | - Gaëlle Romain
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program (VAMOS), Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT; Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
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Zhai J, You S, Liang Z, Yu H, Zhu C, Han L. Diagnostic Potential of Complementation of MRI to Prenatal Ultrasound for Detecting Orofacial Clefts in High-Risk Fetuses: A Network Meta-Analysis. Cleft Palate Craniofac J 2025; 62:905-913. [PMID: 38490217 DOI: 10.1177/10556656241231119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
ObjectiveTo compare the complementation of magnetic resonance imaging (MRI) to prenatal ultrasound (US) with prenatal US alone in detecting orofacial clefts in high-risk fetuses.DesignA network meta-analysis.SettingLiterature retrieval in PubMed, EMBASE, and Cochrane library, and meta-analysis based on STATA 14.0.PatientsFetuses were at high-risk for orofacial clefts.InterventionsPrenatal US and the complementation of MRI to prenatal US.Main outcome measuresThe pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and area under the curve (AUC).ResultsThirteen studies involving 776 patients were included. Direct meta-analysis showed that the complementation of MRI to prenatal US did not differ from prenatal US in detecting orofacial clefts if the type of orofacial clefts was not distinguished. Subgroup analysis showed that the specificity of prenatal US for the detection of isolated cleft palate (CP) was lower than that of the complementation of MRI to prenatal US. Furthermore, network meta-analysis consistently suggested a comparable diagnostic value between prenatal US and the complementation of MRI to prenatal US. Moreover, subgroup analysis showed that the specificity of prenatal US was significantly lower than that of complementation of MRI to prenatal US for the detection of isolated CP.ConclusionsMRI is more accurate than ultrasound in detecting cleft palate. Therefore, MRI should be offered if there is a fetus with a possible or ultrasound diagnosis of cleft palate, especially if the evaluation of cleft palate is deemed unsatisfactory after careful evaluation of the images.
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Affiliation(s)
- Jing Zhai
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Shuyan You
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Zhonghua Liang
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Haihua Yu
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Chengfeng Zhu
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Lu Han
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
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Ting J, Songer K, Bailey V, Rotman C, Lipsitz S, Rosenberg AR, Delgado-Corcoran C, Moynihan KM. Impact of Subspecialty Pediatric Palliative Care on Children with Heart Disease; A Systematic Review and Meta-analysis. Pediatr Cardiol 2025; 46:1142-1156. [PMID: 38907871 PMCID: PMC12021694 DOI: 10.1007/s00246-024-03535-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/23/2024] [Indexed: 06/24/2024]
Abstract
While many experts in pediatric cardiology have emphasized the importance of palliative care involvement, very few studies have assessed the influence of specialty pediatric palliative care (SPPC) involvement for children with heart disease. We conducted a systematic review using keywords related to palliative care, quality of life and care-satisfaction, and heart disease. We searched PubMed, EMBASE, CINAHL, CENTRAL and Web of Science in December 2023. Screening, data extraction and methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Pairs of trained reviewers independently evaluated each article. All full texts excluded from the review were hand-screened for eligible references including systematic reviews in general pediatric populations. Two reviewers independently extracted: (1) study design; (2) methodology; (2) setting; (3) population; (4) intervention/exposure and control definition; (5) outcome measures; and (6) results. Of 4059 studies screened, 9 met inclusion criteria including two with overlapping patient data. Study designs were heterogenous, including only one randomized control and two historical control trials with SPPC as a prospective intervention. Overall, there was moderate to high risk of bias. Seven were single centers studies. In combined estimates, patients who received SPPC were more likely to have advance care planning documented (RR 2.7, [95%CI 1.6, 4.7], p < 0.001) and resuscitation limits (RR 4.0, [2.0, 8.1], p < 0.001), while half as likely to have active resuscitation at end-of-life ([0.3, 0.9], p = 0.032). For parental stress, receipt of SPPC improved scores by almost half a standard deviation (RR 0.48, 95%CI 0.10, 0.86) more than controls. Ultimately, we identified a paucity of high-quality data studying the influence of SPPC; however, findings correlate with literature in other pediatric populations. Findings suggest benefits of SPPC integration for patients with heart disease and their families.
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Affiliation(s)
- James Ting
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn Songer
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Valerie Bailey
- Department of Cardiology, Boston Children's Hospital, MS BCH3215, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Chloe Rotman
- Medical Library, Boston Children's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Department of General Internal Medicine and Primary Care, Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, MA, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, MS BCH3215, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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