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.

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.

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).

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.

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.

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.

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.

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.

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.

A systematic review and meta-analysis were performed to determine the association of metabolic syndrome (METS) in women with and without overactive bladder (OAB).

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.

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.

Women with OAB display associations with age, BMI, waist circumference, and METS factors.

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.

To compare the effectiveness of non-pharmacological interventions in enhancing depression in people with MS.

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.

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.

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.

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).

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.

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 %).

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.

The prospective registration of the meta-analysis was conducted on PROSPERO in July 2024 with the protocol number 565988.

Inflammation and endothelial dysfunction are important risk factors for chronic diseases, including cardiovascular diseases and related mortality.

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.

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.

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.

Available evidence suggests that a MED diet supplemented with olive oil compared with the LFD significantly improves inflammation and serum endothelial function in adults.

PROSPERO registration no. CRD42023485718.

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.

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.

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.

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.

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.

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.

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).

TNK administration in an extended time window for AIS patients leads to favorable neurological outcomes with a good safety profile.

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.

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.

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.

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).

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.

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.

To determine the prevalence of masticatory disorders in community-dwelling older adults.

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.

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%.

The prevalence of self-assessed masticatory disorders in community-dwelling older adults is approximately 36%.

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.

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.

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.

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.

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.

LPDs demonstrated beneficial effects on renal function in patients with CKD, which is supported by moderate to very low certainty evidence.

PROSPERO registration no. CRD42023473647.

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.

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.

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.

These findings are important to guide rehabilitation strategies and future planning. This review has also highlighted the scarcity of research on specific outcomes.

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.

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.

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.

In this prospective study of 2 Scandinavian birth cohorts, no association was observed between early-life diet diversity and the subsequent risk of IBD.

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.

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.

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).

Pediatric thyroid surgery, although safe, has a high risk of transient hypocalcemia or hypoparathyroidism. Other complications remain under 3%.

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.

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.

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the WHO ICTRP for studies up to 22 March 2024.

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.

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.

We used RoB 2 to assess risk of bias.

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.

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.

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.

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.

This Cochrane review had no dedicated funding.

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.

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.

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.

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.

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).

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.

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.

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.

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).

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).

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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).

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.

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.

Our meta-analysis showed that the CCR2 V64I polymorphism is associated with PD, especially in Asian populations.

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.

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.

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).

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.

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.

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.

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%).

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.

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.

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.

To assess the impact of SCC on birth attendant behavior and maternal and newborn health outcomes.

A systematic review and meta-analysis was performed searching across five databases from 2009 to 2023.

We included randomized controlled trials, quasi-experimental studies, and pre/post studies.

A meta-analysis yielded a pooled estimate of relative risk (RR) for adherence to and effectiveness of the SCC.

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).

There is moderate evidence demonstrating the effectiveness of the SCC in reducing stillbirths and improving adherence to EBPs.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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]).

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.

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.

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.

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.

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.

This systematic review and meta-analysis evaluated the cariogenicity of aspartame and explored mechanisms of action.

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.

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.

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.

The aim of this research was to determine how common gout flares are after ceasing anti-inflammatory prophylaxis.

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.

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.

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.

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.

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).

We performed a systematic review and meta-analysis to determine the incidence and risk of VTE in patients with iSVT and active malignancy.

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.

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.

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.

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.

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.

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.

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.

None.

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.

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

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

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

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

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

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.