Cone-beam computed tomography (CBCT) assisted bronchoscopy shows prospective advantages in diagnosing peripheral pulmonary lesions (PPLs), but its diagnostic value and potential influencing factors remain unclear. What is the clinical value and optimal strategy of CBCT-assisted bronchoscopy in diagnosing PPLs? The references were searched from PubMed, EmBase, and Web of Science. Studies reporting diagnostic yield and potential influencing factors of CBCT-assisted bronchoscopy were included. The navigational success rate, diagnostic rate, complication rate, and potential influencing factors were pooled by random-effects model and meta-regression. A total of 1,441 patients with 1,540 lesions from 15 studies were included in our meta-analysis. The pooled navigational success rate (97.0% vs 81.6%; odds ratio [OR] 5.12) and diagnostic rate (78.5% vs 55.7%; OR 2.51) of the CBCT-assisted group were significantly higher than those without CBCT. The complication rate of CBCT-assisted bronchoscopy was 4.4% (95%CI: 0.02-0.07). Cone-beam CT combined with r-EBUS can achieve the highest diagnostic rate. Applying positive end-expiratory pressure could improve the diagnostic rate and reduce the complication rate (p < 0.05). Lesions located in the upper lobe could achieve a higher diagnostic rate and lesions located in the right lobes could get a lower complication rate (p < 0.05). Cone-beam CT combined with r-EBUS seems to be the effective and optimal approach to ameliorate the navigation success rate and diagnostic rate of diagnosing PPLs.Clinical trial registration: This study was registered in PROSPERO (Registration Number: CRD42022378992). URL: PROSPERO (york.ac.uk).

Diabetic nephropathy (DN) is a diabetes mellitus (DM)-induced complication that poses high morbidity and mortality risks. The Astragalus and Salvia miltiorrhiza couplet medicines (AS) are commonly employed in DN clinical treatment in China, but their clinical efficacy and potential pharmacological mechanisms are yet to be evaluated.

A meta-analysis of 15 studies involving 1,443 patients was conducted. Furthermore, network pharmacology predicted components and targets, which were verified by molecular docking and in vivo validation.

In our meta-analysis, AS notably elevated clinical outcomes and renal function among patients with DN. Meanwhile, when the treatment duration exceeds 12 weeks, AS demonstrated a significant reduction in fasting blood glucose levels, indicating a time-dependent effect. Moreover, based on network pharmacology results, AS likely enhanced clinical outcomes by interacting with vital signaling pathways, including PI3K/Akt, MAPK, and NF-kappa B. Molecular docking studies have confirmed that PTGS2, the key therapeutic target of AS, can be closely combined with bioactive components GLY, quercetin, apigenin, and daidzein. Additionally, in vivo experiments have corroborated that AS can ameliorate renal function, UACR, and biomarkers associated with iron metabolism, such as GPX4, PTGS2, FTH1, and FTL1.

Through rigorous experimental validation, our study demonstrates AS's significant clinical efficacy in managing DN. Specifically, AS has been shown to enhance renal function, ameliorate renal fibrosis, and positively influence iron metabolism. Despite these promising outcomes, future research with a larger sample size must be conducted to further substantiate these findings.

This study aimed to assess the associations between multidimensional sleep features and type 2 diabetes mellitus (T2DM).

We conducted a systematic search across the PubMed, Embase, Web of Science, and Scopus databases for observational studies examining the association between nighttime sleep duration, nighttime sleep quality, sleep chronotype, and daytime napping with type 2 diabetes mellitus (T2DM), up to October 1, 2024. If I2 < 50%, a combined analysis was performed based on a fixed-effects model, and vice versa, using a random-effects model.

Our analysis revealed that a nighttime sleep duration of less than 7 h (odds ratio [OR] = 1.18; 95% CI = 1.13, 1.23) or more than 8 h (OR = 1.13; 95% CI = 1.09, 1.18) significantly increased the risk of T2DM. Additionally, poor sleep quality (OR = 1.50; 95% CI = 1.30, 1.72) and evening chronotype (OR = 1.59; 95% CI = 1.18, 2.13) were associated with a notably greater risk of developing T2DM. Daytime napping lasting more than 30 min augments the risk of T2DM by 7-20%. Interactively, the incidence of T2DM was most significantly elevated among individuals with poor sleep quality and nighttime sleep duration of more than 8 h (OR = 2.15; 95% CI = 1.19, 3.91).

A U-shaped relationship was observed between sleep duration and type 2 diabetes mellitus (T2DM), with the lowest risk occurring at a sleep duration of 7 to 8 h. Additionally, poor sleep quality, evening chronotypes, and daytime napping exceeding 30 min emerged as potential risk factors for T2DM. These high-risk sleep characteristics interacted with one another, amplifying the overall risk of developing the disease.

This systematic review evaluated a total of 31 included human intervention studies that have assessed methods to improve quercetin bioavailability from different formulations and food matrices using urine or blood samples up to July 2024. The bioavailability of quercetin in humans was affected by several factors. 1) Chemical structure: Quercetin-3-O-oligoglucosides exhibited 2-fold higher bioavailability than quercetin-3-O-glucoside, 10-fold higher than quercetin-3-O-rutinoside and ∼ 20-fold higher than quercetin aglycone. 2) Modification of physicochemical properties: In comparison to quercetin aglycone, the quercetin-3-O-glucoside-γ-cyclodextrin inclusion complex showed a 10.8-fold increase in bioavailability, while the self-emulsifying fenugreek galactomannans and lecithin encapsulation, and lecithin phytosome, showed a 62- and 20.1-fold increase, respectively. 3) Food matrix effects: the addition of dietary fats and fibre increased bioavailability by ∼2-fold. This review summarises key factors that enhance quercetin bioavailability, contributing to the development of more effective and practical quercetin supplements or functional foods for better bioactivity of quercetin in humans.

Oral health care of older people in long-term care facilities is insufficient, stressing the need for clear evidence-based implementation strategies to improve oral care. In 2013, a systematic review was performed and new evidence was published. This study aimed to gain insights into implementation strategies used to promote or improve oral health care for older people in long-term care facilities, explore their effectiveness and uncover strategy content in behavioral change techniques, and report the differences between the current results and those of the 2013 study.

A systematic review of the literature according to PRISMA guidelines and meta-analyses of implementation strategies were performed. Cochrane Library, PubMed, and CINAHL databases were searched for papers published between 2011 and 2023. Strategies were identified using the Coding Manual for Behavioral Change Techniques. Meta-analyses of oral health outcomes ("plaque" and "denture plaque") were performed with random-effects models using R language for statistical computing.

16 studies were included in the current results; 20 studies were included in the 2013 findings. More high-quality studies (67 %) were included in this review than in 2013 (47 %). Dental care professionals were involved in 14 of the 16 studies. Fourteen of the 16 studies used and/ or combined five or more different implementation strategies: knowledge, intention, awareness, self-efficacy, attitude, and facilitation of behavior. Implementation positively affected the knowledge and attitudes of the nursing staff; however, the oral health of older people did not necessarily improve. In the 2013 review, more studies indicated combined oral health measurements were effective (71 %) than in the current review (20 %-33 %). Meta-analysis of four studies on dental plaque (0-3 scale) showed a significant, statistically small mean difference of -.21 (CI -.36; -.07, Cohen's d -.29) between the control and treatment group. Meta-analysis of three studies on denture plaque (0-4 scale), showed a significant, statistically large mean difference of -.76 (CI -1.48; -.05, Cohen's d -.88).

In this review, more implementation strategies and combinations were used to implement oral care in long-term care. Implementation strategies positively affected the knowledge and attitudes of nursing staff; however, the oral health of older people did not necessarily improve. Meta-analyses on plaque showed that oral care implementations are effective; for denture plaque, the effect size was large and thus may have more clinical value than for dental plaque.

Evidence suggests L-arginine may be effective at reducing pre-eclampsia and related outcomes. However, whether L-arginine can prevent or only treat pre-eclampsia, and thus the target population and timing of initiation, remains unknown.

To evaluate the effects of L-arginine and L-citrulline (precursor of L-arginine) on the prevention and treatment of pre-eclampsia.

MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were searched through 7 February 2024.

Trials administering L-arginine or L-citrulline to pregnant women, with the comparison group receiving placebo or standard care, were included.

Meta-analyses were conducted separately for prevention or treatment trials, using random-effects models.

Twenty randomised controlled trials (RCTs) (2028 women) and three non-randomised trials (189 women) were included. The risk of bias was 'high' in eight RCTs and showed 'some concerns' in 12. In prevention trials, L-arginine was associated with a reduced risk of pre-eclampsia (relative risk [RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low-certainty evidence, four trials) and severe pre-eclampsia (RR 0.23; 95% CI, 0.09, 0.55; low-certainty evidence, three trials). In treatment trials, L-arginine may reduce mean systolic blood pressure (MD -5.64 mmHg; 95% CI, -10.66, -0.62; very low-certainty evidence, three trials) and fetal growth restriction (RR 0.46; 95% CI, 0.26, 0.81; low-certainty evidence, two trials). Only one study (36 women) examined L-citrulline and reported no effect on pre-eclampsia or blood pressure.

L-arginine may be promising for pre-eclampsia prevention and treatment, but findings should be interpreted cautiously. More trials are needed to determine the optimal dose and time to commence supplementation and support clinical decision-making.

To systematically evaluate the efficacy of electrical stimulation (ES) in the treatment of patients with foot drop (FD) after stroke, and to compare the efficacy of different types of ES.

We searched 5 English database (PubMed, Web of Science, Embase, Cochrane Library and Scopus) and 4 Chinese databases (China National Knowledge Infrastructure (CNKI), SinoMed (CBM), VIP and Wanfang Data) from inception to June, 2024.

Traditional meta-analysis and network meta-analysis were performed using RevMan5.4 software and Stata 14.0 software respectively. A total of 37 RCTs were included, involving 2309 patients. The results of the traditional meta-analysis showed that compared with CRT, ES combined with CRT was effective in improving the range of motion (ROM) of ankle dorsiflexion in patients with FD after stroke and significantly improved the fugl-meyer assessment of lower extremity (FMA-LE) scores. For patients with FD with different disease duration, the subgroup analysis results showed that the ES improved the ROM of ankle dorsiflexion of patients in recovery phases (1-6 months) better than those in the acute phases (≤ 1 month) and sequelae phases (≥ 6 months), but the overall results of the three groups were not significantly different. The ES improved the lower limb motor function of patients in the recovery phases better than those in the acute phases, and the efficacy was not significant in patients in the sequelae phases (P > 0.05). The results of network meta-analysis showed that the best probability of improving the dorsiflexion angle of the ankle was electroacupuncture (EA) > transcranial direct current stimulation (tDCS) > transcutaneous electrical nerve stimulation (TENS) > functional electrical stimulation (FES) > neuromuscular electrical stimulation (NMES) > electromyographic biofeedback therapy (EMGBFT) > conventional rehabilitation therapy (CRT); the best probability of improving the dorsiflexion angle of the ankle was EA > EMGBFT > tDCS > FES > TENS > NMES > CRT.

The current evidence showed that the ES combined with CRT can effectively improve the ROM of ankle dorsiflexion and lower limb motor function in patients with FD after stroke, especially the patients in recovery phases. Among the different types of ES, EA had the best effect than other types of ES.

Stem cells are specialised precursor cells that can replace aged or damaged cells and thereby maintain healthy tissue function. Stem cell therapy is increasingly used as a treatment for knee osteoarthritis, despite the lack of clarity around the mechanism by which stem cell therapy may slow down disease progression in osteoarthritis, and uncertainty regarding its benefits and harms.

To assess the benefits and harms of stem cell injections for people with osteoarthritis of the knee. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase on 15 September 2023, unrestricted by date or language of publication. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant trial protocols and ongoing trials.

We included randomised controlled trials (RCTs), or trials using quasi-randomised methods of participant allocation, comparing stem cell injection with placebo injection, no treatment or usual care, glucocorticoid injection, other injections, exercise, drug therapy, surgical interventions, and supplements and complementary therapies in people with knee osteoarthritis.

Two review authors selected studies for inclusion, extracted trial characteristics and outcome data, assessed risk of bias and assessed the certainty of evidence using the GRADE approach. The primary comparison was stem cell injection compared with placebo injection. The primary time point for pain, function and quality of life was three to six months, and the end of the trial period for participant-reported success, joint structure changes and adverse event outcomes. Major outcomes were pain, function, quality of life, global assessment of success, radiographic joint progression, withdrawals due to adverse events and serious adverse events.

We found 25 randomised trials (1341 participants) comparing stem cell injections with placebo injection (eight trials), no treatment or usual care (analgesia, weight loss and exercise) (two trials), glucocorticoid injection (one trial), hyaluronic acid injection (seven trials), platelet-rich plasma injections (two trials), oral acetaminophen (paracetamol) (one trial), non-steroidal anti-inflammatory drugs plus physical therapy plus hyaluronic acid injection (one trial) and stem cell injection plus intra-articular co-intervention versus co-intervention alone (three trials) in people with osteoarthritis of the knee. Trials were predominantly small, with sample sizes ranging from 6 to 252 participants, with only two trials having more than 100 participants. The average age of participants across trials ranged from 51 to 66 years, and symptom duration varied from one to 10 years. Placebo-controlled trials were largely free from bias, while most trials without a placebo control were susceptible to performance and detection biases. Here, we limit reporting to the main comparison, stem cell injection versus placebo injection. Compared with placebo injection, stem cell injection may slightly improve pain and function up to six months after treatment. Mean pain (0 to 10 scale, 0 no pain) was 4.5 out of 10 points with placebo injection and 1.2 points better (2.5 points better to 0 points better) with stem cell injection (I2 = 80%; 7 studies, 445 participants). Mean function (0 to 100 scale, 0 best function) was 46.3 points with placebo injection and 14.2 points better (25.3 points better to 3.1 points better) with stem cell injection (I2 = 82%; 7 studies, 432 participants). We are uncertain whether stem cell injections improve quality of life or increase the number of people who report treatment success compared to placebo injection, because the certainty of the evidence was very low. Mean quality of life was 45.3 points with placebo injection and 22.8 points better (18.0 points worse to 63.7 points better) with stem cell injection (I2 = 96%; 2 studies, 288 participants) at up to six months follow-up. At the end of follow-up, 89/168 participants (530 per 1000) in the placebo injection group reported treatment success compared with 126/180 participants (683 per 1000) in the stem cell injection group (risk ratio (RR) 1.29, 95% CI 1.10 to 1.53; I2 = 0%; 4 trials, 348 participants). We downgraded the evidence to low certainty for pain and function due to indirectness (as the source, method of preparation and dose of stem cells varied across studies), and suspected publication bias (up to three larger RCTs have been conducted but withdrawn prior to reporting of results). For quality of life and treatment success, we further downgraded the evidence to very low certainty due to imprecision in addition to indirectness and suspected publication bias. We are uncertain of the potential harms associated with stem cell injection, as there were very low event rates for serious adverse events. At the end of follow-up, 5/219 participants (23 per 1000) in the placebo injection group experienced serious adverse events compared with 4/242 participants (16 per 1000) in the stem cell injection group (RR 0.72, 95% CI 0.20 to 2.64; I2 = 0%; 7 trials, 461 participants) and there were no reported withdrawals due to adverse events. We downgraded the evidence to very low certainty due to indirectness, suspected publication bias and imprecision. Radiographic progression was not assessed in any of the included studies.

Compared with placebo injections and based upon low-certainty evidence, stem cell injections for people with knee osteoarthritis may slightly improve pain and function. We are uncertain of the effects of stem cell injections on quality of life or the number who report treatment success. Although the putative benefits of stem cell therapies for osteoarthritis include potential regenerative effects on damaged tissues, particularly articular cartilage, we remain uncertain of the effect of stem cell injections on structural progression in the knee (measured by radiographic appearance). There is also uncertainty regarding the safety of stem cell injections. Serious adverse events were infrequently reported, although all invasive joint procedures (including injections) carry a small risk of septic arthritis. The risk of other important harms, including potential concerns related to the use of a therapy with the theoretical capacity to promote cell growth, or to the use of allogeneic cells, remains unknown.

In some European countries, animal brucellosis is a concern that requires a comprehensive understanding of its distribution, hosts and transmission routes, particularly involving wild species, in which the disease is still neglected. This systematic review was designed to summarize the current knowledge on the epidemiology of brucellosis in wild boar and domestic pigs in Europe. A systematic search was conducted in four databases to identify relevant original research articles. Thirty-six articles were included. Brucellosis has been identified in 17 European countries and the most reported circulating Brucella species and biovar was Brucella suis biovar 2. Brucella suis biovar 1, Brucella suis biovar 3, Brucella melitensis biovar 3 and Brucella microti were also identified from molecular investigations. We highlight the diversity in the occurrence of this infection, with the presence of Brucella species with zoonotic potential, and emphasize the need for surveillance.

In today's fast-paced world, work-related stress is a prevalent problem, particularly among health care professionals in high-pressure environments such as emergency departments (EDs). This stress can lead to mental health disorders, such as depression and burnout, affecting job performance, patient care, and the quality of professional and private life. This systematic review aimed to investigate the prevalence of burnout, depression, and stress among ED nurses and physicians and the impact of these conditions on personal and professional quality of life (QoL).

The systematic literature search covered PubMed, PsycINFO, Embase, and grey literature databases. Articles were included if they were published in English or German by 31 January 2020, focused on ED physicians or nurses, and examined burnout, depression, or stress and its impact on professional or personal QoL. Quality assessment of the included studies was performed using a modified version of the Newcastle-Ottawa Scale.

The systematic search resulted in 893 articles, of which 11 met the inclusion criteria. All reviewed studies had a cross-sectional study design and were of low to moderate quality. Depression, burnout, and stress were prevalent among ED physicians, ranging from 15.5% to 19.3%, 18% to 71.4%, and 19.5% to 22.7%, respectively. These were associated with lower job satisfaction in ED physicians, while findings in ED nurses also showed a considerable rate of burnout with an inverse association with compassion satisfaction. Burnout and stress were significantly associated with intentions to quit emergency medicine in ED physicians, whereas no association was found for depression. In addition, burnout showed a negative relationship to work-life balance and QoL, while higher stress levels were associated with lower life satisfaction in ED physicians.

Our review underlines the high prevalence of stress, depression, and burnout among ED health care professionals and their potential negative impact on private and professional life, emphasizing the need for targeted support and interventions to enhance resilience, reduce stress, and prevent the onset or deterioration of mental health diseases. This, in turn, can contribute to maintaining and strengthening the already limited human resources in EDs, ensuring the quality of patient care, and strengthening health care systems.

Menopause, marked by a decline in estrogen, leads to disruptive vasomotor symptoms like hot flashes and night sweats, significantly affecting quality of life. This meta-analysis evaluated the efficacy and safety of fezolinetant and elinzanetant, two neurokinin 3 receptor antagonists, in managing vasomotor symptoms in postmenopausal women.

Data sources were identified by searches in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to September 2024. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with the risk of bias assessed using the version 2 of the Cochrane Risk of Bias Tool for Randomized Trials and evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model, and statistical analysis was performed using R version 4.4.1.

Ten studies involving 4663 patients were included in the analysis. Elinzanetant >100 mg and fezolinetant ≤45 mg were the most effective doses for reducing vasomotor symptom frequency and severity. Fezolinetant (MD = -1.38) and elinzanetant (MD = -2.04) achieved ≥50 % reductions in vasomotor symptom frequency, with a greater effect in the elinzanetant group. Additionally, elinzanetant improved menopause-specific quality of life. However, higher doses of both drugs were associated with increased adverse effects, with elinzanetant demonstrating a more favorable side-effect profile than fezolinetant.

Fezolinetant and elinzanetant are effective options for managing vasomotor symptoms. However, further research is needed to compare these treatments directly and evaluate their long-term safety profiles across different patient populations.

This systematic review and meta-analysis evaluated the incidence of serious adverse events (SAEs) in patients with Crohn's disease (CD) and ulcerative colitis (UC) treated with upadacitinib and examined secondary adverse events.

A comprehensive search of PubMed, Embase and Cochrane Library was conducted to identify randomized controlled trials (RCTs) comparing upadacitinib with placebo in adults with inflammatory bowel disease (IBD). The primary outcome was the incidence of SAEs, while secondary outcomes included specific adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.

Six RCTs, including 2611 patients, were analyzed. The incidence of SAEs did not significantly differ between upadacitinib (6.1%) and placebo (7%) (RR = 0.77; 95% CI: 0.50-1.20; p = 0.25). Secondary outcomes showed no significant differences in serious infections, hepatic disorders, nasopharyngitis or herpes zoster. However, neutropenia (RR = 5.63; 95% CI: 1.90-16.65; p = 0.0002) and creatine kinase elevation (RR = 2.34; 95% CI: 1.22-4.47; p = 0.01) were higher with upadacitinib, while anemia (RR = 0.36; 95% CI: 0.27-0.48; p < 0.00001) and arthralgia (RR = 0.47; 95% CI: 0.30-0.75; p = 0.001) were reduced.

Upadacitinib did not increase the overall risk of SAEs in IBD patients, with a notable reduction in anemia and arthralgia. However, the higher risks of neutropenia and CK elevation underscore the importance of monitoring. Further research is necessary to assess long-term safety, particularly regarding rare but serious events such as thromboembolism.

Solitary hepatocellular carcinoma measuring ≤3 cm represents approximately 30% of hepatocellular carcinoma cases, yet treatment guidelines lack robust evidence. This study compares oncologic outcomes after ablation, liver resection, and liver transplantation for solitary, small hepatocellular carcinoma.

We systematically searched databases up to 7 February 2022, for studies including adults with solitary hepatocellular carcinoma ≤3 cm treated by any ablation, liver resection, or liver transplantation. We excluded non-hepatocellular carcinoma cancers, recurrent/metastatic diseases, and alternative therapies. A frequentist network meta-analysis assessed 5-year overall survival and recurrence-free survival using only adjusted effect estimates while accounting for bias risk.

We identified 80 studies (4 randomized controlled trials, 72 retrospectives, and 4 prospective cohorts) with 28,211 patients. In the network meta-analysis for 5-year overall survival (26 studies), liver transplantation was associated with the lowest mortality hazard (hazard ratio, 0.47; 95% confidence interval, 0.31-0.73, referenced to liver resection), followed by liver resection (reference), whereas ablation had the greatest mortality hazard (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49, referenced to liver resection). For 5-year recurrence-free survival (19 studies), liver transplantation had the best outcome (hazard ratio, 0.36; 95% confidence interval, 0.20-0.63, referenced to liver transplantation), followed by liver resection (reference), with ablation showing the least favorable outcome (hazard ratio, 1.67; 95% confidence interval, 1.45-1.93, referenced to liver resection).

This network meta-analysis provides the evidence for comparing treatment modality outcomes for solitary, small (≤3 cm) hepatocellular carcinoma. LT emerges as the superior choice for achieving a better 5-year OS, followed by liver resection, then ablation. When feasible to preserve liver function, liver resection can be prioritized. Ablation with close surveillance should be reserved for individuals unfit for surgery.

Initial management for overactive bladder includes behavioral modification with avoidance of bladder irritants. However, in 2017, the International Consultation on Incontinence concluded that more research is needed to determine the precise role of these irritants in the treatment of overactive bladder.

The objectives were to identify, evaluate, and summarize peer-reviewed literature examining associations between 6 potential bladder irritants as proposed by the National Institute of Diabetes and Digestive and Kidney Diseases (alcohol; spicy foods; chocolate; artificial sweeteners; caffeinated, carbonated, and citrus beverages; and high-acid foods such as citrus and tomatoes) and OAB symptoms.

We performed a systematic literature search on MEDLINE, EMBASE, and SCOPUS. An adapted version of the patient-intervention-comparison-outcome framework was applied. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures assessment tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023466251).

We reviewed 51 unique articles exploring the effect of alcohol (n = 34); spicy foods (n = 1); chocolate (n = 3); artificial sweeteners (n = 5); caffeinated, carbonated, and citrus beverages (n = 27); and high-acid foods (n = 2). The considered outcomes included overactive bladder (n = 16), urgency incontinence (n = 19), urinary urgency (n = 15), frequency (n = 17), and nocturia (n = 17). Overall, observed associations were mixed and inconsistent. The risk of bias was moderate in 23 publications and low for the remaining publications.

This systematic review failed to identify consistent evidence of an association between any of these 6 potential bladder irritants and overactive bladder symptoms.

The hallmark of evidence-based anatomy (EBA) is the anatomical meta-analysis (AMA). The Critical Appraisal Tool for Anatomical Meta-Analysis (CATAM) was recently published to enable users to appraise AMAs quickly and effectively. The tool is valuable for students and clinicians who need to judge the quality of AMAs, which informs clinical decision making and results in better patient care. Subjective measures of the tool's face and content validity have been established, but establishing its reliability provides a more objective measure of the instrument's dependability. This study investigated the interrater reliability (IRR) of the CATAM between novice and expert raters. Three graduate students and three professors (two anatomists and one pharmacist) read the original CATAM paper, and then had a post hoc meeting to discuss scoring with the tool. Three recent AMAs (published between 2017 and 2022) were randomly chosen from PubMed, and all six raters scored the papers blindly. The intraclass correlation coefficient (ICC) statistic was used to calculate the interrater reliability (IRR) between all scores, and then the ICCs between novice and expert scores were compared. Cronbach's alpha (internal consistency) of the CATAM was also calculated (SPSS 25, Armonk, NY). ICC for AMA-1 was 0.999 (95% CI, 0.997-0.999), p = 0.000, and alpha was 0.999. ICC for AMA-2 was 0.994 (95% CI, 0.988-0.998), p = 0.000, and alpha was 0.994. ICC for AMA-3 was 0.998 (95% CI, 0.995-0.999), p = 0.000, and alpha was 0.998. ANOVA showed no significant differences (p > 0.05) in mean ICCs between raters. The CATAM is a robust tool with excellent IRR (ICC > 0.990) and internal consistency (alpha > 0.990). No significant difference in ICC scores between novices and experts suggests the tool does not require prior expert knowledge to be effective. Now that the reliability of the CATAM is established, it can be more widely adopted by students and physicians worldwide to evaluate the quality of AMAs. The CATAM offers widespread applicability, and can be adopted in medical education, journal clubs, and clinical seminars to critically evaluate AMAs.

The administration of crushed or chewed P2Y12 inhibitors (P2Y12i) allows faster platelet inhibition in patients presenting acute coronary syndrome (ACS). Whether this administration approach is safe needs further analysis. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing chewed/crushed to integral P2Y12i administration in patients with ACS. Major bleeding, minor bleeding, and major adverse cardiovascular events (MACE) were analyzed as binary outcomes. Platelet reactivity unit (PRU) was assessed as a continuous outcome to estimate the impact on platelet physiology. A subgroup analysis of P2Y12i administered was performed. Nine studies comprising 1091 patients with ACS were included, 77% were males. Overall, 87% presented with ST-segment elevation acute myocardial infarction. Six studies administered Ticagrelor, while 3 studies used Prasugrel. The absolute risk of bleeding, assessed by TIMI, was low in both intervention and control arms (0.36% vs. 0.95% for major bleedings and 3.3% vs. 4.4% for minor bleedings), and crushed/chewed administration did not increase the relative risk of bleeding events for TIMI major or minor bleedings (RR 0.51, 95% CI 0.09-2.77, p = 0.293; RR 0.76, 95% CI 0.24-2.43, p = 0.542) or MACE (RR 0.94, 95% CI 0.28-3.19, p = 0.902). PRU was significantly reduced within 1 h after administration in the crushed/chewed P2Y12i group (MD: -70.0%, 95% CI, -89.0 to -51.1%, p<0.01) while we did not observe a significant difference after 4 h (MD: -15.1%, 95% CI -34.2 to 4.0%, p = 0.12). The type of drug did not influence the relative risk of crushed/chewed P2Y12i on major or minor bleeding (pinteraction = 0.62 and pinteraction = 0.23, respectively). The crushed/chewed administration of P2Y12i in the setting of ACS was not associated with an increased risk of bleeding, suggesting the safety of this strategy.

Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.

Adverse childhood experiences (ACEs) significantly impact lifelong health and well-being. Despite extensive research, a comprehensive understanding of ACEs' multifaceted impacts continues to be challenging to achieve. This study synthesizes meta-analytic evidence to provide a comprehensive view of ACEs' effects, addressing various approaches to conceptualizing ACEs and their diverse outcomes. Employing an umbrella synthesis methodology, this review integrated findings from 99 meta-analyses involving 592 effect sizes. We examined ACEs through specificity, lumping, dimensional, and child maltreatment-centric approaches, assessing their impact across six domains: biological system dysregulation, neuropsychological impairments, physical health complications, mental health conditions, social and behavioral challenges, and criminal justice involvement. The findings reveal a small to moderate overall effect size of ACEs across outcome domains. Specific ACE approaches exhibited varying impact levels, with notable differences in effects on mental health, social/behavioral issues, and criminal justice involvement. When ACEs were aggregated without distinguishing between different types, but with consideration of their cumulative effects, adverse outcomes were significantly exacerbated. The child maltreatment-centric approach consistently demonstrated substantial effects across all evaluated domains. This review underscores the heterogeneity in ACEs' impacts, influenced by the type of ACE and specific outcomes considered. It highlights the necessity for comprehensive approaches to understanding, preventing, and mitigating the effects of ACEs. These insights are vital for developing targeted interventions and informing policy-making, emphasizing the complexity and varied nature of ACEs' influence on individual development and societal well-being.

To improve dental care for individuals with special needs, it is crucial to understand the effectiveness of endodontic treatments under general anaesthesia. This systematic review explores the feasibility, prognostic factors, and outcomes of root canal treatment and pulpotomy performed under general anaesthesia in adult and adolescent patients with special needs. A comprehensive search of Cochrane Library and MEDLINE databases was conducted until July 2024. The quality of evidence was assessed using the Newcastle-Ottawa scale (NOS). Among the 637 initially identified studies, 5 met the inclusion criteria. Treatment outcomes, radiographic findings, and clinical survival rates were evaluated. Root canal treatment success rates ranged from 81.5 to 90% over a minimum observation period of 12 months. Survival rates varied from 87.7% (9 year cumulative survival rate) to 89.8% (5 year survival rate). One study showed a lower failure risk in endodontic treatment under general anaesthesia compared to local anaesthesia. Another study found no significant difference in root canal treatment quality between general and local anaesthesia. Influencing factors identified by multivariate regression analyses included soft diet, periodontal status, oral hygiene status, pulp vitality, and length of root canal filling. Limited evidence suggests that endodontic treatment under general anaesthesia is feasible and can yield favourable outcomes in patients with special needs. However, the scarcity of studies and concerns about publication bias and methodological limitations emphasize the need for further research.

There is ongoing debate concerning the association of metformin with the risk of dementia in type 2 diabetes mellitus (T2DM). This study was conducted to evaluate the impact of metformin therapy on dementia in patients with T2DM.

PubMed, Embase, Cochrane Library, Web of Science and the ClinicalTrials.gov website were searched until 9 April 2024. Cohort studies investigating the effects of metformin therapy compared with other antidiabetic drugs or no therapy in T2DM were included. The hazard ratio (HR) and the 95% confidence interval (CI) were computed using the random effects model.

Twenty cohort studies (24 individual comparisons) involving 3 463 100 participants were identified. A meta-analysis revealed that people with T2DM who take metformin are linked to a lower incidence of all-cause dementia compared to non-user (n = 17, HR = 0.76, 95% CI = 0.65-0.91, p = 0.002, I2 = 98.9%) and sulfonylureas (n = 5, HR = 0.88, 95% CI = 0.85-0.90, p < 0.001, I2 = 9.7%), but not to thiazolidinedione (n = 2, HR = 0.53, 95% CI = 0.08-3.41, p = 0.503, I2 = 92.7%). Additionally, metformin showed favourable effects in non-specified T2DM (n = 19, HR = 0.75, 95% CI = 0.64-0.89), but not in newly diagnosed T2DM (n = 5, HR = 1.01, 95% CI = 0.81-1.27).

Metformin might correlate with a lower dementia incidence in people with T2DM. However, it is crucial to interpret these results with caution considering the high heterogeneity.

Background: Bats act as reservoirs for a variety of zoonotic viruses, sometimes leading to spillover into humans and potential risks of global transmission. Viral shedding from bats is an essential prerequisite to bat-to-human viral transmission and understanding the timing and intensity of viral shedding from bats is critical to mitigate spillover risks. However, there are limited investigations on bats' seasonal viral shedding patterns and their related risk factors. We conducted a comprehensive review of longitudinal studies on bat viruses with spillover potential to synthesize patterns of seasonal viral shedding and explore associated risk factors. Methods: We extracted data from 60 reviewed articles and obtained 1085 longitudinal sampling events. We analyzed viral shedding events using entropy values to quantitatively assess whether they occur in a consistent, pulsed pattern in a given season. Results: We found that clear seasonal shedding patterns were common in bats. Eight out of seventeen species-level analyses presented clear seasonal patterns. Viral shedding pulses often coincide with bats' life cycles, especially in weaning and parturition seasons. Juvenile bats with waning maternal antibodies, pregnant bats undergoing immunity changes, and hibernation periods with decreased immune responses could be potential risk factors influencing seasonal shedding patterns. Conclusion: Based on our findings, we recommend future longitudinal studies on bat viruses that combine direct viral testing and serological testing, prioritize longitudinal research following young bats throughout their developmental stages, and broaden the geographical range of longitudinal studies on bat viruses based on current surveillance reports. Our review identified critical periods with heightened viral shedding for some viruses in bat species, which would help promote efforts to minimize spillovers and prevent outbreaks.

The field of Clinical High-Risk for Psychosis (CHR-P) is a dynamic area within contemporary psychiatry and serves as a crucial testing ground for precision prognostic models. Nonetheless, some foundational aspects remain inadequately conceptualized and consequently not transparently reported, such as baseline pharmacotherapy. A systematic review and meta-analysis were conducted by searching the MEDLINE and Cochrane Library databases for studies published up to August 31, 2024. Eligible studies included CHR-P samples, reported numeric data on outcomes at follow-up, and examined the transition to psychosis as an outcome. Data extraction adhered to PRISMA guidelines, focusing on baseline pharmacological exposure to antipsychotics, antidepressants, benzodiazepines, and mood stabilizers. A total of 95 studies were analyzed. The majority of studies (96.8 %) explicitly stated whether baseline exposure to antipsychotics was allowed as part of the inclusion criteria. However, actual baseline exposure to antipsychotics was quantified in only 60 % of these studies. Exposure to non-antipsychotic psychoactive therapies was reported in only a fraction of the studies (36.8 % for antidepressants, 16.8 % for benzodiazepines, and 14.7 % for mood stabilizers). In CHR-P longitudinal studies, the meta-analytic proportions of self-disclosed baseline pharmacological exposure ranged from 23.5 % to 24.5 % for antipsychotics, 28.5 % to 30.6 % for antidepressants, 11.2 % to 14.6 % for benzodiazepines, and 5.6 % to 5.9 % for mood stabilizers. Overall, a non negligible fraction of CHR-P participants is already under psychoactive pharmacological treatment at enrollment. The lack of consistent transparency in this respect may limit the effectiveness of prognostic models. Improved reporting practices are necessary to enhance precision in preventive psychiatry.

To conduct the first meta-analysis using only prospective studies to evaluate whether video endoscopic inguinal lymphadenectomy (VEIL) offers advantages in perioperative outcomes compared to open IL (OIL) in patients with penile cancer.

A systematic review with meta-analysis was conducted across multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Latin America and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, and several trial registries up to June 2024. Only randomised controlled trials (RCTs) and prospective cohort studies were included. Data extraction focused on operative time, perioperative complications, drainage time, hospital stay, number of nodes retrieved and oncological outcomes.

Four prospective studies, including three RCTs and one non-randomised study, were included in the analysis, totalling 95 patients and 174 operated limbs. VEIL demonstrated significantly fewer wound infections (P < 0.001; 95% confidence interval [CI] 0.01-0.18; I2 = 0), skin necrosis (P = 0.002; 95% CI 0.04-0.49; I2 = 0), and lymphoedema (P = 0.05; 95% CI 0.09-0.99; I2 = 27%) compared to OIL. The VEIL group also had a shorter drainage period (P = 0.001; mean difference [MD] -1.94, 95% CI -3.15 to -0.74) and hospital stay (P < 0.01; MD -5.48, 95% CI -6.34 to -4.62). Pain intensity and operative time were lower in the VEIL group, contributing to fewer postoperative complications overall. Oncological outcomes showed no significant differences between the groups.

The meta-analysis indicates that VEIL offers significant advantages over OIL in terms of reducing wound infections, skin necrosis, and lymphoedema, leading to shorter hospital stays and overall improved perioperative outcomes. However, the limited sample of 95 patients across four studies underscores the need for further randomised trials and a cautious interpretation of the results, which currently support the use of VEIL in managing patients with penile cancer.

Increasingly, pregnant women with HIV (WHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naive WHIV.

Systematic review and meta-analysis.

We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1 January 1980 and 14 July 2023. We assessed the association of preconception/antenatal ART initiation with preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Data were analysed using random effects meta-analyses. Quality assessments, subgroup and sensitivity analyses were conducted. PROSPERO registration: CRD42021248987.

Thirty-one cohort studies were eligible, including 199 156 women in 19 countries. WHIV with preconception ART were associated with increased risk of PTB [risk ratio (RR) 1.55; 95% confidence interval (CI) 1.27-1.90], VPTB (RR 2.14, 95% CI 1.02-4.47), LBW (RR 2.19, 95% CI 1.32-3.63), VLBW (RR 3.34, 95% CI 1.08-10.35), SGA (RR 1.92, 95% CI 1.01-3.66), and VSGA (RR 2.79, 95% CI 1.04-7.47), compared with women without HIV. WHIV with antenatal ART were associated with increased risk of PTB (RR 1.35, 95% CI 1.15-1.58), LBW (RR 2.16, 95% CI 1.39-3.34), VLBW (RR 1.97, 95% CI 1.01-3.84), SGA (RR 1.77, 95% CI 1.10-2.84), and VSGA (RR 1.21, 95% CI 1.09-1.33), compared with women without HIV. Compared to ART-naive WHIV, WHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: RR 1.40, 95% CI 1.12-1.73; antenatal: RR 1.39, 95% CI 1.11-1.74) and VSGA (preconception: RR 2.44, 95% CI 1.63-3.66; antenatal: RR 2.24, 95% CI 1.48-3.40).

Among WHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naive WHIV.

Telomere length (TL) is a biomarker of cellular aging with variations observed by sex, age, race, and ethnicity. Prior studies have suggested that physical activity (PA) may positively impact TL by potentially elongating telomeres and slowing cellular aging. However, research examining the optimal type and intensity of PA needed to elicit these changes specific to women remains limited. This systematic review aimed to investigate variations in TL in response to PA among women, exploring how these effects differ by age, race, or ethnicity. Following PRISMA guidelines, searches across five databases identified 17 relevant studies published from 2008 to 2022. A narrative synthesis of study findings indicated PA did not have a significant relationship with TL in women. However, a possible positive relationship was noted between specific types of PA and TL, specific to combined aerobic and strength-training PA and high intensity interval training interventions. The impact of PA on TL appeared to be age-dependent as well, showing significant positive relationships between PA and TL in early and later adulthood but not in middle adulthood. Findings related to race or ethnicity were inconclusive due to limited analyses from the included studies. The studies varied greatly by PA type, intensity, duration, and frequency, which, along with the reliance on self-reported PA measures in the observational studies, impacted the ability to draw firm conclusions. This review underscores the necessity for future research in large cohort studies using objectively measured PA interventions to further clarify the complex associations between PA and TL in women.

Several effects of non-sugar-sweetened beverage (NSSBs) intake on health outcomes have been reported; however, the evidence on the association between NSSBs intake and chronic diseases and mortality risk is still inconclusive.

This umbrella review aimed to summarize the evidence on the association between NSSBs intake and the risk of chronic diseases and mortality.

Embase, ISI Web of Science, Cochrane Central, and PubMed were searched up to September 2023 for relevant meta-analyses of observational prospective cohort studies.

Two groups of researchers independently extracted study data and assessed the risk of bias for meta-analyses and primary studies.

Six meta-analyses, reporting 74 summary hazard ratios (HRs) for different outcomes obtained from 50 primary studies, were included. The summary HRs, 95% CIs, and certainty of evidence on the association of NSSBs intake with risk of chronic diseases and mortality were as follows: all-cause mortality (per 355 mL/d: 1.06 [1.01 to 1.10]; moderate certainty); stroke (per 250 mL/d: 1.09 [1.04 to 1.13]; high certainty); coronary heart disease (CHD) (per 250 mL/d: 1.06 [1.02 to 1.11]; high certainty); hypertension (HTN) (high vs low intake: 1.14 [1.09 to 1.18]; moderate certainty); type 2 diabetes (T2D) (high vs low intake: 1.16 [1.08 to 1.26]; low certainty); metabolic syndrome (MetS) (high vs low intake: 1.32 [1.22 to 1.43]; low certainty); colorectal cancer (high vs low intake: 0.78 [0.62 to 0.99]; moderate certainty); and leukemia (high vs low intake: 1.35 [1.03 to 1.77]; moderate certainty). For other outcomes, including the risk of cardiovascular and cancer mortality, chronic kidney diseases, breast cancer, prostate cancer, endometrial cancer, pancreatic cancer, multiple myeloma, and non-Hodgkin lymphoma, no association was found.

This study provides further evidence that NSSBs are associated with increased risk of all-cause mortality, stroke, CHD, HTN, T2D, MetS, and leukemia. Moreover, a higher intake of NSSBs was associated with a lower risk of colorectal cancer. However, it should be noted that the magnitudes of the associations are not large. Further studies are needed to clarify the long-term effects of different NSSBs intakes on health.

PROSPERO no. CRD42023429981.

The association of telomere length (TL) and coronary heart disease (CHD) is still debated, and there is a lack of dose-response meta-analyses on this issue. The aim is therefore to integrate existing evidence on the association between TL and CHD risk and explore the dose-response relationship between them.

PubMed, EMBASE, and Web of Science were searched for relevant studies up to September 2024. Meta-analysis was performed using a random-effects model, with data presented as RRs and 95 % CIs. Restricted cubic splines were used to assess linear and nonlinear associations. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. Fourteen articles (8 prospective cohort studies, 2 case-cohort studies, 2 case-control studies, and 2 cross-sectional studies) were finally included in the meta-analysis, with a total sample size of 199,562 participants and 25,752 cases. For CHD, the total RR for the highest TL group compared to the lowest TL group was 0.69 (95 % CI: 0.61, 0.78, I2 = 64.5 %). For every 1 kilobase pair (kbp) increase in TL, the CHD risk decreased by 23 % (RR = 0.77, 95 % CI: 0.69, 0.87, I2 = 89.0 %). The nonlinearity test indicated a linear association between TL and CHD risk (Pnon-linearity = 0.930). Sensitivity analyses indicated that the results were robust.

The meta-analysis showed a linear relationship between TL and CHD. People with low TL may be more likely to develop CHD than those with high TL. The association between the two did not change in a wide range of populations.

The alcohol and other drug treatment needs of young people differ from adults. It is important that outcomes measured in this client population are meaningful and use tools that are validated among young people. However, there has been no research to date that has looked at which outcomes and tools are most relevant for this population. This scoping review identifies outcome domains for young people that are supported by the research literature and clinical practice frameworks and identifies important evidence gaps. We also assessed which validated tools exists to measure these domains.

A scoping review of peer reviewed and grey literature was undertaken. Five electronic databases for published papers and eight grey literature databases were searched. Details of studies were extracted in a table and a quality assessment was undertaken on a group level.

3688 publications were identified, with 38 meeting inclusion criteria being included in the final review. Overall, the quality of the evidence was satisfactory to good, except for the level of evidence component. Twelve outcome domains and 47 outcome tools were identified.

Alcohol and other drug use, peers and social networks, mental health and wellbeing and family were identified as most relevant for young people in treatment. Although many outcome tools were identified, none of the identified tools completely meet the needs of clinicians and young people in alcohol and other drug treatment (for example, too long or do not capture all domains).

Sleep deprivation may have a deleterious effect on inhibitory control; however, this effect is not consistent across studies. To arrive at an overall estimate of the relationship between sleep deprivation and inhibitory control, this report used meta-analysis to summarise the magnitude of the effects of sleep deprivation on inhibitory control as measured by the Go/No-Go and Stop Signal Tasks. These are two widely used tasks in the literature. A systematic search of four databases (APAPsycINFO, Medline, CINAHL and Embase) from their inception to November 2023 identified 24 studies involving 712 healthy individuals. Separate random-effects models were used to estimate the effect size of sleep deprivation on performance in these tasks. The meta-analysis revealed a moderate negative effect of sleep deprivation on inhibitory control in both the Go/No-Go and Stop Signal Tasks. Given the importance of inhibitory control in everyday behaviour, future research should investigate the neural and neurophysiological mechanisms underlying this relationship and explore its impact in clinical populations.

Previous researches have reported correlations between overweight/obesity and common digestive system cancers (DSCs), including gastric, liver, esophageal, colorectal, and pancreatic cancers. However, the inconsistency in defining overweight/obesity and the risk of recall bias from case-control and retrospective cohort studies may influence existing results. Therefore, we aimed to validate the relationship between overweight/obesity and common DSCs by combining prospective cohort studies based on the World Health Organization (WHO) criteria for defining overweight/obesity.

A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane databases, covering all publications up to February 7, 2024. The inclusion criteria focused on prospective cohort studies that examined the link between overweight/obesity and risks of DSCs. R software 4.1.3 and STATA 12 were utilised to calculate the relative risk (RR), with 95% confidence interval (CI) and prediction interval (PI). TSA v0.9.5.10 Beta software was used for trial sequential analysis (TSA).

The meta-analysis encompassed 39 articles. The overall analysis showed that compared with normal weight, overweight/obesity increased the risks of liver cancer (overweight: RR [95% CI] =  1.237 [1.112-1.377]; 95% PI: 0.888-1.725; obesity: RR [95% CI] =  1.642 [1.466-1.839]; 95% PI: 1.143-2.358) and colorectal cancer (overweight: RR [95% CI] =  1.124 [1.056-1.197]; 95% PI: 0.931-1.357; obesity: RR [95% CI] =  1.366 [1.242-1.503]; 95% PI: 0.959-1.945) in the total population. Subgroup analysis revealed that overweight (RR [95% CI] =  1.237 [1.165-1.314]; 95% PI: 1.154-1.327) and obesity (RR [95% CI] =  1.306 [1.152-1.480]; 95% PI: 1.108-1.539) were associated with an increased risk of pancreatic cancer only in women, and overweight also increased the gastric cancer risk of women (RR [95% CI] =  1.041 [1.013-1.070], 95% PI: 0.806-1.230). No significant association of overweight/obesity and esophageal cancer was observed in both male and female.

Our study suggested that overweight/obesity elevated the risks of liver and colorectal cancer in both men and women. No significant association was found between overweight/obesity and the risk of developing esophageal cancer. Clinicians are advised to consider weight control as an effective measure for preventing pancreatic, liver, and colorectal cancers.

Recent evidence from clinical and animal studies with anti-inflammatory agents in depression is conflicting. One possible reason is the heterogeneity of baseline inflammation levels. Since older adults are generally associated with chronic low-grade inflammation and depression is one of the most common mental disorders in this population, this meta-analysis aimed to evaluate the therapeutic and preventative effects of anti-inflammatory interventions for depression among older adults. PubMed, Cochrane Library, Embase, and PsycINFO were searched for randomized controlled trials (RCTs) up to November 18, 2024. The primary outcomes were mean change scores of depression scores and incidences of depression after treatment. Pooled standard mean differences (SMDs) and odds ratios (ORs) including 95% confidence intervals (95% CI) were calculated. Of 3116 screened articles, 31 RCTs met the inclusion criteria, with 25 studies investigating efficacy and 7 studies investigating the incidence following anti-inflammatory treatment. Anti-inflammatory interventions were statistically significantly more effective than placebo in reducing depressive scores for older adults with depression (SMD = -0.57, 95% CI = -0.98 to -0.15, p = 0.008). Sub-group analyses supported the use of omega-3 fatty acids (SMD = -0.14, 95% CI = -0.27 to -0.02, p = 0.03) and botanical drug or dietary intervention (SMD = -0.86, 95% CI = -1.58 to -0.13, p = 0.02) among older participants. While limited by substantial heterogeneity among included studies, these results reveal the moderate beneficial effects of anti-inflammatory interventions for the treatment and prevention of depression among older adults. Future high-quality RCTs are warranted to determine which anti-inflammatory interventions are most preferential for older patients with depression.

Explore how previous patient safety research has described issues related to patient participation in psychiatric hospital care.

Integrated literature review.

The literature review was conducted according to Cooper's framework with the following five-step protocol: problem identification, a literature search, data evaluation, data analysis, and the presentation of results.

CINAHL, PubMed, PsycINFO, Scopus databases, years 2005-2023. After quality appraisal, a total of 62 articles were reviewed.

Three main categories related to patient participation in psychiatric hospital care were identified: communication (having information, being heard, therapeutic relationships and interaction quality), decision-making (treatment planning, treatment decisions, activities and working on behalf of patients) and restrictive measures (setting limits, exercising power, balancing patient autonomy and safety).

Psychiatric hospital care nursing staff continuously balance patients' autonomy, self-determination, and safety, taking into account their well-being and issues of responsibility. Wider use of positive risk-taking is needed to increase patient participation and safety in psychiatric hospital care.

Nursing staff should create favourable facilities for patient participation, foster an atmosphere of trust, respect, and encouragement, provide patients individual time to improve patient safety and recognise that they can exert power over patients due to constantly balancing patient autonomy and safety.

PRISMA guidelines.

No patient or public contribution.

Three-port (trocar) laparoscopic appendectomy is the standard treatment for acute appendicitis and previous studies have compared to single-incision approach, however, they often include both pediatric and adult patients and fail to account for surgeons' experience, leading to variability in outcomes. This systematic review and meta-analysis aims to address these literature gaps by focusing on adult patients and controlling for surgeon expertise. We conducted a comprehensive search of randomized controlled trials comparing single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) up to November 2024. We assessed the length of hospitalization, operative duration, postoperative complications, and surgical wound infections. Data were synthesized using random-effects models to account for variability among studies. The meta-analysis included four studies with a total of 408 patients, comprising 202 in the single-incision laparoscopic appendectomy (SILA) group and 206 in the conventional laparoscopic appendectomy (CLA) group. For the length of hospitalization, no statistically significant difference was observed, with a weighted mean difference (WMD) of 0.07 days (95% CI  - 0.32 to 0.47, I2 = 0%, p = 0.72). Similarly, the operative duration showed no significant difference, with a WMD of 4.49 min (95% CI  - 7.02 to 16.00, I2 = 89%, p = 0.44). The analysis of postoperative complications also revealed no significant difference between the groups, with an odds ratio (OR) of 1.32 (95% CI 0.69 to 2.51, I2 = 0%, p = 0.40). Surgical wound infections were found to be comparable, with an OR of 1.14 (95% CI 0.46 to 2.83, I2 = 0%, p = 0.78). Sensitivity analysis indicated that the results were statistically significant regarding operative duration when Kim et al. was excluded from the analysis. SILA and CLA yield comparable outcomes in terms of hospitalization length, operative duration, and complications, suggesting that both techniques are viable options for the management of acute appendicitis in adults. Further studies investigating overall cosmesis, patient satisfaction, and postoperative pain are warranted to optimize surgical approaches.PROSPERO registration: CRD42024612596.

This study aims to review clinical trials investigating dietary or nutritional interventions for Parkinson's Disease (PD) and identify potential research gaps. A PubMed search yielded 3378 results, and after applying inclusion and exclusion criteria, 38 studies were selected. Of these, 13 focused on interventions with potential neuroprotective effects against PD, 18 examined symptom improvement, and 7 explored their relationship to antiparkinsonian medication. Most studies were randomized controlled trials (RCTs) and demonstrated promising results. However, they were often limited by small sample sizes and short durations. Large-scale, double-blind, placebo-controlled RCTs are necessary to further investigate the effects of dietary and nutritional interventions in PD. Other nutrients with promising results in preclinical research should be further evaluated in clinical trials. Moreover, research should prioritize dietary pattern interventions, like the Mediterranean and ketogenic diets, while closely monitoring patient adherence to these approaches. Lastly, future research should further explore the role of gut microbiota and its potential pathogenic involvement in PD.

Patient-generated health data (PGHD) from apps and wearables hold significant potential for enhancing personalised care and medical research. Healthcare professionals (HCPs) are key to its successful adoption, as their attitudes can either support or hinder its integration into clinical practice. This review systematically analysed studies on HCPs' and researchers' perspectives on PGHD for clinical and research use. Three databases were searched for articles published between January 2013 and April 2023. Of 246 articles screened, 33 met the inclusion criteria. While most participants viewed PGHD positively, concerns around data security, reliability, and workflow integration persist. Addressing these barriers is essential to maximising PGHD's benefits for participatory medicine and improved clinical outcomes. The included studies presented medium methodological quality, particularly among quantitative and mixed methods with risks of sampling and nonresponse bias, and often low sample sizes in qualitative studies. However, recurring themes across studies allow a valuable interpretation of the findings.

Falls from heights are a leading cause of workplace injuries and fatalities. Ensuring worker fitness is crucial, yet many countries lack formal guidelines for fitness for work (FFW) assessments, posing safety and legal risks. This scoping review sought to identify and map the existing evidence on the assessment of fitness to work at heights.

Scoping review following the Joanna Briggs Institute Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

Searches were conducted in March 2024 across ProQuest Central, Google Scholar, PubMed, Scopus, ScienceDirect, Web of Science and PsycINFO. Grey literature was sourced from the websites of organisations including the International Labour Organisation, Safe Work Australia, Canadian Centre for Occupational Health and Safety, Health and Safety Executive (UK), Occupational Safety and Health Administration (USA), WHO, Centre for Construction Research and Training (USA), Institution of Occupational Safety and Health (UK), South African Society of Occupational Medicine, South African Society of Occupational Health Nursing and Institute for Work at Height (South Africa), in addition to general Google searches.

Our inclusion criteria encompassed both peer-reviewed and grey literature that addressed either 'fitness for work at heights', 'fitness for work in high-risk settings requiring work at heights' or human risk factors associated with working at heights.

A data extraction framework and guidance sheet were developed, piloted and refined through team discussions. An iterative review process was followed, with one author extracting and coding data while two authors conducted quality checks. Deductive qualitative content analysis was applied to the extracted data.

68 articles met the inclusion criteria, but only 7 directly addressed fitness to work at heights, with the rest focusing on fitness to work in high-risk settings requiring work at heights or human risk factors associated with work at heights. This highlights a lack of peer-reviewed research specific to the topic. Key challenges included FFW assessments failing to reflect job demands, inconsistent application of FFW evaluations, lack of standardisation and inadequate stakeholder collaboration. Legal tensions between employer safety obligations and worker rights were also noted. Critical human risk factors-such as physical and mental limitations, adverse states, human error and rule violations-significantly affected worker safety, though evidence of their specific impact in this context remained limited. Findings on the economic implications of FFW assessments were also inconclusive.

Assessing FFW at heights is vital for worker safety, yet key challenges persist. This review highlights gaps in evidence on human risk factors and assessment methods. Findings emphasise the need for practice-based research, standardised fitness criteria and interdisciplinary protocols for preplacement assessment and ongoing monitoring.

Clinicians face a difficult challenge in identifying vertebrobasilar insufficiency (VBI) resulting from atherosclerosis. VBI is a term utilized to describe a reduction in blood flow to the vertebral and basilar arteries that supply the posterior cerebral system. For musculoskeletal clinicians, diagnostic differentiation of VBI is essential, because its presence directly impacts the clinical use of manual treatment interventions. Clinical guidelines provide a set of cardinal symptoms (inclusive of Coman's 5D's) in which VBI may manifest, the accuracy of which is under contestation because literature provides evidence suggesting a wider set of symptoms.

The objectives of this study were to gather all relevant literature reporting features of VBI pertaining to atherosclerosis, with the aim to help provide evidence that may guide clinical practice in the use of manual therapy interventions and to raise awareness of the manifestations that VBI may present.

Six databases were searched from inception to September 2024 (Allied and Alternative Medicine Database [AMED], AgeLine, SPORTDiscus, Medical Literature Analysis and Retrieval System Online [MEDLINE], Cochrane, and Cumulative Index of Nursing and Allied Health (CINAHL Plus). Articles were screened in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, The included articles required a diagnosis of VBI through clinical examination with radiological evidence of atherosclerotic lesions, without evidence of existing or previous neurological infarcts, concomitant arterial pathology, or any other form of pathological mechanism. Primary data were extracted utilizing a template, and the methodological quality was assessed utilizing the Joanna Briggs Institute critical appraisal tool. Findings were summarized utilizing a narrative synthesis and a table of descriptive statistics.

Two hundred and eighty-three papers were identified, and 15 were included (93 cases, 50M/43F, age 64 years old ± 9 standard deviation [SD] yrs). Vertigo was the most common reported symptom, within a total of 37 different symptoms reported either in isolation or combination. Symptoms inclusive to Coman's 5D's accounted for 22 % of reported features.

Vertigo is the most common symptom (27.7 %) of VBI induced by atherosclerosis. However, there is not sufficient data to make concrete conclusions, although results do instill doubt over the sole use of Coman's 5D's in clinical practice. Prospective observational studies with standardized data extraction for VBI symptoms and their pattern of behavior are warranted.

This review investigates the relationship of paternal smoking and overweight/obesity during pregnancy and up to one-year post-birth with childhood overweight/obesity up to age 12. Both exposures were analysed separately and together, if appropriate.

Included studies indicate that paternal overweight/obesity is consistently associated with increased risk of childhood overweight/obesity, suggesting a robust intergenerational link. Conversely, findings on paternal smoking are less consistent. Five out of six studies suggest that paternal smoking during pregnancy may contribute to increased risk but one found no association. Children of fathers with overweight/obesity are at higher risk of overweight/obesity in childhood. Paternal smoking was associated with higher risk of child overweight/obesity in most studies. Trajectories of overweight and obesity are likely to be transgenerational and systemic changes to tackle their socioeconomic determinants may be required to address these.

Household water treatment (HWT) is a prevalent method for improving the safety of drinking-water. We conducted a systematic review of peer-reviewed literature from 1997 to 2021 on microbiological performance of common HWT technologies including porous ceramic filters, carbon block or membrane filtration, granular media filtration, thermal treatment, solar disinfection, UV irradiation, chemical disinfection, and combined coagulation-disinfectant products. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) best practices and searched SCOPUS, Web of Science, PubMed, and Agricola and further consulted an expert working group to add relevant publications reporting microbial performance of HWT (n = 396 peer-reviewed studies). Reported log10 reduction values (LRVs) varied widely across and within technology categories. We summarize microbial performance by technology type; pathogen class (bacteria, virus, protozoa); and study setting (field or laboratory). Combined coagulation-disinfectant products had the highest LRV performance for bacterial (6.3) and viral (5.3) classes, and porous ceramic had the highest LRV for protozoa (3) when n > 3. Findings can inform the selection of candidate HWT options, but factors such as product design, time burden of use, cost, and long-term maintenance requirements are important considerations in technological performance. Microbiological performance is meaningless if the technology is not used consistently, correctly, and sustainably.

We conducted a systematic review to assess the efficacy and safety of nitisinone for the treatment of patients with alkaptonuria (AKU).

Randomized clinical trials that assessed the impact of nitisinone on urinary and serum homogentisic acid (HGA), quality of life, joint range of motion, and adverse events in AKU patients were retrieved from Pubmed and EMBASE up to May 2024. Risk of bias assessment was performed with RoB 2.0, and the GRADE approach assessed the certainty of evidence (CoE) of each main outcome.

Four publications from three studies summarizing data of 218 patients with AKU were included in the review process. Nitisinone administration decreased the urinary HGA levels (mean difference [MD]: -38.98; 95 % confidence interval [95 %-CI]: -53.18 to -24.78; CoE: moderate) without changes in the range of motion of the worst hip joint (MD: -6.23; 95 %-CI: -13.91 to 1.44; CoE: High). On the other hand, large increases in tyrosine were observed associated with nitisinone treatment (MD: 708.77; 95 %-CI: 649.32 to 768.22; CoE: High). AKU patients treated with nitisinone presented increased general health perception (MD: 2.77; 95 %-CI: 0.62 to 4.91), mental health (MD: 1.03; 95 %-CI: 0.90 to 1.19) and mental role functioning (MD: 5.57; 95 %-CI: 0.47 to 10.66). No statistical increases in overall adverse events (Relative Risk [RR]: 1.03; 95 %-CI: 0.90 to 1.19; CoE: High) or serious adverse events (RR: 2.47; 95 %-CI: 0.24 to 25.91; CoE: low) were observed.

This systematic review identified significant potential for nitisinone to modify the natural history of AKU, considering the relevance of clinical changes induced by the treatment.

The purpose of this systematic review and meta-analysis was to examine the effects of MBIs on quality of sleep in patients with cancer and explore methods, intervention and participants' characteristics as moderators to the effects.

Ten electronic databases were searched from inception to October 2024 including Ovid Medline, CINAHL, PubMed, Scopus, APA PsycINFO, Age line, ProQuest Dissertation and Theses, Web of Science, Academic Search Complete, and ScienceDirect. We reviewed studies on quality of sleep outcomes for patients with cancer receiving mindfulness-based interventions based on Buddhist teaching. We only reviewed randomized controlled trials written in English. A random-effects model was used to compute the effect size. We used Funnel plot, Q statistics, and I2 to test the heterogeneity across studies. Also, we examined moderators to explore sources of heterogeneity.

Across 25 included studies providing 26 comparisons (N = 2263), 1157 cancer patients participated in mindfulness interventions; 1106 served as controls. Most cancer patients were males (s = 14). Mean age ranged from 39.02 to 70.86 yrs. (Mean = 53.70, SD = 6.52). Overall, MBIs had a moderate effect on improving quality of sleep among cancer patients (g = 0.598, 95 %CI 0.332, 0.864, p < .001, I2 = 88 %). Funding and time of outcome measure were moderators affecting ES. No primary studies reported the adverse effects.

MBIs significantly improved quality of sleep among patients with cancer. Clinicians should consider using MBIs as alternative complementary treatment for improving quality of sleep among patients with cancer.

The risk of recurrent ischemic stroke, intracranial hemorrhage, and mortality in people with atrial fibrillation detected after stroke (AFDAS) is still unclear compared with people with known atrial fibrillation (KAF). We systematically reviewed the literature to provide updated estimates for the risk of recurrent stroke, intracerebral hemorrhage, and mortality in AFDAS compared with KAF.

Our protocol was registered in PROSPERO (CRD42024583064). Presentation followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and MedRxiv up to August 28, 2024, for studies comparing AFDAS and KAF for the following outcomes of interest: recurrent ischemic stroke (primary), intracerebral hemorrhage, mortality, and any stroke recurrence. We included cohort, observational studies (either prospective or retrospective) and randomized controlled trials and excluded studies with less than 15 patients per group. Eligible studies were assessed for bias using the Risk of Bias in Non-Randomized Studies tool. We pooled study-level results through random-effect meta-analysis of risk ratios (RRs). We also performed prespecified sensitivity analysis for study quality, timing of search for AF, propensity score matching, and study data source (administrative vs local data), and we planned meta-regression analysis to test for the interaction of sex, comorbid cardiovascular risk factors, and anticoagulation status on the difference between AFDAS and KAF.

Seventeen studies were retrieved (n = 113,365; nKAF = 80,339; nAFDAS = 33,026; female in KAF, 49.0%; female in AFDAS, 45.1%), eight of which had low risk of bias. Ischemic stroke recurrence was significantly lower in AFDAS compared with the KAF group (RR = 0.79, 95% CI = 0.66-0.95, I2 = 70%; nstudies = 10). Meta-regression analysis revealed no interaction of anticoagulation, CHA2DS2-VASc score, or sex on the difference in risk of recurrent ischemic stroke between groups. Mortality was lower in the AFDAS group compared with KAF (RR = 0.84, 95% CI = 0.74-0.95, I2 = 74%; nstudies = 14). The rates of any intracerebral bleeding (RR = 0.97, 95% CI = 0.68-1.39, I2 = 58%; nstudies = 5) and any stroke recurrence (RR = 0.99, 95% CI = 0.75-1.30; I2 = 60; nstudies = 3) were similar in AFDAS and KAF.

AFDAS may carry a lower risk of ischemic stroke recurrence and mortality compared with KAF, with similar risk of intracerebral hemorrhage. Stratification through implementation of AF burden measures may support more personalized management for people with AFDAS.