Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials

Psychological interventions for treatment of inflammatory bowel disease

BACKGROUND

Persons with inflammatory bowel disease (IBD) have an increased risk of suffering from psychological problems. The association is assumed to be bi-directional. Psychological treatment is expected to improve quality of life (QoL), psychological issues and, possibly, disease activity. Many trials have tested various psychotherapy approaches, often in combination with educational modules or relaxation techniques, with inconsistent results.

OBJECTIVES

To assess the effects of psychological interventions on quality of life, emotional state and disease activity in persons of any age with IBD.

SEARCH METHODS

We searched Web of Science Core Collection, KCI-Korean Journal Database, Russian Science Citation Index, MEDLINE, Psyndex, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, and LILACS from inception to May 2023. We also searched trial registries and major gastroenterological and selected other IBD-related conferences from 2019 until 2023.

SELECTION CRITERIA

Randomized controlled trials of psychological interventions in children or adults with IBD compared to no therapy, sham (i.e. simulated intervention), or other active treatment, with a minimum follow-up time of two months, were eligible for inclusion, irrespective of publication status and language of publication. Interventions included psychotherapy and other non-pharmacological interventions addressing cognitive or emotional processing, patient education, or relaxation techniques to improve individual health status.

DATA COLLECTION AND ANALYSIS

Two raters independently extracted data and assessed the study quality using the Risk of Bias 2 Tool. Pooled standardized mean differences (SMD) for continuous outcomes and relative risks (RR) for event data were calculated with 95% confidence intervals (CI), based on separate random-effects models by age group, type of therapy and type of control. An SMD of 0.2 was considered a minimally relevant difference. SMD ≥ 0.4 was considered a moderate effect. Group analyses were planned to examine differential effects by type of IBD, disease activity, psychological comorbidity, therapy subtype, and treatment intensity. Statistical heterogeneity was determined by calculating the I2 statistic. Publication bias was assessed by presenting a funnel plot and calculating the Eggers Test. GRADE Profiling was used to describe the certainty of the evidence for relevant results.

MAIN RESULTS

Sixty-eight studies were eligible. Of these, 48 had results reported in sufficient detail for inclusion in the meta-analyses (6111 adults, 294 children and adolescents). Two trials were excluded from the meta-analysis following sensitivity analysis and tests for asymmetry because of implausible results. Most studies used multimodular approaches. The risk of bias was moderate for most outcomes, and high for some. The most common problems in individual trials were the inability to blind participants and investigators and outcome measures susceptible to measurement bias. The main issues leading to downgrading of the certainty of the evidence were heterogeneity of results, low precision and high or moderate risk of bias in the included trials. Publication bias could not be shown for any of the inspected analyses. In adults, psychotherapy was slightly more effective than care-as-usual (CAU) in improving short-term QoL (SMD 0.23, 95% CI 0.12 to 0.34; I2 = 13%; 20 trials, 1572 participants; moderate-certainty), depression (SMD -0.27, 95% CI -0.39 to -0.16; I2 = 0%; 16 trials, 1232 participants; moderate-certainty), and anxiety (SMD -0.29, 95% CI -0.40 to -0.17; I2 = 1%; 15 studies, 1135 participants; moderate-certainty). The results for disease activity were not pooled due to high heterogeneity (I2 = 72%). Interventions which used patient education may also have small positive short-term effects on QoL (SMD 0.19, 95% CI 0.06 to 0.32; I2 = 11%; 12 trials, 1058 participants; moderate-certainty), depression (SMD -0.22, 95% CI -0.37 to -0.07; I2 = 11%; 7 studies, 765 participants; moderate-certainty) and anxiety (SMD -0.16, 95% CI -0.32 to 0.00; I2 = 10%; 6 studies, 668 participants; moderate-certainty). We did not find an effect of education on disease activity (SMD -0.09, 95% CI -0.28 to 0.10; I2 = 38%; 7 studies, 755 participants; low-certainty). Pooled results on the effects of relaxation techniques showed small effects on QoL (SMD 0.25, 95% CI 0.08 to 0.41; I2 = 30%; 12 studies, 916 participants; moderate-certainty), depression (SMD -0.18, 95% CI -0.35 to -0.02; I2 = 0%; 7 studies, 576 participants; moderate-certainty), and anxiety (SMD -0.26, 95% CI -0.43 to -0.09; I2 = 13%; 8 studies, 627 participants; moderate-certainty). Results for disease activity were not pooled due to high heterogeneity (I2 = 72%). In children and adolescents, multimodular psychotherapy increased quality of life (SMD 0.54, 95% CI 0.06 to 1.02; I2 = 19%; 3 studies, 91 participants; moderate-certainty). The results for anxiety were inconclusive (SMD -0.09; 95% CI 0.-64 to 0.46; 2 trials, 51 patients, very low-certainty). Pooled effects were not calculated for depressive symptoms. Disease activity was not assessed in any of the trials compared to CAU. In education, based on one study, there might be a positive effect of the intervention on quality of life (MD 7.1, 95% CI 2.18 to 12.02; 40 patients; low-certainty evidence) but possibly not on depression (MD -6, 95% CI -12.01 to 0.01; 41 patients; very low-certainty). Anxiety and disease activity were not assessed for this comparison. Regarding the effects of relaxation techniques on children and adolescents, all results were inconclusive (very low-certainty).

AUTHORS' CONCLUSIONS

Psychological interventions in adults are likely to improve the quality of life, depression and anxiety slightly. Psychotherapy is probably also effective for improving the quality of life in children and adolescents. The evidence suggests that psychological interventions may have little to no effect on disease activity. The interpretation of these results presents a challenge due to the clinical heterogeneity of the included trials, particularly concerning the type and various components of the common multimodular interventions. This complexity underscores the need for further research and exploration in this area.

Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors combination therapy for adults with type 2 diabetes mellitus: a network meta-analysis

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To evaluate the relative benefits and harms of therapy with glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose co-transporter-2 inhibitors (SGLT2i), and their combination in adults with type 2 diabetes mellitus. Secondary objectives To determine the relative rankings of GLP-1RA, SGLT2i, and their combination, according to their comparative efficacy for the critical outcomes identified in this review through a network meta-analysis.

Early Initiation of Sodium-Glucose Cotransporter 2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta-Analysis

BACKGROUND

Observational studies and small randomized controlled trials have suggested the benefits of early introduction of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in acute heart failure (AHF). However, current evidence on their efficacy and safety in this clinical setting remains limited.

METHODS

We performed a systematic review and meta-analysis to assess efficacy/safety of early use of SGLT2is in AHF. PUBMED/EMBASE/Cochrane were searched from inception to May 31, 2024, for randomized controlled trials evaluating outcomes of SGLT2i early initiation in patients with AHF. Efficacy outcomes were all-cause death and heart failure rehospitalizations. Safety outcomes included acute kidney injury, ketoacidosis, urinary tract infections, hypotension, and hypoglycemia. Early initiation was defined as performed before or shortly after discharge (within 3 days). A sensitivity analysis was conducted, including only patients with initiation before discharge.

RESULTS

Seven randomized controlled trials that enrolled 2320 patients were included. Early use of SGLT2is was associated with a significant reduction in all-cause death (odds ratio, 0.71 [95% CI, 0.55-0.92; 95% PI, 0.55-0.98]) and HF rehospitalizations (odds ratio, 0.73 [95% CI, 0.57-0.94; 95% PI, 0.58-0.93]), even after adjusting for follow-up duration. SGLT2i initiation before discharge yielded consistent results for efficacy outcomes. Safety outcomes could not be usefully determined because of a low events rate resulting in wide CIs. The impact of diabetic status remains basically unknown due to the small number of available randomized controlled trials investigating this population.

CONCLUSIONS

Early introduction of SGLT2is in AHF improves all-cause death and rehospitalization rates, can be performed before discharge, and should be offered to most patients with AHF.

Effectiveness and recommendation strategies for videoconference-based interventions to alleviate social isolation and loneliness in older adults: A systematic review and meta-analysis

OBJECTIVE

To summarize and update the current knowledge regarding the effectiveness of videoconference-based interventions in alleviating loneliness and social isolation among older adults.

METHODS

A systematic search of the PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and PsycINFO databases was performed in February 2024. Two researchers independently conducted literature screening, risk-of-bias assessment, and data extraction.

RESULTS

Ten studies with 1034 participants were included. The meta-analysis indicated that interventions had a significantly small-to-medium effect on enhancing social support (SMD=0.40, CI=0.13 to 0.66) and small effect on reducing loneliness (SMD=-0.30, CI=-0.50 to -0.10) and depressive symptoms (SMD=-0.34, CI=-0.57 to -0.11). The subgroup analysis showed that familial interaction was identified as a significant intervention component for loneliness, whereas intervention by trained experts was pivotal for depressive symptoms.

CONCLUSION

This review provides robust evidence from a comprehensive perspective that videoconference-based interventions can be effectively applied as a strategic approach to manage mental health in older adults.

Prophylactic antibiotics for uterine evacuation procedures to manage miscarriage

BACKGROUND

Procedural management of early pregnancy loss (EPL) involves removing any residual pregnancy tissue from the uterus. Clinical evidence and guidance are clear that antibiotic treatment is needed for women experiencing EPL, with signs and symptoms of infection. However, it is less clear whether prophylactic antibiotics are routinely required during procedural management in those without features of infection.

OBJECTIVES

To evaluate the effectiveness of routine antibiotic prophylaxis for women undergoing uterine evacuation procedures to manage early pregnancy loss.

SEARCH METHODS

We searched the Cochrane Fertility Regulation Review Group trials register, CENTRAL, MEDLINE, Embase, Global Health (Ovid), Scopus (conference abstracts only), and grey literature in October 2023. We checked references and contacted study authors and experts in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials comparing prophylactic antibiotics with placebo or no treatment. Trials with a cluster-randomised design and trials published only in abstract form were also eligible for inclusion. We included all types of EPL managed with surgical uterine evacuation. There was no gestational age limit. We excluded women with signs and symptoms of infection.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted and checked data for accuracy, and assessed the certainty of evidence using the GRADE approach. We contacted the authors of the ongoing trial for additional information.

MAIN RESULTS

We included six RCTs with a total of 4371 participants undergoing uterine evacuation procedures to manage EPL. Prophylactic antibiotics may have little or no effect on uterine infection after uterine evacuation for EPL compared with placebo or no treatment, but this evidence was uncertain (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.47 to 1.28; I² = 50%; 6 studies, 4371 participants; low-certainty evidence).   Sensitivity analysis of three studies including 3737 participants (85% of total participants) showed that when only studies with low risk of bias were meta-analysed, the effect was larger and of high certainty, resulting in a 43% reduction in the risk of developing a uterine infection (RR 0.57, 95% CI 0.37 to 0.86; I² = 0%; 3 studies, 3737 participants; high-certainty evidence). Both the overall estimate and the sensitivity analysis limited to studies with low risk of bias were consistent with a reduction in uterine infection with prophylactic antibiotics. A single study reported on adverse effects. Prophylactic antibiotics likely result in little or no difference in the risk of vomiting (RR 1.20, 95% CI 0.61 to 2.38; 1 study, 3404 participants; moderate-certainty evidence), and likely result in little or no difference in the risk of having diarrhoea (RR 0.92, 95% CI 0.51 to 1.65; 1 study, 3404 participants; moderate-certainty evidence). Prophylactic antibiotics may increase the risk of allergy (RR 3.01, 95% CI 0.12 to 73.76; 1 study, 3404 participants; low-certainty evidence); the study reported no cases of anaphylaxis (very low-certainty evidence). Prophylactic antibiotics may reduce the need for antibiotic treatment to treat infection, but the evidence is very uncertain (RR 0.94, 95% CI 0.54 to 1.64; I2 = 63%; 3 studies, 3574 participants; very low-certainty evidence). Meta-analysis of three studies also found that prophylactic antibiotics may reduce hospitalisation for treatment of infection, but the effect was very uncertain (RR 0.76, 95% CI 0.40 to 1.46; I² = 0%; 3 studies, 3859 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

When all studies were considered, the evidence suggested that routine antibiotic prophylaxis may reduce uterine infection amongst women undergoing uterine evacuation procedures to manage early pregnancy loss (EPL), but the evidence is of low certainty. It is important to note that the quality of the evidence included was seriously affected by poor follow-up and high non-compliance with antibiotic prophylaxis. A sensitivity analysis based on three trials assessed to have low risk of bias (85% of the total participants), demonstrated a larger effect size with high certainty, resulting in a 43% reduction in the risk of uterine infection rates with antibiotic prophylaxis. Prophylactic antibiotics may reduce hospitalisation for treatment of infection, and may reduce the need for a course of antibiotics to treat infection after uterine evacuation procedures to treat EPL, but this evidence is very uncertain. Data were limited and uncertain with regard to potential adverse effects, such as vomiting, diarrhoea, allergy, and anaphylaxis.

Gestational diabetes mellitus and vascular malperfusion lesions in the placenta: A systematic review and meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) can result in increased placental lesions related to high maternal blood glucose, but these relationships are not well understood.

OBJECTIVE

To examine the relationship between GDM and placental vascular malperfusion lesions: accelerated villous maturation, increased syncytial knots, delayed villous maturation, and increased fibrin deposition.

SEARCH STRATEGY

PubMed, BIOSIS, and Web of Science databases were systematically searched for full-text articles in English from inception until August 21, 2024.

SELECTION CRITERIA

Our inclusion criteria were randomized controlled trials, case-control, cohort, and cross-sectional studies that examined the relationship between GDM and selected placental vascular malperfusion lesions. The outcome must have been reported as a total proportion.

DATA COLLECTION AND ANALYSIS

We included all eligible studies in narrative synthesis. If an outcome of interest was in at least three studies, we calculated the odds ratios (ORs) by GDM diagnosis, with 95% confidence intervals (CIs), using mixed-effects logistic regression with random study effects. We evaluated the risk of bias with the Newcastle-Ottawa Scale.

MAIN RESULTS

We screened 151 studies, of which eight were included (n = 1291), and six met the criteria for meta-analysis (n = 561). Unadjusted odds (95% CI) of delayed villous maturation were six-fold higher (OR: 6.37 [3.28-12.37]) in pregnancies with GDM than in those without GDM. The narrative synthesis of the literature found higher proportions of increased syncytial knots, delayed villous maturation, and increased fibrin deposition, but not accelerated villous maturation, in pregnancies with versus without GDM.

CONCLUSIONS

GDM was associated with a higher risk of three placental malperfusion lesions, although there is a small number of studies in this area. Future investigations should examine if these vascular malperfusions are associated with adverse pregnancy outcomes often linked with GDM.

An umbrella review and meta-analysis of 87 meta-analyses examining healthcare workers' mental health during the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers (HCWs) experienced several changes in their work (e.g., longer hours, new policies) that affected their mental health. In this study, an umbrella review and meta-analysis of meta-analyses was conducted to examine the prevalence of various mental health problems experienced by HCWs during the COVID-19 pandemic. We conducted a systematic review searching PubMed, EMBASE, PsycINFO, Cochrane Library, and Scopus databases (PROSPERO: CRD42022304823). We performed a meta-analysis to summarize prevalence of different mental health problems and examined whether these differed as a function of job category, sex/gender, sociodemographic index (SDI), and across time. Eighty-seven meta-analyses were included in the umbrella review and meta-analysis, including 1846 non-overlapping articles and 9,400,962 participants. The overall prevalence ratio for the different mental health outcomes ranged from 0.20 for PTSD (95 % CI: 0.16-0.25) to 0.44 for burnout (95 % CI: 0.32-0.56), with ratios for depressive symptoms, anxiety symptoms, psychological distress, perceived stress, sleep problems, and insomnia symptoms falling between these ranges. Follow-up analyses revealed little variation in outcomes across job category, and sex. Prevalence of mental health problems in HCWs was high during the pandemic. Administrators and policymakers worldwide need to address these growing problems through institutional policies and wellness programming.

Core characteristics, and effectiveness of mobile health interventions on dyspnoea and quality of life in older persons with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

AIM

To systematically review the core characteristics, and effectiveness of mobile health interventions (MHIs) on dyspnoea and quality of life (QoL) in older persons with chronic obstructive pulmonary disease (COPD).

METHODS

A comprehensive search was conducted from inception to 21 February 2023 in Chinese and English databases, with an updated search performed on 30 April 2024. Randomised controlled trials (RCTs) involving MHIs with four core functions - customisation, self-monitoring, alerts, and goal-setting - in older persons with COPD were included. Two reviewers independently identified the core characteristics of MHIs using the Template for Intervention Description and Replication (TIDieR) checklist. The Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were used to assess the methodological quality of RCTs and the overall quality of evidence.

RESULTS

28 RCTs were included, with 43% of studies adequately reported core characteristics of MHIs according to the TIDieR checklist. Meta-analysis suggested that MHIs may alleviate dyspnoea and improve disease-specific QoL questionnaires (CRQ and CCQ) and generic-related QoL questionnaires (SF-36 and EQ-5D), but not other disease-specific QoL questionnaires (SGRQ and CAT). Subgroup analyses showed that multi-component MHIs were effective in improving dyspnoea. Dyspnoea showed statistically significant improvement at 3 months, 6 months and 12 months, whereas QoL improved at 4 months (SGRQ), 2 months (CAT) and 6 months (CAT).

CONCLUSION

Reporting on the core characteristics of MHIs is currently incomplete, and it is recommended that healthcare professionals develop and report multi-component MHIs based on the TIDieR checklist to help alleviate dyspnoea and enhance QoL in older persons with COPD.

A systematic review and meta-analysis of pharmacological methods to manipulate experimentally induced secondary hypersensitivity

ABSTRACT

Understanding the physiology of specific clinical features of persistent pain, such as secondary hypersensitivity, is crucial for developing effective treatments. This systematic review and meta-analysis investigated the effects of pharmacological manipulations on the magnitude (primary outcome) and surface area (secondary outcome) of experimentally induced secondary hypersensitivity. Following Cochrane Collaboration guidelines and a published and registered protocol, we conducted an electronic search on February 7, 2024. After screening articles in duplicate, we included 117 articles, consisting of 222 datasets. Risk of bias assessments identified potential flaws in methodological quality. Datasets were pooled by the mechanism of action of the manipulation and by outcome. Effect sizes were estimated using standardised mean difference (SMD). Most datasets (207 of 222) had an unclear risk of performance and detection bias for inadequate reporting of blinding procedures. Thirteen different methods were used to induce, and 23 different drug classes were used to manipulate secondary hypersensitivity. The pooled SMDs [95% CI] suggested that alpha-2-delta subunit of voltage-gated calcium channel ligands reduced both the magnitude (-0.24 [-0.39; -0.08]) and surface area (-0.38 [-0.59; -0.18]) of secondary hypersensitivity, and that both N-methyl-D-aspartate receptor antagonists (-0.36 [-0.55; -0.17]) and voltage-gated sodium channel blockers (-1.02 [-1.63; -0.42]) reduced only the surface area of secondary hypersensitivity. These results suggest a need to understand and compare the physiological underpinnings of magnitude and area of secondary hypersensitivity, and to clarify the relative importance of magnitude vs anatomical spread (ie, surface area) of secondary hypersensitivity to people living with pain.

Participation and Yield of Gastric Cancer Screening Programs: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Hundreds of gastric cancer (GC) screening programs have been launched worldwide over the past 3 decades. However, no comprehensive study evaluating the outcomes of these programs has been conducted.

METHODS

This meta-analysis aimed to evaluate the temporal and geographical patterns of three key indicators in GC screening programs: endoscopic uptake rate (EUR), GC detection rate (GCDR), and early GC detection rate (EGCDR). The search was conducted until September 20, 2023. Pooled random-effect estimates of the indicators were computed, with further subgroup analysis stratified by study period, country, screening setting, local GC age-standardized incidence, and pre-screening modality.

RESULTS

A total of 67 studies were included in the analysis. Of these, 42 reported an EUR of 46% (95% confidence interval [CI], 41%-52%), 47 reported a GCDR of 0.76% (95% CI, 0.55%-0.96%), and 27 reported an EGCDR of 59% (95% CI, 49%-70%). Developed countries demonstrated notably superior performance in EUR (51% vs 37%; P = .009) and EGCDR (78% vs 44%; P < .001) compared with developing countries. A gradual increase in the EUR was found, rising from 46% pre-2010 to 48% post-2010 (P = .739). In contrast, both GCDR and EGCDR exhibited a slight decline, with GCDR decreasing from 0.78% pre-2010 to 0.75% post-2010 (P = .905), and EGCDR from 65% pre-2010 to 56% post-2010 (P = .404). Multivariate meta-regression analysis revealed that a higher local GC incidence and studies conducted in Japan were independently associated with higher values of both EUR (P = .010 and P = .027, respectively) and EGCDR (P = .008 and P = .002).

CONCLUSIONS

The participation and yield of GC screening programs were comprehensively assessed using 3 indicators proposed in this study.

The structural and functional brain alternations in tobacco use disorder: a systematic review and meta-analysis

Background

While numerous previous studies have indicated that nicotine intake results in gray matter and functional brain abnormalities in tobacco use disorder (TUD), the majority of results could not be replicated or even reversed. Consequently, it is important to utilize relevant coordinate data for a comprehensive meta-analysis to identify the shared patterns of structural, functional, and multimodal alternations in TUD.

Method

The present study conducted a systematic retrieval of studies published on PubMed, Web of Science, and Scopus from January 1, 2010, to December 12, 2023, to identify studies on voxel-based morphometry (VBM) and resting-state functional magnetic resonance imaging (rs-fMRI) for TUD. Then, two meta-analyses using the anisotropic seed-based d mapping method were used to detect brain comprehensive alterations in individuals with TUD. Furthermore, two meta-analyses were pooled for multimodal analysis to discover multimodal anomalies. Finally, subgroup analyses were performed to explore the sources of TUD heterogeneity from both methodological and age perspectives.

Result

This study encompassed a total of 25 VBM studies, including 1,249 individuals with TUD and 1,874 healthy controls (HCs), and 35 rs-fMRI studies, including 1,436 individuals with TUD and 1,550 HCs. For rs-fMRI analysis, individuals with TUD exhibited increased intrinsic function in the right cerebellum crus2, left superior frontal gyrus, left inferior parietal gyrus, and left supplementary motor area and decreased intrinsic function in the right gyrus rectus, right superior/middle frontal gyrus, and left inferior frontal gyrus. For VBM analysis, individuals with TUD showed decreased gray matter volume (GMV) in the left superior temporal gyrus, right superior frontal gyrus, right anterior cingulate/paracingulate gyrus, left superior frontal gyrus, and right anterior thalamic region and increased GMV in the right lingual gyrus.

Conclusion

This meta-analysis illustrates structural and functional abnormalities of the default mode network, executive control network, and salience network in individuals with TUD. Multimodal analysis of the right lingual gyrus provided additional information, offering the potential for identifying more therapeutic targets for interventions against TUD.

Biomarkers of Skeletal Muscle Atrophy Based on Atrogenes Evaluation: A Systematic Review and Meta-Analysis Study

Muscle atrophy leads to decreased muscle mass, weakness, inactivity, and increased mortality. E3 ubiquitin ligases, key regulators of protein degradation via the ubiquitin-proteasome system, play a critical role in atrophic mechanisms. This meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and its objective was to evaluate the association between E3 ligases Muscle Atrophy F-box (MAFbx)/Atrogin-1 (Fbxo32) and Muscle RING-finger protein 1 (MuRF-1) (TRIM63) E3 ligase mRNA levels, reductions in skeletal muscle CSA measures, and atrophy conditions. We examined papers published on PubMed®, Scopus, and Web of Science that studied E3 ligase gene expression signatures for Fbxo32 (MAFbx/Atrogin-1) and Trim63 (MuRF1) in different types of muscle atrophy and hypertrophy murine models. Twenty-nine studies selected by two independent raters were analyzed. Standardized mean differences (SMDs)/effect sizes (ESs) and 95% confidence intervals (CIs) were calculated for the outcomes using fixed-effects models. We found that 6- and 4.8-fold upregulation, respectively, of Fbxo32 and Trim63 was sufficient to reduce the ES to -3.89 (95% CI: -4.45 to -3.32) for the muscle fiber cross-sectional area and the development of skeletal muscle atrophy. I² and Q test statistics did not indicate heterogeneous data. There was a low probability of bias after both the funnel plot and Egger's test analyses. These results were sustained independently of the atrophic model and muscle type. Therefore, the magnitude of the increase in muscle Fbxo32 and Trim63 mRNA is a feasible, reliable molecular marker for skeletal muscle atrophy in mice. The next step for the Ubiquitin-proteasome system (UPS) field involves elucidating the targets of E3 ligases, paving the way for diagnostic and treatment applications in humans.

Digital tracking, provider decision support systems, and targeted client communication via mobile devices to improve primary health care

BACKGROUND

Digital tracking on mobile devices, combined with clinical decision support systems and targeted client communication, can facilitate service delivery and potentially improve outcomes.

OBJECTIVES

To assess the effects of using a mobile device to track service use when combined with clinical decision support (Tracking + CDSS), with targeted client communications (Tracking + TCC), or both (Tracking + CDSS + TCC).

SEARCH METHODS

Cochrane CENTRAL, MEDLINE, Embase, Ovid Population Information Online (POPLINE), K4Health and WHO Global Health Library (2000 to November 2022).

SELECTION CRITERIA

Randomised and non-randomised trials in community/primary care settings.

PARTICIPANTS

primary care providers and clients Interventions: 1. Tracking + CDSS 2. Tracking + TCC 3. Tracking + CDSS + TCC Comparators: usual care (without digital tracking) DATA COLLECTION AND ANALYSIS: Two authors independently screened trials, extracted data and assessed risk of bias using the RoB 1 tool. We used a random-effects model to meta-analyse data producing risk differences (RD), risk ratios (RR), or odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Evidence certainty was assessed using GRADE.

MAIN RESULTS

We identified 18 eligible studies (11 randomised, seven non-randomised) conducted in Bangladesh, China, Ethiopia, India, Kenya, Palestine, Uganda, and the USA. All non-randomised studies had a high risk of bias. These results are from randomised studies. 'Probably/may/uncertain' indicates 'moderate/low/very low' certainty evidence. Tracking + CDSS Relating to antenatal/ postnatal care: Providers' adherence to recommendations May slightly increase home visits in the week following delivery (2 studies, 4531 participants; RD 0.10 [0.07, 0.14]) May slightly increase counselling for initiating complementary feeding (2 studies, 4397 participants; RD 0.12 [0.08, 0.15]) May slightly increase the mean number of home visits in the month following delivery (1 study, 3023 participants; MD 0.75 [0.47, 1.03]) Uncertain effect on home visits within 24 hours of delivery Clients' health behaviours May slightly increase skin-to-skin care (1 study, 1544 participants; RD 0.05 [0.00, 0.10]) May slightly increase early breastfeeding (2 studies, 4540 participants; RD 0.08 [0.05, 0.12]) Uncertain effects on applying nothing to the umbilical cord, taking ≥ 90 iron-folate tablets during pregnancy, exclusively breastfeeding for six months, delaying the newborn's bath at least two days and Kangaroo Mother Care. Clients' health status May reduce low birthweight babies (1 study, 3023 participants; RR 0.53 [0.38, 0.73]) May increase infants with pneumonia or fever seeking care (1 study, 3470 participants; RR 1.13 [1.03, 1.24]) Uncertain effects on stillbirths, neonatal and infant deaths, or testing positive for HIV during antenatal testing Tracking + TCC Clients' health status In stroke patients over 12 months: May slightly increase blood pressure (BP) medication adherence (1 study, 1226 participants; RR 1.10 [1.00, 1.21]) May reduce deaths (1 study, 1226 participants; RR 0.52 [0.28, 0.96]) May slightly reduce systolic BP (1 study, 1226 participants; MD -2.80 mmHg [-4.90, -0.70]) May slightly improve EQ-5D scores (1 study, 1226 participants; MD 0.04 [0.02, 0.06]) May reduce stroke hospitalisations (1 study, 1226 participants; RR 0.45 [0.32, 0.64]). Tracking + CDSS + TCC Providers' adherence to recommendations Probably increases guideline adherence for antenatal screening and management of anaemia (1 study, 10,502 participants; OR 1.88 [1.52, 2.32]), diabetes (1 study, 8669 participants; OR 1.45 [1.14, 1.84}), hypertension (1 study, 15,555 participants; OR 1.62 [1.29, 2.04]) and probably leads to lower adherence for abnormal foetal growth (1 study, 1165 participants; OR 0.59 [0.37, 0.95]). May slightly increase nevirapine prophylaxis in infants of HIV+ve mothers (1 study, 609 participants; OR 1.75 [0.73, 4.19]) Data quality In pregnant women (1 study, 6367 participants), tracking + CDSS + TCC: Probably slightly reduces missing data for haemoglobin (RR 0.77 [0.71, 0.84]) but slightly more for BP at delivery (RR 1.16 [1.08, 1.24]) May have little or no effect on missing data on gestational age (RR 0.96 [0.81, 1.14]) or birthweight (RR 0.90 [0.77, 1.04]) Clients' health behaviour May have little or no effect on being on anti-retroviral therapy at delivery (1 study, 438 participants; OR 1.41 [0.81, 2.45]) or exclusive breastfeeding for six months (1 study, 695 participants; OR 1.74 [0.95, 3.17]) in HIV+ve mothers Uncertain effects on physical activity in high cardiovascular-risk adults Clients' health status May reduce the number of deaths in patients with hypertension and diabetes (1 study, 3698 participants; OR 0.61 [0.35, 1.06]) May reduce new cardiovascular events in high-cardiovascular risk adults over 6-18 months (1 study, 8642 participants; OR 0.58 [0.42, 0.80}) May slightly decrease in antenatal women severe hypertension, but the confidence interval includes both a decrease and increase (1 study, 6367 participants; OR 0.61 [0.27, 1.37]) In women receiving antenatal care (1 study, 6367 participants), tracking + CDSS + TCC maymake little or no difference to adverse pregnancy outcomes (OR 0.99 [0.87, 1.12]), moderate or severe anaemia (OR 0.82 [0.51, 1.31]), or large-for-gestational-age babies (OR 1.06 [0.90, 1.25]). In adults with hypertension or diabetes (1 study, 3324 participants), tracking + CDSS + TCC maymake little or no difference to HbA1c (MD 0.08 [-0.27, 0.43]), total cholesterol (MD -2.50 [-7.10, 2.10]), 10-year cardiovascular risk (MD -0.40 [-2.30, 1.50]), tobacco use (MD-0.05 [-0.47, 0.37]), alcohol use (MD 0.70 [-3.70, 5.10]), or PHQ-9 (MD -1.60 [-4.40, 1.20]). Uncertain effects on maternal or infant mortality before the baby reaches 18 months in HIV-positive mothers, patients who achieve optimal BP, BP controlled at five years, diastolic or systolic BP, body mass index, fasting glucose and quality of life in adults with hypertension or diabetes Client service utilisation May have little or no effect on missed early infant diagnosis visits (1 study, 1183 participants; OR 0.92 [0.63, 1.35]). Uncertain effects on linkage to care Client satisfaction Probably increases slightly the number of adults with hypertension or diabetes reporting "slightly/much better" change in the quality of care (1 study, 3324 participants; RR 1.02 [1.00, 1.03]). No studies evaluated time between presentation and appropriate management, timeliness of receiving/accessing care, provider acceptability/satisfaction, resource use, or unintended consequences.

AUTHORS' CONCLUSIONS

Digital tracking may improve primary care workers' ability to follow recommended antenatal and chronic disease practices, quality of patient records, patient health outcomes and service use. However, these interventions led to small or no outcome differences in most studies.

Clinical Benefits and Risks of Antiamyloid Antibodies in Sporadic Alzheimer Disease: Systematic Review and Network Meta-Analysis With a Web Application

BACKGROUND

Despite the increasing approval of antiamyloid antibodies for Alzheimer disease (AD), their clinical relevance and risk-benefit profile remain uncertain. The heterogeneity of AD and the limited availability of long-term clinical data make it difficult to establish a clear rationale for selecting one treatment over another.

OBJECTIVE

The aim of this work was to assess and compare the efficacy and safety of antiamyloid antibodies through an interactive online meta-analytic approach by performing conventional pair-wise meta-analyses and frequentist and Bayesian network meta-analyses of phase II and III clinical trial results. To achieve this, we developed AlzMeta.app 2.0, a freely accessible web application that enables researchers and clinicians to evaluate the relative and absolute risks and benefits of these therapies in real time, incorporating different prior choices and assumptions of baseline risks of disease progression and adverse events.

METHODS

We adhered to PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for reporting of systematic reviews with network meta-analysis) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines for reporting and rating the certainty of evidence. Clinical trial reports (until September 30, 2024) were retrieved from PubMed, Google Scholar, and clinical trial databases (including ClinicalTrials.gov). Studies with <20 sporadic AD patients and a modified Jadad score <3 were excluded. Risk of bias was assessed with the RoB-2 tool. Relative risks and benefits have been expressed as risk ratios and standardized mean differences, with confidence, credible, and prediction intervals calculated for all outcomes. For significant results, the intervention effects were ranked in frequentist and Bayesian frameworks, and their clinical relevance was determined by the absolute risk per 1000 people and number needed to treat (NNT) for a wide range of control responses.

RESULTS

Among 7 treatments tested in 21,236 patients (26 studies with low risk of bias or with some concerns), donanemab was the best-ranked treatment on cognitive and functional measures, and it was almost 2 times more effective than aducanumab and lecanemab and significantly more beneficial than other treatments on the global (cognitive and functional) Clinical Dementia Rating Scale-Sum of Boxes (NNT=10, 95% CI 8-16). Special caution is required regarding cerebral edema and microbleeding due to the clinically relevant risks of edema for donanemab (NNT=8, 95% CI 5-16), aducanumab (NNT=10, 95% CI 6-17), and lecanemab (NNT=14, 95% CI 7-31), which may outweigh the benefits.

CONCLUSIONS

Our results showed that donanemab is more effective and has a safety profile similar to aducanumab and lecanemab, highlighting the need for treatment options with improved safety. Potential bias may have been introduced in the included trials due to unblinding caused by frequent cerebral edema and microbleeds, as well as the impact of the COVID-19 pandemic.

Medical cannabis for the treatment of insomnia

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of medical cannabis on adults with insomnia.

Association Between Energy Delivery and Outcomes in Adult Critically Ill Patients Diagnosed With or At Risk of Malnutrition: A Systematic Review and Meta-analysis With Trial Sequential Analysis

CONTEXT

There is a common belief that adult critically ill patients diagnosed with or at risk of malnutrition would benefit from higher energy delivery.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the association between energy delivery and mortality in adult critically ill patients diagnosed with or at risk of malnutrition.

DATA SOURCES

Databases including Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, and Google Scholar were searched from inception to November 20, 2023.

DATA EXTRACTION

Randomized controlled trials (RCTs) and observational studies that (1) included critically ill patients (aged ≥18 years) diagnosed with or at risk of malnutrition using validated tools following intensive care unit (ICU) admission, (2) had at least 20% energy difference between intervention and comparison groups, and (3) reported mortality outcomes were included. The random-effects model was used to pool the data.

DATA ANALYSIS

Two RCTs (4681 at-risk patients) and 5 observational studies (1587 at-risk patients [including 389 high-risk patients]) were included. The pooled mean energy delivered during the first 7-14 days of ICU admission in higher vs lower energy groups was 25.6 ± 5.9 vs 9.7 ± 5.6 kcal/kg per day (P = .004) in RCTs and 21.0 ± 5.2 vs 13.3 ± 5.3 kcal/kg per day (P < .001) in observational studies. No mortality difference was found between higher vs lower energy groups in at-risk patients (risk ratio: 0.99; 95% CI: 0.85, 1.17; P = .94) in RCTs and high-risk patients (adjusted odds ratio: 1.37; 95% CI: 0.43, 4.32; P = .59) in observational studies. Trial sequential analysis was performed and 31 232 patients were required to show a potential treatment effect.

CONCLUSION

These data do not support the prevailing belief that higher energy delivery improves survival in adult critically ill patients diagnosed with or at risk of malnutrition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021274378.

The role of TACE in the era of immune-targeted therapy for hepatocellular carcinoma: a meta-analysis based on PSM

Background

Hepatocellular carcinoma (HCC) is a major global health challenge, with over 50% of patients ineligible for curative treatments at diagnosis. The combination of molecular targeted therapies and immunotherapy has shown promise in improving outcomes for advanced HCC.

Objective

This meta-analysis aims to assess the efficacy of combining transarterial chemoembolisation (TACE) with immune-targeted therapies in patients with unresectable HCC.

Methods

A systematic review and meta-analysis conforming to PRISMA guidelines were conducted by searching PubMed, Embase, Web of Science, and the Cochrane Library for studies published up to January 5, 2025. Due to the limited clinical evidence, our study exclusively included retrospective studies based on propensity score matching (PSM) analysis that compared the efficacy of TACE in combination with immune-targeted therapy to immune-targeted therapy alone. Key outcomes assessed included objective response rate (ORR), disease control rate (DCR), one-year overall survival (1-OS), one-year progression-free survival (1-PFS), median overall survival (mOS), and median progression-free survival (mPFS).

Results

A total of 9 PSM studies involving 2119 patients were included. The meta-analysis revealed that TACE significantly improved ORR, DCR, 1-OS, and 1-PFS, in addition to extending mOS and mPFS.

Conclusion

The findings suggest that the inclusion of TACE in treatment regimens for unresectable HCC notably enhances tumour control and patient survival. This study provides moderate to high-quality evidence supporting the integration of TACE in advanced HCC management, particularly for those patients not meeting standard TACE criteria.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42025631817.

Collaborative care interventions to reduce suicidal behavior among patients with depression or at risk of suicide in primary-care settings: A systematic review and meta-analysis

INTRODUCTION

Suicide is a leading cause of preventable death worldwide. While Collaborative Care (CC) effectively treats depression in primary care led by general practitioners, its impact on reducing suicide behavior remains uncertain. Additionally, the optimal intensity and duration of CC interventions are unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effect of CC interventions on suicidal behavior in patients with depression or at risk of suicide in primary care settings.

METHODS

We searched PubMed, Embase, and Cochrane databases from inception to April 2024. Two researchers independently performed data selection, extraction, and quality assessment. Data were pooled using the odds ratio (OR) and a random-effects model. The main outcome was suicidal behavior, including attempts and ideation. Subgroup analyses assessed the effectiveness of intensity and duration. A meta-analysis was conducted using the R "meta" package, and the protocol was registered with PROSPERO (CRD 42023477655).

RESULTS

From 3696 articles, 10 randomized controlled trials with 20,110 participants were included. CC interventions significantly reduced suicidal behavior compared to controls (pooled OR = 0.66; 95 % CI, 0.46-0.96). High-intensity interventions were particularly effective (pooled OR = 0.56; 95 % CI, 0.40-0.78). However, no significant relationship was found between intervention duration and suicidal behavior. There was no clear evidence of publication bias.

CONCLUSIONS

CC interventions can reduce suicidal behavior in primary care settings, especially with high-intensity interventions. However, caution is needed due to study heterogeneity and low quality.

Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young

PURPOSE

The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients.

MATERIALS AND METHODS

A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models.

RESULTS

Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low.

CONCLUSION

Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy.

PROTOCOL REGISTRATION

PROSPERO, CRD42022325051Clinical ImpactUncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.

Seizure outcomes after resection of temporal encephalocele in patients with drug-resistant epilepsy: A systematic review and meta-analysis

OBJECTIVE

Temporal encephaloceles (TEs) are seen in patients with drug-resistant epilepsy (DRE); yet they are also common incidental findings. Variability in institutional pre-surgical epilepsy practices and interpretation of epileptogenic network localization contributes to bias in existing epilepsy cohorts with TE, and therefore the relevance of TE in DRE remains controversial. We sought to estimate effect sizes and sample sizes necessary to demonstrate clinically relevant improvements in seizure outcome with different surgical approaches.

METHODS

We searched Medline, Embase, and Cochrane to identify studies reporting the outcomes of epilepsy surgery after 12 months in patients with DRE and TE. The main outcome was seizure freedom or favorable seizure outcome. We also assessed the rates of seizure freedom among patients with DRE, TE, and the following covariables: use of intracranial electroencephalography (iEEG), side of the encephalocele, sex, and type of surgical resection (anterior temporal lobectomy [ATL] vs lesionectomy). Random-effects meta-analysis was used to calculate the proportion of patients attaining seizure outcomes.

RESULTS

We identified 332 studies, of which 15 (282 patients) met inclusion criteria for meta-analysis. Seizure-freedom rate was 65% (95% confidence interval [CI] 53-76), whereas the favorable outcome rate was 78% (95% CI 70-85). There was no significant interstudy heterogeneity. Patients with TE undergoing iEEG (risk ratio [RR] 0.80, 95% CI 0.74-0.87) had a lower chance of a favorable seizure outcome. A power analysis estimated a sample size of 28 932 patients with TE (13 764 with ATL) necessary to determine a significant difference in seizure freedom between limited resection and ATL.

SIGNIFICANCE

Retrospective cohort studies demonstrate good outcomes after TE resection regardless of the extent of resection. Prohibitively large sample sizes necessary to observe outcome differences between surgical approaches and presurgical predictors indicate that improved biomarkers and mechanistic understanding of TE epileptogenicity are needed.

Spontaneous Brain Activity Abnormalities in Patients With Temporal Lobe Epilepsy: A Meta-Analysis of 1474 Patients

BACKGROUND

Abnormalities in resting-state functional brain activity have been detected in patients with temporal lobe epilepsy (TLE). The results of individual neuroimaging studies of TLE, however, are frequently inconsistent due to small and heterogeneous samples, analytical flexibility, and publication bias toward positive findings.

PURPOSE

To investigate the most consistent regions of resting-state functional brain activity abnormality in patients with TLE through a quantitative meta-analysis of published neuroimaging data.

STUDY TYPE

Meta-analysis.

SUBJECTS

Exactly 1474 TLE patients (716 males and 758 females) from 31 studies on resting-state functional brain activity were included in this study.

FIELD STRENGTH/SEQUENCE

Studies utilizing 1.5 T or 3 T MR scanners were included for meta-analysis. Resting-state functional MRI using gradient echo-planar imaging, T1-weighted imaging.

ASSESSMENT

PubMed, Web of Science, Chinese National Knowledge Infrastructure, and WanFang databases were searched to identify studies investigating amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) at the whole-brain level between patients with TLE and healthy controls (HCs).

STATISTICAL TESTS

Seed-based d Mapping with Permutation of Subject Images, standard randomization tests and meta-regression analysis were used. Results were significant if P < 0.05 with family-wise error corrected.

RESULTS

Patients with TLE displayed resting-state functional brain activity which was a significant increase in the right hippocampus, and significant decrease in the right angular gurus and right precuneus. Additionally, the meta-regression analysis demonstrated that age (P = 0.231), sex distribution (P = 0.376), and illness duration (P = 0.184), did not show significant associations with resting state functional brain activity in patients with TLE.

DATA CONCLUSION

Common alteration patterns of spontaneous brain activity were identified in the right hippocampus and default-model network regions in patients with TLE. These findings may contribute to understanding of the underlying mechanism for potentially effective intervention of TLE.

LEVEL OF EVIDENCE: 1

TECHNICAL EFFICACY STAGE

Stage 2.

Lung volumes, gas transfer and oscillometry after preterm birth: systematic review and meta-analysis

BACKGROUND

Small airway and lung parenchymal abnormalities frequently occur following preterm birth but are commonly missed by spirometry. Static lung volumes, diffusing capacity of the lung for carbon monoxide (D LCO) and oscillometry provide a more precise characterisation of these conditions. We hypothesised that differences in these measures exist between individuals born preterm and at term and we aimed to systematically review the literature to identify and quantify these differences in lung function.

METHODS

This systematic review and meta-analysis, registered with PROSPERO (CRD42022320775) and guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, searched six databases up to 29 December 2024. We included studies comparing lung function between preterm subjects and term controls via static lung volumes, gas transfer or oscillometry. Differences in lung function were analysed using random-effects meta-analysis to compute the standardised mean difference (SMD).

RESULTS

From 12 143 titles, we analysed 52 cohorts with static lung volumes, 37 with gas transfer and 18 with oscillometry data. While total lung capacity was similar between preterm and term cohorts (SMD -0.08, 95% CI -0.17 to 0.004), preterm participants showed increased residual volume (SMD 0.32, 95% CI 0.19 to 0.44) and residual volume/total lung capacity (SMD 0.45, 95% CI 0.28 to 0.63). D LCO was lower in preterm cohorts (SMD -0.51, 95% CI -0.64 to -0.38). Preterm cohorts also demonstrated increased airway resistance at 5/6 Hz (SMD 0.44, 95% CI 0.22 to 0.67), difference between airway resistance at 5/6 Hz and 20 Hz (SMD 0.51, 95% CI 0.07 to 0.96), resonant frequency (SMD 0.63, 95% CI 0.12 to 1.15) and area under the reactance curve (SMD 0.62, 95% CI 0.35 to 0.88).

INTERPRETATION

We demonstrate that preterm birth is linked to notable abnormalities in static lung volumes, gas transfer and oscillometry, underscoring the necessity of employing comprehensive pulmonary function tests beyond spirometry to monitor and address long-term respiratory outcomes effectively.

Type 2 and type 3 gastric neuroendocrine tumors have high risk of lymph node metastasis: Systematic review and meta-analysis

OBJECTIVES

Lymph node metastasis (LNM) is crucial in determining treatment strategies for gastric neuroendocrine tumors (gNETs). While type 3 is considered more aggressive than types 1 and 2 within the clinical subtype of gNETs, the supporting data were insufficient, due to their rarity. We aimed to study the prevalence and risk factors associated with LNM in gNETs.

METHODS

We searched electronic databases from 1990 to 2023 to identify case-control and cohort studies regarding gNETs resected either endoscopically or surgically. The primary outcome measured was the pooled prevalence of LNM in gNETs. Secondary outcomes included categorizing the prevalence of LNM by clinical subtypes and identifying pathological risk factors associated with LNM in gNETs.

RESULTS

We included 28 studies, involving 1742 patients, among whom 240 had LNM (pooled prevalence rate, 11.8%; 95% confidence interval 7.6-17.9%). The pooled prevalence rates of LNM for type 1, type 2, and type 3 gNETs were 6.0%, 38.5%, and 23.2%, respectively. Type 2 (odds ratio [95% confidence interval] 11.53 [3.46-38.49]) and type 3 (6.88 [3.79-12.49]) gNETs exhibited a higher risk for LNM compared to type 1. Pathological risk factors for LNM included tumor size >10 mm (4.18 [1.91-9.17]), tumor invasion into the muscularis propria or deeper (11.21 [3.50-35.92]), grade 2/grade 3 (5.96 [2.65-13.40]), and lymphovascular invasion (34.50 [6.70-177.51]).

CONCLUSION

We demonstrated that type 2 gNETs, as well as type 3, had a high risk of LNM. Additionally, four pathological risk factors associated with LNM were identified.

Environmental and Clinical Factors Concerning Gastrointestinal Bleeding: An Umbrella Review of Meta-Analyses

OBJECTIVES

Gastrointestinal bleeding, an emergency and critical disease, is affected by multiple factors. This study aims to systematically summarize and appraise various factors associated with gastrointestinal bleeding.

DESIGN

Umbrella review.

SETTING AND PARTICIPANTS

Meta-analyses that evaluated environmental and clinical factors concerning gastrointestinal bleeding.

METHODS

We conducted a systematic search to identify eligible meta-analyses. For each included study, the risk estimates, heterogeneity estimates, small-study effects, excess significance tests, and publication biases were recalculated and appraised. Furthermore, we considered the methodologic quality and classified the evidence.

RESULTS

In this study, 51 beneficial and 44 harmful associations were found. This study found that preemptive transjugular intrahepatic portosystemic shunt was the most reliable treatment to reduce gastroesophageal variceal bleeding and mortality risk, followed by antibiotics. For gastroduodenal ulcer bleeding, Yunnan Baiyao and proton pump inhibitors (PPIs) were relatively dependable treatment drugs, and the comparatively reliable prophylactic drugs comprised PPIs and H2-receptor antagonists. Patients with hemodynamic instability and larger ulcers had a higher risk of rebleeding. Both weekend admissions and the combination of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs were high-risk factors for upper gastrointestinal bleeding and mortality. We also found that tranexamic acid was a credible drug for overall gastrointestinal bleeding. Meanwhile, aspirin, warfarin, diabetes, and renal failure were all high-risk factors.

CONCLUSIONS AND IMPLICATIONS

Altogether, many factors can substantially influence gastrointestinal bleeding. Therefore, in daily life and clinical practice, we should not only remain cautious in prescribing and taking some drugs but also pay attention to the management of lifestyle and underlying diseases. If necessary, protective drugs should be properly supplemented.

Adverse childhood experiences and loneliness: A systematic review and meta-analysis

Adverse childhood experiences are considered a powerful determinant of emotional health. One indicator of emotional health is loneliness, which refers to a distressing experience that one's social relationships are less in quality and quantity than those desired. This preregistered review aimed to examine the association between adverse childhood experiences (e.g., physical abuse/neglect, emotional abuse/neglect, sexual abuse, parental separation/divorce, family conflict, domestic violence) and loneliness in adulthood. A database search (Embase, Ovid, Cochrane Library, APA PsychINFO, Medline, Pubmed, Scopus) was conducted. After removal of duplicates, 3689 papers were reviewed and 20 met inclusion criteria. When feasible, results were pooled using a random-effects meta-analysis and inverse variance modelling and reported narratively. Meta-analyses revealed a statistically significant association between cumulative adverse childhood experiences and loneliness (r = 0.30, 95% CI [0.22-0.37]; prediction interval = 0.04-0.52) and between specific adversity types and loneliness, namely sexual abuse, physical abuse, physical neglect, emotional abuse, and emotional neglect. Some heterogeneity was observed across studies. Subgroup and sensitivity analyses revealed no differences in age, gender, age group, continent, or measures of adversity/loneliness. This research indicates that adversities in childhood may have some long-term influences on loneliness, both cumulatively and within adversity subtypes.

Meta-analysis of the acoustic adaptation hypothesis reveals no support for the effect of vegetation structure on acoustic signalling across terrestrial vertebrates

Acoustic communication plays a prominent role in various ecological and evolutionary processes involving social interactions. The properties of acoustic signals are thought to be influenced not only by the interaction between signaller and receiver but also by the acoustic characteristics of the environment through which the signal is transmitted. This conjecture forms the core of the so-called "acoustic adaptation hypothesis" (AAH), which posits that vegetation structure affects frequency and temporal parameters of acoustic signals emitted by a signaller as a function of their acoustic degradation properties. Specifically, animals in densely vegetated "closed habitats" are expected to produce longer acoustic signals with lower repetition rates and lower frequencies (minimum, mean, maximum, and peak) compared to those inhabiting less-vegetated "open habitats". To date, this hypothesis has received mixed results, with the level of support depending on the taxonomic group and the methodology used. We conducted a systematic literature search of empirical studies testing for an effect of vegetation structure on acoustic signalling and assessed the generality of the AAH using a meta-analytic approach based on 371 effect sizes from 75 studies and 57 taxa encompassing birds, mammals and amphibians. Overall, our results do not provide consistent support for the AAH, neither in within-species comparisons (suggesting no overall phenotypically plastic response of acoustic signalling to vegetation structure) nor in among-species comparisons (suggesting no overall evolutionary response). However, when considering birds only, we found weak support for the AAH in within-species comparisons, which was mainly driven by studies that measured frequency bandwidth, suggesting that this variable may exhibit a phenotypically plastic response to vegetation structure. For among-species comparisons in birds, we also found support for the AAH, but this effect was not significant after excluding comparative studies that did not account for phylogenetic non-independence. Collectively, our synthesis does not support a universal role of vegetation structure in the evolution of acoustic communication. We highlight the need for more empirical work on currently under-studied taxa such as amphibians, mammals, and insects. Furthermore, we propose a framework for future research on the AAH. We specifically advocate for a more detailed and quantitative characterisation of habitats to identify frequencies with the highest detection probability and to determine if frequencies with greater detection distances are preferentially used. Finally, we stress that empirical tests of the AAH should focus on signals that are selected for increased transmission distance.

The impact of gut microbiome modulation on anthropometric indices in metabolic syndrome: an umbrella review

Background

Metabolic syndrome (MetS) is a complex disorder characterized by a cluster of metabolic risk factors. Recent research highlights the gut microbiome's role in metabolic regulation, suggesting that modulation through probiotics, prebiotics, and synbiotics may provide a novel approach to managing MetS. This umbrella review aims to integrate insights from existing meta-analyses to explore how changes in gut microbiota influence key body measurement indicators in individuals with MetS.

Methods

A systematic search of PubMed, Scopus, and Web of Science databases identified meta-analyses that assessed the impact of probiotics, prebiotics, or synbiotics on anthropometric indices in MetS patients.

Results

The results indicated that microbial therapy leads to a significant reduction in body mass index (BMI) (SMD: -0.22; 95% CI: -0.35 to -0.09; P < 0.01) and waist circumference (WC) (SMD: -0.47; 95% CI: -0.80 to -0.15; P < 0.01). However, microbial therapy did not significantly affect body fat mass (SMD: -0.30; 95% CI: -0.64 to 0.02; P = 0.06), body fat percentage (SMD: -0.29; 95% CI: -0.62 to 0.03; P = 0.07), waist-to-hip ratio (SMD: -0.09; 95% CI: -0.46 to 0.28; P = 0.63), and weight (SMD: -0.06; 95% CI: -0.21 to 0.08; P = 0.37).

Conclusions

Gut microbial modulation, mainly through probiotics and synbiotics, shows promise in reducing BMI and WC in MetS patients. However, its effects on other anthropometric indices remain uncertain, warranting further high-quality research to fully understand microbial interventions' therapeutic potential.

Effects of non-pharmacological interventions on anxiety in patients undergoing colonoscopy: A network meta-analysis of randomized controlled trials

BACKGROUND

Anxiety is a common and significant problem in patients who need to undergo colonoscopy. However, the question of which non-pharmacological intervention is the best strategy to reduce anxiety in patients undergoing colonoscopy remains unanswered.

OBJECTIVES

To evaluate and rank the effectiveness of various non-pharmacological interventions for reducing anxiety in patients undergoing colonoscopy in order to identify the most effective strategies.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, and Medline for randomized controlled trials published from the database construction to March 2024. The primary outcome was the difference between pre- and post-intervention anxiety means. A network meta-analysis was conducted utilizing the "gemtc" package based on R4.3.0.

RESULTS

The analysis encompassed 24 randomized controlled trials, incorporating 2525 participants and evaluating 9 non-pharmacological interventions. All non-pharmacological interventions reduced anxiety in patients undergoing colonoscopy compared to standard care, with music intervention (SMD = -0.52, 95 %CI (-0.84,-0.20)), audiovisual distraction (SMD = -0.54, 95 %CI(-0.96,-0.12)), video information (SMD = -1.47, 95 %CI(-2.03,-0.90)), individual education (SMD = -1.72, 95 %CI(-2.76,-0.70)), and electroacupuncture (SMD = -1.12, 95 %CI(-2.10,-0.13)) having statistically significant effects. SUCRA ranking identified the priority of individual education (SUCRA: 92.5 %) and video information (SUCRA: 87.7 %). Meta-regression and sensitivity analysis further demonstrated the stability of the evidence. The certainty of the evidence was mostly rated as medium to low.

CONCLUSION

This review highlights the superior effects of individual education and video information in reducing anxiety in patients undergoing colonoscopy. The findings of our review could provide clinical decision-makers and healthcare practitioners, such as doctors and nurses, with evidence-based practices for selecting interventions to reduce anxiety in patients undergoing colonoscopy.

Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of stratified aggregate data

BACKGROUND

A 2021 meta-analysis of 37 randomised controlled trials (RCTs) of vitamin D supplementation for prevention of acute respiratory infections (ARIs) revealed a statistically significant protective effect of the intervention (odds ratio [OR] 0·92 [95% CI 0·86 to 0·99]). Since then, six eligible RCTs have been completed, including one large trial (n=15 804). We aimed to re-examine the link between vitamin D supplementation and prevention of ARIs.

METHODS

Updated systematic review and meta-analysis of data from RCTs of vitamin D for ARI prevention using a random effects model. Subgroup analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration, dosing regimen, or age. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov between May 1, 2020 (end-date of search of our previous meta-analysis) and April 30, 2024. No language restrictions were imposed. Double-blind RCTs supplementing vitamin D for any duration, with placebo or lower-dose vitamin D control, were eligible if approved by a Research Ethics Committee and if ARI incidence was collected prospectively and pre-specified as an efficacy outcome. Aggregate data, stratified by baseline 25(OH)D concentration and age, were obtained from study authors. The study was registered with PROSPERO (no. CRD42024527191).

FINDINGS

We identified six new RCTs (19 337 participants). Data were obtained for 16 085 (83·2%) participants in three new RCTs and combined with data from 48 488 participants in 43 RCTs identified in our previous meta-analysis. For the primary comparison of any vitamin D versus placebo, the intervention did not statistically significantly affect overall ARI risk (OR 0·94 [95% CI 0·88-1·00], p=0·057; 40 studies; 61 589 participants; I2=26·4%). Pre-specified subgroup analysis did not reveal evidence of effect modification by age, baseline vitamin D status, dosing frequency, or dose size. Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (OR 0·96 [95% CI 0·90-1·04]; 38 studies; I2=0·0%). A funnel plot showed left-sided asymmetry (p=0·0020, Egger's test).

INTERPRETATION

This updated meta-analysis yielded a similar point estimate for the overall effect of vitamin D supplementation on ARI risk to that obtained previously, but the 95% CI for this effect estimate now includes 1·00, indicating no statistically significant protection.

FUNDING

None.

The effect of automated insulin delivery system use on diabetes distress in people with type 1 diabetes and their caregivers: A systematic review and meta-analysis

AIMS

Diabetes distress (DD) is prevalent among people with diabetes. While automated insulin delivery systems (AIDs) improve glycaemic control, their impact on DD is unclear. We aimed to investigate the effect of AIDs on DD in people with diabetes and their caregivers.

METHODS

We focused on people with diabetes using AIDs versus other insulin delivery systems, with DD as the outcome. We included randomised controlled trials (RCTs), before-after studies (BAS) and observational studies until 4 April 2024. After screening, 40 studies were included in the systematic review, comprising 5426 participants (3210 adults, 1131 paediatric and 1085 caregivers). Twenty-seven studies were selected for the meta-analysis (focusing solely on type 1 diabetes). We used random effects models by population and study design. We also conducted a subgroup analysis by age group (children vs. teenagers).

RESULTS

In adults, eight BAS and five RCTs indicated a significant small DD reduction post-AID initiation (standardised mean difference [95% confidence intervals] -0.32 [95% CI: -0.40, -0.24] and [-0.19 (-0.27, -0.11)]). No significant changes were observed in the paediatric population. In caregivers, eleven BAS and five RCTs indicated a significant moderate DD reduction (-0.48 [95% CI: -0.78, -0.18] and (-0.22 [-0.38, -0.06])). Subgroup analysis revealed an increased benefit in parents of children compared to parents of teenagers.

CONCLUSIONS

This work suggests that AIDs is associated with a DD reduction in adults and caregivers but not in children/teenagers with type 1 diabetes. More longitudinal studies and better systematic DD assessments are needed.

Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis

BACKGROUND

This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago.

METHODS

A comprehensive search was conducted on 3 June 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear-mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs).

RESULTS

We retrieved a total of 15 417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I2  = 94%) and 23.5 (95% CI 9.0-61.3; I2  = 100%) per 10 000 colonoscopies, respectively. The " > 80 years" group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I2  = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I2  = 0%) compared to the "65-80 years" group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I2  = 0%) and 27 (95% CI 9.0-81.0; I2  = 99%) per 10 000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I2  = 1%) and 16 (95% CI 8.1-31.3; I2  = 98%) per 10 000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10 000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10 000 colonoscopies). The prevalence of cardiopulmonary AEs in the elderly population is relatively high, although the definition used varies across different studies.

CONCLUSIONS

We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AE rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.

The Effectiveness of Mind-Body Exercise on Health-Related Quality of Life and Mental Health During and After Breast Cancer Treatment: An Umbrella Review of Meta-Analyses for Randomized Controlled Trials

BACKGROUND

Previous studies regarding mind-body exercise among people with breast cancer mostly focused on one type of mind-body exercise and provided conflicting results.

AIMS

This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind-body exercises.

METHODS

We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind-body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.

RESULTS

The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as "low" quality and 6 articles as "critically low" quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = -0.77, 95% Confidence Interval [-0.93, -0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind-body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).

LINKING EVIDENCE TO ACTION

Mind-body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind-body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.

Endovascular thrombectomy for large vessel occlusion in acute ischemic stroke patients with concomitant intracranial hemorrhage

BACKGROUND

Endovascular thrombectomy (EVT) is the gold standard for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, concomitant intracranial hemorrhage (ICH) might render AIS-LVO patients ineligible for EVT in real-life practice.

OBJECTIVE

To provide robust evidence regarding the outcomes of EVT in AIS-LVO patients with concomitant ICH.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data analysis was performed using OpenMetaAnalyst software. We assessed the pooled incidence rate with a 95 % confidence interval (CI) for qualitative data and analyzed the pooled mean difference (MD) with a 95 % CI for continuous data. The pooled effect size for all outcomes was calculated using the DerSimonian and Laird random-effects model.

RESULTS

Six studies were included in the meta-analysis. The overall incidence rate of successful revascularization was 85.3 % (95 % CI: 75.8 %-94.7 %), with rates of 76.1 % for ipsilateral hemorrhages and 66.1 % for contralateral hemorrhages. Functional independence was achieved in 20 % of patients (95 % CI: 4.8 %-36.8 %), with rates of 23 % for ipsilateral and 27.7 % for contralateral hemorrhages. Mortality was reported at 52 % (95 % CI: 34.9 %-69 %), with a higher rate of 52.6 % for ipsilateral hemorrhages compared to 36.8 % for contralateral hemorrhages.

CONCLUSION

This meta-analysis indicates that EVT is feasible in AIS patients with concurrent ICH, yet it is associated with poor functional outcomes and high mortality rates. Careful patient selection is essential to optimize the outcomes, and further research is needed to enhance outcomes for these high-risk patients.

Prophylactic Interventions for Heel Pressure Ulcers in Critically Ill Patients Admitted to an Intensive Care Unit: A Systematic Review and Meta-Analysis

Pressure ulcers are one of the most predictable adverse events, and nurses play a major role in their prevention. Patients receiving intensive care are at a particularly high risk of developing pressure ulcers. The heel is a common area for pressure ulcers, but the number of comparative studies on preventing pressure ulcers is small. Therefore, it is important to combine the evidence. This study aimed to investigate the effectiveness of interventions to prevent heel pressure ulcers by comprehensively extracting and quantitatively integrating the results of studies on preventive care for heel pressure ulcers in critically ill patients. Systematic reviews and meta-analyses were performed. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) 2020. Eligible criteria were randomized controlled trials (RCTs) and non-RCTs examining interventions for the prevention of heel pressure ulcers as an adjunct to standard care in critically ill adult patients in intensive care units. According to the eligibility and exclusion criteria, two review authors independently screened and extracted data from the included literature. The risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Studies were grouped based on intervention type, and a random-effects meta-analysis was performed. A total of 2,800 studies were searched in four databases. In the primary screening, 122 met the eligibility criteria, and in the secondary screening, seven studies (1,412 patients) met the eligibility criteria. Of the seven studies, three (1,037 eligible patients) applied dressings to the heel, two (237 eligible patients) applied oil, and two (138 eligible patients) wore heel protectors. The risk of bias of the included studies was low. Preventive intervention for heel pressure ulcers significantly reduced the incidence of pressure ulcers compared with usual care (odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.08-0.33, I² = 0%) In the subgroup analysis, dressing was effective in preventing heel pressure ulcers (three studies, OR = 0.15, 95% CI = 0.05-0.45, I² = 0%). Protector was effective in preventing heel pressure ulcers (two studies, OR = 0.15, 95% CI = 0.05-0.45, I² = 0%). However, oil application was not significantly effective in preventing pressure ulcers (two studies, OR = 0.34, 95% CI = 0.06-1.90, I² = 0%). In this subgroup analysis, oil application alone was ineffective in preventing pressure ulcers. This number of studies is insufficient to draw firm conclusions, and further studies are required.

Cognitive behavioral therapy for insomnia across the spectrum of alcohol use disorder: A systematic review and meta-analysis

Insomnia is prevalent among patients with alcohol use disorder (AUD), potentially undermining treatment and increasing the risk of relapse. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia, but its efficacy is not well-characterized in patients across the spectrum of AUD. The aim of this meta-analysis was to quantify the effectiveness of CBT-I in improving insomnia severity and alcohol-related outcomes in adults with heavy alcohol use and/or varying levels of AUD severity and comorbid insomnia. MEDLINE, Cochrane Library, PsycINFO and ClinicalTrials.gov were systematically searched (up to February 2024) to retrieve randomized controlled trials (RCTs). Multilevel meta-analyses were conducted to estimate mean differences over time in insomnia severity, measured using the Insomnia Severity Index (ISI), as well as in alcohol craving and alcohol-related psychosocial problems between CBT-I and control groups. For the number of heavy-drinking/abstinent days, incidence rate ratios were estimated. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool. Eight RCTs encompassing 426 adults (68.78 % men) were included. Compared with control conditions, CBT-I resulted in a large reduction of insomnia severity post-treatment [estimated ISI reduction = -5.51, 95% CI (-7.13 to -3.90)], which was maintained at 1-to-3-month [7 studies; estimate = -4.39, 95% CI (-6.08 to -2.70)], and 6-month follow-up [4 studies; estimate = -4.55, 95% CI (-6.77 to -2.33)]. Alcohol-related outcomes were reported less consistently, and no significant differences were found. The included trials were judged to have a low or moderate overall risk of bias for the assessment of all outcomes. CBT-I effectively reduces insomnia severity across the spectrum of AUD, supporting wide implementation in AUD prevention and treatment settings. PROSPERO REGISTRATION NUMBER: CRD42023464612.

Pharmacological Efficacy of Intravenous Magnesium in Attenuating Remifentanil-Induced Postoperative Hyperalgesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Remifentanil-based anesthesia is linked to opioid-induced hyperalgesia (OIH), increasing postoperative pain and analgesic requirements. Magnesium, an N-methyl-D-aspartate (NMDA) receptor antagonist, might alleviate OIH. We aimed to assess whether intravenous magnesium reduces postoperative pain, analgesic requirements, and hyperalgesia in adults receiving remifentanil-based anesthesia. Methods: We searched PubMed, Embase, the Cochrane Library, and Web of Science (1 December 2024) for randomized controlled trials (RCTs) comparing intravenous magnesium vs. placebo. Risk of bias was evaluated with the Cochrane RoB 2 tool, and random-effects meta-analyses were conducted. GRADE was used to assess evidence quality. Primary outcomes were postoperative analgesic requirements and pain scores; secondary outcomes included intraoperative remifentanil consumption, shivering, postoperative nausea/vomiting (PONV), extubation time, hypotension, and bradycardia. PROSPERO registration: CRD42024609911. Results: Twenty-two RCTs (n = 1362) met eligibility. Magnesium significantly decreased 24 h analgesic requirements (standardized mean difference [SMD] -1.51; 95% confidence interval [CI] -2.15 to -0.87; p < 0.0001) and pain scores (SMD -0.61; 95% CI -0.90 to -0.32; p < 0.0001), with benefits persisting up to 48 h. It also reduced intraoperative remifentanil use (SMD -0.52), shivering (odds ratio [OR] 0.25), and PONV (OR 0.66), without prolonging extubation or increasing hypotension/bradycardia risk. High heterogeneity, potential publication bias, and moderate-to-very-low evidence certainty warrant caution. Conclusions: Intravenous magnesium appears beneficial in remifentanil-based anesthesia, but further large-scale, methodologically robust trials are needed to confirm optimal and clarify safety profiles across diverse surgical populations.

Effectiveness of tuberculosis preventive treatment in patients with rheumatic diseases: a global systematic review and meta-analysis

Background

Patients with rheumatic disease (RD) are particularly vulnerable to progressing to tuberculosis disease (TBD). The effectiveness of tuberculosis preventive treatment (TPT) in this high risk group needs systematic assessment.

Methods

We conducted a systematic review and meta-analysis by searching PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and China National Knowledge Internet (CNKI) for relevant cohort studies from inception through January 2025. Eligible studies evaluated the incidence of TBD and/or the effectiveness of TPT in patients with RD. Two authors independently reviewed and extracted summary data from published reports. Pooled incidence rate (IR), risk ratio (RR) and their 95% confidence interval (CI) were calculated as the primary effect measure. Prospero registration number is CRD42023473966.

Findings

64 studies with 116,015 patients with RD were included to evaluate effectiveness of TPT. TPT decreased the overall risk of TBD in patients with RD (RR: 0.76, 95% CI 0.63-0.91). TPT showed better effectiveness in high tuberculosis (TB) burden countries/regions (RR: 0.46, 95% CI 0.27-0.77). Using isoniazid (INH) monotherapy for 9-12 months was effective (RR: 0.54, 95% CI 0.35-0.85). Taking tuberculin skin test (TST) combined with interferon gamma release assays (IGRA) as tuberculosis infection (TBI) screening methods might maximize the benefits of TPT (RR: 0.58, 95% CI 0.39-0.88). TPT showed optimal protective effects in patients with RD in TBI positive status (RR: 0.11, 95% CI 0.04-0.32). Compared with patients with RD receiving biologics, TPT showed better effects in patients with RD only receiving traditional treatment (RR: 0.44, 95% CI 0.27-0.73). And TPT performed more effectively in systematic lupus erythematosus (SLE) than arthritis.

Interpretation

TPT decreased the risk of TBD in patients with RD, especially in TB high burden countries/regions. When using isoniazid monotherapy, extending the treatment course might have better protection. TST combined with IGRA might be optimal when screening the TBI. More types of RDs, short-course regimens containing rifamycins and high-quality randomized controlled trials (RCT) should be the focus of future research.

Funding

This study was supported by the National Natural Science Foundation of China (82373648), Capital's Funds for Health Improvement and Research (2024-2-4016), and the National High Level Hospital Clinical Research Funding (2022-PUMCH-C-013, 2022-PUMCH-A-119).

The association between sleep quality and telomere attrition: A systematic review and meta-analysis comprising 400,212 participants

Psychosocial stressors accelerate telomere attrition, a biomarker of cell aging, whereas good sleep is hypothesized to be a mitigating factor. However, methodological aspects - particularly underpowered studies, inconsistent findings, and multiple approaches to assessing sleep - demonstrate the need for a meta-analysis. After PROSPERO registration, we conducted a systematical search of the following databases until June 2024 to identify studies examining the relationship between sleep quality and telomere length in adult humans: CINAHL, Cochrane Library, MEDLINE, PsychINFO, PubMed, Web of Science, and Google Scholar. In total, 29 studies met inclusion criteria for the systematic review according to the preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA), 19 of which provided data that was appropriate for meta-analytic calculations. We identified the Pittsburgh sleep quality index (PSQI) global score (odds ratio (OR) 1.24, CI 95 % [1.03; 1.50], p = 0.02), sleep-related daytime impairments (OR 1.01 [1.00; 1.02], p = 0.04), and wake after sleep onset (WASO) time (OR 1.28 [1.12; 1.47], p < 0.01) as to be significantly associated with telomere attrition. Thus, the subtle telomere attrition-mitigating role of sleep has been demonstrated based on a sufficiently large body of data and defined aspects of sleep quality.

Effects of Anticipation and Dual-Tasking on Lower Limb Biomechanics While Performing Change-of-Direction Tasks in Physically Active Individuals: A Systematic Review with Meta-Analysis

BACKGROUND

Anterior cruciate ligament (ACL) injuries are highly prevalent in team sport athletes and often occur while performing change-of-direction (COD) tasks in combination with high cognitive demands, such as decision making or divided attention. Given the expanding body of research in this field, an updated literature review is warranted, as the most recent meta-analysis on this topic included original studies published up to November 2020.

OBJECTIVE

The aim of this systematic review was to examine the effects of anticipation and/or dual-tasking on lower limb biomechanics during COD tasks in healthy individuals.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

A systematic literature search was conducted in the electronic databases PubMed, Web of Science, CINAHL and SPORTDiscus from inception until February 2024. The included studies examined the effects of anticipation and/or dual-tasking on knee kinetics and kinematics in the frontal and sagittal planes during COD tasks.

METHODS

A multilevel meta-analysis was performed to aggregate the results of studies comparing unanticipated versus anticipated CODs on lower limb biomechanics. Due to the limited available literature on dual-task versus single-task conditions, this aspect was analyzed qualitatively.

RESULTS

The meta-analysis included 17 studies involving 355 individuals from different sports (e.g., soccer, American Football). No statistically significant differences were found between unanticipated and anticipated CODs for knee abduction and flexion moments as well as knee abduction angles (p > 0.05). Significantly higher knee flexion angles were found in unanticipated CODs (SMD = 0.74, 95% CI: 0.30-1.19; p < 0.01). Qualitative analyses of six studies including 171 individuals provided initial evidence for higher knee abduction moments and flexion angles during anticipated CODs while performing a secondary task concurrently.

CONCLUSION

Findings from quantitative and qualitative analyses indicate that anticipation and dual-tasking during COD performance have an impact on injury-related aspects of lower limb biomechanics. Hence, cognitive challenges should be implemented in injury risk screening and preventive strategies. Further studies with high methodological quality are needed to improve the understanding of the biomechanical and cognitive interplay in injury-threatening situations.

PROSPERO REGISTRATION NUMBER

CRD42023433074.

DATE OF REGISTRATION

13.10.2023.

Effects of Physical Exercises in Asthma: An Umbrella Review of Systematic Review and Meta-Analysis

BACKGROUND

As a disease-modifying strategy, physical exercise has been demonstrated to significantly improve quality of life, exercise capacity, and lung function in individuals with asthma. However, the quality and robustness of this evidence has not been thoroughly examined in many large-scale investigations. In order to assess the evidence addressing the effects of physical exercise in patients with asthma, we therefore carried out an umbrella review.

METHODS

A comprehensive search of the PubMed, Web of Science, and Cochrane databases for systematic reviews and meta-analyses of the effects of physical activity on asthma was conducted up to December 31, 2022. The study was registered in Prospero (CRD42023382921). For every qualified systematic review and meta-analysis, we extracted information on the main characteristics and general findings. The GRADE tool was utilized to quantify the strength of the evidence, and the AMSTAR2 score was employed to evaluate the methodological quality.

RESULTS

A total of 1254 articles were searched, and 42 independent results were identified as eligible in the 11 articles that were included. Of the 42 unique outcomes, two were rated as high, two as medium, and the rest as low or very low. Physical exercise is beneficial for improving QoL, exercise capacity, and lung function in patients with asthma.

CONCLUSIONS

According to our research, physical activity benefits QoL of patients with asthma, exercise tolerance, and lung function. In the future, further evidence from superior prospective studies will be required because the quality of the available evidence is now insufficient.

Effects of bacterial vaginosis treatment during pregnancy on maternal-fetal outcome: A systematic review and network meta-analysis

BACKGROUND

Bacterial vaginosis (BV) can lead to adverse pregnancy outcomes such as preterm delivery. However, it is unclear whether BV treatment during pregnancy can reduce the incidence of adverse maternal-fetal outcomes.

METHODS

We performed a meticulous literature search across various databases, including PubMed, EMBASE, Web of Science, and the Cochrane Database. Utilizing meta-analysis, we delved into the relationship between diverse drug treatments, encompassing probiotics, antibiotics, and combination therapy, and their potential impact on adverse pregnancy outcomes. We also used network meta-analysis to explore the effects of different medications on the primary outcome of preterm delivery and ranked the intervention effects using P-scores.

RESULTS

Twenty-four eligible randomized controlled trials (RCTs) were included. Regardless of the type of treatment administered, the meta-analysis demonstrated that there was no decrease in the occurrence of preterm delivery following BV treatment during pregnancy (RR = 1.00, 95 % CI = 0.80-1.24, P = 0.96). But among the UK population, it was found that BV treatment during pregnancy was significantly associated with a reduced risk of preterm delivery (RR = 0.47, 95 % CI = 0.30-0.73, P < 0.001). Through network meta-analysis, oral probiotics obtained the highest P-scores (P-score = 0.86), but with a low quality evidence. This was followed by vaginal clindamycin plus clotrimazole (P-score = 0.78), and oral clindamycin (P-score = 0.58). Furthermore, it has not been discovered that BV treatment during pregnancy can decrease the likelihood of various other adverse outcomes, such as puerperal infections, miscarriages, premature rupture of membranes, low birth weight, and neonatal intensive care unit (NICU) admission rates.

CONCLUSION

The current evidence fails to endorse the treatment of BV during pregnancy as a means to mitigate the risk of preterm delivery. Although probiotic therapies exhibit promising potential, the available data remains inadequate. Future research is necessary to further establish the safety and effectiveness of antibiotics and probiotics in the prevention or management of BV during pregnancy.

Systematic Review and Meta-Analysis: Multisystemic Therapy and Functional Family Therapy Targeting Antisocial Behavior in Adolescence

OBJECTIVE

Youth criminal justice systems are under growing pressure to reduce re-offending behavior and to support young people's health and developmental needs. This systematic review and meta-analysis sought to synthesise evidence for 2 prominent community-based interventions for delinquent and antisocial behavior, namely, multisystemic therapy (MST) and functional family therapy (FFT).

METHOD

We searched Medline, PsycInfo, Scopus, Web of Science, and Social Services Abstracts for randomized controlled trials (RCTs) and quasi-experimental studies evaluating MST/FFT. Included studies involved participants aged under 18 years; included interventions targeted delinquent/antisocial behavior, but not maltreatment. We estimated effect sizes for 6 primary outcomes, synthesising RCTs comparing MST/FFT to usual care using correlated hierarchical effects meta-analysis. We assessed risk of bias and evidence strength using best-practice tools. Given the additional resources needed to implement MST/FFT, we rated evidence strength against a minimum clinically important difference rather than a null effect. This study is registered with PROSPERO, CRD42021279736.

RESULTS

We included 35 studies for MST (16 RCTs meta-analyzed comprising 4,095 participants, 26% female) and 19 studies for FFT (7 RCTs meta-analyzed comprising 1,471 participants, 22% female). MST had a likely clinically important effect on time in out-of-home care, but no clinically important effects on other primary outcomes (delinquency, new offenses/convictions, placement in out-of-home care, substance use), with low-to-moderate evidence strength. FFT demonstrated possible clinically important effects for the number of new offenses/convictions, time in out-of-home care, and substance use, but evidence strength was low.

CONCLUSION

Contrary to reports in some evidence clearinghouses indicating that MST/FFT are supported by the highest level of evidence strength, there is limited evidence that these interventions are superior to usual care in reducing delinquent and antisocial behavior in adolescence. These findings should be viewed in the context of important methodological differences with prior reviews, including the rating of evidence strength against a minimum clinically important difference.

PLAIN LANGUAGE SUMMARY

Delinquent and antisocial behavior by young people imposes high costs on the wellbeing of individuals and the broader community. This systematic review summarized evidence for two prominent community-based interventions for delinquent and antisocial behavior: multisystemic therapy ([MST], 35 studies) and functional family therapy ([FFT], 19 studies). MST led to a reduced time in out-of-home care compared to usual treatment. FFT had larger favorable effects on delinquency, new offenses and convictions, placement in out-of-home care, and substance use, but the quality of the evidence was poor. The authors concluded that there is limited evidence that either MST or FFT are superior to usual care in reducing delinquent and antisocial behavior in adolescence.

STUDY PREREGISTRATION INFORMATION

The effect of Multi-Systemic Therapy and Functional Family Therapy in addressing child and adolescent delinquent and/or antisocial behavior and childhood maltreatment; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=279736.

Efficacy of couple-based dyadic interventions on the relationship outcomes of couples with cancer: A systematic review and network meta-analysis

PURPOSE

To compare the effects of different couple-based dyadic interventions on patient-partner couple's relationship outcomes.

METHODS

A systematic search of the nine databases, Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, CINHAL, PsyclINFO, China National Knowledge Infrastructure and WanFang was conducted from database inception to October 22, 2024 for randomized controlled trials (RCTs) of patients with cancer and their partners receiving couple-based dyadic interventions. The outcome indicators included couple relationship quality. The results were plotted and presented by Stata 14.0. The surface under the cumulative ranking area (SUCRA) was employed for intervention level estimation.

RESULTS

This study included 2519 patients with cancer and their partners from 25 RCTs. For patients with cancer, supportive care demonstrated the largest effect size in improving couples' relationships (standardized mean difference [SMD]: -0.69; 95% confidence intervals [CI]: -1.15,-0.23) and had the highest cumulative probability (SUCRA: 69.4%) compared to skills training. Mindfulness demonstrated the largest effect size for partners in improving relationships of couples (SMD: -0.51, 95% CI: -0.98,-0.05) and had the highest cumulative probability (SUCRA: 87.2%) compared to skills training.

CONCLUSIONS

Mindfulness represents the most promising couple-based dyadic intervention for improving relationship quality between partners of patients with cancer. However, no significantly effective interventions have been identified to enhance couple relationships for patients. Future research should consider the requirements of patients and partners who are the units, and develop more targeted programs to facilitate relationship adjustment. The results provide a low level of certainty, suggesting the need for further rigorous studies to validate these findings.

Efficacy of erector spinae plane block for postoperative pain management: A meta-analysis and trial sequential analysis of randomized controlled trials

BACKGROUND

Postoperative pain remains a major problem across a wide range of surgical procedures. The efficacy and clinical utility of the Erector Spinae Plane Block (ESPB) in reducing postoperative pain remains uncertain.

OBJECTIVE

To evaluate the efficacy and safety of the ESPB compared with placebo or sham block in perioperative pain management.

EVIDENCE REVIEW

We searched PubMed, Embase, Web of Science, Scopus, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing ESPB to placebo or sham block in surgical patients. Primary outcomes included postoperative pain at 2 h, 6 h, 24 h, and 48 h, intraoperative and cumulative postoperative opioid consumption (24 h), and postoperative nausea and vomiting, pruritus, and block-related adverse events. Subgroup and sensitivity analyses, as well as meta-regressions, were performed to explore sources of heterogeneity. Trial sequential analysis (TSA) was used to assess the quantitative robustness of the available data. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024583633.

FINDINGS

Forty-three RCTs were included, with 1361 patients randomized to the Erector Spinae Plane Block group. ESPB reduced postoperative pain at 2 h (MD -1.46;95 % CI -1.98 to -0.94;p < 0.001;I2 = 91 %), 6 h (MD -1.23;95 % CI -1.64 to -0.83;p < 0.001;I2 = 89 %), 24 h (MD -0.47;95 % CI -0.67 to -0.28;p < 0.001;I2 = 78 %), and 48 h (MD -0.24;95 % CI -0.39 to -0.09;p = 0.002;I2 = 10 %). Also, intraoperative opioid consumption (MD -137.43 μg;95 % CI -208.73 to -66.13;p < 0.001;I2 = 100 %), 24 h cumulative opioid consumption (MD -25.62 mg;95 % CI -31.31 to -19.93;p < 0.001;I2 = 99 %), and incidence of postoperative nausea and vomiting (RR 0.56;95 % CI 0.44 to 0.72;p < 0.001;I2 = 16 %) were significantly lower in patients submitted to ESPB. No significant differences were found in postoperative pruritus (RR 0.62;95 % CI 0.35 to 1.10;p = 0.105;I2 = 27 %). Notably, no block-related adverse events were reported in any study. Certainty of evidence was rated as low to moderate for most outcomes. TSA suggested that no further trials are needed to assess ESPB efficacy in the analyzed outcomes, except for postoperative pruritus.

CONCLUSION

ESPB is a safe and effective regional anesthesia technique that significantly reduces postoperative pain and opioid consumption across various surgical procedures.

Overall and Cause-Specific Mortality in Patients With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Population-Based Studies

INTRODUCTION

Current guidelines recommend endoscopic surveillance of Barrett's esophagus (BE) but do not account for competing mortality unrelated to esophageal cancer (EC). We conducted a systematic review and meta-analysis to estimate EC and non-EC mortality risk in BE patients.

METHODS

We searched multiple databases for studies reporting mortality in BE. We included population-based studies providing standardized mortality ratio (SMR). The primary outcome was SMR from all causes and EC and non-EC etiologies. SMR was calculated by dividing the observed mortality over the expected mortality. Logarithmic form of SMRs was pooled using random-effects model.

RESULTS

Our search yielded 2,826 articles, of which 7 studies (n = 34,454) were included. All-cause mortality was elevated in BE patients compared with population controls (pooled SMR 1.24, 95% confident interval [CI] 1.01-1.53) driven in part by increased EC mortality risk (SMR 8.98, 95 CI 5.12-15.77). The mortality risk was still increased but attenuated after excluding EC mortality (SMR 1.21, 95% CI 1-1.46). There was no increased mortality risk of non-EC malignancies (SMR 1.22, 95% CI 0.82-1.82) or mortality due to noncancer etiologies (SMR 1.13, 95% CI 0.90-1.43). Death due to cardiovascular diseases was higher in BE (SMR 1.16, 95% CI 1.02-1.33). BE patients were 10 times more likely to die from noncancer etiologies than EC (risk ratio 10.71, 95% CI 5.98-19.16). Subgroup analysis of studies that excluded prevalent EC at baseline (3 studies) also showed increased all-cause (SMR 1.12, 95% CI 1.07-1.18) and EC mortality (SMR 4.7, 95% CI 3.58-6.17) among BE patients.

DISCUSSION

BE patients exhibit a higher all-cause mortality, driven in part by risk of EC mortality. A personalized approach to surveillance, mitigating risk of EC while recognizing the broader mortality risks, is warranted.

The effectiveness of interventions used to improve general health check uptake by the older adult population: a systematic review and meta-analysis

Undergoing general health check enable early detection of common diseases and giving individuals a sense of control over their wellbeing. However, the general health check uptakes are typically unsatisfactory. Various interventions have been introduced to improve general health check uptakes. This review aims to answer how well these interventions work. A comprehensive literature search was conducted in four electronic databases in August 2020 and updated between 2021 and 2024. Randomised controlled trials (RCTs) that met the inclusion criteria were selected. Meta-analysis was performed on qualified RCTs to estimate the overall effectiveness of the interventions. The components of intervention were characterised using the Behaviour Change Technique Taxonomy. A total of 3360 records were screened. Eight RCTs were finally included. Among these RCTs, nine types of interventions were identified with all implemented in the invitation stage, including enhanced invitation letters, telephone invitations, question-behaviour-effect (QBE) questionnaires, financial incentives, leaflets, pre-notification short message service (SMS), SMS reminders, reminder letters and point-of-care automated prompts to clinical staff. All these interventions showed a significant improvement in the general health check uptakes than the control groups, except leaflets and QBE questionnaires. A total of fifteen behaviour change techniques were used in these interventions. A meta-analysis showed the pooled effect of these interventions was significantly associated with the improvement in the general health check uptakes than the control (OR =1.30, 95% CI =1.15 - 1.46). However, the high heterogeneity observed (84%) could reduce the reliability of the pooled summary effect. This review found that interventions primarily implemented during the invitation process are effective in improving the general health check uptake rates. Future research should aim to extend these interventions beyond the invitation stage to address internal and external barriers that deter older adults from seeking general health checks. The systematic review protocol is registered on PROSPERO (ref: CRD42021221041).

The short-term relation between load and acute psychophysiological responses in football: a meta-analysis and methodological considerations

Relations between load and acute psychophysiological responses have been widely studied in football. However, due to the large heterogeneity in contexts, operationalization, and results, the direction and strength of these relations remain unclear. In this meta-analysis, we examine the relation between load and typical acute (i.e. within one week) responses - wellbeing, recovery, and heart rate measures - in football players from all football codes (soccer, rugby, futsal, American football, and Australian rules football). We consulted PubMed, Web of Science, and CINAHL up to the 19th of June 2024, and included 62 articles and 1,474 participants in the meta-analysis. Subsequently, we estimated 12 meta-analysis models and applied meta-regression models to explore the influence of several moderators. Significant relations were found between load and overall wellbeing (r = -0.33 [95%CI: -0.48; -0.19]), muscle soreness (r = -0.36 [95%CI: -0.49; -0.24]), fatigue (r = -0.41 [95%CI: -0.56; -0.26]), sleep quality (r = -0.21 [95%CI: -0.31; -0.10]), and stress (r = -0.16 [95%CI: -0.26; -0.06]). Given the high risk of bias, inconsistency (wide prediction intervals), and imprecision, the certainty in these findings based on the GRADE assessment is very low. Additionally, the high risk of bias scores indicates that the overall quality of the included studies is low. In conclusion, this meta-analysis provides comprehensive information on the acute responses of the athlete to load, and directions for improvement of the quality of future studies.

Prevention of mental disorders after exposure to natural hazards: a meta-analysis

QUESTION

Mental health complaints are increased in survivors of natural hazards and disaster responders. This meta-analysis assessed the efficacy of psychological and psychosocial interventions for the prevention of mental disorders after exposure to natural hazards.

STUDY SELECTION AND ANALYSIS

We searched Web of Science, PsycINFO and MEDLINE for peer-reviewed randomised controlled trials evaluating preventive interventions targeting symptoms of post-traumatic stress disorder, depression and anxiety. Trials conducted in both, civilians and disaster responders, were included. Random-effect meta-analyses were conducted to assess the efficacy of interventions relative to active and passive control conditions.

FINDINGS

The results from 10 included studies (5068 participants) did not find preventive interventions to be superior compared with active or passive control conditions regarding symptoms of post-traumatic stress disorder (g=0.08 and g=0.05) and depression (g=0.13 and g=0.32, respectively). Effects on anxiety symptoms remain unclear. Aggregated effects for all outcomes were significant at follow-up compared with passive controls, but the interpretability is limited by the low number of studies. Intervention effects were not significantly associated with intervention type (psychotherapy vs psychosocial), age or delivery mode (online vs face-to-face). The risk of bias across studies was high.

CONCLUSIONS

The current evidence does not allow for any recommendations regarding prevention programmes in the aftermath of natural hazards. A larger body of high-quality research is needed to develop effective and evidence-based preventive interventions for disaster survivors and responders.

STUDY REGISTRATION

https://osf.io/4es65.

Effectiveness of molnupiravir as early treatment for COVID-19 to prevent mortality and hospitalisation in high-risk adults: A systematic review and meta-analysis of randomised trials and real-world studies involving 1,612,082 patients

BACKGROUND

The efficacy of molnupiravir for COVID-19 treatment remains controversial due to substantial heterogeneity in dosage and study settings across randomised controlled trials (RCTs).

METHOD

We systematically searched Medline, PubMed, Embase, and the Cochrane Register of Clinical Trials up to February 3, 2025, for RCTs and real-world studies evaluating molnupiravir 800 mg twice daily as an early treatment for COVID-19 to prevent mortality and hospitalisation in high-risk adult outpatients. The primary outcomes were all-cause mortality and all-cause hospitalisation. Random-effects models were used to estimate pooled effect sizes.

RESULTS

Thirty-four studies were included, comprising 30,345 participants from 11 RCTs and 1,581,737 participants from 23 cohort studies. Molnupiravir reduced mortality risk by 55 %-65 % at 28 days (RCTs: risk ratio [RR] 0.35; 95 % CI 0.12-0.98, I2 0 %; cohort studies: RR 0.45; 95 % CI 0.27-0.73, I2 91 %). This benefit persisted at 3 months (RR 0.47; 95 % CI 0.23-0.95, I2 93 %) and 6 months (RR 0.62; 95 % CI 0.52-0.74, I2 0 %). The effectiveness in preventing 28-day hospitalisation varied by participants' mean age in both RCTs (35-45 vs. 45-57 years: RR 0.55; 95 % CI 0.36-0.84 vs. 1.06; 95 % CI 0.81-1.39, subgroup difference P = 0.01) and cohort studies (62-74 vs. 75-85 years: RR 0.88; 95 % CI 0.77-1.01 vs. 0.56; 95 % CI 0.44-0.72, subgroup difference P < 0.01).

CONCLUSIONS

Molnupiravir significantly reduces the risk of mortality. It also lowers the risk of hospitalisation in the oldest group (mean age ≥75 years) but not in younger groups (mean age 45-74 years).

Effect and safety of perioperative ketamine/esketamine administration on postoperative pain and depression after breast cancer surgery: a systematic review and meta-analysis

Background

Patients with breast cancer experience varying degrees of pain, depression, and anxiety after surgery, which affect their postoperative recovery. Although ketamine/esketamine exhibit potential for opioid-sparing and controlling postoperative pain and depression, their effects on postoperative pain and depression remain unclear. This meta-analysis aimed to evaluate whether perioperative administration of ketamine/esketamine could reduce postoperative pain and depression, improve postoperative recovery, and reduce the incidence of adverse events in patients after breast cancer surgery.

Material and methods

PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials were searched from inception until June 2, 2024 for randomized controlled trials in English language on the effect of perioperative ketamine/esketamine on postoperative pain in patients undergoing breast cancer surgery. The primary outcome was the postoperative pain score, and the secondary outcomes were the postoperative depression score, quality of postoperative recovery, incidence of adverse events, and extubation time. The standardized mean difference and 95% confidence interval (CI) were calculated for continuous outcomes, and the risk ratio and 95% CI were calculated for binary variables.

Results

Seven studies involving 748 patients were included in this meta-analysis. No significant differences were found in postoperative pain scores at 2 h, 4 h, 1 day, 3 days, 7 days, and 3 months after surgery. Postoperative depression scores at 3 and 7 days after surgery were lower in the ketamine/esketamine group. The incidence of dizziness was lower in ketamine/esketamine group. No statistically significant differences were observed in postoperative depression scores at 30 days after surgery, quality of postoperative recovery at 1 and 3 days after surgery, extubation time, or the incidence of nausea, vomiting, and nightmares.

Conclusion

Perioperative ketamine/esketamine administration did not significantly reduce postoperative pain in patients undergoing breast cancer surgery; however, it may reduce depression within a short period after the surgery.

Clinical Trial Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42024572414, identifier CRD42024572414.