Measuring inconsistency in meta-analyses

The Pooled Prevalence of Metabolic Syndrome in Morocco Population: A Systematic Review and Meta-Analysis of 32 Studies

The prevalence of metabolic syndrome (MetS) is increasing worldwide. This is becoming a significant public health problem. In Morocco, it is estimated that 94.3% of people aged between 18 and 69 years have at least one risk factor for non-communicable diseases. This systematic review and meta-analysis aimed to measure the overall prevalence of MetS in the Moroccan population. This systematic review included studies published up to March 20, 2024. Data were retrieved from international databases, including EMBASE, Scopus, and MEDLINE/PubMed. Searches were conducted using the keywords "metabolic syndrome," "prevalence," and "Moroccan." The overall prevalence of MetS was calculated using a random-effects model to account for heterogeneity across studies. A total of 32 studies were conducted in Morocco, with a sample of 13 889 participants. The overall prevalence of MetS in the Moroccan population was 34.68%, with 39.66% in women and 30.51% in men. The pooled prevalence in apparently healthy individuals was 29.41%, which increased to 61.84% in patients with type 2 diabetes, 58.81% in patients with general obesity, 47.09% in patients with hypertension, and 28.29% in patients with rheumatoid arthritis. For an average age under 40 years, the pooled prevalence was 25.44%; for an average age between 40 and 50 years, the pooled prevalence was 25.52%; and for an average age of 50 years or more, the prevalence was 43.23%. The results of this study highlight the huge prevalence of MetS in the Moroccan population, with significant variations depending on the subgroups studied, diagnostic criteria used, and age group, highlighting the urgent need to develop and implement effective strategies to tackle this major public health challenge in Morocco.

Prognostic indicators in medication-related osteonecrosis of the jaw: A systematic review and meta-analysis

Modulation of bone turnover by antiresorptive agents impairs wound healing of jaw bones, and can result in an adverse event termed medication-related osteonecrosis of the jaw (MRONJ). In recent years, the prevalence, risk factors, and prevention strategies for MRONJ have been extensively investigated, but only few studies have focused on its treatment outcome, and the proposed prognostic factors have varied greatly. We systematically reviewed the prognostic factors in patients undergoing treatment for MRONJ. In total, 33 studies met the inclusion criteria out of 1,388 screened citations. For analysis, we grouped the prognostic factors into five categories as follows: medication-related, underlying conditions, lesion-related, serum markers, and treatment modalities. Discontinuation of antiresorptive therapy was a medication-related factor significantly associated with better treatment outcomes. Regarding underlying conditions, malignancy, especially multiple myeloma, was associated with worse treatment outcomes. Among lesion-related factors, better treatment outcome was noted for maxillary lesions and lesions with sequestrum formation. By contrast, lesions of advanced stages and those with periosteal reaction had poor treatment outcomes. Regarding treatment modality, surgical therapy was associated with a better chance of healing. Results of our meta-analysis helped identify prognostic indicators of MRONJ and will assist in decision-making in the clinical setting. Based on our results, surgeons may have a better cognitive context to discuss treatment options with patients. Additionally, our findings provide convincing evidence for physicians to consider postponing antiresorptive therapy in patients with MRONJ lesions.

Cognitive markers of resilience to dementia in mild Neurocognitive Impairment: a meta- analysis

BACKGROUND

Numerous risk factors for dementia have been identified, but the concern of how cognitive functions in the mild Neurocognitive Impairment (mild NCI) stage predict dementia occurrence and incidence is still a matter of debate. The present paper aims to fill this gap by conducting an updated meta-analysis of studies examining the probability over time of developing dementia in relation to measures of global cognitive functioning, long-term verbal memory, complex attention, visuoconstructional ability, and language in the mild NCI stage.

METHODS

We conducted a systematic literature search up to March 2024 in PubMed, PsycINFO (PROQUEST), and Scopus databases. We used random-effects models to pool the ratio measure (odds, hazard, or risk ratios) for the association between cognitive domains and the risk of developing dementia in people with mild NCI.

RESULTS

The systematic search in electronic databases identified 44 relevant studies. Results showed that better performance in long-term verbal memory, visuoconstructional, and language abilities in individuals with mild NCI were associated with a lower risk of progression to dementia.

DISCUSSION

These findings might suggest that interventions aimed at preserving or enhancing these cognitive domains could be beneficial in delaying or preventing dementia onset, offering a potential therapeutic target for clinicians working with at-risk populations.

Systematic Review and Meta-Analysis on the Accuracy of Artificial Intelligence Algorithms in Individuals Gender Detection Using Orthopantomograms

The integration of artificial intelligence (AI) into dental imaging has led to significant advancements, particularly in the analysis of panoramic radiographs, also known as orthopantomograms (OPGs). One emerging application of AI is in determining gender from these radiographs, a task traditionally performed by forensic experts using manual methods. This systematic review and meta-analysis aim to evaluate the accuracy of AI algorithms in gender determination using OPGs, focusing on the reliability and potential clinical and forensic applications of these technologies. A systematic review and meta-analysis were conducted according to PRISMA guidelines. The study included research articles that utilised AI algorithms for gender detection based on OPG images. Five major databases were searched, and studies were selected based on strict inclusion and exclusion criteria. The analysis focused on studies that reported accuracy, sensitivity, and specificity of AI models. Statistical analyses were performed using R software, including forest plots and funnel plots, to evaluate the diagnostic performance and potential publication bias. The meta-analysis included 13 studies, yielding a pooled accuracy estimate of 88.66%. The results demonstrated high specificity among the AI models, with some studies achieving accuracy rates as high as 99.20%. However, there was variability in sensitivity across different studies, indicating that some models are more reliable than others depending on the dataset and features used. The funnel plot analysis suggested slight asymmetry, indicating potential publication bias or heterogeneity. AI models show significant potential in accurately determining gender from OPG images, with some models achieving near-perfect accuracy. Continued research is needed to enhance model consistency and expand the applicability of these tools across different demographic groups.

The Difference of RCB 0 and RCB I in Prognosis of Breast Cancer After Neoadjuvant Therapy: A Meta-Analysis

BACKGROUND

The use of the residual cancer burden (RCB) for assessing breast cancer after neoadjuvant therapy (NAT) is increasingly common, but the prognostic difference between RCB 0 and RCB I is unclear.

METHODS

We systematically reviewed literature from PubMed, Embase, Web of Science, and oncology conferences until September 24, 2023. We used fixed- and random-effects models to calculate hazard ratio (HR) with 95% confidence interval (CI) for event-free survival (EFS), overall survival (OS), and distant disease-free survival (DDFS).

RESULTS

Our meta-analysis, encompassing 19 studies with 5894 patients, revealed that in the general population, RCB I had worse EFS (HR = 2.13; 95% CI: 1.75-2.58), OS (HR = 2.08; 95% CI: 1.48-2.93), and DDFS (HR = 2.10; 95% CI: 1.65-2.67) than RCB 0. Consistent with results from the general population, RCB I exhibited poorer EFS, OS, and DDFS in human epidermal growth factor 2-positive (HER2+) subtype and triple-negative breast cancer (TNBC) compared to RCB 0. Conversely, luminal subtype with RCB 0 and RCB I showed similar EFS (HR = 1.04; 95% CI: 0.62-1.72).

CONCLUSIONS

RCB I experienced a poorer prognosis compared to RCB 0 in the general population, a pattern also observed in the HER2+ subtype and TNBC. However, no significant prognostic disparity was noted between RCB 0 and RCB I in the luminal subtype.

Herbivory by multiple arthropods does not hinder the attraction of natural enemies to plant volatiles: insights from a meta-analysis

Plants under herbivore attack emit herbivore-induced plant volatiles (HIPVs) that recruit natural enemies (NEs) of the herbivores for defense. The composition of HIPVs is often specific to the herbivore species, and infestation by multiple herbivore species produces a distinct volatile blend compared to single infestations, potentially influencing tritrophic interactions. Although two decades of research have investigated how multiple herbivory can affect chemically mediated tritrophic interactions, a comprehensive understanding on this topic remains elusive, as studies have shown varying results depending on the system examined. We performed a quantitative synthesis of 29 studies, extracting effect sizes from 94 experiments that assessed the olfactory preferences of NEs for HIPVs emitted from multiple-infested and single-infested plants. Our analysis revealed that multiple infestations do not affect the attractiveness of HIPVs to NEs, regardless of whether the plant is infested by nonhosts, hosts from different or the same feeding guild, the NE dietary specialization, or guild. However, specialist NEs prefer HIPVs emitted from plants with hosts even if they are infested by multiple herbivores over those infested by only a single nonhost herbivore. Our meta-analysis provides valuable insights into the complexity of chemically mediated tritrophic interactions, demonstrating that the coinfestation with nonhosts or multiple hosts do not affect attractiveness of HIPVs to NEs.

Potential therapeutic targets for ovarian hyperstimulation syndrome revealed by proteome-wide mendelian randomization and colocalization analysis

Ovarian hyperstimulation syndrome (OHSS) is a severe complication associated with assisted reproductive technologies, characterized by metabolic, immune and vascular disorders. Understanding the molecular mechanisms underlying OHSS could reveal potential therapeutic targets and improve patient outcomes. In this study, We aimed to utilize proteome-wide Mendelian randomization (MR) and colocalization analysis to identify plasma proteins associated with OHSS and evaluate their potential as therapeutic targets through druggability assessment. We employed proteome-wide MR analysis summary data-based Mendelian randomization (SMR) analysis and phenome-wide association study (PheWAS) analysis to establish causal relationships between plasma proteins and OHSS. Colocalization analysis confirmed overlaps between proteins and genetic signals associated with OHSS. Pathway and network analyses were conducted to explore biological functions and protein interactions, while drug-target databases were queried for potential therapeutic interventions. Our results showed that 4 key proteins, including Suprabasin (SBSN), SLAMF4 (CD244), Enolase 3 (ENO3) and Thioredoxin domain-containing protein 12 (TXNDC12) were identified as significant contributors to OHSS. Pathway enrichment and interaction analyses further supported their involvement in metabolic, immune and structural pathways related to OHSS. Drug availability for colocalized proteins reveled potential drug targets for ENO3 (2-deoxy-D-glucose), CD244 (lenalidomide) and TXNDC12 (Auranofin), while no potential drug targets were identified for SBSN. Over all, our study identified15 plasma proteins, including SBSN, CD244, ENO3, and TXNDC12, as key contributors to the risk of OHSS through MR and colocalization analysis. These proteins were involved in metabolic regulation, immune response and antioxidant pathways, highlighting potential therapeutic targets and suggesting new directions for treatment strategies.

Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials

INTRODUCTION

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.

METHODS

A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).

RESULTS

A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).

CONCLUSION

In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.

Efficacy and safety of cancer vaccine therapy in malignant melanoma: a systematic review

INTRODUCTION

Malignant melanoma is a cancer that develops from melanocytes in the skin and mucous membranes. Surgery, and chemotherapy, radiation therapy, or immunotherapy are also used in cases of distant metastasis. Immunotherapy includes immune checkpoint inhibitors and cancer vaccine therapy; however, their efficacy remains limited.

METHODS

A systematic review and meta-analysis of cancer vaccine therapies were conducted. PubMed was used to search the literature up to December 2023, and clinical trials were also identified for the same period. RCTs involving patients with resectable or unresectable malignant melanoma were included. The primary outcome was OS, and secondary outcomes were PFS, DFS, and RFS. Safety was assessed based on AEs. Integrated results were presented as risk ratio and risk difference.

RESULTS

The initial search identified 418 studies on cancer vaccine therapy and 44 studies on effector T-cell therapy. We supplemented this with our PubMed search, extracting 149 studies. After database searches and screening, 611 studies were initially considered. Following exclusions based on eligibility criteria, 20 RCTs using cancer vaccines remained. For the primary outcome, OS, the pooled RR was 1.11 (95% CI, 0.97-1.32, I2 = 59.0%), and the pooled RD was 0.02 (-0.01 to 0.06, I2 = 74.0%) at 12 months. PFS, DFS, and RFS did not show statistically significant differences, and AEs did not increase significantly.

CONCLUSION

Cancer vaccine therapy, neither alone, or in combination with other agents for malignant melanoma did not show a significant improvement in OS, PFS, DFS, or RFS nor did it significantly increase AEs.

Differences in activation amplitude between semitendinosus and biceps femoris during hamstring exercises: A systematic and critical review with meta-analysis

The aim of this systematic review and meta-analysis was to compare the amplitude of electromyographic (EMG) recordings for the semitendinosus (ST) and biceps femoris (BF) muscles during selected exercises. Searches were conducted in PubMed, Web of Science, and Scopus databases up to 31 August 2024. Included studies focused on healthy adults, reported ST and BF muscle activation during hamstring strengthening exercises, and presented outcomes as a percentage of maximal voluntary contraction. The analysis included 619 participants. No overall significant difference in activation was observed between ST and BF across knee- and hip-based exercises. However, EMG amplitude was greater in ST during the Nordic hamstring exercise (Standardized mean difference, SMD: -0.33, p = 0.01), whereas EMG amplitude was greater in BF during prone-lying curls (SMD: 0.94, p = 0.0076). Among hip-based exercises, EMG amplitude was greater in BF during back extensions (SMD: 0.34, p = 0.0092), whereas EMG amplitude was greater in ST during kettlebell swings (SMD: -0.59, p = 0.0007). Nonetheless, the variability in the methods used to record and analyze EMG as well as the properties of the signal itself make it difficult to reach firm conclusions on whether specific exercises can preferentially recruit ether ST or BF.

Efficacy of Biologics in Reducing Exacerbations Requiring Hospitalization or an Emergency Department Visit in Patients with Moderate or Severe, Uncontrolled Asthma

INTRODUCTION

Patients with moderate or severe, uncontrolled asthma are often prescribed biologic therapies to improve disease control and reduce asthma exacerbations. The efficacy of different biologics in reducing asthma exacerbations associated with hospitalization or an emergency department (ED) visit has varied across randomized controlled trials (RCTs). This study summarizes published US Food and Drug Administration-approved biologic efficacy data for exacerbations that required hospitalization or an ED visit in patients with moderate or severe, uncontrolled asthma.

METHODS

A PubMed literature search (24 May 2024) identified phase 2b/3 RCTs of omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, or tezepelumab. Annualized asthma exacerbation rate (AAER) ratios for exacerbations that required hospitalization or an ED visit, or hospitalization regardless of an ED visit, were extracted. A pooled efficacy estimate of the AAER ratio for exacerbations that required hospitalization or an ED visit across the RCTs was assessed using a meta-analysis based on a random effects model. The percentage of total variation across all included RCTs that was due to heterogeneity was calculated (I2).

RESULTS

Among 308 articles identified, nine publications describing 10 RCTs reported relevant AAER ratio data. No suitable omalizumab data were identified. In all trials, biologic treatment showed a reduction versus placebo in the AAER for exacerbations that required hospitalization or an ED visit, except in one of two benralizumab studies and both reslizumab studies. The pooled efficacy estimate showed a 56% reduction (95% CI 37-69) in the AAER for exacerbations requiring hospitalization or an ED visit (I2, 59.93%; p = 0.0075). One of three mepolizumab trials and both tezepelumab trials showed a reduction versus placebo in the AAER for exacerbations that required hospitalization regardless of an ED visit.

CONCLUSION

These findings suggest that there may be differential effects of biologics in reducing exacerbations that require hospitalization or an ED visit in patients with moderate or severe, uncontrolled asthma.

Scapular stabilization exercise on pain and functional recovery in people with shoulder impingement syndrome: a systematic review and meta-analysis

OBJECTIVE

To investigate the effects of scapular stabilization exercise training on pain and functional recovery in people with shoulder impingement syndrome. Design: A systematic review protocol was registered with PROSPERO. We systematically searched different databases. A random-effects model was used to determine the mean difference (MD) and 95% confidence interval (CI) for pain and functional recovery. Heterogeneity among studies was examined using the I2 statistic.

RESULTS

Fourteen studies (666 participants) were included in the analysis. Addition of scapular stabilization-based exercise training to general exercises reduce pain MD - 0.8 cm (95% CI, -1.07 to -0.4; I² = 0%) and improve the functional recovery and shoulder abduction range of motion MD -13.27 (95% CI, -16.85 to -9.69; I² = 5%) and MD 2.74 degrees (95% CI, 0.3 to 5.2; I² = 0%), respectively. However, the certainty of the evidence is low to very low. No significant differences in pain or functional recovery were found between participants in the scapular stabilization-based exercise training with the feedback group and those in the scapular stabilization-based exercise training without the feedback group.

CONCLUSION

Our findings are promising; however, higher quality RCT is needed to better establish the superiority of the rehabilitation programs that include scapular stabilization exercises.

Shifting reliance between the internal and external world: A meta-analysis on visual-working memory use

Visual working memory (VWM) is a fundamental cognitive capacity that allows us to temporarily hold visual information, but storage is effortful and content-fragile. Rather than loading VWM to the maximum, individuals usually rely on the external world and access information just in time. However, participants do rely on VWM more as access costs to external information increase. This phenomenon is commonly investigated with so-called copy tasks, which differ across paradigms, manipulations, and dependent variables. We here present findings of a meta-analysis into the reliability and consistency of shifts in the assumed trade-off between storing and sampling across manipulations and dependent variables, using data from 28 experiments. We found that all cost manipulations led to substantial shifts from external sampling to storage in VWM. Cost manipulations did not differ in their effect across studies even though such differences are reported within studies. All dependent variables were associated with clear but different strong effects. We argue that the differences observed between indicators are not only due to sensitivity differences but also due to differential aspects of behavior that are measured. New variables and techniques might now pave the way to understanding the trade-off between storing and sampling more in-depth. Collectively, our findings suggest that the reliance on VWM or the external world shifts consistently as access cost is increased, is largely irrespective of cost manipulations, and expresses itself reliably across dependent variables. With this work, we seek to help establish standards and comparability across this growing body of work.

Caution is necessary in interpreting musculoskeletal physiotherapy intervention outcomes: a methodological review of physiotherapy neuromusculoskeletal reviews

OBJECTIVES

The physiotherapy literature lacks high-quality, registered systematic reviews (SRs) and 'trustworthy' randomized controlled trials (RCTs). It is unknown whether considering quality and 'trustworthiness' impact publication bias, heterogeneity, and the certainty of clinical recommendations observed in the literature.

METHODS

We performed a methodological review of SRs investigating physiotherapy treatment of neuromusculoskeletal conditions indexed by MEDLINE, between 1 January 2018, and 25 October 2023. Blinded reviewers examined the prospective intent and quality of SRs and the 'trustworthiness' of RCTs included therein. Blinded reviewers extracted data for the variables of interest (Numeric Pain Rating Scale and Visual Analog Scale).

RESULTS

Of the SRs identified (N = 677), 13 were included in the final review. These included a total of 109 RCTs, including duplicates. Only eight of these trials were deemed 'trustworthy.' Publication bias was identified, and heterogeneity across the trials (N = 55) included in the quantitative analysis was high (I2 = 80.11%, 95% CI [75.88, 83.60]). Publication bias and heterogeneity were eliminated (I2 = 0%, 95% CI [0.00, 37.44]) upon considering those prospectively registered (N = 14). Statistical significance, assessed via the p-value at baseline (<.001), was eliminated (p = .746) once prospective, external, and internal validity was considered. Statistical inference through estimation, evaluated via effect size, confidence intervals, and minimal detectable change, was not present at baseline and reduced throughout the screening process.

DISCUSSION

Trials of musculoskeletal interventions to manage pain in patients with neuromusculoskeletal conditions lack certainty and confidence in their treatment effects and exhibit high heterogeneity. Statistically significant effects and heterogeneity are eliminated when considering 'trustworthy' quality evidence.

CONCLUSIONS

Consistent with previous findings, null effects, and low heterogeneity arise when considering the best available evidence. Meaningful effects are likely rare when assessed holistically using statistical inference through estimation and the confidence and certainty of the estimated effect.

The temporal stability of problematic gaming and gaming disorder: A systematic review and meta-analysis

Classifying problematic gaming/gaming disorder as a formal psychiatric diagnosis requires data on its level of temporal stability: are the dysfunctional symptoms transient or can they persist in the absence of treatment? To evaluate this question, we conducted a literature review and meta-analysis to investigate temporal stability in problematic gaming/gaming disorder. We identified 50 relevant longitudinal studies on PubMed, PsycINFO, and SCOPUS. Our review and meta-analysis engaged on two types of temporal stability: categorical stability and dimensional stability. We used MetaXL to run the meta-analysis for categorical stability. Our meta-analysis revealed that overall, the categorical stability rate was approximately 34-38% for the 2-year follow-up studies and approximately 43-45% for the 1-year follow-up studies. This indicates that between 1/3 and 1/2 of the gamers who initially met the threshold for problematic gaming/gaming disorder continued to meet such a threshold at follow-ups. Our meta-analysis included predominantly adolescent groups, which should be noted when generalizing the obtained categorical stability rates. Our review results also showed that overall, the dimensional stability was positive and statistically significant, indicating moderate or high correlations between symptom severity at baseline and at follow-ups. Temporal stability can be a complex concept. Our results suggest that although the categorical stability of problematic gaming/gaming disorder is not as strong as some major psychiatric disorders such as schizophrenia and bipolar disorder, it is similar to personality disorder and gambling disorder. Many complex factors may affect the temporal stability of problematic gaming/gaming disorder, possibly including severity of the disorder, whether the data is from clinical or nonclinical populations, and an individual's age group or developmental stage. More methodologically rigorous longitudinal studies that address these issues are needed.

Assessing the evidence for antibiotic management of laboratory-confirmed Streptococcus A skin infections to prevent acute rheumatic fever and rheumatic heart disease: a systematic review

Objectives

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are potential sequelae of untreated group A streptococcal (Strep A) infections. Guidelines focus on treating Strep A pharyngitis but seldom on skin infections. This systematic review explored whether directed antibiotic therapy for superficial Strep A skin infections prevents ARF/RHD.

Methods

We searched PubMed, Scopus, Cochrane Library, and clinical trial registries for published and ongoing trials measuring the eradication of Strep A and clinical resolution of polymicrobial infections with antibiotics through December 13, 2024. We calculated risk ratios and absolute risk differences, using the grading of recommendations, assessment, development, and evaluation (GRADE) to assess the certainty of evidence.

Results

No trials were reported on ARF/RHD outcomes. However, we identified 12 trials and pooled data comparing penicillin, cotrimoxazole, macrolides, and cephalosporins. There was probably no difference between interventions for eradicating Strep A (very low certainty evidence). For clinical resolution, cotrimoxazole was comparable to intramuscular benzathine benzylpenicillin and macrolides to penicillin (moderate certainty evidence). First- and second-generation cephalosporins showed no difference (low certainty evidence), whereas third-generation cephalosporins demonstrated improved clinical response (moderate certainty evidence). Benzathine benzylpenicillin-associated injection-site pain and oral antibiotic-associated gastrointestinal disorders were commonly reported.

Conclusions

The available evidence for directed treatment of Strep A skin infections to prevent ARF/RHD is uncertain, requiring further research, with consideration of antimicrobial resistance and the limited antibiotic pipeline.

Patient-Reported Outcome Measures Show No Relevant Change Between 1-Year and 2-Year Follow-Up After Treatment for Anterior Shoulder Instability: A Systematic Review

PURPOSE

To compare patient-reported outcome measures (PROMs) at 1-year and 2-year follow-up after treatment for anterior shoulder instability.

METHODS

Randomized controlled trials and prospective studies that evaluated and reported PROMs after a capsulolabral repair (with or without remplissage), bone augmentation, or nonoperative treatment to treat anterior shoulder instability at both 1-year and 2-year follow-up were included. PROMs were compared between 1-year and 2-year follow-up; forest plots with mean difference were created to compare baseline, 1-year, and 2-year follow-up; and scatterplots were created to visualize clinical improvement over time.

RESULTS

Fourteen studies, comprising 923 patients, with levels of evidence Level I and II were included. Nine PROMs, of which predominantly were the Western Ontario Shoulder Instability Index (WOSI; 11 studies; 79%), were evaluated. Minimal to no statistically significant change in WOSI, Oxford Shoulder Instability Score, American Shoulder and Elbow Surgeons (ASES), Subjective Shoulder Value, Simple Shoulder Test, Disabilities of Arm, Shoulder, and Hand (DASH), Quick DASH, Single Assessment Numeric Evaluation, or visual analog scale was observed between 1-year and 2-year follow-up. Pooling of the WOSI, Oxford Shoulder Instability Score, ASES, and Single Assessment Numeric Evaluation demonstrated improvement from baseline to 1-year follow-up and minimal to no change between 1-year and 2-year follow-up. Scatterplots of the WOSI and ASES demonstrated the most improvement within 6 months and no clear improvement after 1-year follow-up. Recurrence rates increased with time but varied between studies.

CONCLUSIONS

In contrast to recurrence rates, which have been shown to increase with time, minimal to no statistically significant change was observed for any of the included PROMs between 1-year and 2-year follow-up. This finding raises the question as to whether it is necessary to evaluate PROMs in long-term follow-up of patients after shoulder stabilization treatment.

LEVEL OF EVIDENCE

Level II, systematic review of Level I and II studies.

The Relationship Between Co-rumination and Depressive Symptoms: A Systematic Review and Meta-Analysis

Numerous studies have explored the link between co-rumination and depressive symptoms, but a consensus remains elusive. This study proposes a dual-pathway model to explain this relationship through a "positive path" (adaptive response) and a "negative path" (distress response). It also conducts a meta-analysis to evaluate the exact association between co-rumination and depressive symptoms in children, adolescents, and young adults. A total of 66 studies (27,794 participants) were included in the meta-analysis. In this study, the main effect test revealed a significant positive correlation between co-rumination and depressive symptoms (n = 70; r = 0.128; 95% CI = 0.106 to 0.150). Moreover, age was found to be a significant moderator. Specifically, the association between co-rumination and depressive symptoms was weaker in adolescents compared to undergraduates and adults. In addition, measure of co-rumination was identified as an important moderator, showing marginal significance. The association was stronger when using the original Co-Rumination Questionnaire compared to other versions and code methods. Finally, the relationship between co-rumination and depressive symptoms was not moderated by gender, measure of depressive symptoms, publication year, study quality, or simple size. The current study reveals the positive association between co-rumination and depressive symptoms while highlighting both the positive and negative trade-offs of co-rumination.

Effects of physical rehabilitation interventions on exercise performance, dyspnea, and health-related quality of life in acute and post-acute COVID-19 patients: Systematic review and meta-analysis

ObjectiveTo analyze the published randomized controlled trials (RCTs) that investigated the effects of physical rehabilitation interventions provided directly (face to face) and by telerehabilitation on exercise performance, dyspnea, and health-related quality of life (HRQoL) in acute and post-acute COVID-19 patients.MethodsFor this systematic review and meta-analysis, different electronic databases were searched up to January 2023. Mean difference (MD), (standardized mean difference (SMD) were calculated.Results34 studies (2214 patients) met the study criteria. Physical interventions may improve aerobic capacity in acute COVID-19 (SMD 1.7; 95% CI 0.37, 2.8) and in post-acute COVID-19 participants (MD 0.4; 95% CI 0.1, 07) compared to usual care for acute and pos-acute COVID-19 patients, respectively. Physical interventions may also improve dyspnea in acute (SMD -1.4; 95% CI -0.8, -0.01) and in post-acute COVID-19 participants (MD -0.4; 95% CI -0.7, -0.2) compared to usual care. Physical interventions may result in an improvement in HRQoL (physical domain) (SMD 0.6; 95% CI 0.3) in post-acute COVID-19 participants compared to usual care in pos-acute COVID-19 patients.DiscussionThe results support that physical rehabilitation interventions improve aerobic capacity and dyspnea in acute and post-COVID-19 patients. Moreover, physical interventions improve physical domain in HRQoL.

Comprehensive immunogenomic landscape analysis unveils CD33 + myeloid cell-driven immunomodulatory signatures in melanoma development

BACKGROUND

Understanding the causal relationships between immune cell populations and cancer development remains a critical challenge in tumor immunology.

METHODS

We employed Mendelian Randomization analysis leveraging genome-wide association studies of 612 immune cell traits and 91 cancer types to systematically evaluate causal associations. Single-cell RNA sequencing and computational deconvolution analyses were performed to characterize myeloid cell subpopulations in melanoma samples.

FINDINGS

Our analysis revealed significant relationships between specific immune cell subsets and cancer risk, particularly highlighting the role of CD33 + myeloid cells in melanoma pathogenesis. Single-cell RNA sequencing identified distinct CD33high myeloid subpopulations characterized by elevated expression of complement cascade components and chemokine signaling pathways. Through computational deconvolution of The Cancer Genome Atlas melanoma cohort, we demonstrated that elevated CD33high monocyte abundance correlates with increased immune dysfunction scores, reduced CD8 + T cell infiltration, and poor survival outcomes.

INTERPRETATION

Here we delineate the multifaceted mechanisms through which CD33 + myeloid cell populations orchestrate perturbations in the tumor-immune microenvironmental landscape, manifesting in compromised immunosurveillance and enhanced tumor progression. Our findings illuminate novel therapeutic opportunities through targeted modulation of myeloid cell function, while providing a systematic framework for understanding the complex interplay between immune cell populations and oncogenic processes.

Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis

The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.

A meta-analysis of healthy lifestyle interventions addressing quality of life of cancer survivors in the post treatment phase

PURPOSE

This study's primary aim was to investigate whether including a mental health component to healthy lifestyle interventions are associated with greater effects on quality of life (QoL) for post-treatment cancer survivors than addressing physical activity and/or nutrition alone.

METHODS

PsycINFO, Scopus, Medline, CINAHL, and Google Scholar were searched to identify randomised control trials of healthy lifestyle interventions for post-treatment cancer survivors, with a usual care or waitlist control, and measured QoL. Meta-analyses quantified the effects of interventions vs controls at post-treatment on total QoL, physical, emotional, and social well-being. Subgroup analyses compared interventions with vs without a mental health component, modes of delivery, and duration. The quality of the included studies was assessed using the Cochrane Risk of Bias 2.

RESULTS

Eighty-eight papers evaluating 110 interventions were included: 66 effect sizes were extracted for meta-analysis, and 22 papers were narratively synthesised. The pooled effect size demonstrated a small, significant effect of healthy lifestyle interventions in comparison to control for all QoL outcomes (total g = 0.32, p >.001; physical g = 0.19, p = 0.05; emotional g = 0.20, p >.001; social g = 0.18, p = 0.01). There was no significant difference between interventions with vs without a mental health component. Face-to-face delivered interventions were associated with greater total QoL and physical well-being compared to other modalities. Interventions delivered ≤12 weeks were associated with greater physical well-being than those delivered ≥13 weeks. Overall, studies had substantial levels of heterogeneity and 55.9% demonstrated high risk of bias.

CONCLUSIONS

Participating in a healthy lifestyle intervention following cancer treatment improves QoL. Few trials addressed mental health or evaluated online or telephone modalities; future research should develop and evaluate interventions that utilise these features.

IMPLICATIONS FOR CANCER SURVIVORS

Brief healthy lifestyle interventions can be recommended for cancer survivors, particularly those interested in improving physical well-being.

Risk Factors for Adverse Pregnancy Outcomes in Reduced Fetal Movement: An IPD Meta-Analysis

OBJECTIVE

Women experiencing reduced fetal movements (RFM) have an increased risk of adverse pregnancy outcomes (APO). This study aimed to identify factors most associated with APO in RFM pregnancies.

DESIGN

Individual participant data meta-analysis (IPD-MA).

SETTING

Multiple maternity units across the UK.

POPULATION OR SAMPLE

1175 singleton pregnancies with RFM between 28+0 and 41+0 weeks' gestation from four prospective cohorts and two randomised controlled trials (RCTs).

METHODS

Factors associated with APO were assessed using two-stage IPD-MA.

MAIN OUTCOME MEASURES

A composite adverse pregnancy outcome, including: adjusted Odds Ratio, stillbirth, fetal growth restriction (FGR, birthweight ≤ 3rd centile) and neonatal intensive care unit (NICU) admission.

MAIN RESULTS

APO occurred in 7.7% of RFM pregnancies, with FGR being the most common complication (4.6%). The strongest associations with APO were observed for abnormal fetal heart rate (adjusted Odds Ratio (aOR) = 3.65, 95% CI: 1.84-7.23), cigarette smoking (aOR = 2.96, 95% CI: 1.36-6.44) and maternal past medical history (aOR = 2.35, 95% CI: 1.14-4.82). Lower estimated fetal weight (EFW) centile was also significantly associated with APO (aOR = 0.97, 95% CI: 0.95-0.99), though substantial heterogeneity was present between studies (I2 = 80.74%, Q-statistic: p < 0.001).

CONCLUSIONS

IPD-MA enabled the synthesis of individual-level data across studies, allowing for more accurate and reliable associations by accounting for heterogeneity. Further work is required to investigate the model's generalisability across diverse populations.

Efficacy and Safety of Acupuncture for Tourette Syndrome in Children: A Meta-Analysis and Systematic Review

Despite the widespread use of acupuncture, its effectiveness and safety in treating Tourette syndrome (TS) remain controversial. Our research seeks to further evaluate the safety and effectiveness of acupuncture as a replacement therapy approach for children with TS. We conducted a comprehensive search for studies published from their inception to October 2023. The statistical analysis and subgroup analysis were conducted by software. Conduct a meta-analysis on the extracted data using the appropriate effect models. The meta-analysis was conducted on 26 studies consisting 1862 pediatric patients, which were selected from 976 identified articles. Acupuncture group demonstrated a significantly lower risk with a risk ratio (RR) of 0.29 (95% confidence interval [CI] = 0.19, 0.44, P < .0001), with only 5% of participants experiencing adverse reactions. Acupuncture treatment resulted in an 18% improvement in total effectiveness rates (RR = 1.18, 95% CI = [1.12, 1.25], P < .00001). The pooled data demonstrated that acupuncture therapy had a significant advantage in reducing the total score with the weighted mean difference (WMD) -4.92 (95% CI = [-6.38, -3.45], P < .00001) of the Yale Global Tic Severity Scale (YGTSS), the motor tic scores (WMD = -2.24, 95% CI = [-3.14, -1.35], P < .00001), the vocal tic scores (WMD: -2.34, 95% CI = [-3.31, -1.37], P < .00001), and the Traditional Chinese Medicine Syndrome Scores (TCMSS) (WMD: -2.47, 95% CI = [-2.87, -2.07], P < .0001). This meta-analysis reveals that acupuncture is more effective than most existing treatments in mitigating the symptoms of motor and vocal tics in children with TS, while also reducing the incidence of adverse reactions.

The prevalence of posttraumatic stress disorder symptomatology and diagnosis in burn survivors: a systematic review and meta-analysis

Great disparity is observed among studies investigating the prevalence of PTSD after burns. This systematic review and meta-analysis aimed to explore the pooled prevalence of PTSD in adult burn survivors over the first two years post-burn. Five electronic databases were searched for observational studies assessing the prevalence of PTSD symptoms after burns. Meta-analysis was performed using an auto-correlation and hierarchical effects model to estimate the course of PTSD prevalence rates over time and to establish point-prevalences. The effect of different moderators over time was tested with meta-regression. Thirty-two studies were included in the meta-analysis. The overall pooled prevalence of PTSD was 20.5% (95% CI 16.4-24.6) and the prevalence significantly decreased by about 0.37% per month post-burn over time. Questionnaire-based studies, and studies published from 2000 onwards, were more likely to show a decrease in PTSD prevalence over time compared to diagnostic studies and studies before 2000. A qualitative comparison revealed that inter-continental differences are likely to be complex and multi-factorial. PTSD affects about one in five burn survivors, with moderately decreasing rates from six months post-burn onwards. Early screening and identification of burn survivors who require specialist psychological care are vital for burns services.

Efficacy of dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis

BACKGROUND

Patients with irritable bowel syndrome (IBS) are often interested in dietary interventions as a means of managing their symptoms. However, the relative efficacy of available diets for the management of IBS is unclear. We aimed to examine the relative efficacy of various dietary interventions in IBS.

METHODS

For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials from database inception to Feb 7, 2025, to identify randomised controlled trials comparing an active dietary intervention requiring changes to the intake of more than one food in IBS with either a control intervention, such as a habitual diet, sham diet, a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, or alternative miscellaneous dietary advice, or any other active dietary intervention requiring changes to the intake of more than one food. We assessed efficacy using dichotomous assessments of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. We pooled data using a random-effects model, with the efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked interventions according to their P-score, which measures the mean extent of certainty that one intervention is better than another, averaged over all competing interventions.

FINDINGS

We identified 28 eligible randomised controlled trials (comprising 2338 patients) of 11 different dietary interventions compared with four control interventions, of which six (low FODMAP diet, British Dietetic Association/National Institute for Health and Care Excellence [BDA/NICE] diet, lactose-reduced diet, starch-reduced and sucrose-reduced diet, a personalised diet, and a Mediterranean diet) were studied in more than one trial. For global IBS symptoms, assessed in 28 randomised controlled trials and when considering only the dietary interventions studied in more than one trial, a starch-reduced and sucrose-reduced diet ranked first (RR of global IBS symptoms not improving 0·41 [95% CI 0·26-0·67]; P-score 0·84; two trials), a low FODMAP diet ranked fourth (0·51 [0·37-0·70]; P-score 0·71; 24 trials), and a BDA/NICE diet ranked tenth (0·62 [0·43-0·90]; P-score 0·44; eight trials), versus a habitual diet. For abdominal pain, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised controlled trial, a starch-reduced and sucrose-reduced diet ranked second (RR of abdominal pain not improving 0·54 [95% CI 0·33-0·90]; P-score 0·73; two trials), and a low FODMAP diet ranked fifth (0·61 [0·42-0·89]; P-score 0·64; 23 trials), versus a habitual diet. For abdominal bloating or distension, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised trial, only a low FODMAP diet (RR of abdominal bloating or distension not improving 0·55 [95% CI 0·37-0·80]; P-score 0·64; 23 trials) was superior to a habitual diet and ranked fourth. For bowel habit, assessed in 23 randomised trials, none of the dietary interventions was superior to any of the control interventions, but a low FODMAP diet was superior to a BDA/NICE diet (RR of bowel habit not improving 0·79 [95% CI 0·63-0·99]). All comparisons across the network were rated as low or very low confidence, except for direct comparisons between a low FODMAP diet or a starch-reduced and sucrose-reduced diet and habitual diet, both of which were rated as moderate confidence.

INTERPRETATION

In terms of dietary interventions for IBS, the most evidence exists for a low FODMAP diet, but other promising therapies are emerging and should be the subject of further study.

FUNDING

None.

Risk Prediction Models for Sarcopenia in Patients Undergoing Maintenance Haemodialysis: A Systematic Review and Meta-Analysis

BACKGROUND

The number of risk prediction models for sarcopenia in patients undergoing maintenance haemodialysis (MHD) is increasing. However, the quality, applicability, and reporting adherence of these models in clinical practice and future research remain unknown.

OBJECTIVE

To systematically review published studies on risk prediction models for sarcopenia in patients undergoing MHD.

DESIGN

Systematic review and meta-analysis of observational studies.

METHODS

This systematic review adhered to the PRISMA guidelines. Search relevant domestic and international databases, which were searched from the inception of the databases until November 2023. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist was used to extract data. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to assess the risk of bias and applicability. The Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) was used to assess the reporting adherence.

RESULTS

A total of 478 articles were retrieved, and 12 prediction models from 11 articles were included after the screening process. The incidence of sarcopenia in patients undergoing MHD was 16.38%-37.29%. The reported area under the curve (AUC) ranged from 0.73 to 0.955. All studies had a high risk of bias, mainly because of inappropriate data sources and poor reporting in the field of analysis. The combined AUC value of the six validation models was 0.91 (95% confidence interval: 0.87-0.94), indicating that the model had a high discrimination.

CONCLUSION

Although the included studies reported to some extent the discrimination of predictive models for sarcopenia in patients undergoing MHD, all studies were assessed to have a high risk of bias according to the PROBAST checklist, following the reporting guidelines outlined in the TRIPOD statement, and adherence was incomplete in all studies.

REGISTRATION NUMBER

CRD42023476067.

Exercise interventions for health outcomes in children with autism spectrum disorder: An umbrella review of meta-analyses of clinical trials

Exercise interventions have gained widespread acceptance due to their cost-effectiveness, ease of implementation, and low incidence of negative effects. However, the overall effects of exercise interventions on the health outcomes of children with autism are not evaluated systematically. To evaluate the effect of exercise interventions on behavioral, motorial, and psychosocial health outcomes in autistic children, as well as to determine the quality of evidence for each outcome. We conducted an umbrella review of meta-analyses investigating the associations between exercise interventions and health outcomes in autistic children from inception to November 27, 2024. Following exercise interventions, maladaptive behavior [standardized mean difference (SMD): -0.73; 95 % confidence interval (95 % CI): -0.71, -0.03] showed a substantial improvement. However, no discernible impact on stereotyped behavior (SMD: 0.09; 95 % CI: -0.30, 0.48) was observed. Sensitivity analysis revealed that all overall effect sizes indicated statistically significant differences, even though the reanalysis of meta-analyses showed no significant effectiveness of exercise interventions on social communication (SMD: -0.09; 95 % CI: -0.61, 0.43), social skill (SMD = -0.22; 95 % CI: -0.99, 0.54), social function (SMD = 2.64; 95 % CI: -0.10, 5.39), and motor skills (SMD: 0.71; 95 % CI: -0.97, 2.39). Exercise interventions are suggested to improve maladaptive behaviors and may help with social communication, social skills, social function, and motor skills. The evidence for the effectiveness of exercise interventions in reducing stereotyped behaviors is weak, but it still merits investigation. We need more carefully planned randomized controlled studies.

Genetic polymorphisms on temporomandibular disorders: Network meta-analysis

OBJECTIVE

The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the effects of different genetic polymorphisms on the susceptibility of temporomandibular disorders (TMDs) occurrence.

DESIGN

The central question formulated was: "Are genetic polymorphisms involved in the etiology of TMDs?" Following PROSPERO registration (CRD42024507886), electronic searches were conducted in five databases for publications up to November 2024.

RESULTS

Sixty-three studies were included in the systematic review and 7 composed the NMA. The qualitative analysis summarized the association between 120 genes (and 206 polymorphisms) and TMDs. Thirty-two polymorphisms (in 24 genes) were linked to overall TMDs, while 22 polymorphisms (in 22 genes) with degenerative bone changes in the temporomandibular joint (TMJ). Additionally, 17 polymorphisms were identified in cases of painful chronic TMD, while 12 polymorphisms in intra-articular disorders. These polymorphisms were in genes related to neurotransmission (COMT, ADRB2, DRD2, ANKK1, SLC6A4 and HTR2A), inflammatory mediators (TNFα, IL10 and MMP1), sex hormones (ESR1and ESRRB), oxidative stress (GSTM1) and bone metabolism (VDR). A protective effect for myalgia occurrence with the COMT_rs165774 polymorphism compared to the wild-type genotype was found in the pairwise meta-analysis (AG genotype: OR: 0.33; 95 %CI: 0.14, 0.76; p < 0.01 and GG genotype: OR: 0.32; 95 %CI: 0.14, 0.74; p < 0.01) and this polymorphism showed the highest probability of being associated with the myalgia (97 %) and arthralgia (93 %) conditions.

CONCLUSIONS

Genetic polymorphisms in genes related to neurotransmission, inflammatory response, and sex hormones seem to be risk factors related to the TMDs pathogenesis.

Efficacy of telemedicine-based antimicrobial stewardship program to combat antimicrobial resistance: A systematic review and meta-analysis

IntroductionAntimicrobial resistance (AMR) is a major public health threat. Improving antimicrobial use is the main strategy against AMR, but it is challenging to implement especially in low-resource settings. Thus, this review aims to explore the efficacy of telehealth-based antimicrobial stewardship programs (ASP), which is more accessible.MethodsRegistered to PROSPERO and following PRISMA guidelines, literature search was performed in databases including PubMed, Scopus, Cochrane, Science Direct, EBSCOhost, EMBASE, and Google Scholar, searching for studies implementing telehealth ASP. Critical appraisal of studies was performed using Newcastle-Ottawa Scale for Cohort Studies (NOS), Cochrane Risk-of-Bias tool (RoB) 2.0, and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I). We utilized inverse variance, random effects model to obtain the pooled odds ratio (OR) and mean difference (MD) estimates, as well as sensitivity and subgroup analysis.Results and DiscussionThe search yielded 14 studies. Telehealth-based ASP was associated with better adherence to guidelines (pooled OR: 2.78 [95%CI:1.29-5.99], p = 0.009; I2 = 93%), within which streamlining yielded better odds (pooled OR: 30.54 [95%CI:10.42-89.52], p < 0.001) more than the compliance with policy subgroup (pooled OR: 1.60 [95%CI:1.02-2.51], p = 0.04). The odds of antimicrobial prescription rate reduced significantly (pooled OR: 0.60 [95%CI:0.42-0.85], p = 0.005; I2 = 94%), especially for the lower respiratory infection subgroup (pooled OR: 0.37 [95%CI:0.28-0.49], p < 0.001). Days of therapy decreased (pooled MD: -47.12 [95%CI: -85.78- -8.46], p = 0.02; I2 = 100%), with the greatest effect in acute care settings (pooled MD: -97.73 [95%CI:-147.48-47.97], p = 0.0001). Mortality did not change significantly (pooled OR: 1.20 [95%CI:0.69-2.10], p = 0.52; I2 = 63%).ConclusionTelehealth-based ASP was proven beneficial to increase adherence to guideline and reduce prescription rates, without significantly affecting patient clinical outcome. After further studies, we recommend more widespread use of telemedicine to combat AMR.

Comparing fondaparinux and low molecular weight heparin for thromboprophylaxis after hip and knee arthroplasty: a systematic review and meta-analysis

Venous thromboembolism (VTE) remains a significant cause of perioperative morbidity and mortality despite the availability of prophylactic medications. There has been a debate about which thromboprophylaxis medication, Fondaparinux or low-molecular weight heparin (LMWH), is better after hip and knee arthroplasty. We have compared these two treatment regimens in our study. Electronic databases like PubMed, Cochrane, and ScienceDirect were searched from inception to August 2024. The weighted mean difference (WMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were pooled using the Review Manager software version 5.4.1, and a random effects model was employed. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool (ROB 2.0) were used to assess the quality of the included studies. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression. GRADE assessment was used to analyze the certainty of evidence. A total of 17 studies, 9 Cohorts, and 8 Randomized controlled trials (RCTs) pooling a total of 74 499 patients were included in this meta-analysis. Fondaparinux showed a statistically significant reduction in the risk of VTE [0.59; 95% confidence interval (CI): [0.48, 0.71]; P  < 0.00001; I2  = 36%] and deep venous thrombosis (DVT) (RR = 0.75, 95% CI: [0.56, 1.00]; P  = 0.05; I2  = 68%) compared to LMWH. Major bleeding (RR = 2.06, 95% CI: [1.19, 3.57]; P  = 0.01; I2  = 43%), surgical site bleeding (RR = 1.67, 95% CI: [1.04, 2.66]; P  = 0.03; I2  = 9%), and postoperative transfusions (RR = 1.07, 95% CI: [1.02, 1.12]; P  = 0.004; I2  = 0%) were significantly higher in the Fondaparinux group. Symptomatic VTE, pulmonary embolism, mortality, and operating time showed no significant difference between the two groups. In conclusion, Fondaparinux is superior to LMWH in VTE and DVT prophylaxis. However, it is associated with an increased risk of major bleeding, surgical site bleeding, and postoperative transfusions.

Successful aging rates of global older adults: A subgroup meta-analysis

OBJECTIVE

The aim of this study was to assess the successful aging (SA) rates of individuals aged 60 and above in different subgroups based on gender, age, region, etc., in order to provide a scientific basis for improving the quality of life of the older adults.

SETTING AND PARTICIPANTS

Older adults (≥60 years).

METHODS

A systematic review was conducted by searching six electronic databases including PubMed, Embase, CINAHL, Web of Science, SCOPUS, and PsycINFO as of July 17, 2023. Quality assessment, screening, data extraction, and analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. A total of 64 studies involving 546 228 individuals aged 60 and above were included, and subgroup analyses were conducted based on sex, age, region, study time, and study quality. Statistical analyses were conducted using Revman 5.3 and Stata 11.0.

RESULTS

The SA rate was higher in males (26.0 %, 95 % CI 22.0 %-30.0 %) compared to females (19.0 %, 95 % CI 16.0 %-22.0 %). The SA rates in older adults in the 60-69 (36.0 %), 70-79 (30.0 %), and 80+ (19.0 %) age groups showed a decreasing trend. In regional subgroup analysis, SA rates were higher in North America (30.0 %) and South America (26.0 %), and lower in Asia (19.0 %), Africa (17.0 %), Oceania (16.0 %) and Europe (15.0 %). The SA rate before 2010 (26.0 %) was higher than that 2010 and after (22.0 %). Compared to low quality studies (18.0 %), high quality studies (27.0 %) had a higher SA rate.

CONCLUSIONS AND IMPLICATIONS

The study found that males had a higher SA rate than females, and the SA rate decreased with age. There were regional differences in SA rates. Variations in economic and educational levels among different countries may affect the likelihood of achieving SA in the older population. Measures are recommended to improve the living conditions of older adults with low education and economic status.

Mortality and hospitalization in contaminated sites with petrochemical and steel plants: a meta-regression ecological study

BACKGROUND

Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population.

METHODS

Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013-2017) and hospitalization (2014-2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMRpooled/SHRpooled) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0-1, 0-19, 20-29 years). All the analyses were performed separately for the two groups of CSs, and by sex.

RESULTS

In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMRpooled=1.11 (CI90% 1.00-1.23) and SHRpooled=1.18 (0.99-1.40) and among females SMRpooled=1.13 (1.03-1.25) and SHRpooled=1.20 (1.05-1.38), while in the S group, SMRpooled=1.17 (1.02-1.34) and SHRpooled=1.27 (0.87-1.86) among males and SMRpooled=1.21 (0.93-1.59) and SHRpooled=1.19 (0.91-1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20-29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0-1-year age-subgroup.

CONCLUSIONS

The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.

Central line-associated bloodstream infections in children: a systematic review and meta-analysis

Background

Central line-associated bloodstream infection (CLABSI) in pediatric patients poses significant clinical challenges, with prevention strategies heavily reliant on identifying modifiable risk factors. Despite numerous studies investigating these risk factors, heterogeneity in study designs, populations, and regional settings necessitates a systematic synthesis of evidence to guide clinical practice. This meta-analysis aims to consolidate existing data and quantify key risk factors for pediatric CLABSI.

Methods

A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for observational studies (cohort and case-control) published up to April 1, 2024. Two independent reviewers screened studies, extracted data, and assessed quality using the MOOSE checklist for observational meta-analyses. Meta-analyses were performed using Stata 15.0 software, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) calculated via random-effects models. Heterogeneity was evaluated with I2 statistics.

Results

Seventeen studies (17 cohort studies) involving 15,221 pediatric patients were included. Significant risk factors for CLABSI were: blood transfusions (OR =5.69; 95% CI: 2.93-11.05), congenital diseases (OR =2.58; 95% CI: 1.14-5.83), central nervous system (CNS) diseases (OR =4.13; 95% CI: 1.17-9.98), total parenteral nutrition (OR =4.37; 95% CI: 1.14-16.82), multiple catheters (OR =4.16; 95% CI: 2.36-7.31), prolonged catheterization time (OR =1.19; 95% CI: 1.08-1.30). Subgroup analyses confirmed consistency across regions and study types (I2<50% for most factors).

Conclusions

This meta-analysis identifies blood transfusions, congenital/CNS comorbidities, parenteral nutrition, and catheter-related practices as critical modifiable risk factors for pediatric CLABSI. Clinicians should prioritize early catheter removal, judicious blood product use, and intensified monitoring for high-risk patients. These findings align with existing guidelines but provide stronger evidence for pediatric-specific protocols.

A systematic review and meta-analysis of the relationship between genes and reflexive attention

Defined as the semi-autonomous orientation to either a moving or rapidly appearing stimulus, reflexive attention (RA) is a crucial process for humans. While there are multiple outcomes used to assess RA, their relationships have not been tested. Disruptions in RA often relate to neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder or autism spectrum disorder, so RA might be moderated by age. Additionally, the current academic consensus is that multiple genes influence RA, but this has not been assessed in a meta-analysis. A better understanding of RA using previously collected data will allow us to improve the design of future research studies.

Methods

In accordance with PRISMA, we conducted a broad search for potentially relevant articles pertaining to genes associated with RA. Selected studies included those (1) published in English, (2) involving human participants, and (3) referencing specific genetic markers in association with a measure of RA. For subgroup comparisons, we analyzed 14 studies assessing children and 23 assessing adults. We also compared 18 dopamine-related to 19 non-dopamine related studies.

Results

The main analysis produced a non-significant overall effect size; however, our most interesting finding was that results varied by age group. We explore this as well as difference by outcome type and the relation of the gene studied to dopamine.

Conclusion

Our findings vary by age group. However, due to heterogeneity we recommend more studies to answer some questions about a broader range of neurotransmitters, to include younger age groups, and to clarify difference by outcome type. We discuss issues of relevance to researchers to guide future meta-analyses.

Systematic review registration

Prospero: International prospective register of systematic reviews. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD42018090220.

Death of backcountry winter-sports practitioners in avalanches - A systematic review and meta-analysis of proportion of causes of avalanche death

This study estimates the proportions of the three major causes of avalanche death globally, and reviews potential factors influencing the proportions of causes of avalanche-related deaths (PCAD). By searching databases and consulting experts, we retrieved studies and registries in multiple languages, which examined PCAD. As a result, we retrieved 1,415 reports and included 37 for the study (22 for meta-analysis). We performed a meta-analysis to estimate pooled proportions. Between-study heterogeneity was assessed jointly by [Formula: see text] and 95% prediction interval of pooled estimates. PCAD by trauma and asphyxia are 29% (95%CI 21-39%) and 82% (95%CI 72-88%), after the year of 2000. PCAD by hypothermia is 2% (95%CI 1-4%), estimated with studies having sufficient sample size. Time periods (before or after 2000), data representativeness (national subgroup), forensic procedures, and sample size explained between-study variation for proportions to a considerable extent. Factors influencing PCAD, that were either available or not available for quantitative synthesis, were summarized in a narrative systematic review (37 studies). In conclusion, we re-affirm asphyxia as the predominant cause of avalanche death, followed by trauma, and then hypothermia. Patterns of PCAD by trauma and asphyxia varied more after the year of 2000. A sample size > 75 is needed to estimate the proportion of hypothermia. PCAD discrepancies are lower in the data representing fatalities from a country than from regions. Without proper forensic diagnosis procedure, PCAD by trauma can be over-estimated. Under-reporting of forensic diagnostic criteria is an important bottleneck to the reliability of evidence in the field. Evidence on the role of other influencing factors to PCAD such as fatalities' expertise and usage of mitigation gear is anecdotal and warrants further research. The results of meta-analysis build upon synthesizing and summarizing studies with moderate to high risk of bias and should be interpreted with caution.

Transdiagnostic psychological interventions for emotional disorders: A comprehensive meta-analysis

Previous meta-analyses have integrated evidence on the effects of transdiagnostic interventions for depression and anxiety symptoms. Nevertheless, no recent study covers all types of transdiagnostic interventions administered through a wide range of delivery formats, and targeting participants with different emotional disorders (i.e., mixed samples with different anxiety disorders or mixed depression/anxiety symptomatology). We used the most recent available searches (1st January 2024) of the Metapsy meta-analytic project of randomized trials on psychotherapy for depression and anxiety to identify studies comparing an intervention targeting at least two emotional disorders with a control group (waitlist, usual care, other non-active control). We conducted random-effects meta-analyses of 94 trials (108 comparisons between a psychotherapy and a control group) with 12,443 patients (who have at least a principal diagnosis of anxiety and/or unipolar depressive disorder, or a score above a cut-off point on an anxiety or depression validated self-report scale), to examine the effects on depression and anxiety symptomatology at post-treatment. The overall effect size of the pooled outcomes of depression and anxiety was g = 0.59 (95 % CI 0.50-0.68), with high heterogeneity (I2 = 78.88; 95 % CI 74.8-82.3) and a broad prediction interval (-0.18-1.37). The effects remained comparable after a series of sensitivity analyses, including multilevel analyses, exclusion of outliers, adjustment for risk of bias, and adjustment for publication bias. The results were also comparable for depression and anxiety symptoms when considered separately (effect sizes ranged from g = 0.54 to 0.61). However, when considering the impact on anxiety symptoms in studies focusing exclusively on participants with several anxiety disorders, the effects were somewhat larger (g = 0.87). A significantly higher risk of study dropout was found in the intervention conditions compared to the control groups. Transdiagnostic interventions are probably effective at post-treatment for adults with depression and/or anxiety.

Residential exposure to municipal solid waste incinerators and health effects: a systematic review with meta-analysis

BACKGROUND

Municipal solid waste incinerators (MSWIs) are widely used for waste management. However, the health effects of their emissions remain uncertain, needing further investigation and monitoring of the potential risks associated with such exposure. The aim of this study is to update and synthesize evidence on the health effects of residential exposure to MSWIs.

METHODS

A systematic review with meta-analysis was conducted following PRISMA guidelines. The systematic search in MEDLINE, EMBASE, and Web of Science (April 2025), using specific search strategies, identified observational studies reporting quantitative estimates on the association between long term residential exposure to MSWIs and health outcomes. Study quality was assessed using the Navigation Guide tool. A narrative synthesis was conducted for all outcomes. When possible, a random-effects meta-analysis was performed and Higgins I2 was used to summarize heterogeneity. For the overall body of evidence, heatmaps were used to visually represent the direction of the associations (positive, negative or lack of association) stratified by study quality.

RESULTS

Out of 3,273 records identified, 51 studies were included. The most frequently investigated outcomes were congenital anomalies, pregnancy outcomes, cardiovascular and respiratory diseases, and cancers. The narrative synthesis suggests a weak association for hospitalizations due to cardiovascular and respiratory diseases in high-quality studies and a potential increased risk for non-Hodgkin lymphoma, based on low-quality evidence. The meta-analysis confirms a slight increased risk for respiratory diseases (HR 1.02; 95% CI 0.94-1.11), particularly for COPD (HR 1.08; 95% CI 0.82-1.41) and asthma (HR 1.02; 95% CI 1.00-1.05). Moderate heterogeneity was observed for most outcomes (I2 = 30%-60%).

CONCLUSIONS

This review highlights the current uncertainty surrounding the long-term health effects of MSWI exposure. While a slight indication of increased risk emerged for cardiovascular and respiratory hospitalizations, and a weak association with non-Hodgkin's lymphoma was observed, overall evidence remains weak. Methodological limitations, heterogeneity across studies, and low exposure levels complicate risk assessment and comparability. Standardized, high-quality research is needed to clarify these associations and support evidence-based public health decisions and transparent communication with affected communities.

TRIAL REGISTRATION

The protocol of this review was registered in PROSPERO on 02/06/2024 (CRD42024550168).

Factors contributing to bracing success in juvenile idiopathic scoliosis and current limitations : a systematic review and meta-analysis

Aims

There is a general lack of guidelines on nonoperative treatment in juvenile idiopathic scoliosis (JIS). This review aims to explore factors determining bracing success in JIS and to identify limitations in current literature.

Methods

A literature search was conducted according to the PRISMA 2020 guidelines. Data extraction focused on the factors affecting bracing success, including pre-brace curve magnitude in Cobb angle, curve type, pre-brace rib vertebral angle difference, in-brace correction, brace type, brace-wear compliance, the time of brace initiation, and bracing duration. Bracing success is defined as 1) avoidance of corrective surgical intervention (curve exceeding 45° at maturity) and/or 2) major curve Cobb angle of < 5° progression at maturity. Meta-analysis was performed for individual factors.

Results

After initial and full-text screening, 16 articles were included in the review. Pooled odds ratio (OR) from eight studies and 560 patients using the threshold of Cobb angle of 30° revealed that patients with pre-brace curve < 30° were associated with bracing success (odds ratio (OR) 3.58; 95% CI 2.26 to 5.65; p < 0.001; I2 = 0.08). Major thoracic curves were associated with reduced likelihood of bracing success compared to thoracolumbar/lumbar curves (OR 0.49; 95% CI 0.28 to 0.86; p = 0.010; I2 = 0.35). Full-time compliance was significantly associated with bracing success (OR 5.22; 95% CI 2.24 to 12.19; p < 0.001; I2 = 0.76).

Conclusion

This review identified that a pre-brace major Cobb angle < 30° and full-time compliance of at least 18 to 20 hours/day are prognostic factors favourable for bracing success, while presence of thoracic curves is prognostic for unfavourable brace outcome. Longer bracing duration does not translate to a higher success rate. Clinicians should devise more efforts to modify patient compliance in order to achieve optimal brace outcomes. The general lack of high-quality evidence and heterogeneity of results in existing studies indicates the need for further rigorous research on JIS.

Pharmacotherapy options for the management of subjective tinnitus: a systematic review and network meta-analysis

OBJECTIVES

This study aims to compare the outcomes of different pharmacotherapies for subjective tinnitus patients using a comprehensive network meta-analysis.

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

PubMed, EMBASE, Web of Science and CINAHL Complete databases were searched from inception until 6 March 2025.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) comparing pharmacotherapy treatment effects for subjective tinnitus patients were included with tinnitus severity as the primary outcome, and annoyance and tinnitus loudness as secondary outcomes.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently retrieved and screened full articles using a standardised and prepiloted Excel form. Network meta-analysis was conducted with heterogeneity, study risk of bias (ROB), risk of publication bias and certainty of evidence examined using I2, τ2, ROB2, funnel plots and Grading of Recommendations, Assessment, Development, and Evaluation assessments.

RESULTS

Sixty full-text RCTs from 21 countries were included in the analysis with 22% low ROB, 58% some concerns and 20% high ROB. The heterogeneity parameter I2 was 0.67 (95% CI 0.33 to 0.84), 0 (95% CI 0 to 0.9) and 0.63 (95% CI 0 to 0.89) for the severity, annoyance and loudness network analysis, respectively. The only significant publication bias assessment by Egger's test was detected in the loudness network analysis (p<0.05). Ginkgo biloba with vitamin (standardised mean differences (SMD): -3.11, 95% CI (-4.15 to -2.06)), acamprosate (SMD: -0.88, 95% CI (-1.81 to -0.04)) and fluoxetine (SMD: -3.28, 95% CI (-4.23 to -2.34)) ranked first in severity, annoyance and loudness, respectively, compared with placebo. There are three significant inconsistent comparisons observed in the severity network and ranked with very low certainty of evidence by GRADE assessment.

CONCLUSIONS

This meta-analysis found that antioxidant supplementation, such as Ginkgo biloba, and vitamins and gamma-aminobutyric acid agonists, represented by acamprosate, could be promising treatments for subjective tinnitus. Further trials with rigorous design and larger sample sizes are necessary to supplement the current evidence.

TRIAL REGISTRATION NUMBER

INPLASY202480066.

Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis

Background/Objectives: Inverted sinonasal papilloma (IP) is a benign epithelial proliferation that can recur and undergo malignant transformation. We performed a systematic review and meta-analysis to answer the following question: what are the risk factors for malignant transformation in IP? Methods: A search was performed in PubMed and Embase databases. Numbers of affected individuals in exposed versus non-exposed individuals, or odds ratio values, were compared for each specific risk factor examined. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. To assess the overall quality of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were conducted using the fixed-effects and the random effects models. Heterogeneity of the results was assessed by I2 statistic output. Meta-analyses and forest plots were obtained using Review Manager (RevMan) software version 5.4. Results: After examining 1875 results (942 from PubMed; 933 from Embase), 26 articles were selected. Among the 26 selected articles, the number of cases examined ranged from 14 to 162. All studies examined a population of 1271 IPs, with a carcinoma incidence of 230/1271 (18.1%). Three meta-analyses were performed for the following risk factors: smoking, alcohol, and HPV. Using the fixed-effects model, significant values were obtained for smoking (p = 0.002) and HPV (p < 0.001), with moderate and low quality of evidence, respectively. Alcohol did not reach statistical significance (p = 0.95). Conclusions: This study demonstrates that both smoking and HPV are risk factors for IP malignant transformation. Possible interventions include smoking cessation and HPV vaccination in individuals affected by IP.

The Association Between Fast Food Consumption and Inflammatory Bowel Disease: A Case-Control Study and Meta-Analysis

Background: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic conditions influenced by various factors, including diet. This study examined the association between fast food consumption and IBD risk through a case-control study and a meta-analysis of epidemiological evidence. Methods: We analyzed data from a hospital-based case-control study conducted in Riyadh. The study included 158 UC patients, 244 CD patients, and 395 controls without IBD. Fast food consumption was assessed using a self-administered questionnaire distributed before diagnoses were made. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) of UC and CD for individuals who reported daily fast food consumption. Then, we merged our results with those from other studies investigating the same association into a meta-analysis. Results: In the case-control study, daily consumption of fast food was strongly associated with UC and CD among Saudi people: age- and sex-adjusted ORs (95% CIs) = 6.29 (3.89, 10.16) and 5.92 (3.98, 8.80), respectively. The associations remained robust after further adjustments: ORs (95% CIs) = 6.61 (3.93, 11.12) and 5.90 (3.89, 8.94), respectively. Similarly, the meta-analysis revealed higher odds of fast food intake associated with UC and CD, with pooled odds ratios (95% CIs) of 2.41 (1.07, 5.45) and 2.65 (1.23, 5.70), respectively. Conclusions: Our findings highlight the potential role of fast food consumption in the development of IBD. From a preventive medicine perspective, fast food consumption should be discouraged to reduce the risk of IBD.

Efficacy and safety of three-dimensional printing technology assisted open reduction and internal fixation versus conventional surgery in the treatment of acetabular fractures: a meta-analysis of randomized controlled trials

PURPOSE

The objective of this meta-analysis was to assess the influence of three-dimensional (3D) printing technology on open reduction and internal fixation (ORIF) of acetabular fractures from current randomized controlled trials (RCTs).

METHODS

A structured meta-analysis was conducted, and we searched online databases for published RCTs related to 3D printing and acetabular fracture, including PubMed, Cochrane Library, ScienceDirect, Wan fang, and CNKI up to November 2024. The outcome data of intraoperative blood loss, operation time, hip function (Harris score), quality of fracture reduction (Matta score) and incidence of complications were extracted. Stata16.0 and RevMan5.3 were used for our meta-analysis.

RESULTS

19 RCTs met our inclusion criteria and a total of 1046 patients were included in this meta-analysis. The meta-analysis showed significant difference in intraoperative blood loss (WMD = -274.65, 95% CI [-326.47, -222.83]), operation time (WMD = -53.26, 95% CI [-63.72, -42.80]), intraoperative fluoroscopy (WMD = -5.24, 95% CI [-6.57, -3.91]), instrumentation time (WMD = -35.31, 95% CI [-53.42, -17.21]), and post-surgery Matta score (RR = 1.17, 95% CI [1.09, 1.25]), incidence rate of complications (RR = 0.34, 95%CI [0.22, 0.52]). There is no significant difference in time from injury to operation (WMD=-0.06, 95%CI [-0.36, 0.24]) and Harris score (RR = 1.22, 95%CI [0.83, 1.79]) between two groups.

CONCLUSION

3D printing group showed reduced intraoperative blood loss, shorter operation time, faster instrumentation, less intraoperative fluoroscopy, better post-surgery reduction, and reduced incidence rate of complications. Therefore, based on existing research, ORIF guided by 3D printing technology should be a more effective method for treating acetabular fractures.

Retention in HIV care among Southeast Asian people living with HIV: A systematic review and meta-analysis

Background

Despite the effectiveness of antiretroviral therapy (ART) in reducing HIV-related morbidity and mortality, the retention of HIV care remains suboptimal in Southeast Asia.

Objective

This systematic review and meta-analysis aimed to investigate the coverage of retention in care and the likelihood factors for retention in HIV care among Southeast Asian people living with HIV, to inform targeted interventions and policy improvements.

Methods

Following the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines, this study included observational studies reporting factors associated with retention in HIV care among Southeast Asian adults, with searches conducted in PubMed, Scopus, Cochrane Library, and CINAHL up to July 15, 2024. Demographic and clinical factors were analyzed using a random-effects model with the generalized linear mixed-effect model (GLLM) to estimate proportion and the DerSimonian-Laird method to estimate odds ratios (OR) with 95% confidence intervals (CI), assessing heterogeneity using the I² statistic.

Results

Among the eleven studies with 46,480 pooled participants analyzed, the coverage of retention in care revealed a pooled proportion of 75.2% (95% CI: 66.7-82.1). Significant clinical factors associated with a higher likelihood of retention included high CD4 count (≥200 cells/mm³) (OR 2.17 (95%CI: 1.19-3.97, p = 0.01), WHO stage 3-4 (OR 2.06, 95%CI: 1.09-3.87, p = 0.02), not being on ART (OR 6.88, 95%CI: 1.89-25.06, p = 0.001), hemoglobin levels ≥10 g/dL (OR 0.50, 95% CI: 0.25-0.99, p = 0.04), and demographic factors of employment (OR 1.18, 95% CI: 1.02-1.38; p = 0.03). Other clinical factors, such as HIV stage, TB co-infection, drug abuse/substance use, and hemoglobin levels, did not significantly affect the likelihood of retention. Similarly, demographic factors such as age, gender, education, marital status, and geographic setting also showed no significant impact on likelihood retention.

Conclusion

Retention in care among Southeast Asian people living with HIV was still below 95%. Clinical factors, particularly high CD4 counts, WHO stage, and the absence of ART, were likelihood factors for retention in HIV care, whereas other clinical and demographic factors studied did not show a significant impact. A universal test and treatment strategy is required to improve retention in care.

The effects of sodium-glucose cotransporter-2 inhibitors in chemotherapy-induced cardiotoxicity and mortality in patients with cancer: a systematic review and meta-analysis

BACKGROUND

The effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on reducing cardiovascular events in different subgroups of diabetic patients are under investigation. The current systematic review and meta-analysis investigated the effects of SGLT2 inhibitors on preventing cardiovascular events and mortality and their adverse events in patients with active cancer and diabetes undergoing cardiotoxic cancer treatment.

METHODS

We searched PubMed, Embase, Web of Science, and Scopus to find studies investigating the effects of SGLT2 inhibitors on patients with diabetes and confirmed cancer until 19 August 2024. Meta-analyses were conducted using the random-effects model to compare all-cause mortality, cancer-associated mortality, heart failure (HF) hospitalization, arrhythmia, and adverse event rates such as ketoacidosis, hypoglycemia, urinary tract infection, and sepsis between patients with or without SGLT2 inhibitors use. Risk ratios (RRs) with 95% confidence intervals (CI) were used to compare outcomes between SGLT2 inhibitors and non-SGLT2 inhibitors groups.

RESULTS

Eleven studies were included with 88,096 patients with confirmed cancer (49% male). Among the total population, 20,538 received SGLT2 inhibitors (age 61.68 ± 10.71), while 67,558 did not receive SGLT2 inhibitors (age 68.24 ± 9.48). The meta-analysis found that the patients who received SGLT2 inhibitors had a significantly lower mortality rate than those who did not receive SGLT2 inhibitors (RR 0.46, 95% CI 0.34 to 0.63, p-value < 0.0001). Similarly, the cancer-associated mortality rate was also lower (RR 0.29, 95% CI 0.27 to 0.30, p-value < 0.0001). Further analysis found that the SGLT2 inhibitor group had a lower rate of HF hospitalization, compared to controls (RR 0.44, 95% CI 0.27 to 0.70, p-value = 0.0007). Moreover, patients receiving SGLT2 inhibitors had a statistically lower rate of arrhythmia (RR 0.38, 95% CI 0.26 to 0.56, p-value < 0.0001). Finally, patients in the SGLT2 inhibitors group had a lower rate of adverse events (RR 0.51, 95% CI 0.42 to 0.62, p-value < 0.0001).

CONCLUSIONS

SGLT2 inhibitors are effective in reducing mortality (all-cause and cancer-associated), HF hospitalization, arrhythmia, and drug adverse events in patients with cancer. If confirmed in future studies, these agents could be a potentially ideal candidate to prevent cardiotoxicity of cancer therapies.

Effectiveness of health education in improving treatment adherence among patients with chronic communicable diseases: A systematic review and meta-analysis

INTRODUCTION

Chronic communicable diseases, such as tuberculosis, HIV, hepatitis B, and hepatitis C, remain major global health challenges. Effective treatment adherence is crucial for improving patient outcomes and health education plays a key role in enhancing adherence. However, evidence for the most effective educational interventions remains limited.

OBJECTIVE

This study aimed to evaluate the effectiveness of health education interventions in improving treatment adherence among patients with chronic communicable diseases.

METHODS

A systematic review and meta-analysis were conducted following the preferred item for systematic review and meta-analysis (PRISMA) guidelines. Comprehensive searches were performed in PubMed, CINAHL, Scopus, and the Web of Science for studies published between 2015 and 2024. Eligible studies included randomised controlled trials. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. Statistical analysis was performed using the Mantel-Haenszel method to estimate odds ratios (OR) and standardised mean differences (SMD) with 95% confidence intervals (CI) using a random effects model. Meta-regression was conducted to explore potential sources of heterogeneity.

RESULTS

Seventeen studies involving 4,157 participants were included. Health education interventions significantly improved treatment adherence compared to usual care (OR 2.42; 95% CI: 1.58-3.72; p <0.0001). Subgroup analyses showed the highest effectiveness in remote-based interventions (OR 5.65; 95% CI: 2.37-13.47), among patients with tuberculosis (OR 6.52; 95% CI: 3.59-11.84), and in upper-middle-income countries (OR 4.54; 95% CI: 1.54-13.39). Meta-regression indicated that younger participant age and intervention type were significant moderators, with media-based and remote-based showing greater effectiveness.

CONCLUSION

Health education interventions significantly improve treatment adherence among patients with chronic communicable diseases, particularly those with tuberculosis and hepatitis C. Remote-based models, such as mHealth platforms and digital reminders, demonstrate the highest effectiveness, especially in low- and middle-income countries where stigma and limited healthcare access remain key barriers.

Post-incident debriefing for people with schizophrenia after coercive measures

BACKGROUND

Schizophrenia and schizophrenia-type psychosis, severe mental illnesses globally impacting millions, present a dual challenge with their characteristic positive and negative symptoms, economic burdens, and heightened susceptibility to coercive measures. These measures, including seclusion and restraint, raise ethical concerns despite their intent to ensure safety, particularly during acute stages marked by violent behaviour. Addressing this backdrop, the significance of post-incident debriefing as an intervention to curtail the use and duration of coercive measures and alleviate the negative psychological effects of using these methods in managing individuals with schizophrenia is underscored. The employment of coercive measures, such as physical restraint and seclusion, to manage aggressive behaviour in psychiatric settings necessitates a thorough examination of their ethical implications and potential psychological harm. Although post-incident debriefing is recommended, the limited evidence supporting its efficacy and concerns about its impact on psychological well-being prompt a comprehensive analysis of existing literature.

OBJECTIVES

To investigate the effects of post-incident debriefing after coercive measures for people with schizophrenia or schizophrenia-type psychosis.

SEARCH METHODS

The Information Specialist conducted searches of the Cochrane Schizophrenia Specialised Register (compiled from searches of CENTRAL, MEDLINE, Embase, PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, WHO ICTRP, ISRCTN, ProQuest Dissertations and Theses A&I) on 28 February 2023. We also inspected the references of all identified studies.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) of post-incident debriefing after coercive measures in adult psychiatric care with participants diagnosed with schizophrenia or schizophrenia-type psychosis, encompassing various clinical states and stages. We considered studies if the post-incident debriefing was the only intervention randomised.

DATA COLLECTION AND ANALYSIS

At least two authors inspected the citations, selected studies, extracted data and conducted quality appraisal. We calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous outcomes. We assessed study risk of bias and used the GRADE approach to create a summary of findings table.

MAIN RESULTS

We included one study; the total number of participants randomised was 422, of which 109 participated. Participants were between 18 and 65 years old with psychotic disorder, at the acute stage of their illness, and had experienced at least one coercive measure during their hospital stay. The study included a standardised post-coercion review that was conducted until the discharge of the participant. For the primary outcome, we found that there may be an increased risk of being secluded again for those receiving post-incident debriefing compared to treatment as usual, but the evidence is very uncertain (RR 1.32, 95% CI 0.74 to 2.33; 1 study, 109 participants; very low-certainty evidence). No evidence was found that post-incident debriefing had an effect in reducing peritraumatic distress (MD -1.62, 95% CI -7.47 to 4.23; 1 study, 82 participants; very low-certainty evidence) or increasing satisfaction with care (perceived coercion: MD -0.37, 95% CI -1.59 to 0.85; 1 study, 109 participants; coercion experience: MD -1.61, 95% CI -13.36 to 10.14; 1 study, 109 participants; very low-certainty evidence) compared to treatment as usual. The evidence is very uncertain about the effect of post-incident debriefing on these outcomes. No usable data were available for change in patient behaviour or adverse effects.

AUTHORS' CONCLUSIONS

Considering the available evidence, it is not possible to arrive at definitive conclusions that post-incident debriefing after coercive measures is effective for people with schizophrenia or schizophrenia-type psychosis. Further high-quality studies are warranted to evaluate the effects of post-incident debriefing in psychiatric inpatient care.

Safety and efficacy of rebamipide compared to artificial tears for the treatment of dry eye: a systematic review and meta-analysis

BACKGROUND

Rebamipide (RBM) is a novel drug that increases mucin secretion on the ocular surface. Nevertheless, the therapeutic efficacy of topical RBM for dry eye disease (DED) treatment remains inconclusive. Accordingly, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of RBM for DED treatment.

METHODS

We searched the PubMed, Embase, and Cochrane Library databases for eligible RCTs. The primary outcome was posttreatment changes in tear breakup time (TBUT). We also assessed changes in the values of Schirmer's test (Sch), corneal fluorescein staining scores, and DED-related symptom scores.

RESULTS

We retrieved 12 RCTs with 1368 eyes published during 2012-2023. The results demonstrated that compared with artificial tears, 2% RBM significantly increased the TBUT [standard mean difference (SMD) = 1.42, 95% confidence interval (CI) = 0.20 to 2.64]. Moreover, 2% RBM led to more significant improvements in overall DED-related symptom scores than did artificial tears (SMD = - 1.61, 95% CI = - 2.61 to - 0.61). The differences in the adverse events between the 2% RBM and artificial tears groups were nonsignificant (SMD = 1.23, 95% CI = 0.62 to 2.44).

CONCLUSION

Topical RBM ophthalmic suspension is a safe and effective treatment for DED patients. Compared to artificial tears, 2% RBM improved TBUT and subjective symptoms of DED. It may be considered as the first-line treatment option for short- TBUT dry eye patients.

The Incidence and Risk Factors for Medical Adhesive-Related Skin Injury in Cancer Patients in China: A Systematic Review and Meta-Analysis

To explore the incidence and risk factors for medical adhesive-related skin injury (MARSI) in cancer patients in China, and to provide a basic framework for approaches designed to reduce the occurrence of MARSI and improve the management of its risk factors. PubMed, Web of Science, The Cochrane Library, EmBase, CNKI, VIP, Wanfang, and CBM were searched from database inception to October 2024. The Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale were used to assess the quality of the included studies, and a random-effects model with Stata 15.0 software was utilized for calculating the pooled incidence and risk factor for MARSI in cancer patients. A total of 18 studies were included, with 11,393 patients. Meta-analysis showed that the pooled incidence of MARSI in Chinese cancer patients was 24%. In subgroup analyses, dermatitis demonstrated the highest incidence rate (10%). MARSI history, allergy history, dressing type (3M), puncture site (upper arm), gender (female), BMI > 25 kg/m2, moist skin, and age (≥ 50 years) were risk factors for MARSI in cancer patients. The incidence of MARSI in Chinese cancer patients is high, and MARSI history, allergy history, dressing type (3M), puncture site, gender (female), BMI > 25 kg/m2, moist skin, and age (≥ 50 years) were risk factors for the occurrence of MARSI in Chinese cancer patients, suggesting that early identification and protection of high-risk patients, and timely targeted preventive measures are important to reduce the incidence of MARSI in cancer patients.

Personality traits in people with multiple sclerosis: A systematic review and meta-analysis

Objective: Although numerous studies have investigated personality traits in people with multiple sclerosis (PwMS), a thorough systematic review and meta-analysis of this evidence has not been conducted. This review aimed to elucidate the personality profile of PwMS relative to healthy controls (HCs) and to assess the overall correlations between personality traits and mood, cognitive performances, fatigue, and physical function in PwMS. Methods: PubMed/MEDLINE, Scopus, Embase, and Web of Sciences were systematically searched up to 18 August 2024, to identify studies (1) comparing personality traits, including Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness, between PwMS and HCs or (2) assessing the correlation between personality traits, anxiety, depression, cognition, fatigue, and physical function in PwMS. The pooled standardized mean differences (SMDs) or correlations were estimated. Results: Sixty-three studies on 8068 PwMS and 1588 HCs were included. PwMS exhibited different personality traits, notably higher Neuroticism, compared to HCs. Furthermore, Neuroticism showed the most significant pooled correlations with mood and fatigue, while Conscientiousness demonstrated the greatest pooled correlations with disability and cognitive performance in PwMS. The meta-analysis confirmed these findings, revealing that PwMS have higher Neuroticism (SMD = 0.35) than HCs. Additionally, higher Neuroticism was significantly linked to increased anxiety (r = 0.78), depression (r = 0.53), and fatigue (r = 0.35), and Conscientiousness was significantly correlated with decreased Expanded Disability Status Scale (EDSS) (r = -0.21) and Symbol Digit Modalities Test (SDMT) (r = 0.13). Conclusions: PwMS exhibited distinct personality traits compared to healthy individuals. Additionally, personality traits, particularly Neuroticism and Conscientiousness, had relationships with mood, cognitive performance, fatigue, and physical function of PwMS.