Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Systematic Review and Meta-Analysis of Thermal Stress Assessment in Poultry Using Infrared Thermography in Specific Body Areas

Thermal stress is a health and welfare concern in the poultry industry. Poultry have specific thermoregulation strategies for heat stress (i.e., vasodilatation) or cold stress (i.e., vasoconstriction). Infrared thermal (IRT) analysis is a non-invasive temperature assessment technology with significant benefits compared to conventional temperature measurements, which are invasive and time-consuming. However, a wide range of IRT methodologies and equipment are used for temperature assessment in poultry. The aim of this study was to perform a systematic review and meta-analysis of IRT applications in poultry undergoing thermal stress. The bibliographic search yielded 17 records for qualitative synthesis and 10 for quantitative analysis. The results showed IRT is more commonly studied during heat stress than cold stress, and more research is being conducted on laying hens than other poultry species. Also, four body areas (parts of the head, body, face, and leg) were identified as common areas of interest for body surface temperature measurement. There is a clear thermoregulation response to thermal stress in poultry, with marked differences between featherless and feather-covered areas. IRT in poultry undergoing thermal stress has a good diagnostic value and represents an important welfare assessment tool for future research, particularly when combined with other welfare assessment methods.

Neurocognitive effects of proanthocyanidin in Alzheimer's disease: a systematic review of preclinical evidence

Cognitive disorders and dementia largely influence individual independence and orientation. Based on the Alzheimer's Disease International (ADI) estimation, approximately 75% of individuals with dementia are undiagnosed. In fact, in some low- and middle-income countries, the percentage is as high as 90%. In this systematic review, which is based on PRISMA guidelines, we aim to identify the mechanism of action of proanthocyanidin. Finding a natural product alternative as a potential nootropic can help increase the number of armamentariums against dementia and other cognitive impairments. In this preclinical research, we determined the effect of proanthocyanidins on Alzheimer's disease (AD) by searching electronic bibliographic databases like Scopus, Proquest, ScienceDirect, PubMed, and Google. There was no imposed time limit. However, the search was limited to only English articles. The review protocol is registered on PROSPERO as CRD42022356301. A population, intervention, control, and outcomes (PICO) technique was utilized for report inclusion, and all reports were assessed for risk of bias by using the SYRCLE's RoB tool. The article's bibliographic information, induction model, type of proanthocyanidins, animal strain/weight/age, and outcome measurements were acquired from ten papers and are reported here. Further analysis was validated and determined for the review. The included studies met the review's inclusion criteria and suggested that proanthocyanidins have a neurocognitive effect against AD. Additionally, the effectiveness of proanthocyanidins in reducing oxidative stress, acetylcholinesterase activity, amyloid beta, its efficacy in alleviating superoxide dismutase, cognitive properties, and in facilitating cholinergic transmission in various models of AD has been collectively observed in ten studies.

Incidence and relative risk of delirium after major surgery for patients with pre-operative depression: a systematic review and meta-analysis

BACKGROUND

Delirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients.

METHODS

We conducted a systematic review and meta-analysis of studies reporting the incidence or relative risk (or relative odds) of delirium in the immediate postoperative period for adults with pre-operative depression. We included studies that defined depression as either a formal pre-existing diagnosis or having clinically important depressive symptoms measured using a patient-reported instrument before surgery. Multilevel random effects meta-analyses were used to estimate the pooled incidences and pooled relative risks. We also conducted subgroup analyses by various study-level characteristics to identify important moderators of pooled estimates.

RESULTS

Forty-two studies (n = 4,664,051) from five continents were included. The pooled incidence of postoperative delirium for patients with pre-operative depression was 29% (95%CI 17-43%, I2 = 99.0%), compared with 15% (95%CI 6-28%, I2 = 99.8%) in patients without pre-operative depression and 21% (95% CI 11-33%, I2 = 99.8%) in the cohorts overall. For patients with pre-operative depression, the risk of delirium was 1.91 times greater (95%CI 1.68-2.17, I2 = 42.0%) compared with patients without pre-operative depression.

CONCLUSIONS

Patients with a previous diagnosis of depression or clinically important depressive symptoms before surgery have substantially greater risk of experiencing delirium after surgery. Clinicians and patients should be informed of these increased risks. Robust screening and other risk mitigation strategies for postoperative delirium are warranted, especially for patients with pre-operative depression.

Voice and Behavior of Children and Adolescents With Obesity: Integrative Literature Review

PURPOSE

To verify the relationship between obesity, voice and behavior in childhood and adolescence, through an integrative review.

METHODS

The researchers surveyed the articles indexed in the following databases: Embase, Web of Science, Scopus and Pubmed, using uniterms found in the Medical Subject Headings, related to the subject of the study, combined by the Boolean operators "and" and "or", published until January 2022. In the end, three reviewers selected the articles.

RESULTS

When searching for studies related to voice, obesity and behavior, 62 articles were found that did not meet the selection criteria and were excluded. Given this result, new searches were carried out with the following crossing strategies: voice and obesity and; Voice, Behavior and Child Behavior Checklist (CBCL). After the evaluation of the reviewers, two articles were selected referring to the intersection "voice and obesity in children and adolescents" and, two studies, in the intersection between "voice, behavior and CBCL". The first study on voice and obesity showed that the greater the abdominal circumference, the greater the maximum expiratory force and sound pressure found. The second study showed high Jitter and NHR values in obese children. Furthermore, studies on voice, behavior and CBCL showed that children with vocal nodules were more sociable than children without vocal nodules, and had behaviors described as "screams a lot" and "teases a lot". On the other hand, another study found potential risks of behavioral changes in the face of vocal complaints.

CONCLUSIONS

Although this literature review did not find studies associating obesity with vocal and behavioral disorders, the literature found showed the presence of vocal alteration in some acoustic parameters in obese children. Regarding voice, behavior and CBCL, two studies were found reporting the presence of behavioral changes in children with voice-related complaints, according to the opinion of their parents.

The Effects of Cognitive Remediation on Negative Symptoms in Schizophrenia-Spectrum Illness: A Meta-analytic Investigation of Efficacy

BACKGROUND AND HYPOTHESIS

The number of clinical efficacy trials of Cognitive Remediation (CR), a behavioral intervention consisting of cognitive task practice and/or strategy training to improve cognitive skills in schizophrenia, has increased substantially over the past 25 years. While recent reviews have highlighted the effects of CR on cognition and function, CR effects on negative symptoms remain understudied. Given the overlap between negative symptoms and cognition, CR effects might be expected.

STUDY DESIGN

Electronic databases were evaluated up to September 2023 using a broad range of search terms. Sixty-nine unique, controlled trials that used negative symptoms as an outcome were meta-analyzed. Data were independently extracted with excellent (>98%) reliability. Random effects models assessed the effects of CR on summary and expressive vs. experiential negative symptoms. Moderator analyses evaluated a broad array of treatment and participant factors.

STUDY RESULTS

The meta-analysis (5319 participants) revealed that CR produced a small effect size improvement on summary negative symptoms (Hedge's g = 0.179). Sample differences in age, duration of illness, symptoms, and antipsychotic dosage did not serve as a barrier to treatment benefit. CR also produced small-to-moderate improvements in alogia (Hedge's g = 0.312) but not experiential negative symptoms. Programs of CR that utilized bridging activities that relate training of cognitive skills to activities of daily living produced greater improvement in negative symptoms (g = 0.281 vs 0.055). Longer CR programs also produce larger effects on negative symptoms.

CONCLUSIONS

CR produces small, consistent reductions in negative symptoms in people with schizophrenia. Variations in CR effects may be linked to different treatment ingredients.

Sarcopenia is a prognostic factor in lymphoma patients: a systematic review and meta-analysis

Findings regarding the relationship between sarcopenia and lymphoma have been inconsistent across studies. This study investigated the association between sarcopenia and lymphoma. We systematically searched the Embase, Science Direct, Cochrane Library, and PubMed databases from inception to 31 March 2024 to identify relevant studies. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Twenty-six studies with 3659 participants were included. Sarcopenic lymphoma patients had poor overall survival (OS) (HR = 1.88; 95% CI: 1.47-2.41; p < 0.001). The heterogeneity was high (I2=80%). However, the result of the Egger test indicated a significant publication bias (p < 0.001). After employing the trim and fill method to adjust for this bias, the HR of OS became non-significant (p > 0.05). The progression-free survival (PFS) was worse in sarcopenic patients (HR = 1.77; 95% CI: 1.37-2.29; p < 0.001; I2=70%). There was no significant publication bias (p > 0.05). In the subgroup analyses, sarcopenia was a negative predictor of OS in lymphoma patients who undergo hematopoietic cell transplantation (HCT) (HR  = 1.61;95% CI: 1.19-2.18; I2=30%). Male lymphoma patients with sarcopenia had a significantly worse OS (HR = 2.29; 95% CI:1.24-4.24; p = 0.009). Among patients with primary central nervous system lymphoma (PCNSL), those with sarcopenia defined by temporal muscle thickness (TMT) exhibited significantly worse OS (HR = 2.20; 95% CI:1.04-4.65; p = 0.039; I2=68%). Sarcopenia is associated with worse PFS in lymphoma patients. Subgroup analyses indicate that sarcopenia is a negative predictor of OS after HCT, and male lymphoma patients who suffer from sarcopenia have higher mortality. Sarcopenia defined by TMT is also a negative predictor of OS for patients with PCNSL.

A Guide to the Implementation and Design of Ex Vivo Perfusion Machines for Vascularized Composite Allotransplantation

Background

Ex vivo machine perfusion (EVMP) is a versatile platform utilized in vascularized composite allotransplantation (VCA) to prolong preservation, salvage tissue, and evaluate graft viability. However, there is no consensus on best practices for VCA. This article discusses the common components, modifications, and considerations necessary for a successful VCA perfusion.

Methods

A systematic literature review was performed in several databases (PubMed, Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov) to identify articles published on VCA EVMP (face, limb, abdominal wall, uterus, penis, and free flaps) before August 2022. Graft type and animal model, general perfusion parameters, core components of the circuit, and optional components for enhanced monitoring were extracted from the articles.

Results

A total of 1370 articles were screened, and 46 articles met inclusion criteria. Most articles (84.8%) were published in the last 10 years. Pigs were the main model used, but 10 protocols used human grafts. Free flaps were the most common graft type (41.3%), then upper extremities/forelimbs (28.3%), uteruses (17.4%), and hindlimbs (13.0%). Postperfusion replantation occurred in 15.2% of studies. Normothermic perfusion predominated (54.1%), followed by hypothermic (24.3%), and subnormothermic (21.6%). The majority of studies (87.0%) oxygenated their systems, most commonly with carbogen.

Conclusions

EVMP is a rapidly growing area of research. Leveraging EVMP in VCA can optimize VCA procedures and allow for expansion into replantation, flap salvage, and other areas of plastic surgery. Currently, VCA EVMP is achieved through a variety of approaches, but standardization is necessary to advance this technology and attain clinical translation.

Preterm birth in singleton pregnancies conceived by in vitro fertilization or intracytoplasmic sperm injection: an overview of systematic reviews

BACKGROUND

The rate of preterm birth of singletons conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is increased, being as high as 15% to 16% across Europe and the United States. However, the underlying etiology, phenotype, and mechanisms initiating preterm birth (PTB) are poorly understood.

OBJECTIVE

To quantify the PTB risk and examine supposed etiology in IVF/ICSI singleton pregnancies compared to naturally conceived.

STUDY DESIGN

Overview of reviews including all available systematic reviews with meta-analysis comparing PTB risk in IVF/ICSI and naturally conceived singletons. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases was performed up to December 31, 2023. Information available on etiology, phenotype, initiation of PTB, and relevant moderators was retrieved and employed for subgroup analyses. Random-effects meta-analysis models were used for pooling effect measures. Estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The extent of overlap in the original studies was measured using the corrected covered area assessment. The quality of the included reviews was evaluated with the AMSTAR 2 tool. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to rate evidence certainty. The protocol was registered on PROspective Register of Systematic Reviews (CRD42023411418).

RESULTS

Twelve meta-analyses (16,522,917 pregnancies; ˃433,330 IVF/ICSI) were included. IVF/ICSI singletons showed a significantly higher PTB risk compared to natural conception (PTB ˂37 weeks: OR: 1.72, 95% CI: 1.57-1.89; PTB<32 weeks: OR: 2.19, 95% CI: 1.82-2.64). Influential analysis reinforced the strength of this association. Subgroup analyses investigating supposed etiology revealed a comparable risk magnitude for spontaneous PTB (OR: 1.79, 95% CI: 1.56-2.04) and a greater risk for iatrogenic PTB (OR: 2.28, 95% CI: 1.72-3.02). PTB risk was consistent in the subgroup of conventional IVF (OR: 1.95, 95% CI: 1.76-2.15) and higher in the subgroup of fresh only (OR: 1.79, 95% CI: 1.55-2.07) vs frozen-thawed embryo transfers (OR: 1.39, 95% CI: 1.34-1.43). There was minimal study overlap (13%). The certainty of the evidence was graded as low to very low.

CONCLUSION

Singletons conceived through IVF/ICSI have a 2-fold increased risk of PTB compared to natural conception, despite the low certainty of the evidence. There is paucity of available data on PTB etiology, phenotype, or initiation. The greater risk increase is observed in fresh embryo transfers and involves iatrogenic PTB and PTB ˂32 weeks, likely attributable to placental etiology. Future studies should collect data on PTB etiology, phenotype, and initiation. IVF/ICSI pregnancies should undertake specialistic care with early screening for placental disorders, cervical length, and growth abnormalities, allowing appropriate timely follow-up, preventive measures, and therapeutic interventions strategies.

A systematic review of herbicide safener toxicity

Herbicide safeners are agrochemicals added to herbicide formulations to protect crops from herbicide damage without reducing the effectiveness of the herbicide against weeds. While safeners are typically structurally similar to their co-formulated herbicides, they are classified as "inert" in the United States, meaning they are not held to the same regulatory standards as the herbicides. This review systematically examines the toxicity of safeners, which is important given their large-scale global use and potential for exposure to wildlife, livestock, and humans. A systematic review of peer-reviewed literature identified only seven studies examining safener toxicity. Regulatory toxicity data, compiled from the European Chemicals Agency (ECHA) database, included data for 9 of the 18 commercial safeners. Most safeners have low acute ecotoxicity and mammalian toxicity; however, chronic effects and the underlying mechanism are less clear. Benoxacor showed enantioselective metabolism and depletion by drug-metabolizing enzymes. In conclusion, despite the widespread use of safeners, significant knowledge gaps exist regarding their toxicity. More research is needed to fully characterize the potential risks of safeners to human health and the environment. Regulatory agencies should consider reclassifying safeners as active ingredients to ensure adequate toxicity testing and risk assessment.

Assisted reproductive technology outcomes in women with congenital uterine anomalies: a systematic review

PURPOSE

The present systematic review aimed to assess the fecundity of women with congenital uterine anomalies (CUAs) undergoing assisted reproductive technology (ART).

METHODS

The present systematic review of the literature was reported according to the PRISMA guidelines. We systematically searched PubMed, MEDLINE, Embase and Scopus, from database inception to 17th October 2023. Studies were deemed eligible only if they included women with CUAs clearly fitting into one of the categories of the ASRM Müllerian anomalies classification 2021.

RESULTS

Data relevant to the reproductive outcomes of women with CUAs who underwent ART were extracted from 55 studies. Regarding Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, studies on gestational surrogacy reported a live birth rate (LBR) ranging from 37 to 54%. Uterus transplant, although still experimental, showed promising results. Most studies reported a negative impact of unicornuate uterus and partial or complete septate uterus on both the miscarriage rate (MR) and the live birth rate (LBR). The reproductive prognosis of women with unicornuate uterus was shown to be particularly poor in case of twin pregnancy. Uterus didelphys, bicornuate and arcuate uterus seem not to negatively impact the ART reproductive outcomes. Uterus didelphys was associated with an increased risk of preterm birth (PTB), cesarean section and low birth weight (LBW).

CONCLUSION

Women with CUAs should be informed regarding the impact (if any) of their congenital anomaly on both the chances of success of ART and on pregnancy-related complications. Elective single embryo transfer (eSET) should always be the first choice in patients with an increased baseline obstetric risk.

Local anesthesia vs. general anesthesia in cochlear implant surgery: Impact on surgical duration, postoperative recovery, costs and clinical insights. An extensive meta-analysis

INTRODUCTION

recent studies have shown that around 30 % of men and 20 % of women at the age of 70 have a hearing loss, rates that rise to 55 % and 45 % respectively at the age of 80. Treatment options include hearing aids and cochlear implants. Cochlear implant surgery under local anesthesia (L.A.) is gaining popularity for its potential benefits. We analyzed the current literature comparing L.A. and general anesthesia (G.A.) surgery by assessing operation duration, post-operative observation time and length of hospital stay.

METHODS

The study was conducted following the PRISMA guidelines. The search was performed on different database for articles published from 1984 to 2023. Comparative studies between cochlear implants in L.A. and G.A. with information on duration of surgery, length of hospital stay and time in postoperative care unit (PACU) were included.

RESULTS

Of 65 articles identified, 5 studies were included, involving 634 patients. The studies showed that L.A. surgery had a shorter surgical time than G.A. (p < 0.0001). No significant differences were found in length of hospital stay (p = 0.14) or time in PACU (p = 0.08). The cost of anesthesia was significantly lower for L.A.

DISCUSSION

The LA procedure has become popular, especially among elderly patients. The LA procedure has a shorter operative time and lower costs, without significantly affecting hospitalisation or time in PACU. Our study highlighted the advantages of L.A. in cochlear implant surgery, also showing the relatively low costs of the procedure. Better post-operative management could bring further benefits for patients and reduce hospital costs.

Music-Based Interventions for Symptom Management in Critically Ill, Mechanically Ventilated Adults: A Scoping Review of the Literature

Background: Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. Methods: A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. Results: A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Conclusions: Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population.

Examining Conversation Analysis in Palliative Care: A Systematic Review

Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.

Clinical and Dermoscopic Characteristics of Cutaneous Chondroid Syringoma: A Systematic Review

INTRODUCTION

Cutaneous chondroid syringoma (CS) is a rare benign mixed skin tumor originating from sweat glands. Despite its rarity, accurate diagnosis and management are crucial due to its potential for malignant transformation.

OBJECTIVE

This study aimed to provide comprehensive insights into the main features of cutaneous CS, encompassing its epidemiology, clinical presentation, and particularly, dermoscopic findings.

METHODS

A systematic review was conducted to identify relevant literature on CS up to November 2023. Data extraction included clinical and histopathological characteristics from case reports and small case series.

RESULTS

The systematic review identified 347 unique CS cases, predominantly benign. Clinical features included a predilection for the head and neck region, with variations in morphology observed. Dermoscopic patterns, although limited, revealed recurrent features aiding diagnosis. Malignant CS cases constituted a notable subset, exhibiting distinct clinical and histopathological features.

CONCLUSION

Cutaneous chondroid syringoma presents with characteristic clinical and histopathological features, necessitating comprehensive diagnostic approaches. Dermoscopy emerges as a valuable tool, although further research is needed to establish definitive patterns. Treatment primarily involves wide local excision, with collaboration among clinicians essential for optimal management. Future studies are warranted to address existing knowledge gaps and enhance understanding of this rare skin neoplasm.

Social contagion of pain and fear results in opposite social behaviors in rodents: meta- analysis of experimental studies

Introduction

The study aimed to explore the key factors influencing emotional valence in rodents, focusing on the critical elements that distinguish the contagion processes of fear and pain.

Methods

Through a systematic review and meta-analysis, we examined behavioral outcomes of rodents exposed to painful or fearful catastrophes to see whether they are prosocial or antisocial through three-chamber test and dyadic social interaction paradigm.

Results

Fear contagion, particularly when witnessed, leads to social avoidance behavior, unaffected by sex difference but more pronounced with age. In contrast, pain contagion promotes social approach and caring/helping behaviors.

Discussion

The present study demonstrates that the emotional valence induced by pain contagion is quite different from fear contagion and this difference may result in different motivations and social behaviors, namely, social contagion of pain is likely to be more associated with prosocial behaviors, however, social contagion of fear is likely to be more associated with antisocial behaviors.

Systematic Review Registration

PROSPERO (CRD42024566326).

The association between benzodiazepine co-prescription, opioid agonist treatment and mortality: a systematic review

BACKGROUND

Opioid agonist treatment (OAT) is the preferred treatment for opioid dependence due to benefits such as treatment retention, reduced opioid use and mortality. Benzodiazepine co-dependence is common in OAT patients and has been linked to increased mortality. Prescribing benzodiazepines during OAT has been tried to reduce the harms of extra-medical benzodiazepine use. This systematic review examines association between benzodiazepine co-prescription during OAT and mortality.

METHODS

We searched MEDLINE, Embase, Psych INFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Epistemonikos for reports published from database inception to June 2021. The searches were updated in February 2024. We included studies comparing mortality rates in OAT patients with and without benzodiazepine co-prescription. Two reviewers independently screened, extracted data, and assessed risk of bias from eligible studies with the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. We combined the effect estimates in meta-analyses where possible. The certainty of the pooled effect estimates was assessed using the GRADE approach.

RESULTS

We included six observational studies (N = 84,452) conducted in Sweden, Scotland, Canada, England, and the USA. Moderate-certainty evidence linked benzodiazepine prescription to higher all-cause mortality on OAT (HR 1.83; 95% CI 1.59 to 2.11). Moderate-certainty evidence associated benzodiazepine prescription with higher non-drug-induced mortality during OAT and the whole observation period (HR 1.73; 95% CI 1.33 to 2.25) and HR 2.02; 95% CI 1.29 to 3.18). Low-certainty evidence suggested an association with higher drug-induced mortality on OAT (HR 2.36; 95% CI 1.38 to 4.0). Very low-certainty evidence linked benzodiazepine prescription to higher all-cause and drug-induced mortality throughout the observation period (HR 1.49; 95% CI 1.02 to 2.18 and HR 2.19; 95% CI 0.80 to 6.0).

CONCLUSIONS

There is probably an association between prescribed benzodiazepine use and higher risk of all-cause mortality (on OAT) and mortality due to non-drug-induced causes (on OAT and on and off OAT). Benzodiazepine prescription may also be associated with higher all-cause mortality (on and off OAT) and drug-induced mortality (on OAT and on and off-OAT), but this is highly uncertain due to methodological issues and possible confounding.

Acupuncture: A Review of the Safety and Adverse Events and the Strategy of Potential Risk Prevention

Acupuncture is widely accepted as a therapeutic treatment by patients and healthcare providers globally. The safety record has been well established in acupuncture practice although some rare adverse events (AEs) were reported in the literature. While acupuncture-related AEs are generally defined as any undesirable event that occurs in patients during acupuncture treatment that may or may not be associated with the treatment, acupuncture-related adverse reactions (ARs) are defined as any undesirable or harmful reaction induced by trained practitioners practicing acupuncture treatment with standard doses. In this review, we clarify the relationship between AEs and ARs. Furthermore, we compile a list of acupuncture-related AEs reported in systematic reviews and meta-analysis articles. We find that serious acupuncture-related AEs are rare, with serious AEs occurring at a rate of approximately 0.04-0.08 per 10,000 treatments. The most likely serious AEs are pneumothorax, central and peripheral nerve injuries, heart injuries, abdominal organ injuries, infections, and needle breakage. Commonly reported minor AEs include bruising, hematoma, or bleeding at the needling site, as well as vasovagal reactions such as tiredness, dizziness, fainting, or residual pain at insertion points. The analysis identifies contributing factors for serious AEs being deep needle penetration, incorrect acupoint selection, and improper needle manipulation. It also addresses infections caused by contaminated needles, environmental factors, and inadequate skin disinfection. Moreover, other serious AEs, like needle breakage, are mostly due to aggressive manipulation and repeated reheating. Importantly, most acupuncture-related AEs are preventable. To avoid such AEs, acupuncturists in clinical practice should carefully select needling areas, be aware of cautions and contraindications of acupuncture, maintain safe acupuncture depth and hygiene, and strictly adhere to standard operating procedures.

Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis

BACKGROUND

The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries.

METHODS

We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity.

RESULTS

Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = -0.43; 95% CI = -0.77 to -0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = -0.05 to 0.39), block performance time (SMD = -0.14; 95% CI = -0.51 to 0.22), onset of sensory blockade (SMD = -0.13; 95% CI = -0.59 to 0.33) and onset of motor blockade (SMD = -0.17; 95% CI = -0.26 to 0.12). No high heterogeneity was seen among the included studies.

CONCLUSION

Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.

Effect of sling exercise training on motor function in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate the efficacy of sling exercise training on balance and gross motor movement in children with cerebral palsy, and to investigate the effects of different intervention times and ages on treatment outcomes.

METHODS

Randomized controlled trials on sling exercise training for children with cerebral palsy published in full text from CNKI, Wanfang datebase, PubMed, Cochrane Library, Web of Science, and Scopus were searched from the time of build to November 2023. Literature screening, data extraction, and quality assessment were performed independently by 2 researchers, and Meta-analysis was performed using RevMan5.4 and Stata17.0 software.

RESULTS

A total of 12 studies with 725 patients were included sling exercise training significantly improved balance (I2 = 0%, mean difference [MD] = 3.42, 95% CI: 2.93-3.92, P < .00001), gross motor function (I2 = 0%, MD = 5.90, 95% CI: 1.50-10.29, P < .00001), standing function (I2 = 14%, MD = 2.73, 95% CI: 2.17-3.29, P < .00001) walking and running and jumping function(I2 = 79%, MD = 5.93, 95% CI: 3.82-8.04, P < .00001) and 10-meter maximum walking speed(I2 = 58%, MD = 1.47, 95% CI: 0.52-2.42, P = .003) in children with cerebral palsy. Subgroup analyses of balance showed that children in the 5 + age group (I2 = 0%, MD = 3.73, 95% CI: 2.55-4.91, P < .00001) had better outcomes relative to the 4-5 year old group (I2 = 23%, MD = 3.49, 95% CI: 2.88-4.09, P<0.00001) and the under 4 year old group (I2 = 0%, MD = 282.73, 95% CI: 1.57-4.06, P < .00001). Subgroup analyses of walking and running and jumping function showed that a 6-month treatment course(I2 = 0%, MD = 5.93, 95% CI: 3.82-8.04, P < .00001) had better efficacy relative to a 3-month treatment course(I2 = 0%, MD = 4.11, 95% CI: 2.84-5.39, P < .00001).

CONCLUSION

Sling exercise training significantly improves balance and gross motor function in children with cerebral palsy, and The average age of 5+ years is a critical period for the development of balance in children with cerebral palsy, and the treatment course is an important factor affecting walking and running and jumping function.

Effectiveness of psychological interventions for carers of patients with severe mental illness (SMI): a systematic review

OBJECTIVES

Interventions for carers of patients with severe mental illness (SMI) are effective in improving patient outcomes. This review examined the effectiveness of psychological interventions or support designed to help carers of patients with SMI.

DESIGN

A systematic review of randomised controlled trials (RCTs) was conducted. Study selection, data abstraction and risk of bias assessments were independently conducted and duplicated. The reporting of this review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, CENTRAL, EMBASE, Medline and PsycINFO were searched from inception to 30 April 2024.

ELIGIBILITY CRITERIA

Only studies using an RCT were considered. All other research designs were excluded. The included population was carers over 18 caring for a patient with SMI. Any psychological, psychosocial or psychoeducational interventions were included. Patients under 18, diagnosed with dementia or learning disabilities comorbidity, were excluded.

DATA EXTRACTION AND SYNTHESIS

Study characteristics and outcome data (mean and SD) for each included study were collected. Review Manager (RevMan) was used to manage the data. Meta-analysis was not considered appropriate due to the heterogeneity of the included studies. The results were presented as a narrative synthesis.

RESULTS

This review included 3869 participants from 32 RCTs and demonstrated a beneficial effect of psychological interventions for carers. Psychoeducation was widely used and the most evaluated intervention for carers.

CONCLUSIONS

Psychological interventions for carers are beneficial in helping to reduce negative outcomes and enhance positive outcomes. Future research could focus on exploring the impact of interventions on less evaluated outcomes such as depressive and anxiety symptoms.

PROSPERO REGISTRATION NUMBER

CRD42021233181.

Maximizing the Impact and ROI of Leadership Development: A Theory- and Evidence-Informed Framework

Globally, organizations invest an estimated USD 60 billion annually in leadership development; however, the workplace application of learning is typically low, and many programs underperform or fail, resulting in wasted time and money and potential harm. This article presents a novel theory- and evidence-informed framework to maximize the outcomes and return on investment (ROI) of leadership development programs. The foundation of the framework derives from four separate literature reviews: three systematic reviews on leadership development, including the only two to isolate gold-standard elements of effective design, delivery, and evaluation, and one on "training transfer". Informed by innovative principles of leadership development and unique theoretical models and frameworks, this framework consists of 65 evidence-informed strategies that can be applied as a foundation (9), and before (23), during (17), at the conclusion of (11), and sometime after (5), programs, to maximize impact and ROI. Implications for practice and further research are also presented. Given the stakes, there is an urgent need for evidence and tools to maximize the impact and ROI of leadership development. This novel framework provides robust theory- and evidence-informed guidance for governments, policymakers, and those funding, designing, delivering, and supporting development.

Costs of Palliative Care in Oncological and Non-Oncological Patients with Different Types of Ambulatory-Based Attention: Cost-Study Protocol

Background: Ambulatory-based palliative care is vital to managing oncological and non-oncological patients. Its economic impact on the healthcare and social system has recently begun to be considered significant. It is essential to agree on the cost types, the methodology for approaching and analyzing these costs, and how to determine the burden imposed by this attention on the healthcare and social system. Aim: This study aims to design a study on the economic burden of palliative care (PC) in oncological and non-oncological pathologies in the context of outpatient care (ambulatory-based and home support teams). Methods: A prospective cross-sectional study on the economic burden of ambulatory-based palliative care (ABPC) in three phases is conducted. Phase I: A systematic literature review (SLR) first defines the methodology and data to acquire for costing (results already published). Phase II: The next phase is the piloting of the registration questionnaires for costs/expenses (results already analyzed and presented). Phase III: A cross-sectional study is being conducted to collect data on the direct and indirect costs of ABPC assumed by the healthcare system and patients/caregivers to estimate its economic and social burden (in progress). Discussion: In this study, we create and propose a methodology and extend the approach to the funding of PC in an ambulatory-based context to determine its social cost and provide stakeholders with more information to assign resources more efficiently.

Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis

BACKGROUND & AIMS

Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.

METHODS

We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.

RESULTS

We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.

CONCLUSIONS

This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).

Mental health problems in pregnant and postpartum women living with HIV in sub-Saharan Africa: Systematic review and meta-analysis protocol

BACKGROUND

Existing evidence on the burden of mental health problems among pregnant and postpartum women living with HIV, a vulnerable population in sub-Saharan Africa (SSA), is limited and fragmented, affecting the development of context-sensitive and integrated interventions. This systematic review aims to provide an up-to-date and comprehensive synthesis of available evidence to estimate the burden and identify the determinants of mental health problems among pregnant and postpartum women living with HIV across countries in sub-Saharan Africa.

METHODS

We will retrieve all relevant studies (published and unpublished) through searches in PubMed, Embase, PsycINFO, CINAHL, LILACS, Google Scholar, Scopus and Web of Science from inception to 30th June 2024, without language restriction. We will use the following search terms 'mental health disorder', 'mental health problem', 'pregnant women', 'postpartum women' and 'HIV' nested with all applicable alternate terms and the names of countries in SSA for running the searches. We will also search HINARI, African Index Medicus, African Journals Online, Academic Search Premier, medRxiv, ProQuest, EBSCO Open Dissertations, and reference lists of relevant studies. We will contact experts in the field for potentially relevant unpublished studies. All retrieved articles from the electronic databases and grey literature will be collated and deduplicated using Endnote and exported to Rayyan QCRI. Two reviewers will independently select studies using a pretested study selection flow chart developed from the pre-specified eligibility criteria. Two reviewers will extract data using a pretested data extraction form and assess the risk of bias in the included studies using the risk of bias tool for prevalence studies by Hoy et al. (2012). Any disagreements will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence of mental health problems among pregnant and postpartum women living with HIV) will be evaluated using pooled proportions (for non-comparative studies) and odds ratio (OR) or risk ratio (RR) (for comparative studies), and mean difference for continuous outcomes, all will be reported with their 95% confidence intervals (CIs). Heterogeneity will be assessed graphically for overlapping CIs and statistically using the I2 statistic. If substantial heterogeneity is found, random-effects model meta-analysis will be performed; otherwise, fixed-effect meta-analysis will be employed. We will conduct subgroup analysis (to assess the impact of heterogeneity) and sensitivity analyses to test the robustness of the generated effect estimates to the quality domains. The overall level of evidence will be assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).

EXPECTED OUTCOMES

The review is expected to produce an up-to-date and comprehensive synthesis of the available evidence, allowing for the generation of country-specific estimates of the burden of mental health problems among mothers living with HIV across SSA populations. Also, the review will attempt to identify the determinants of mental health problems among pregnant and postpartum women living with HIV, to shed light on the factors that contribute to the occurrence of mental health problems in this vulnerable population.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42023468537.

Hyperflexing the horse's neck: a systematic review and meta-analysis

The article reports a meta-analysis of 58 peer-reviewed studies investigating on dorsoventral hyperflexion of the neck in horses, a practice under substantial public and scientific scrutiny for the past two decades. The following databases were last searched on 28.05.2023: CAB, Google Scholar, Web of Science, NAL/Agricola, PubMed and ScienceDirect. After evaluating the conclusions of each study, we performed statistical analyses to establish a consensus on welfare and performance (performance marks, kinematics and musculoskeletal) outcomes in horses performing with a hyperflexed head and neck posture (HNP). The analysis revealed that a significant majority of the articles (75% of n = 36; Z = 3.00; P>|Z|=0.0027) expressed concerns about the welfare of horses working in this posture. Parameters such as dressage training level, prior experience, duration, and method of achieving the hyperflexed posture did not influence welfare concern conclusions significantly (P > 0.1). Therefore, it appears that the practice impairs welfare regardless of how it is imposed. A concurrent assessment of the weight of evidence for performance benefits showed inconclusive results: approximately one-quarter of the studies showed benefits and one-quarter detrimental effects, while the largest proportion (44%) showed no significant effect on performance. On balance, it appears that the costs associated with hyperflexed HNPs exceed potential benefits.

Non-invasive positive pressure ventilation for acute asthma in children

BACKGROUND

Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review.

OBJECTIVES

To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication.

SELECTION CRITERIA

We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods.

MAIN RESULTS

We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence.

AUTHORS' CONCLUSIONS

The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.

Efficacy and safety of veliparib in the treatment of advanced/metastatic breast cancer: a meta-analysis of phase II and III randomized controlled trials

We conducted a meta-analysis to evaluate the efficacy and safety of veliparib in the treatment of advanced/metastatic breast cancer. Databases were searched for relevant studies till June 2023. Six RCTs involving 1912 patients were included. The pooled analysis provided evidence that veliparib-containing regimens could significantly improve the PFS (HR: 0.71; 95% CI: 0.61-0.83; p < 0.0001), OS (HR: 0.87; 95% CI: 0.76-0.99; p = 0.03), and ORR (RR: 1.52; 95% CI:1.06-2.18; p = 0.02) than those of controls for treating advanced/metastatic breast cancer. Breast cancer patients with BRCA-mutation tended to have a better PFS than the BRCA-wildtype group, and patients with TNBC tended to associated with a longer PFS than the non-TNBC group. Veliparib could significantly increase the risk of anemia, leukopenia, neutropenia, diarrhea, stomatitis, fatigue, and peripheral neuropathy. Anemia and neutropenia should be well concerned. The veliparib-containing regimen was efficacious in treating advanced/metastatic breast cancer with a controllable safety factor.

Outcomes after Surgical Resection of Jugular Foramen Schwannomas: Systematic Review and Meta-Analysis

Objectives  We sought to perform a systematic review and meta-analysis of outcomes after surgical resection of jugular foramen schwannomas (JFSs). Design  A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Setting  PubMed, Scopus, and Embase databases were searched. Participants  Case series of at least five patients undergoing surgical resection of JFSs were included. Main Outcome Measures  Primary outcomes included gross total resection (GTR) and near total resection (NTR) rates, as well as a composite of the two (GTR + NTR). Additional outcomes included new or worsening cranial nerve (CN) palsies and cerebrospinal fluid (CSF) leak. Random effects models were used to generate pooled outcomes. Results  A total of 25 studies comprising 567 patients were included in the study. The proportions of each tumor grade were the following: grade A (33.1%), grade B (16.1%), grade C (9.2%), and grade D (41.6%). The pooled rate of GTR was 81% (95% confidence interval [CI]: 70-88; I 2  = 78.9%) and the composite GTR + NTR rate was 88% (95% CI: 81-93; I 2  = 66.4%). Rates of new or worsening CN palsies were the following: 12% hearing loss (95% CI: 7-20; I 2  = 69.4%), 27% dysphagia (95% CI: 20-36; I 2  = 66%), 20% hoarseness (95% CI: 14-28; I 2  = 62.6%), and 19% facial palsy (95% CI: 13-28; I 2  = 64.6%). The pooled rate of CSF leak was 9% (95% CI: 6-15; I 2  = 43.9%). Conclusion  The literature suggests high GTR rates of JFSs can be achieved. However, new CN deficits are not uncommon.

Perioperative Regional Anesthesia on Persistent Opioid Use and Chronic Pain after Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Whether regional anesthesia impacts the development of chronic postsurgical pain is currently debateable, and few studies have evaluated an effect on prolonged opioid use. We sought to systematically review the effect of regional anesthesia for adults undergoing noncardiac elective surgery on these outcomes.

METHODS

A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and CINHAL for randomized controlled trials (from inception to April 2022) of adult patients undergoing elective noncardiac surgeries that evaluated any regional technique and included one of our primary outcomes: (1) prolonged opioid use after surgery (continued opioid use ≥2 months postsurgery) and (2) chronic postsurgical pain (pain ≥3 months postsurgery). We conducted a random-effects meta-analysis on the specified outcomes and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to rate the quality of evidence.

RESULTS

Thirty-seven studies were included in the review. Pooled estimates indicated that regional anesthesia had a significant effect on reducing prolonged opioid use (relative risk [RR] 0.48, 95% CI, 0.24-0.96, P = .04, I 2 0%, 5 trials, n = 348 patients, GRADE low quality). Pooled estimates for chronic pain also indicated a significant effect favoring regional anesthesia at 3 (RR, 0.74, 95% CI, 0.59-0.93, P = .01, I 2 77%, 15 trials, n = 1489 patients, GRADE moderate quality) and 6 months (RR, 0.72, 95% CI, 0.61-0.85, P < .001, I 2 54%, 19 trials, n = 3457 patients, GRADE moderate quality) after surgery. No effect was found in the pooled analysis at 12 months postsurgery (RR, 0.44, 95% CI, 0.16-1.17, P = .10).

CONCLUSIONS

The results of this study suggest that regional anesthesia potentially reduces chronic postsurgical pain up to 6 months after surgery. Our findings also suggest a potential decrease in the development of persistent opioid use.

Short-term exposure to sulfur dioxide and the occurrence of chronic obstructive pulmonary disease: An updated systematic review and meta-analysis based on risk of bias and certainty of evidence

Several studies have documented a relationship between short-term exposure to atmospheric sulfur dioxide (SO2) and chronic obstructive pulmonary disease (COPD). However, findings vary across different regions. This meta-analysis employed a random-effects model to calculate the combined risk estimate for each 10-μg/m3 increase in ambient SO2 concentration. Subgroup analysis aimed to identify sources of heterogeneity. To assess potential bias, studies were evaluated using a domain-based assessment tool developed by the World Health Organization. Sensitivity analyses, based on bias risk, explored how model assumptions influenced associations. An evidence certainty framework was used to evaluate overall evidence quality. The study protocol was registered with PROSPERO (CRD42023446823). We thoroughly reviewed 191 full-text articles, ultimately including 15 in the meta-analysis. The pooled relative risk for COPD was 1.26 (95 % CI 0.94-1.70) per 10-μg/m3 increase in ambient SO2. Eleven studies were deemed high risk due to inadequate handling of missing data. Overall evidence certainty was rated as medium. Given SO2's significant public health implications, continuous monitoring is crucial. Future research should include countries in Africa and Oceania to enhance global understanding of atmospheric SO2-related health issues.

Colorectal screening following appendectomy in adult patients: a systematic review

PURPOSE

Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.

METHODS

A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.

RESULTS

Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography-colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.

CONCLUSION

Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis

OBJECTIVE

We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.

DESIGN

Systematic review, Meta-Analysis.

SETTING

We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.

PARTICIPANTS AND INTERVENTIONS

RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.

MEASUREMENT

Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).

RESULTS

The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.

CONCLUSION

The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.

Reusable surgical headwear has a reduced carbon footprint and matches disposables regarding surgical site infection: a systematic review and meta-analysis

Surgical headwear is designed to maintain sterility and prevent microbial contamination. However, the environmental impact of the healthcare industry carries an obligation to develop sustainable alternatives. We aim to explore the environmental impact and safety of reusable surgical headwear. A systematic review and meta-analysis were performed using MEDLINE, Embase, Scopus, Google Scholar, PubMed, and the Cochrane Library until December 10, 2023. Studies were reviewed for suitability and risk of bias using the ROBINS-I tool, with the results aggregated using Review Manager Version 5.4 for odds ratios (ORs) and 95% confidence intervals (CIs), and the I2 was used to assess heterogeneity. This systematic review included nine studies, and the meta-analysis included six studies involving 45,708 procedural cases. There was no significant difference in surgical site infection (SSI) rates between the reusable and disposable groups (OR: 0.79; 95% CI: 0.59-1.07; P=0.13). Policy implementation did not affect SSI rates (OR: 1.21; 95% CI: 0.85-1.73; P=0.30). Reusable surgical head covers demonstrated a significantly lower carbon footprint (P<0.001), ozone depletion (P<0.005), fossil fuel depletion (P<0.005), terrestrial acidification (P<0.005), and fine particulate matter formation (P<0.005) than disposable alternatives. Reusable surgical headwear matches disposable options for SSI incidence and offers environmental advantages. These findings support a shift towards reusable alternatives in healthcare, aligning patient safety with ecological responsibility. By adopting reusable alternatives, healthcare systems can actively contribute to planetary health, thereby highlighting the significant role of sustainable practices in modern medical settings.

Non-invasive brain stimulation in the treatment of generalized anxiety disorder: A systematic review and meta-analysis

BACKGROUND

Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS), continuous theta-burst stimulation (cTBS), and transcranial direct current stimulation (tDCS), is an emerging intervention that has been used to treat various mental illnesses. However, previous studies have not comprehensively compared the efficacies of various NIBS modalities in alleviating anxiety symptoms among patients with generalized anxiety disorder (GAD). Therefore, this study conducted a systematic review and meta-analysis to assess the efficacy of NIBS for patients with GAD.

METHODS

A systematic search of four major bibliographic databases (Embase, PubMed, Web of Science and The Cochrane Library) was conducted from inception dates to November 26, 2023 to identify eligible studies. The data were analyzed using a random-effects model.

RESULTS

Seven randomized controlled trials (RCTs) were included in the meta-analysis. Significant differences were found in changes in Hamilton anxiety rating scale (HARS) scores, study-defined response, and remission between the intervention and control groups. Moreover, the intervention groups experienced a significantly higher frequency of headaches.

CONCLUSION

The results revealed that interventions improved GAD compared to control groups. cTBS and rTMS exhibited better treatment efficacy than tDCS, which did not appear to have a significant therapeutic effect. Longer follow-up periods and larger sample sizes are required in future RCTs.

TRIAL REGISTRATION

This meta-analysis was conducted in accordance with PRISMA guidelines and registered at PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, CRD42023466285).

Physical Activity Interventions Among Older Adults with Chronic Illnesses: Systematic Review and Network Meta-Analysis

To investigate the individual effectiveness of motivational interviewing, tailor-made interventions, social context-related interventions, shared decision making, and monitoring & feedback versus active- and passive control groups on physical activity level among older adults at short-, middle-, and long term. Secondary aim is to compare the effectiveness of interventions using a single motivational strategy versus interventions combining multiple motivational strategies. Literature search of PubMed, EMBASE, CINAHL, and PEDro databases using keywords and subject headings. Randomized controlled trials comparing two or more arms, with one arm focused on motivational strategies influencing physical activity were included. We identified 20,690 titles, of which 51 (comprising 11,596 participants) were included. Methodological quality and quality of evidence was evaluated using PEDro scale and GRADE approach. Outcomes were physical activity levels measured by objective- or subjective instruments at 3-, 6-, and 12 months follow-up. Standardized mean differences between intervention- and control groups were used as the mode of the analyses. For primary outcome, 6 months follow-up, pooled data demonstrated a statistically significant trend for higher effectiveness interventions using multiple motivational strategies compared with an active control intervention, while other singular motivational strategies did not show similar results for this comparison. The quality of the body of evidence was graded as very low for all motivational strategies. In our search, we have used broad in- and exclusion criteria for eligible studies regarding population characteristics resulting in a wide variety of conditions and illnesses included in our review which warrants a better representation of daily clinical practice. However, this led to data being pooled from a wide variety of different study populations and settings, content of interventions and outcome measures, increasing the heterogeneity of study characteristics. Interventions combining multiple motivational strategies show a trend to be more effective than using singular treatment strategies, although the optimal composition remains unclear.

Analysis of risk of bias assessments in a sample of intervention systematic reviews, part I: many aspects of conduct and reporting need improvement

OBJECTIVES

Current standards for systematic reviews (SRs) require adequate conduct and complete reporting of risk of bias (RoB) assessments of the individual studies included in the review. We investigated the conduct and reporting of RoB assessments reported in a sample of SRs of interventions for persons with cerebral palsy (CP).

STUDY DESIGN AND SETTING

We included SRs published from 2014 to 2021. Authors worked in pairs to independently extract data on the characteristics of the SRs and to rate their conduct and reporting. The conduct of RoB assessment was appraised with the three AMSTAR-2 items related to RoB assessment. Reporting completeness was evaluated using the two items related to RoB assessment within studies in the PRISMA 2020 guidelines. We use descriptive statistics to report the consensus data, in accordance with our protocol.

RESULTS

We included 145 SRs. Among the 128 (88.3%) SRs that assessed RoB, the standards for AMSTAR-2 item 9 (use of an adequate RoB tool) were partially or fully satisfied in 73 (57.0%). Across the 128 SRs that assessed RoB, 46 (35.9%) accounted for RoB in interpreting the SR's findings and, of the 49 that included a meta-analysis, 11 (22.4%) discussed the impact of RoB on this. 123 (96.1%) of the 128 SRs named the RoB tool that was used for at least one of the study designs they included, 96 (75.0%) specified the RoB items assessed and 89 (69.5%) reported the findings for each item, 81 (63.2%) fully reported the processes for RoB assessment, 68 (53.1%) reported how an overall RoB judgment was reached, and 74 (57.8%) reported an overall RoB assessment for every study.

CONCLUSION

The selection and application of RoB tools in this sample of SRs about interventions for CP are comparable to those reported in other recent studies. However, most SRs in this sample did not fully meet the appraisal standards of AMSTAR-2 regarding the adequacy of the RoB tool applied and other aspects of RoB assessment conduct; Cochrane SRs were a notable exception. Overall, reporting of RoB assessments was somewhat better than conduct, perhaps reflecting the more widespread uptake of the PRISMA guidelines. Our findings may be generalizable to some extent, considering the extensive literature reporting widespread inadequacies in health care-related intervention SRs and reports from other specialties that document similar RoB assessment deficiencies. As such, this study should remind authors, peer reviewers, and journal editors to follow the RoB assessment reporting guidelines of PRISMA 2020 and to understand the corresponding critical appraisal standards of AMSTAR-2. We recommend a shift of focus from the documentation of inadequate RoB assessments and well-known deficiencies in other components of SRs towards the implementation of changes to address these problems along with plans to evaluate their effectiveness.

Efficacy of transdermal anti-inflammatory patches for musculoskeletal pain: a systematic review and meta-analysis

Aim: To determine the efficacy of transdermal anti-inflammatory patches in the treatment of acute and chronic musculoskeletal pain.Methods: A comprehensive search of: Cochrane Central register of controlled trials, EMBASE, MEDLINE, CINAHL and PubMed, for studies using transdermal anti-inflammatory patches vs placebo for management of musculoskeletal pain, e.g. soft tissue injuries or tendonitis (last search January 2024). Cochrane Risk of Bias Tools v1 was used for quality assessment and GRADE determined certainty of evidence. Meta-analysis was performed.Results: Twenty-three randomized placebo-controlled trials (n = 4729) were included. There was low-certainty evidence that transdermal patches provided statistically and clinically significant pain relief on movement at long-term follow-up for chronic musculoskeletal pain (effect size -2-69 (95% CI: -4.14, -1.24) and at short-term follow-up which was non-clinically significant, (-1.24: 95% CI: -1.78, -0.69).Conclusion: Several types of transdermal anti-inflammatory patches may offer short-term and long-term pain relief for acute and chronic musculoskeletal conditions. However, the clinical significance of this effect for the long-term pain relief was based on low-certainty evidence of transdermal anti-inflammatory patches versus placebo; for short-term pain there was an overall non-clinically significant improvement. Performing a meta-analysis for all outcomes was not possible due to insufficiency in the evidence-base.Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42020185944.

How is recovery defined and measured in patients with low back pain? A mixed study systematic review

BACKGROUND

Despite the burden of low back pain (LBP) there is no currently accepted definition for its recovery, nor is there a gold standard for measurement. In addition, it is currently unclear how the perspective of patients are used in making recovery determinations. The purpose of this mixed study systematic review across both quantitative and qualitative literature was to (1) explore how recovery has been defined and measured for patients experiencing LBP, and (2) examine how the perspectives of patients and providers for recovery of LBP align or differ.

METHODS

This was a mixed study systematic review. Key databases were searched from inception until February 20, 2023: Medline, EMBASE, CINAHL, Cochrane, PEDro looking for sources examining definitions and measures of recovery in patients with LBP. Grey literature was identified through the ProQuest Thesis & Dissertation database. Two reviewers used the Mixed Methods Appraisal Tool for quality assessment of both qualitative and quantitative studies to explore definitions, measurements and perspective of recovery.

RESULTS

466 original studies were included: 12 qualitative studies, 88 quantitative randomized control trials, 348 quantitative non-randomized studies, 16 quantitative descriptive studies, and two mixed methods studies. Most of the time recovery was not defined, with six other themes identified: comparison of scores, in relation to a singular cut-off score, improvement of absence of clinical symptoms, a return to a pre-injury state, change/improvement score from baseline and as a process/trajectory. For recovery measurements, six themes described the data: multiple measures, single measure excluding recovery, a recovery measure, recovery and an additional measure, pain and an additional measure, or indirect/ not specified. Lastly recovery perspectives were made from either the patient, provider, or a combination of patient and provider.

CONCLUSION

For patients living with LBP, the concept of recovery continues to lack consensus for its definition and measurement in patients with LBP. The perspectives of patients were mostly not preserved in making recovery determinations. Urgent action is needed to generate consensus across clinicians, researchers, and patients regarding how recovery should be defined and measured. A multitude of study-specific definitions limit knowledge syntheses and definition of best practice.

Risk of Dementia in Parkinson's Disease: A Systematic Review and Meta-Analysis

Estimates of the risk of dementia in Parkinson's disease (PDD) vary widely. We aimed to review the incidence of PDD and in a meta-analysis estimate the pooled annual incidence and relative risk of PDD while also exploring factors that may contribute to heterogeneity between studies. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed and MEDLINE and EMBASE were searched for articles reporting the number of cases of dementia in a population, followed longitudinally, with a minimum of 100 dementia-free Parkinson's disease (PD) patients at baseline. Meta-analyses and meta-regressions were used to estimate the pooled incidence rate of PDD and the relative risk of PDD versus healthy controls (HC). A total of 32 studies were identified, 25 reporting the incidence of PDD and 10 reporting the relative risk of PDD versus HC. The pooled incidence rate of PDD was 4.45 (95% confidence interval [CI], 3.91-4.99) per 100 person-years at risk, equating to a 4.5% annual risk of dementia in a PD prevalent population. The relative risk of PDD was estimated to be 3.25 (95% CI, 2.62-4.03) times greater than HC. Factors contributing to study heterogeneity and disparities in the estimated risk of PDD include the age of patients, year of recruitment, and study location. Significant gaps remain with no studies identified in several geographical regions. Future studies should stratify by age and standardize reporting to reduce overall heterogeneity. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Remimazolam vs. propofol for general anaesthesia in elderly patients: a meta-analysis with trial sequential analysis

BACKGROUND

Elderly patients comprise an increasing proportion of patients undergoing surgery, and they require special attention due to age-related physiological changes. Propofol is the traditional agent for anaesthesia, and recently, remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as an alternative to propofol in general anaesthesia.

OBJECTIVES

We aim to compare remimazolam vs . propofol for general anaesthesia in elderly patients regarding hypotension, induction characteristics, haemodynamics and recovery outcomes.

DESIGN

Meta-analysis with sensitivity and trial sequential analyses (TSA) to assess inconsistencies. Risk ratios and mean differences with 95% confidence intervals (95% CIs) were computed using a random effects model. Subgroups and meta-regression according to anaesthesia methods were also performed.

DATA SOURCES

We systematically searched MEDLINE, Embase and Cochrane for randomised controlled trials (RCTs) up to January 1, 2024.

ELIGIBILITY CRITERIA

Patients at least 60 years old, comparing remimazolam vs . propofol for general anaesthesia.

RESULTS

Eleven RCTs (947 patients) were included. Compared with propofol, remimazolam was associated with lower postinduction and intra-operative hypotension (RR 0.41, 95% CI 0.27 to 0.62, P  < 0.001) and incidence of bradycardia (risk ratio 0.58, 95% CI 0.34 to 0.98, P  = 0.04), with a higher heart rate ( P  = 0.01). The incidence of injection pain was lower ( P  < 0.001), but remimazolam was associated with a longer time to loss of consciousness ( P  < 0.001) and a higher bispectral index at loss of consciousness ( P  = 0.04). No differences were found for mean arterial pressure, emergence time, extubation time and incidence of emergence agitation. The TSA was consistent and achieved the required information size for hypotension.

CONCLUSIONS

Remimazolam significantly reduced the risk of hypotension, bradycardia and injection pain, despite an increase in the time to loss of consciousness. Remimazolam appears to be an effective and well tolerated alternative to propofol in elderly patients undergoing general anaesthesia.

Comparing the Efficacy of Renal Artery Denervation in Uncontrolled Hypertension: A Systematic Review and Network Meta-Analysis

The study aims to compare the outcomes of different renal denervation (RDN) procedures in the treatment of uncontrolled hypertension. We searched Scopus, PubMed, Web of Science, and Cochrane for RCTs evaluating different procedures of RDN for hypertension. The outcomes of this study were systolic blood pressure (SBP) daytime, diastolic blood pressure (DBP) daytime, SBP nighttime, DBP nighttime, SBP 24-hour, DBP 24-hour, SBP home, DBP home, SBP office, and DBP office. We did a frequentist network meta-analysis of 38 published RCTs evaluating the efficacy of different renal artery denervation procedures for uncontrolled hypertension compared to sham procedures or standardized stepped-care antihypertensive treatment (SSAHT). Radiofrequency (RF) alone showed a statistically significant reduction in DBP (24 hours), DBP (daytime), and DBP (nighttime): standardized mean difference (SMD): -2.01 (95% CI: (-3.34; -0.68)), SMD: -4.36 (95% CI: (-8.28; -0.44)), and SMD: -3.50 (95% CI: (-6.23; -0.76)), respectively, and showed a statistically significant reduction in SBP (24 hours), SBP (daytime), and SBP (nighttime): SMD: -3.93 (95% CI: (-6.01; -1.84)), SMD: -5.88 (95% CI: (-9.91; -1.85)), and SMD: -5.79 (95% CI: (-10.0; -1.58)), respectively. RF added to SSAHT has statistical significance in the reduction of DBP (nighttime), SBP (daytime), SBP (home), and SBP (nighttime) with a SMD of -7.63 (95% CI: (-14.21; -1.06)), SMD of -10.56 (95% CI: (-21.03; -0.08)), SMD of -23.20 (95% CI: (-36.72; -9.26)), and SMD of -14.03 (95% CI: (-25.43; -2.63)), respectively. We found that renal denervation, especially by RF, when added to SSAHT may be a promising therapeutic option for patients with treatment-resistant hypertension, particularly in cases where medication alone fails to achieve adequate blood pressure control.

Preventive effect of foam rolling on muscle soreness after exercise: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effect of foam rolling (FR) on exercise-induced muscle soreness.

METHODS

PubMed, EMBASE, Web of Science, ProQuest, Cochrane Library and China National Knowledge databases were searched to identify randomized controlled trials (RCTs) of the effect of FR intervening muscle soreness after exercise, from their inception to August 2022. The outcome indicators were visual analogue scale (VAS) and pressure-pain threshold (PPT).

RESULTS

A total of 16 studies were included, involving 515 subjects. Meta-analysis results show that FR has a certain effect of elimination of muscle soreness after exercise. The standard mean deviation (SMD) and 95% confidence interval (95%CI) of VAS and PPT immediately after intervention, 24, 48 and 72 h: [SMD = -0.38, 95%CI (-0.61, -0.15), P = 0.001], [SMD = -0.53, 95%CI (-0.82, -0.25), P = 0.0003], [SMD = -0.77, 95%CI (-1.12, -0.42), P < 0.00001], [SMD = -0.67, 95%CI (-1.09, -0.24), P = 0.002], [SMD = 0.23, 95%CI (0.62, 0.16), P = 0.25], [SMD = 0.48, 95%CI (0.11, 1.07), P = 0.11], [SMD = 0.39, 95%CI (-0.24, 1.02), P = 0.22], [SMD = 0.37, 95%CI (0.01, 0.74), P = 0.04].

CONCLUSION

Using foam rolling after exercise has a certain preventive effect on muscle soreness. Our study found that the effect of intervention of FR immediately is tiny after exercise, while the effective of intervening is relative obvious above 24 h.

REGISTRATION

PROSPERO (registration number: CRD42021250174).

The implication of alexithymia in personality disorders: a systematic review

BACKGROUND

Alexithymia, characterized by difficulty identifying and expressing emotions, is often associated with various psychiatric disorders, including personality disorders (PDs). This study aimed to explore the relationship between alexithymia and PD, focusing on their common origins and implications for treatment.

METHODS

A systematic review was conducted following PRISMA guidelines using databases such as MEDLINE (PubMed), Scopus, and Web of Science. The inclusion criteria were studies assessing adults with DSM-5-diagnosed personality disorders using validated alexithymia scales. The Newcastle‒Ottawa Scale was used to assess the quality of the included studies.

RESULTS

From an initial yield of 2434 citations, 20 peer-reviewed articles met the inclusion criteria. The findings indicate a significant association between alexithymia and personality disorders, particularly within Clusters B and C. Patients with these disorders exhibited higher levels of alexithymia, which correlated with increased emotional dysregulation and interpersonal difficulties. The review also highlighted the comorbidity burden of conditions such as psychosomatic disorders, eating disorders, depression, anxiety, suicidal behavior, and substance use disorders.

CONCLUSIONS

These findings underscore the need for integrating alexithymia-focused assessments into clinical practice to enhance therapeutic approaches, allowing for more personalized and effective interventions. Addressing the emotional processing challenges in patients with personality disorders could significantly improve patient outcomes. Future research should prioritize establishing clinical guidelines and conducting longitudinal studies to explore the relationship between alexithymia and specific personality disorder subtypes, ensuring the practical translation of these findings into clinical practice.

Outcomes of patients undergoing anatomical total shoulder arthroplasty with augmented glenoid components - a systematic review

Background

Glenoid loosening is an issue in anatomic total shoulder arthroplasty (a-TSA). This has been attributed to abnormal glenoid anatomy, common among these patients. Different alternatives have been proposed to tackle glenoid bone loss and restore joint alignment with augmented glenoid implants being increasingly used to deal with this problem. This systematic review aims to evaluate the clinical and radiological outcomes of patients undergoing augmented glenoid a-TSAs. Our hypothesis was that augmented glenoid components will lead to good patient outcomes with a low incidence of complications and revision procedures.

Methods

MEDLINE, EMBASE, CENTRAL and CINHAL were searched from inception to February 2022 for information pertaining to outcomes of patients undergoing a-TSA with augmented glenoid implants.

Results

Eighteen studies reported on outcomes of 814 a-TSA (800 participants) with a mean follow-up of 3.7 years. Most studies (67%) were Type IV level of evidence. Almost 70% of participants underwent an a-TSA secondary to primary glenohumeral osteoarthritis. Most glenoids were type B2 (73%). Augmented glenoids material was mostly all-polyethylene (81%) with full wedge (45%) and stepped components (38%) designs being the most common. Most studies reported good clinical outcomes. 17 patients (4%) underwent a revision surgery.

Conclusions

Our review found that patients undergoing a-TSA with augmented glenoid components report good outcomes at short-to-mid-term follow-up. Further research is warranted to determine if such outcomes remain similar in long term.

Level of evidence

Level III, Systematic Review of Therapeutic Studies.

BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline

OBJECTIVES

to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients.

SOURCES

This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri‑implant diseases and conditions [2].

METHODOLOGY

The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.

RESULTS AND CONCLUSION

Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public.

CLINICAL SIGNIFICANCE

The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri‑implant diseases.

Is pulmonary hypertension protective against cardiac tamponade? A systematic review

The presence of pulmonary hypertension (PH) may affect whether cardiac tamponade physiology develops from a pericardial effusion. Specifically, the increased intracardiac pressure and right ventricular hypertrophy associated with PH would seemingly increase the intrapericardial pressure threshold at which the right-sided chambers collapse. In this systematic review, we examined the impact of PH on the incidence, in-hospital and long-term mortality, and echocardiographic findings of patients with cardiac tamponade. Using the PRISMA guideline, a systematic search was conducted in PubMed, Academic Search Premier, Web of Science, Google Scholar, and the Cochrane Database for studies investigating PH and cardiac tamponade. The Newcastle-Ottawa Scale was used to analyze the quality of returned studies. Primary outcomes included the incidence of cardiac tamponade, as well as in-hospital and long-term mortality rates. Secondary outcomes were the presence or absence of echocardiographic findings of cardiac tamponade in patients with PH. Forty-three studies (9 cohort studies and 34 case reports) with 1054 patients were included. The incidence of cardiac tamponade was significantly higher in patients with PH compared to those without PH, 2.0% (95% CI 1.2-3.2%) vs. 0.05% (95% CI 0.05-0.05%), p < 0.0001, OR 40.76 (95% CI 24.8-66.9). The incidence of tamponade in patients with a known pericardial effusion was similar in those with and without PH, 20.3% (95% CI 12.0-32.3%) and 20.9% (95% CI 18.0-24.1%), p = 0.9267, OR 0.97 (95% CI 0.50-1.87). In patients with tamponade, those with PH demonstrated a significantly higher in-hospital mortality than those without PH, 38.8% (95% CI 26.4-52.8%) vs. 14.4% (95% CI 14.2-14.6%), p < 0.0001, OR 3.77 (95% CI 2.12-6.70). Long-term mortality in patients with tamponade was significantly lower in those with PH than in those without PH, 45.5% (95% CI 33.0-58.5%) vs. 59.1% (95% CI 54.7-63.4%), p = 0.0258, OR 0.576 (95% CI 0.33-1.01). However, after stratifying by non-malignant etiologies, the long-term mortality benefit for those with PH disappeared. In the studies that described specific echocardiographic findings of cardiac tamponade, only 10.5% of patients with PH and tamponade showed right atrial and right ventricular collapse. When evaluating patients with pericardial effusions, physicians must recognize the effects of underlying PH on the incidence, in-hospital and long-term mortality rates, and potentially atypical echocardiographic presentation of cardiac tamponade.

Longitudinal change in neurocognitive functioning in children and adolescents at clinical high risk for psychosis: a systematic review

Clinical high risk of psychosis (CHR-P) population has become an attractive area of interest in preventing transitions to psychosis. The consequences of developing a psychotic disorder may be worse in cases of early onset. Thus, childhood and adolescence represent a critical developmental window, where opportunities to gain social and adaptive abilities depend on the individuals' neurocognitive performance. There have been previous syntheses of the evidence regarding neurocognitive functioning in CHR-P individuals and its longitudinal changes. However, there has been less focus on children and adolescents at CHR-P. A multistep literature search was performed from database inception until July 15th, 2022. PRIMSA/MOOSE compliant systematic review and PROSPERO protocol were used to identify studies reporting on longitudinal changes in neurocognitive functioning in children and adolescents (mean age of sample ≤ 18 years) at CHR-P and matched healthy control (HC) group. A systematic review of identified studies was then undertaken. Three articles were included, resulting in a total sample size of 151 CHR-P patients [mean (SD) age, 16.48 (2.41) years; 32.45% female] and 64 HC individuals [mean (SD) age, 16.79 (2.38) years; 42.18% female]. CHR-P individuals had worse outcomes in verbal learning, sustained attention and executive functioning domains compared to HC. Individuals taking antidepressants had better outcomes in verbal learning in contrast with those taking antipsychotics. In children and adolescents, neurocognition may be already impaired before the psychosis onset, and remains stable during the transition to psychosis. Further study should be performed to obtain more robust evidence.

Associations of Socioeconomic Factors and Unhealthy Lifestyles with Allostatic Load: A Meta-analysis

BACKGROUND

Allostatic load (AL) is a biological tool for objectively assessing chronic stress and has been discussed inconsistently for its correlation with socioeconomic factors and unhealthy lifestyles. Therefore, this meta-analysis was performed to explore the impact of socioeconomic factors and unhealthy lifestyles on AL.

METHOD

Different databases, including Web of Science, PubMed, EBSCOhost, Embase, CNKI, VIP, SinoMed, and Wanfang, were searched from inception to June 6, 2023. A total of 25 studies, reporting the correlations of seven socioeconomic factors and three unhealthy lifestyles with AL, were finally included. The pooled odds ratios (OR) and 95% confidence intervals (CIs) were examined using random-effect and fixed-effect models. Literature quality, heterogeneity, and publication bias were evaluated.

RESULTS

The meta-analysis showed a significantly increased risk of high AL in the older individuals as compared to the younger ones (OR = 1.05, 95% CI 1.04-1.06), in the individual with low education as compared to those with high education (OR = 1.25, 95% CI 1.05-1.48), and in the individuals with low physical activities as compared to those with high physical activities (OR = 1.44, 95% CI 1.26-1.64). This meta-analysis also showed a significantly decreased risk of high AL in the individuals with high income as compared to those with low income (OR = 0.77, 95% CI 0.71-0.83) and in women as compared to men (OR = 0.80, 95% CI 0.80-0.81).

CONCLUSION

This meta-analysis showed older people, men, and people having low physical activity, low income, and low education were more likely to have a high AL.

TRIAL REGISTRATION

This meta-analysis was registered on the PROSPERO database with trial registration number CRD42022326105. Instead of providing information at registration, we added an author (Tingyu Mu), who provided critical revisions to the paper in this meta-analysis.

Zika virus and brain cancer: Can Zika be an effective treatment for brain cancer? A systematic review

INTRODUCTION

Many studies have highlighted the use of oncolytic viruses as a new class of therapeutic agents for central nervous system (CNS) tumors, especially glioblastomas (GMB). Zika Virus (ZIKV) proteins targeted to specific stem cells have been studied in vitro and animal models with promising results.

MATERIALS AND METHODS

A systematic review was evaluated the efficacy and safety of the ZIKV use for CNS tumors treatment. Data were extracted and the in vivo studies were evaluated using the Robins-I tool. We assessed bias in each study using criteria such as selection bias, performance bias, detection bias, attrition bias, reporting bias, and others. According to Cochrane guidelines, bias was classified as high, low, or uncertain. High bias occurred when studies did not meet the criteria. Low bias was assigned when criteria were clearly met. Uncertain bias reflected insufficient information for a clear classification.

RESULTS

The 14 included studies shown that ZIKV reduced cell viability or inhibited the growth, proliferation of glioma stem cells (GSCs), and Bcl2 expression - which could potentially enhance the effect of chemotherapy/radiotherapy; caused cytopathic effects, induced tumor cell damage, manifested oncolytic properties, and even selectively safely killed GSCs; ultimately, it led to significant tumor remission and enhanced long-term survival through enhanced T-cell response.

CONCLUSIONS

Although current evidence suggests ZIKV as a promising treatment for CNS tumors and may improve survival when combined with surgery and radiotherapy. Despite limited human evidence, it shows potential benefits. Further research is needed to confirm safety, efficacy, and optimize treatment in humans.

Therapeutic Efficacy of Adipose Tissue-Derived Components in Neuropathic Pain: A Systematic Review

BACKGROUND

Neuropathic pain results from a defect in the somatosensory nervous system caused by a diversity of etiologies. The effect of current treat-ment with analgesics and surgery is limited. Studies report the therapeutic use of adipose tissue-derived components to treat neuropathic pain as a new treatment modality.

OBJECTIVE

The aim of this systematic review was to investigate the therapeutic clinical efficacy of adipose tissue-derived components on neuro-pathic pain.

METHODS

PubMed, Medline, Cochrane and Embase databases were searched until August 2023. Clinical studies assessing neuropathic pain after autologous fat grafting or the therapeutic use of adipose tissue-derived com-ponents were included. The outcomes of interest were neuropathic pain and quality of life.

RESULTS

In total, 433 studies were identified, of which 109 dupli-cates were removed, 324 abstracts were screened and 314 articles were excluded. In total, ten studies were included for comparison. Fat grafting and cellular stromal vascular fraction were used as treatments. Fat grafting indications were post-mastectomy pain syndrome, neuromas, post-herpetic neuropathy, neuro-pathic scar pain and trigeminal neuropathic pain. In seven studies, neuropathic pain levels decreased, and overall, quality of life did not improve.

CONCLUSIONS

The therapeutic efficacy of adipose tissue-derived components in the treatment of neuropathic pain remains unclear due to the few performed clinical trials with small sample sizes for various indications. Larger and properly designed (randomized) controlled trials are required.