Measuring inconsistency in meta-analyses

Practice and associated factors of Covid-19 prevention among health professionals in Ethiopia: a systematic review and meta-analysis

Health professionals (HPs) who work on the front lines are more likely to contract COVID-19.Healthmanners of HPs impact control and prevention activities employed in answer to the contagion crisis. Therefore, this systematic review and meta-analysis aimed to assess the pooled level of practice and associated factors toward COVID-19 prevention among HPs in Ethiopia. PubMed, Scoups, Web of Science, Google Scholar (search engine), Google Advance, and Cochrane Library were searched from December 20, 2023 -January 30, 2024. Data was dugout using Microsoft Excel (version 10) and analysis was computed using STATA version 11. Funnel plot and quantitatively further through Egger's regression test, with P < 0.05 was used to check publication bias. I2 statistics were used to check the heterogeneity of the studies. Pooled analysis was used using a weighted inverse variance random-effects model. A subgroup analysis was conducted based on publication year and region. Meta-regression and sensitivity analysis were used. Eighteen studies with 7,775 Health professionals were included in the review process. Among them, 57.03% (95% CI; 48.41, 65.65%) of HPs practice correctly. Although the risk factors reported were inconsistent between studies, access to infection prevention training (IP) (AOR = 1.79; 95% CI 1.54, 2.08), good knowledge (AOR = 1.92; 95% CI 1.38, 2.66), MSc degree and above (AOR = 3.53; 95% CI 2.64, 4.71), and positive attitude (AOR = 2.19; 95% CI 1.50, 3.19) were significant predictors of good practice. Nearly 43% of health professionals had poor practice. Good knowledge, positive attitude, level of education, and infection prevention training were the main determinants of good practice. The responsible authorities do emphases to halt barriers and improving the zero infection principles of health professionals during the pandemic.

Efficacy and Safety of Intranasal Etripamil for Paroxysmal Supraventricular Tachycardia: Meta-Analysis of Randomized Controlled Trials

Background: Patients with arrhythmias, particularly paroxysmal supraventricular tachycardia (PSVT), face an increased risk of cardiac complications. Currently, non-parenteral medications for rapid PSVT cessation are lacking. Etripamil, a novel intranasal, short-acting calcium channel blocker, offers a rapid onset and the potential for unsupervised PSVT management. However, data on its use in arrhythmia management remain limited. Aims: We aimed to assess the efficacy and safety of 70 mg of etripamil compared with placebo in the treatment of PSVT. Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) from inception to April 2025. We calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs) using random or common effects models, depending on the heterogeneity. Results: Four RCTs including 540 patients were analyzed. Etripamil demonstrated higher conversion rates to the sinus rhythm at 15 min (RR 1.84 [95% CI: 1.32-2.48]), 30 min (RR 1.80 [95% CI: 1.38-2.35]), and 60 min (RR 1.24 [95% CI: 1.04-1.48]). PSVT recurrence rates were similar between groups (RR 0.52 [95% CI: 0.20-1.34]). Adverse events (AEs) and severe AEs were comparable between etripamil and the placebo. Etripamil was associated with higher rates of nasal discomfort, nasal congestion, rhinorrhea, and epistaxis but not with increased bradyarrhythmia, atrial fibrillation, or non-sustained ventricular tachycardia. Conclusions: Etripamil appears to be a promising treatment for cardiac arrhythmias. Larger long-term RCTs are needed to confirm its safety and efficacy in clinical practice.

The Value of Remote Vital Signs Monitoring in Detecting Clinical Deterioration in Patients in Hospital at Home Programs or Postacute Medical Patients in the Community: Systematic Review

BACKGROUND

Vital signs monitoring (VSM) is used in clinical acuity scoring systems (APACHE [Acute Physiology and Chronic Health Evaluation], NEWS2 [National Early Warning Score 2], and SOFA [Sequential Organ Failure Assessment]) to predict patient outcomes for early intervention. Current technological advances enable convenient remote VSM. While the role of VSM for ill, hospital ward-treated patients is clear, its role in the community for acutely ill patients in the hospital at home (HAH) or postacute setting (patients who have just been discharged from an acute hospital stay and at increased risk of deterioration) is less well defined.

OBJECTIVE

We assessed the efficacy of remote VSM for patients in the HAH or postacute setting.

METHODS

This systematic review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched studies in PubMed (MEDLINE), Embase, and Scopus. Studies focused on the postacute phase were included, as only 2 case series addressed the HAH setting. Risk of bias (ROB) was evaluated using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs), the Newcastle-Ottawa scale for observational studies, and the case methods outlined by Murad et al for case reports. The GRADE (Grading Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of evidence. Outcomes of interest included hospital readmissions, mortality, patient satisfaction, and compliance. Risk ratios (RR) were used to measure effect sizes for readmission and mortality, with patient satisfaction and compliance reported descriptively.

RESULTS

The search yielded 5851 records, with 28 studies meeting eligibility criteria (8 RCTs, 7 cohort studies, and 13 case series). Two focused on HAH, while 26 studies addressed the postacute phase. Nineteen studies looked at heart failure, 3 studied respiratory conditions, and 6 studies studied other conditions. Meta-analysis was conducted with 6 studies looking at hospital readmission within 60 days and 4 studies at mortality within 30 days. Readmissions did not significantly decrease (RR 0.81, 95% CI 0.61-1.09; P=.16). Significant heterogeneity was observed for readmissions (I2=58%). Conversely, mortality reduced significantly (RR 0.65, 95% CI 0.42-0.99; P=.04). There was no significant heterogeneity in mortality (I2=0%). There was high heterogeneity in the study populations, interventions, and outcomes measured. Many studies were of poor quality, with 50% (4/8) of RCTs exhibiting a high ROB. The certainty of evidence for both readmission and mortality was very low.

CONCLUSIONS

Published data on the effects of remote VSM in acutely ill patients at home remains scarce. Future studies evaluating all common vital signs (heart rate, blood pressure, oxygen saturation, and temperature) with consistent monitoring frequencies and clear intervention protocols to better understand how to integrate remote VSM into HAH programs are needed.

TRIAL REGISTRATION

PROSPERO CRD42023388827; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023388827.

Role of tumor mutational burden in patients with urothelial carcinoma treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Background

The predictive value of tumor mutation burden (TMB) on the efficacy of immunotherapy has been confirmed in multiple cancer types in previous studies. For urothelial carcinoma (UC) patients treated with immune checkpoint inhibitors (ICIs), whether TMB is a suitable biomarker to predict the benefit of ICIs remains a matter of much debate. We conducted this meta-analysis to evaluate the role of TMB in patients with UC treated with ICIs.

Methods

Two investigators independently searched the literature, screened eligible studies, extracted valid data, and scored quality assessments. Meta-analyses of the effect size hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS), and effect size odds ratio (OR) for objective response rate (ORR) were performed and visualized with forest plots using the STATA14.0 software. The statistical difference in benefit from ICIs for UC patients between the high TMB group and the low TMB group was significant when the p-value <0.05. Sensitivity analysis and publication bias further verified the stability and reliability of statistical results.

Results

A total of 2,499 patients from 14 studies were included in this meta-analysis. The results indicated that UC patients with high TMB showed significantly longer OS and PFS than those with low TMB after ICI treatment (OS: HR 0.69, 95% CI 0.62, 0.76, p < 0.05; PFS: HR 0.67, 95% CI 0.59, 0.76, p < 0.05). The high TMB group exhibited a superior response to ICIs than the low TMB group, with no significant difference (OR 1.64, 95% CI 0.94, 2.86, p = 0.08). The results were stable and reliable, with no publication bias.

Conclusions

This meta-analysis demonstrated that UC patients with high TMB exhibited significantly longer survival than those with low TMB after ICI treatment. TMB may be a favorable predictor for UC immunotherapy in future clinical practice.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42025642602.

Reproductive outcomes after letrozole stimulated versus artificial frozen-thawed embryo transfer cycles in women with PCOS and/or oligo-anovulation: a systematic review and meta-analysis

BACKGROUND

The global increase in frozen-thawed embryo transfer (FET) cycles has led to a critical evaluation of endometrial preparation methods. While various approaches such as natural or modified natural cycle FET, stimulated FET by use of letrozole (LTZ) and/or gonadotrophins, and artificial cycle (AC) FET, are currently in clinical use, the optimal regimen remains unclear, particularly for women with oligo-anovulation or polycystic ovarian syndrome (PCOS). This systematic review and meta-analysis compares LTZ FET with AC FET regarding reproductive, obstetric, and neonatal outcomes in these populations.

OBJECTIVE AND RATIONALE

The aim was to determine whether LTZ FET improves reproductive, obstetric, and neonatal outcomes compared to AC FET in women with ovulatory disorders and/or PCOS.

SEARCH METHODS

A comprehensive search of MEDLINE, Cochrane, and ClinicalTrials.gov databases was conducted for studies until June 2024. Eligible studies included women with ovulatory disorders and/or PCOS, comparing LTZ FET to AC FET. Data extraction focused on the live birth rate (LBR), ongoing pregnancy rate, clinical pregnancy rate, pregnancy loss rate, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), birth weight, small for gestational age (SGA), large for gestational age (LGA), and congenital malformations.

OUTCOMES

The search identified 74 studies, and included 15 observational studies and two randomized controlled trials (RCTs) meeting the inclusion criteria; the studies encompassed a total of 8307 women treated with LTZ FET (±additional gonadotropin) and 16,940 women treated with AC FET. The meta-analysis comparing LTZ FET to AC FET demonstrated a modest yet statistically significant increase in the odds of LB (OR 1.37, 95% CI 1.21-1.56), corresponding to an 8% risk difference (95% CI 4%-11%). The one RCT that reported on LB yielded a similar LBR for LTZ FET and AC FET, thus did not support a better outcome after LTZ FET. Pregnancy losses, defined either as a loss following a positive serum hCG or following a clinical pregnancy, were compared between LTZ FET and AC FET. The meta-analysis indicated a reduction in the odds of PL with LTZ FET (OR 0.63, 95% CI 0.51-0.78). However, the two RCTs reporting this outcome exhibited high heterogeneity, introducing uncertainty of the result. LTZ FET was associated with lower risks of HDP (OR 0.70, 95% CI 0.58-0.84) and LGA (OR 0.75, 95% CI 0.67-0.85), but no significant differences were observed for GDM or SGA. For all outcomes, the certainty of evidence was low.

WIDER IMPLICATIONS

LTZ FET may offer a modest improvement in reproductive outcomes and a lower risk of some obstetric complications compared to AC FET, particularly in women with oligo-anovulation. However, the quality of evidence remains low, and more well-designed RCTs are needed to confirm these findings. While awaiting further data, LTZ FET may be recommended as a viable alternative to AC FET for women with ovulatory disorders.

REGISTRATION NUMBER

PROSPERO-CRD42023395117.

Reconstruction of the Chest Wall in Primary and Secondary Tumors: A Systematic Review and Meta-Analysis Comparing Rigid Versus Flexible Materials

BACKGROUND

Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions.

PATIENTS AND METHODS

We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I2 statistics.

RESULTS

In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31).

CONCLUSIONS

Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.

Impact of e-Health Interventions on Mental Health and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: The prevalence of breast cancer (BC) is significant globally. The malignancy itself and the related treatments have a considerable impact on patients' overall well-being. The adoption of e-health solutions for patients is increasing rapidly worldwide, since these innovative tools hold significant potential to positively impact the mental health and quality of life (QoL) of BC patients. However, their overall impact is still being explored, and further understanding and analysis are required. This review paper aims to present, quantify, and summarize the cumulative available randomized evidence on the state of the art of supportive interventions delivered via e-health applications for patients' mental health and QoL before, during, and after BC treatment. Methods: A systematic review was conducted following the PRISMA guidelines in the Scopus and PubMed databases on 7 November 2024 to identify studies that utilized internet-based interventions in BC patients. The inclusion criteria were as follows: adult men and women (aged > 18 years) diagnosed with breast cancer (BC) who received patient-directed e-health interventions, compared to standard care or control interventions. The studies had to focus on outcomes such as quality of life (QoL), anxiety, depression, and distress, and be limited to randomized controlled trials (RCTs). The PRISMA-P guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias (RoB) tool for randomized controlled trials. Results: A total of 27 randomized studies, involving 2898 patients, were included in this systematic review. The e-health interventions significantly affected patients' anxiety (SMD = -0.80; 95% CI: -1.33 to -0.27; p < 0.01; and I2 = 94%), depression (SMD = -0.74; 95% CI: -1.40 to -0.09; p = 0.026; and I2 = 95%) and QoL (SMD = 0.65; 95% CI: 0.27 to 1.04; p < 0.01; and I2 = 90%) but had no significant effect on distress (SMD = -0.78; 95% CI: -1.93 to 0.37; p = 0.184; and I2 = 95%). Conclusions: This study showed that e-health interventions can improve QoL, reduce anxiety, and decrease depression in adult BC patients. However, no noticeable impact on reducing distress levels was observed. Additionally, given the diversity of interventions, these results should be interpreted with caution. To determine the optimum duration, validate different intervention approaches, and address methodological gaps in previous studies, more extensive clinical studies are needed.

Diagnostic performance of color vision tests for color vision deficiency: a network meta-analysis on comparisons of multiple color vision tests

PURPOSE

This network meta-analysis (NMA) was done to compare the performance of color vision tests in the detection of individuals with color vision deficiency (CVD).

METHODS

Medline (via PubMed), Embase, and Web of Science were comprehensively searched from inception of the databases to 17 January, 2023. Conventional meta-analysis of diagnostic indicators was performed. The superiority of a diagnostic approach was depicted using the Superiority (S) Index.

RESULTS

Six studies were enrolled. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve of summary receiver operating characteristic of the Ishihara tests were 0.89 (0.81, 0.94), 0.99 (0.96, 1.00), 110.8 (18.1, 677.0), 0.10 (0.05, 0.20), 1105 (112, 10,930), and 0.98 (0.96, 0.99). Waggoner Computerized Color Vision Test ranked the best performance in the detection of CVD, followed by CAD test, Ishihara test, Fletcher Lantern test, and HHR test as the rest second to the fifth most effective modalities.

CONCLUSION

This NMA revealed that CAD test, Ishihara test, Fletcher Lantern test, and HHR test had favorable diagnostic validity in the detection of CVD.

Factors leading to implant failure: An umbrella review of meta-analyses of observational studies and trials

STATEMENT OF PROBLEM

The evidence concerning factors leading to implant failure remains inconclusive. Existing systematic reviews have reported mixed results for patient-related, surgical, and prosthetic factors contributing to implant failure.

PURPOSE

The purpose of this umbrella review was to summarize the evidence and assess existing biases from meta-analyses of randomized controlled trials (RCTs) and observational (cohort and case-control) studies to establish clinically relevant factors associated with implant failure.

MATERIAL AND METHODS

The study had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025634487). The Scopus, PubMed, the Cochrane Database of Systematic Reviews, and Epistemonikos databases were searched from inception until June 2024, and the effect sizes were recalculated using a random-effects model for each meta-analysis. Between-study heterogeneity, 95% prediction interval, small-study effects, excess significance, and credibility ceilings were evaluated. The credibility of evidence from meta-analyses of cohort and case-control studies was ranked by established criteria as nonsignificant, weak, suggestive, highly suggestive, or convincing.

RESULTS

A total of 2922 publications were identified, 224 full-texts were evaluated, and 25 articles describing 35 associations were included in the study. Among meta-analyses of RCTs (n=9), 6 (67%) statistically significant associations were identified (P<.05). According to the GRADE assessment, turned versus anodized implants, submerged versus nonsubmerged implant healing, and bone augmentation with long implants versus short implants were associated with a higher risk of implant failure (high certainty evidence). Short implants (<10 mm) versus long implants (>10 mm) and immediate versus delayed implant placement were associated with higher risk for implant failure (moderate certainty evidence). Among the meta-analyses of cohort and case-control studies (n=26), 18 (69%) associations were statistically significant (P<.05). None were graded as convincing. Highly suggestive evidence was established for the association between smoking and implant failure. Suggestive evidence emerged for associations including periodontally compromised versus periodontally healthy patients, proton pump inhibitor therapy, Crohn's disease, bone quality type II versus type IV, bone quality type III versus type IV, nonsubmerged immediately loaded versus submerged delayed loaded implants, short implants (<10 mm) versus long implants (>10 mm), selective serotonin re-uptake inhibitor therapy, turned versus anodized implants, and immediately loaded versus conventionally loaded implants. These findings remained robust after sensitivity analyses.

CONCLUSIONS

Observational studies suggest that smoking is associated with an increased incidence of implant failure. Evidence from observational and randomized trials has supported using anodized implants for better outcomes. Several factors were identified as leading to an increased risk of dental implant failure. The remaining factors require additional high-quality studies for better assessment and clinical recommendations.

Association of antioxidants intake in diet and supplements with risk of Alzheimer's disease: a systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND & AIMS

Previous studies have shown that antioxidants may be associated with risk of Alzheimer's disease (AD). However, some findings have failed to demonstrate a significant correlation. To rigorously evaluate this relationship, a comprehensive review and meta-analysis were conducted.

METHODS

All relevant cohort studies reporting association between antioxidants intake (diet and/or supplement use) and AD risk were searched in 9 electronic databases and 4 registration platforms from their inception up to March 15, 2023. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using either a fixed-effects or random-effects model. Heterogeneity was assessed using I2 statistics. Furthermore, a dose-response meta-analysis was conducted to explore potential dose-response relationships.

RESULTS

Eleven cohort studies were included. The pooled HRs of AD were 0.90 (95% CI = 0.60-1.34) and 0.94 (95% CI = 0.75-1.17) for the dietary intake of vitamin E, 0.90 (95% CI = 0.76-1.07) for the vitamin E supplement use. The pooled HRs of AD were 0.84 (95% CI = 0.76-0.93) and 0.60 (95% CI = 0.35-1.02) for the dietary intake of vitamin C, 0.85 (95% CI = 0.72-1.00) for the vitamin C supplement use. The pooled HRs of AD were 1.02 (95% CI = 0.85-1.22) and 0.86 (95% CI = 0.68-1.07) for the dietary intake of beta-carotene. Notably, no significant dose-response relationship was observed.

CONCLUSIONS

A high dietary intake of vitamin C (≥ 75 mg/d) was found to have a statistically significant impact on reducing the risk of AD. However, no significant association was observed between dietary intake of vitamin E or beta-carotene, or the use of vitamin E or vitamin C supplement use, and the risk of AD.

Amphibian susceptibility to parasitism in relation to environmental contaminant exposure: a meta-analysis

Amphibians are declining globally, which may have consequences for structure and function of ecosystems. In the natural environment, amphibians are often challenged with multiple threats simultaneously. Two challenges that amphibian species currently face include exposure to environmental contaminants (ECs), and exposure to parasites. The relationship between EC exposure and amphibian susceptibility to parasites has been investigated for multiple amphibian species, parasite types, and ECs. However, the overall effect of EC exposure on amphibian susceptibility to parasites remains unclear. Therefore, we conducted a meta-analysis to summarize the overall effect of EC exposure on amphibian susceptibility to parasitism and to investigate whether moderating factors influenced the effect of EC exposure on amphibian susceptibility to parasitism. We did not detect an overall effect of EC exposure on amphibian susceptibility to parasitism. The effect of ECs on amphibian parasite levels differed depending on EC class, parasite type, the relative order the host was exposed to ECs and parasites, the host's developmental stage when exposed to parasites, and which organism was exposed to ECs. Amphibian parasite levels increased as the total experiment duration increased. The effect of ECs on parasite-associated amphibian mortality differed depending on EC class, with fungicides increasing parasite-associated amphibian mortality relative to the other EC classes tested. We identified two main considerations for future research: to broaden the array of ECs and parasites tested, and to investigate the ontogeny of EC exposure on amphibian susceptibility to parasites. We also implore researchers to publish their raw data to facilitate data collection and analysis for future meta-analyses.

Oral Bisphosphonates for Colorectal Cancer Prevention: A Meta-Analytic Reappraisal Beyond Bone Health

Background: Oral bisphosphonates (BPs) are the standard therapy for osteoporosis and skeletal metastases, and exhibit anti-tumor properties in preclinical models. Observational studies assessing their impact on colorectal cancer (CRC) risk have yielded inconsistent results. We aimed to systematically review and meta-analyze the association between oral bisphosphonate use and CRC risk, applying a unified exposure definition. Methods: A systematic search was conducted in PubMed, Embase, and Scopus (January 1966-April 2025) to identify cohort, nested case-control, or population-based case-control studies reporting adjusted estimates of relative risk, odds ratios (ORs), or hazard ratios (HRs) for CRC among oral bisphosphonate users. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Random-effects meta-analyses pooled risk estimates for "any use" of bisphosphonates, with subgroup analyses by duration of use (<1, 1-3, >3 years). We assessed publication bias through Egger's test and the trim-and-fill method. Results: A total of eight studies published between 2010 and 2020, including 29,169 CRC cases, fulfilled the inclusion criteria. Any bisphosphonate use was not significantly associated with CRC risk (pooled OR 0.97; 95% C.I., 0.90-1.03). However, 1-3 years of use conferred a protective effect (OR 0.86; 95% C.I., 0.73-0.99), as did >3 years (OR 0.91; 95% C.I., 0.85-0.97). Heterogeneity was moderate, and no significant publication bias was detected. Conclusions: While overall oral bisphosphonate exposure is not significantly linked to CRC risk, prolonged use (≥1 year) appears to reduce risk. Prospective studies and randomized trials are needed to confirm these chemo-preventive effects and guide clinical recommendations.

Multiple sclerosis is associated with worse body composition across compartments: Results from a systematic review and meta-analysis

BACKGROUND

There is conflicting evidence regarding specific differences in body composition (i.e., body fat, lean, and bone) between people with multiple sclerosis (MS) and non-MS controls. The objective of this meta-analysis was twofold: (1) quantify overall and compartment-specific differences in body composition between people with MS and controls; and (2) identify individual and disease-specific moderators of any differences in body composition between groups.

METHODS

A search of five electronic databases (MEDLINE, EMBASE, Cochrane Central, CINAHL, and Scopus) was performed by an information specialist.

RESULTS

Overall, 180 effects were derived from 37 studies, 155 (86.1 %) of which were negative, with a mean effect ∆ of -0.39 (95 %CI: -0.46, -0.32, Z = -10.86, p < 0.001) suggesting poorer overall body composition in people with MS. Disability status was significantly associated with overall effect size (β = 0.31, Z = 4.33, p < 0.0001); effects were significantly larger at higher disability levels. Regarding body fat, 55/61 (90.2 %) effects were negative, resulting in a mean effect ∆ of -0.32 (95 %CI: -0.43, -0.21, Z = -5.72, p < 0.001). With regards to lean tissue, 38/43 (88.4 %) effects were negative, with a mean effect ∆ of -0.38 (95 %CI: -0.56, -0.21, Z = -4.28, p < 0.001). Lastly, 62/76 (81.6 %) effects for bone mineral density were negative, with a mean effect ∆ of -0.44 (95 %CI: -0.55, -0.34, Z = -8.28, p < 0.001).

CONCLUSIONS

Current evidence supports poorer overall and compartment-specific body composition in people with MS, and this may be particularly relevant at higher disability. Strategies for managing body composition in MS should consider the need for maintaining lean mass and bone health, while managing obesity.

The effect of treatment on the quality of life of patients with obsessive-compulsive disorder: systematic review and meta-analysis

This systematic review and meta-analysis investigated whether treatments for obsessive-compulsive disorder (OCD) are associated not only with decreases in symptom severity but also with improvements in quality of life (QoL). A systematic search of PUBMED, PsycInfo, Scopus, Web of Science and ClinicalTrials databases was performed. The inclusion criteria involved RCTs that investigated adults diagnosed with OCD and incorporated evaluations of baseline and endpoint assessments for QoL and OCD symptom severity. The search found 3872 records, with 19 remaining after all screening process. Most of the studies investigated psychological interventions, categorizable into clusters of CBT-based treatments, interventions with meditation components, and augmentation strategies. This categorization was utilized to perform subgroup analysis. All subgroup interventions had a non-significant effect on QoL, except for CBT-based treatments, which demonstrated a statistically significant difference when compared to waiting lists. Regarding the effect of the interventions on the severity of OCD symptoms, the effect sizes were small for CBT-based treatments and medium for interventions with meditation components and augmentation strategies. The CBT-based treatments lead to some improvement in QoL of people with OCD (when compared to no treatment). Evidence suggested that treatments incorporating meditation components or augmentation treatments lead to improvements in OCD symptoms unparalleled by QoL improvement. Further studies are needed to assess pre- and post-intervention QoL measures for a more robust conclusion. This can facilitate the identification of more beneficial and effective treatments, both in reducing symptoms and improving QoL.

Comparative efficacy of adjuvant chemotherapy and immunotherapy after radical surgery for upper tract urothelial carcinoma: A systematic review and meta-analysis

To evaluate the effects of adjuvant chemotherapy (AC) and adjuvant immunotherapy (AI) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). A systematic review and meta-analysis was conducted using studies identified from PubMed, Cochrane Library, Embase, CENTRAL, and ClinicalTrials.gov up to September 2024. We performed pair-wise and network meta-analyses to evaluate survival outcomes, focusing on overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival, and metastasis-free survival. A total of 43 studies involving 13,132 patients were included. Pair-wise meta-analysis showed that AC significantly improved OS (HR 0.74, 95% CI 0.63-0.86, P = 0.0001), CSS (HR 0.74, 95% CI 0.60-0.90, P < 0.00001), and DFS (HR 0.61, 95% CI 0.51-0.75, P < 0.00001). A pooled analysis of three RCTs with 384 UTUC patients showed that AI did not significantly improve DFS (HR 1.19, 95% CI 0.87-1.64, P = 0.28) or OS (HR 1.28, 95% CI 0.81-2.03). Network meta-analysis suggested that combining AC with AI could offer better DFS than AC alone, with AC outperforming AI. Ranking analysis indicated that MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) was the most effective for OS and CSS improvement, followed by GC (gemcitabine and cisplatin). AC improves the prognosis of UTUC patients, whereas the results with AI are less promising. AC shows better outcomes than AI after RNU. Preliminary evidence suggests that combining AC with AI may enhance DFS, but further research is needed to confirm its effectiveness.

Safety and Effectiveness after Atrial Shunt Device in Patients with Heart Failure:A Systematic Review and Meta-Analysis

BACKGROUND

Limited data are available regarding the atrial shunt device (ASD), making it challenging to provide definitive recommendations for patients with heart failure (HF). We conducted a meta-regression analysis to identify individuals who may derive greater benefit from this device.

METHODS

We conducted a search across PubMed, EMBASE, and Cochrane databases, including 8 studies for meta-analysis. Estimated endpoints were derived using random-effects proportional meta-analysis. Additionally, meta-regression analysis was performed to elucidate the potential impact of key covariates on these endpoints.

RESULTS

A total of 522 patients were included. The pooled analysis revealed an estimated mortality rate of 1.9% for patients who underwent ASD. Additionally, the proportion of patients who remained in NYHA III to IV was reduced to 22.5%. Furthermore, there was an improvement of 35.1 meters in the 6-minute walk distance (6MWD) and a 16.2-point improvement in the KCCQ score. Meta-regression analysis indicated that NYHA III to IV status was found to be directly proportional to age (β= 2.799), hypertension (β= 0.782), diabetes (β= 0.951), and atrial fibrillation (β= 0.778). Hypertension and a high level of left ventricular ejection fraction (LVEF) were associated with less improvement in 6MWD and KCCQ score, whereas a higher NT-proBNP level was associated with better improvement in 6MWD and KCCQ score.

CONCLUSIONS

ASD emerges as a safe choice for HF patients aiming to alleviate symptoms. Specifically, individuals with reduced EF or elevated NT-proBNP levels, and without concomitant hypertension, diabetes, or atrial fibrillation, appear to achieve more substantial symptom relief.

A meta-analytic appraisal of robotic-assisted cystectomy outcomes in the elderly octogenarian population

OBJECTIVE

This analysis aims to compare the outcomes of robotic cystectomy in patients with bladder cancer who are under 80 years of age versus those who are 80 years or older.

MATERIALS AND METHODS

A thorough search was conducted across key databases, including Google Scholar, Cochrane Library, PubMed, EMBASE, and Web of Science, with the most recent search conducted in July 2024. Data analysis was performed using Stata 18, applying a random-effects meta-analysis model. Weighted mean differences were calculated for continuous data, and odds ratios for categorical variables, accompanied by 95% confidence intervals.

RESULTS

Four studies were included in the meta-analysis. The baseline data revealed significant differences in age, sex distribution, BMI, ASA scores (≥ 3), and cT2 staging between the two age groups. Patients aged 80 and above had significantly longer surgical durations and a greater number of lymph nodes removed compared to those under 80. Marked heterogeneity was observed in the younger cohort, which showed higher rates of urinary diversion to the neobladder and pelvic lymph node dissection. Blood loss, hospitalization duration, total complications, minor complications, and major complications did not differ notably between the age groups.

CONCLUSION

This study suggests that robot-assisted radical cystectomy (RARC) is a viable and safe procedure for carefully selected elderly patients when performed in high-volume specialized centers. However, the small sample size, intermediate follow-up period, and potential for selection bias warrant caution in interpreting long-term outcomes. Future multi-center studies with longer follow-ups are needed to confirm these findings and establish standardized criteria for patient selection.

Effects of sleep hygiene education for insomnia: A systematic review and meta-analysis

Sleep hygiene education (SHE) as a single therapy for insomnia still lacks sufficient evidence. This study aimed to quantify the effects of SHE on insomnia treatment. A literature search was conducted on seven databases from inception up to 30 September 2024 to retrieve randomized controlled trials. Meta-analyses were performed to estimate the mean difference (MD) of Insomnia Severity Index (ISI) (primary outcome) using a random-effects model. Risk of Bias 2 tool was applied to measure methodological quality. Forty-two RCTs encompassing 4245 adults (65.5 % female) were included. The pooled results showed significant pretreatment-to-posttreatment improvement in ISI score (MD = 3.4, 95 % confidence interval (CI) [2.08, 4.64]). However, SHE was inferior as a cognitive behavioral therapy for insomnia (CBT-I) (MD = 3.8, 95 % CI [2.92, 4.76]), partial CBT-I (MD = 4.5, 95 % CI [3.33, 5.60]), exercises (MD = 2.9, 95 % CI [0.81, 5.04]), and acupressure (MD = 1.9, 95 % CI [0.82, 3.00]) regarding the ISI score. The majority of included trials (85.71 %) had a high overall risk of bias, and the remaining had "some concerns." Future work is encouraged to generate robust evidence through the development of well-designed SHE as an examined intervention for insomnia that involves process evaluation and treatment fidelity.

Real-World 10-Year Outcomes of Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration: A Meta-Analysis

BACKGROUND

This study examines the long-term effectiveness of anti-VEGF therapy in managing neovascular age-related macular degeneration (nAMD). Despite the well-established short-term improvements of anti-VEGF therapy, there is limited data on its continued efficacy over extended periods. This meta-analysis synthesises real-world data to evaluate anti-VEGF therapy's long-term outcomes systematically.

METHODS

We conducted a comprehensive literature review across PubMed, EMBASE and Cochrane databases, focusing on studies that reported outcomes of anti-VEGF treatment for nAMD over a decade. The analysis included pooling baseline patient characteristics, study designs, sample sizes and changes in visual acuity (VA) over 10 years.

RESULTS

Our search produced 12 observational studies encompassing 7509 eyes, with 1274 completing 10-years of follow-up. The most substantial improvement in VA was observed in the first year following the initiation of anti-VEGF therapy. On average, there was a decline of 8.11 letters in VA after 10 years from baseline (95% CI -10.83 to -5.39, p < 0.01). In some cases, VA reverted to baseline levels after 10 years; in others, it declined significantly below baseline. Meta-regression showed that mean VA change was greater in those with a lower baseline VA and those treated with a higher number of injections over 10-years(p < 0.01).

CONCLUSION

Our findings suggest that the mean visual acuity of eyes treated for nAMD deteriorates progressively over the long-term from two years after starting treatment. Regular injections appear crucial for preserving maximum vision. While our analysis did not identify an increased incidence of serious ocular adverse events, the long-term impact of anti-VEGF therapy on geographic atrophy remains unclear and warrants further investigation.

Modifiable determinants of older adults' physical activity and sedentary behavior in community and healthcare settings: a DE-PASS systematic review and meta-analysis

OBJECTIVES

To identify the modifiable determinants targeted in interventions involving older adults, and to determine which of these interventions effectively increased physical activity (PA) and/or reduced sedentary behaviour (SB). Additionally, to explore whether the effects of these interventions vary based on the implementation setting.

METHODS

A search of randomized controlled trials (RCTs) and controlled trials (CTs) was performed in Medline, APA PsycArticles, SPORTDiscus, and Web of Science. Risk of bias assessment was performed with Cochrane's tool. Modifiable determinants were narratively synthesized, and random-effects models were performed to meta-analyse studies reporting device-measured physical activity or sedentary behaviour. Moderator analyses were performed to investigate the role of implementation setting. Standardized between-group mean difference (SMD) with 95% confidence interval (CI) was used to indicate effect sizes.

RESULTS

From 31,727 individual records, 52 eligible studies published between 2012-2022 were identified, 30 and 22 studies from community and health care settings, respectively. Determinants within the category physical health and wellbeing (n = 23) were most frequently reported while only one study reported determinants within a social or cultural context. Eighteen studies were included in the meta-analysis. Interventions targeting physical health and wellbeing revealed an increase in steps (SMD = 0.46; 95%CI: 0.15 to 0.77) and minutes of moderate-to-vigorous intensity physical activity (SMD = 0.41; 95%CI: 0.19 to 0.64) among intervention participants compared to controls, whereas interventions targeting psychological or behavioural determinants showed no between-group differences in steps (SMD = 0.10; 95%CI: -0.12 to 0.32) and moderate-to-vigorous intensity physical activity (SMD = 0.26; 95%CI: -0.24 to -0.75). Interventions targeting physical health and wellbeing showed significant heterogeneity (p < 0.0001; I2 = 73.10%). Subgroup analyses showed a significant effect on device-measured physical activity for the eight community-based interventions (SMD = 0.42; 95%CI: 0.07 to 0.77), while no significant effect was found for the eight studies performed in healthcare settings (SMD = 0.26; 95%CI; -0.10 to 0.62).

CONCLUSION

Interventions targeting physical health and wellbeing may increase PA in older adults, with community-based studies appearing more effective than studies in healthcare settings. The significant heterogeneity of study findings indicates that further research is needed to fully understand the influence of PA and SB determinants across settings, particularly those related to psychological, behavioural, social, and cultural factors.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42022287606.

Prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Antimicrobial-resistant Pseudomonas and Acinetobacter species are emerging as serious public health risks, both globally and in resource-limited countries such as Ethiopia. These microorganisms cause serious, life-threatening infections and are becoming increasingly resistant to commonly prescribed antibiotics. The high prevalence and resistance patterns of these bacteria need immediate action to inform treatment guidelines, increase infection control measure, and develop effective public health policies. This systematic review and meta-analysis aimed to assess the prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia.

METHODS

This systematic review and meta-analysis, which followed PRISMA principles, analyzed data from PubMed, Scopus, and Google Scholar to determine the prevalence and antibiotic resistance trends of Pseudomonas and Acinetobacter species in Ethiopia. Eligible studies were extracted by using Microsoft Excel and exported to STATA version 17 for analysis. The pooled prevalence was estimated using a random-effects model, and heterogeneity was examined using the I2 statistic. Publication bias was investigated using funnel plot analysis and Egger's test, and sensitivity analysis was used to assess the impact of individual studies on the total pooled findings.

RESULT

Of the 1,375 studies identified, 187 were eligible for qualitative analysis, leading to the inclusion of 65 studies in the meta-analysis. This analysis encompassed a total of 1,264 isolates, with 364 identified as Pseudomonas and Acinetobacter species. The systematic review revealed a pooled prevalence of 19.12% (95% CI: 14.86-23.38) for Pseudomonas species and 12.46% (95% CI: 5.82-19.10) for Acinetobacter species. The combined prevalence of both pathogens was 25.31 (95% CI: 18.61-32.00) with substantial heterogeneity (I2 = 93.6%, p < 0.001). across the studies. Pseudomonas exhibited high resistance rates to amoxicillin-clavulanic Acid (83.73%) and tetracycline (89.15%), while Acinetobacter showed 87.21% resistance to tetracycline and 79.72% to ceftriaxone. The overall pooled prevalence of MDR Pseudomonas species was 72.73% (95% CI: 67.02-78.44), and for Acinetobacter species, it reached 84.69% (95% CI: 78.78-90.59), respectively. Moreover, the pooled prevalence of MDR for both species isolated from clinical samples in Ethiopia was 74.79% (95% CI: 70.14-79.43), with significant heterogeneity (I2 = 99.7%, p < 0.001) across the studies.

CONCLUSION

The pooled prevalence of Pseudomonas and Acinetobacter species and their antibiotic resistance were alarmingly high in clinical samples in Ethiopia. These findings highlight the crucial need for more antimicrobial surveillance, stronger stewardship programs, and targeted research to combat the growing threat of resistance. Strategic public health policies are required to decrease these pathogens.

Efficacy of Topical Timolol in Chronic Unhealed Ulcers: A Systematic Review and Meta-Analysis

BackgroundTopical timolol appears to provide a curative effect in managing chronic ulcers. However, the pooled evidence of its effect hasn't been established yet. This is the first Meta-analysis to evaluate and assess the efficacy of topical timolol in accelerating wound healing in patients with chronic refractory ulcers.MethodsWe comprehensively searched different electronic databases; PubMed, Scopus, Web of Science, Cochrane library and ClinicalTrials.gov from their inception to November 2024. The search was conducted without imposing any restrictions on publication date or study design. The ROB-II tool was used to assess the quality of included RCTs. NIH tools were used to evaluate the quality of included cohort and single arm studies. Risk ratios (RR) and mean differences (MD), with 95% confidence intervals (CIs), were used as effect estimates.ResultsSix studies were included in this systematic review, comprising two single-arm studies and four double-arm studies (3 RCTs and 1 cohort study). Data from the four double-arm studies on venous ulcers were pooled for meta-analysis. The results showed that topical timolol significantly reduced ulcer area compared to control at 2 weeks (-23.63%; 95% CI: -29.26 to -18.00; p < 0.00001), 4 weeks (-41.40%; 95% CI: -49.57 to -33.23; p < 0.00001), and 12 weeks (-23.38%; 95% CI: -39.43 to -7.33; p = 0.004). Complete ulcer healing was observed at 4 weeks (RR: 12.00; 95% CI: 1.68 to 85.84; p = 0.01) and 12 weeks (RR: 3.79; 95% CI: 0.44 to 32.54; p = 0.22).ConclusionTopical timolol has the potential to promote healing in chronic unhealed ulcers. This meta-analysis, focusing on chronic venous ulcers, consistently showed favorable results across different time points. However, the small sample sizes, lack of blinding, and inclusion of only four studies limit the generalizability of the findings.

The efficacy of retrograde and antegrade enemas in the management of low anterior resection syndrome in patients undergoing rectal resection: a systematic review and meta-analysis

BACKGROUND

Rectal resection could potentially cause low anterior resection syndrome (LARS). Although recent studies have reported the efficacy of enema against LARS, no systematic review and meta-analysis has been conducted.

METHODS

A systematic search was conducted in PubMed, EMBASE, MEDLINE, CINAHL Complete, Cochrane library and Web of Science. Eligible studies that quantified the effect of enema vs. other approaches on LARS following rectal resection were selected. Meta-analysis was conducted by using RevMan 5.4 software and StataMP 17. Where meta-analysis was not possible, vote counting was performed.

RESULTS

This study comprised five RCTs with 159 participants and meta-analysis was performed in 4 studies. Compared with the control group, enema reduced LARS score with mean differences of -10.84 (95% CI: -16.71 to -4.98, P = 0.0003). Subgroup analysis based on the type of enema were performed, with three European studies using retrograde enema and one Asian study using antegrade enema, with mean differences of -13.77 (95% CI: -17.97 to -9.57, P < 0.00001) and -4.86 (95% CI: -9.26 to -0.46, P = 0.03), respectively. According to follow-up period, two trials reported short-term effects and the other two investigated medium/long-term effects with mean differences of -14.22 (95% CI: -20.05 to -8.38, P = 0.23) and -7.59 (95% CI: -14.47 to -0.71, P = 0.13), respectively. One study that used antegrade enema was key contributor to the substantial interstudy heterogeneity by the leave-one-out sensitivity analysis. After exclusion of this study, no heterogeneity was found (t2 = 0.00; χ2 = 1.63, df = 2, p = 0.44; I2 = 0%). Vote counting also showed positive effects of enema on LARS.

CONCLUSIONS

Enema, particularly retrograde enema, is effective in managing LARS. However, the effectiveness of antegrade enema deserves further investigation. The short-term effects of enema are more pronounced compared to long-term outcomes. Due to the limited number of included studies, these findings should be taken cautiously. More RCTs on other continents are needed to validate the impact of enema on LARS, as well as to develop standardised protocols to facilitate clinical practice.

PROSPERO REGISTRATION

CRD42024539973.

Efficacy, Safety, and Future of GLP-1 Receptor Agonists: A Systematic Literature Review and Meta-Analysis

GLP-1 receptor agonists have emerged as important therapeutic agents for type 2 diabetes mellitus (T2DM), but their comparative efficacy and broader applications remain subjects of ongoing research. The aim of the study was to evaluate and compare the efficacy, safety, and clinical applications of three GLP-1 receptor agonists - Semaglutide, Dulaglutide, and Exenatide - through systematic review and meta-analysis. A comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2023) identified 20 randomized controlled trials and observational studies. Primary outcomes included changes in HbA1c and body weight. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Semaglutide demonstrated superior efficacy with mean HbA1c reduction of 1.45% and weight loss of 1.44 kg. Dulaglutide showed consistent reductions in HbA1c (1.1%) and weight (1.2 kg). while Exenatide exhibited moderate effects. Meta-analysis revealed a significant pooled effect estimate favoring GLP-1 receptor agonists. with a mean HbA1c difference of -0.81 (95% CI: -0.92 to -0.70). Gastrointestinal side effects were most common, with Semaglutide showing the highest incidence. This meta-analysis establishes Semaglutide as the most effective GLP-1 receptor agonist for glycemic control and weight reduction, while Dulaglutide and Exenatide offer viable alternatives with fewer side effects. These findings support evidence-based decision-making in T2DM management and highlight the potential broader therapeutic applications of GLP-1 receptor agonists beyond diabetes care.

Investigating the association between maternal age and cerebral palsy incidence: A meta-analysis

BACKGROUND

Cerebral palsy (CP) is a group of nonprogressive motor and postural disorders resulting from early developmental brain injury. While maternal age is a known factor associated with CP risk, previous studies have shown inconsistent findings, particularly regarding advanced maternal age. In addition, earlier meta-analyses often lack stratification by gestational age or do not include recent population-based studies. This meta-analysis aims to provide an updated and more detailed assessment of the association between maternal age at delivery and the risk of CP, using refined age group classifications and subgroup analyses based on gestational age.

METHODS

We systematically searched the Embase, PubMed & Medline databases (from inception to March 2024) for English publications; we searched for all published studies comparing the number of cases (CP) and the number of controls according to maternal age. A meta-analysis was performed using R Statistical Software version 4.2.2 (The R Foundation for Statistical Computing). The odds of CP were examined among the maternal ages at delivery of 18 years old or younger, 25 years old or younger, 35 years old or older, or 40 years old or older, with a positive log odds ratio (OR) indicating higher odds of CP.

RESULTS

From 9237 initially identified articles, 12 studies were ultimately included. Young maternal age (≤18 years old) was found to significantly increase the risk of CP (OR = 0.1374, P < .0001). The maternal groups defined by the ages of 25 and 35 years showed mixed risks, with term infants from mothers aged 35 years and older having higher odds of CP (OR = 0.9198, P = .0023).

CONCLUSIONS

CP risk is higher in children born to mothers aged 18 years or younger and may also increase in full-term births to mothers aged 35 years or older. These findings may help guide risk assessment and public health planning.

The role of novel biomarkers in the early diagnosis of pancreatic cancer: A systematic review and meta-analysis

BACKGROUND

Early detection of pancreatic cancer is essential for improving survival rates. However, noninvasive diagnostic methods are lacking. Novel biomarkers, detectable through liquid biopsy, such as circulating tumor DNA (ctDNA), microRNAs (miRNAs), protein markers, and metabolites, hold promise for early diagnosis.

METHODS

A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for studies published from January 2014 to May 2024. Studies were included if they evaluated novel biomarkers for early pancreatic cancer detection, reported diagnostic performance metrics (sensitivity, specificity), and had a QUADAS-2 score of ≥3. Data on study characteristics, patient demographics, biomarker types, and diagnostic performance were extracted following PRISMA guidelines. A bivariate random-effects model was used to calculate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). The area under the summary receiver operating characteristic (SROC) curve assessed overall diagnostic accuracy. The primary outcome was the diagnostic accuracy (sensitivity and specificity) of novel biomarkers in detecting early-stage pancreatic cancer.

RESULTS

A total of 43 studies involving 19,326 participants were included, with 2,749 patients having stage I or II pancreatic cancer. The pooled sensitivities and specificities were as follows:. miRNA Biomarkers: Sensitivity 0.88 (95% CI 0.79-0.93), Specificity 0.91 (95% CI 0.82-0.95), DOR 72.68 (95% CI 26.64-198.24), AUC 0.95. Protein Biomarkers: Sensitivity 0.79 (95% CI 0.70-0.86), Specificity 0.88 (95% CI 0.82-0.93), DOR 27.74 (95% CI 14.32-53.76), AUC 0.90. Metabolite Biomarkers: Sensitivity 0.84 (95% CI 0.73-0.92), Specificity 0.85 (95% CI 0.81-0.88), DOR 31.76 (95% CI 12.38-81.48), AUC 0.90. ctDNA Biomarkers: Sensitivity 0.65 (95% CI 0.48-0.81), Specificity 0.94 (95% CI 0.88-0.97), DOR 27.73 (95% CI 12.91-59.55), AUC 0.92. Subgroup analyses showed combining biomarkers with CA19-9 improved diagnostic accuracy. Sensitivity analyses confirmed the robustness of the findings.

CONCLUSIONS

Novel biomarkers, particularly miRNAs and protein markers, demonstrate high diagnostic accuracy for early pancreatic cancer detection and have potential for clinical application in improving early diagnosis and patient outcomes.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, Identifier: PROSPERO (CRD42024553633).

Are there associations between Executive Functions and Theory of Mind in attention deficit hyperactivity disorder? Results from a systematic review with meta-analysis

BACKGROUND

Deficits in Executive Function (EF) and Theory of Mind (ToM) are common and significant in attention deficit hyperactivity disorder (ADHD), impacting self-regulation and social interaction. The nature of ToM deficits is believed to be partially associated with preexisting deficits in other core cognitive domains of ADHD, such as EF, which are essential for making mental inferences, especially complex ones. Evaluating these associations at a meta-analytic level is relevant.

OBJECTIVE

To conduct a systematic literature review followed by a meta-analysis to identify potential associations between EF and ToM among individuals with ADHD and their healthy counterparts, considering different developmental stages.

METHOD

A systematic review was conducted in seven different databases. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. The meta-analytic measurement was estimated with the correlation coefficient as the outcome. Due to the presence of heterogeneity, a random-effects model was adopted. Independent meta-analyses were conducted for different EF subdomains and ADHD and healthy control groups. Subgroup analyses were performed to examine the influence of age on the outcome of interest.

RESULTS

Fifteen studies were analyzed. Moderate associations were found when comparing EF and ToM between individuals with ADHD (0.20-0.38) and healthy subjects (0.02-0.40). No significant differences were found between child and adult samples (p > 0.20).

CONCLUSION

The association between EF and ToM was significant, with a moderate effect size, although no significant differences were found according to age, the presence of ADHD, or EF subdomains. Future research is suggested to expand the age groups and overcome the methodological limitations indicated in this review.

Safety and efficacy of palliative transurethral resection of the prostate for lower urinary tract obstruction in patients with metastatic prostate cancer: a meta-analysis

PURPOSE

This meta-analysis aims to assess the safety, efficacy, and outcomes of palliative transurethral resection of the prostate (TURP) for relieving urinary obstruction in patients with metastatic prostate cancer.

METHODS

A comprehensive literature search was performed across PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar to identify studies published before August 2024. The included studies reported pre- and post-treatment outcomes in patients undergoing palliative TURP for urinary obstruction. Data were analyzed using Comprehensive Meta-Analysis and Review Manager software. Study quality was evaluated using the Newcastle Ottawa Scale, and bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.

RESULTS

Eight studies, including 3,080 patients with advanced prostate cancer, were included. Palliative TURP significantly reduced postvoid residual urine volume by a mean difference of 50.41 milliliters (95% confidence interval: 39.49-61.34, p < 0.00001) and improved the symptom score by 14.13 points (95% confidence interval: 10.03-18.23, p < 0.00001). However, no significant change was observed in the urinary flow rate (mean difference: 4.31 milliliters per second, p = 0.23). Reported complications included repeat TURP (23.4%), incontinence (13.9%), catheterization (10.8%), and TURP syndrome (2.7%).

CONCLUSION

Palliative TURP effectively improves urinary symptoms and reduces urinary retention in patients with metastatic prostate cancer. While it offers symptomatic relief, the risk of postoperative complications should be carefully considered in treatment planning.

Effectiveness and Experience of Implementing Digital Interventions to Promote Smoking Cessation Among Adults With Severe Mental Illness: A Systematic Review and Meta-analysis

INTRODUCTION

Digital technology is increasingly used to support interventions targeting smoking cessation in people with severe mental illness (SMI). However, little is known about their implementation and effectiveness in this population. We aimed to determine the effectiveness, stakeholder experiences, factors influencing implementation, and quality of reporting of digital interventions for smoking cessation in adults living with SMI.

METHODS

Five online bibliographic databases were searched for articles published between December 31, 2000 and January 31, 2023. Studies involving adults accessing treatment for alcohol and substance use disorders, neurocognitive disorders, and terminal illnesses were excluded. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials was conducted. Participant experience and intervention implementation were explored using a narrative synthesis. Quality of reporting of interventions was assessed using the Template for Intervention Description and Replication checklist.

RESULTS

Thirty-one studies enrolling 3794 participants were included. Meta-analysis of biochemically verified abstinence at longest follow-up (month 1 to month 6) did not find an overall effect in favour of intervention (risk ratio = 0.66, 95% confidence interval = -0.005 to 1.37). Interventions tailored to people with SMI were perceived as acceptable. Implementation strategies concentrated on overcoming practical challenges at the participant/user level.

CONCLUSIONS

No evidence of the effectiveness of digital interventions to support smoking cessation in people with SMI was found. The importance of tailoring interventions to the needs of people with SMI is highlighted. Robust reporting of implementation is required to enhance future efforts to support smoking cessation in adults with SMI.

IMPLICATIONS

The findings of this review add to the emerging evidence on digital interventions to support smoking cessation among people with SMI. We highlight the importance of tailoring interventions to the population, particularly considering the role of mental illness and the side effects of psychotropic medication in the accessibility and usability of digital interventions.

Risk factors associated with acute kidney injury in patients with traumatic brain injury: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to identify and quantify the risk factors associated with acute kidney injury (AKI) in patients with traumatic brain injury (TBI).

METHODS

PubMed, Embase, and Web of Science were systematically searched for articles published up to October 2024. Observational studies published in English that reported on risk factors for AKI in TBI patients were included. Data on AKI incidence and risk factors were extracted. A meta-analysis was conducted using a random-effects model when heterogeneity I2 > 50 % and a fixed-effects model when I2 < 50 %. Risk of bias for studies was assessed using the Newcastle-Ottawa Scale (NOS). Certainty of evidence was evaluated using the GRADE approach.

RESULTS

Twenty studies involving 13,115 TBI patients were included in the meta-analysis. The pooled incidence of AKI after TBI was 19 % (95 % CI 16-23). Male gender (odds ratio (OR) 1.43, 95 % CI 1.21-1.70; I2 0 %), diabetes (OR 3.59, 95 % CI 1.74-7.42; I2 0 %), Glasgow Coma Scale (GCS) (mean difference (MD) -0.48, 95 % CI -0.74,-0.23; I2 38 %), GCS ≤ 8 at admission (OR 1.56, 95 % CI 1.28-1.90; I2 0 %), Simplified Acute Physiology Score II (SAPS II) score (MD 4.65, 2.69-6.61; I2 56 %), serum creatinine level at admission (MD 18.17, 95 % CI 1.82-34.51; I2 93 %), hemoglobin (MD -6.82, 95 % CI -12.72, -0.92; I2 79 %), glucose (MD 1.42, 95 % CI 0.64-2.20; I2 0 %), the use of mannitol (OR 2.14, 95 % CI 1.08-4.25; I2 74 %), vancomycin (OR 1.75, 95 % CI 1.35-2.27; I2 0 %) and red blood cell transfusion (OR 3.35, 95 % CI 1.86-6.04; I2 59 %) increased the risk for AKI.

CONCLUSION

These findings highlighted the critical need for proactive surveillance of these risk factors in clinical practice, enabling the development of prediction models to identify TBI patients at high risk of AKI.

Evaluating the Role of Point-of-Care Ultrasound in Central Venous Pressure Monitoring for Critically Ill Patients. A Comprehensive Systematic Review and Meta-analysis

Central venous pressure (CVP) is a critical parameter for assessing volume status in critically ill patients, traditionally measured through invasive central venous catheterization. While effective, this method poses risks such as infection and procedural complications. Point-of-care ultrasound (POCUS) has emerged as a promising, non-invasive alternative, yet its accuracy in estimating CVP remains debated. From inception to December 2024, PubMed, Embase, MEDLINE, Web of Science, and Google Scholar databases were extensively searched. The search strategy used to identify relevant studies from these databases involved combining keywords such as "Point-of-care ultrasound," "central venous pressure," and "critically ill" with Boolean expression "AND" and "OR." Two independent reviewers then screened all potential studies and included those reporting the accuracy of POCUS in predicting CVP and those reporting the correlation between POCUS-measured indices and invasively-measured CVP in critically ill patients. Additionally, two independent reviewers extracted the relevant data from the included studies. Statistical analyses were conducted using MedCalc and Meta-Disc software, and quality appraisal was assessed using the QUADAS-2 tool. The review included studies evaluating POCUS-derived indices from the inferior vena cava (IVC) and internal jugular vein (IJV). Overall, strong correlations were observed between POCUS measurements and CVP, with IVC parameters showing the strongest associations. IJV measurements also demonstrated moderate reliability, particularly in scenarios where IVC assessments were impractical. Sensitivity and specificity analyses indicated that POCUS-derived indices could predict CVP with variable accuracy. These findings support the use of POCUS as a practical, non-invasive tool for estimating CVP in critically ill patients. IVC measurements appear to provide the most reliable correlations, while IJV assessments serve as a useful alternative. Despite its potential, variability in study methodologies and patient factors highlights the need for further research to refine POCUS-based CVP estimation and improve clinical application.

Short-term safety and efficacy of aspirin in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

Objective

Coagulation activation and inflammatory derangements are key characteristics of coronavirus disease 2019 (COVID-19). Aspirin therapy in patients with COVID-19 remains uncertain due to conflicting evidence regarding its ability to balance anti-inflammatory and antithrombotic benefits against potential bleeding risks in the context of COVID-19-associated coagulopathy. This study aimed to compare the clinical safety and efficacy of aspirin in patients with COVID-19 in randomized controlled trials (RCTs).

Methods

In the present systematic review and meta-analysis, the Medline, Embase, and Cochrane Library databases were searched for RCTs from database inception to January 13, 2023. Data were independently extracted and screened by two authors using structured data collection forms based on published reports. Results were calculated using odds ratios (ORs) and 95% confidence intervals (CIs) with the Mantel-Haenszel method. Quality was assessed using the Cochrane Risk of Bias tool. The main outcomes were short-term all-cause mortality, bleeding events and any thrombosis events. This meta-analysis was registered on PROSPERO.

Results

A total of 922 studies were identified. Finally, six RCTs with low risk of bias were pooled in the analysis. The results showed that aspirin use was not associated with a reduction in all-cause mortality (OR = 0.95, 95% CI [0.88-1.03], I2 = 0%) or the risk of any thrombosis (RR 0.88, 95% CI [0.77-1.01], I2 = 0%), but aspirin use was associated with a higher risk of bleeding (OR 1.72, 95% CI [1.32-2.24], I2 = 0%). No obvious risk of bias was found among the included RCTs for the primary outcome.

Conclusion

Routine low-dose aspirin use does not reduce the risk of short-term mortality and risk of any thrombosis but increases the risk of bleeding. The data does not support the use of low-dose aspirin in patients with COVID-19.

R0 Resection Rates in Minimally Invasive Versus Open Pelvic Exenteration for Colorectal Malignancies: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Pelvic exenteration is a curative option for select patients with locally invasive or recurrent colorectal cancer. Achieving clear margins (R0 resection) is critical for optimal oncological outcomes and quality of life. Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, offers advantages in visualisation and precision, but its feasibility is debated given data limitations. This meta-analysis compares outcomes of MIS with open pelvic exenteration for colorectal cancer.

METHODS

A systematic review and meta-analysis were conducted with studies comparing MIS to open approaches for pelvic exenteration in colorectal cancer included. The primary outcome was R0 resection rate, with secondary outcomes encompassing operative, postoperative, and oncological results.

RESULTS

Seven retrospective studies were analysed, including a total of 564 patients. Meta-analysis showed no significant difference in R0 resection rates between MIS and open approaches (RR = 0.74, 95% CI: 0.36, 1.51, p = 0.41) with low heterogeneity (I2 = 19%). MIS had similar lymph node harvest, operative time, and postoperative complications but demonstrated significantly reduced intraoperative blood loss, shorter length of stay, and improved 3-year overall and disease-free survival rates.

CONCLUSIONS

MIS achieves comparable R0 resection rates to open surgery in pelvic exenteration for colorectal cancer, with advantages in recovery and survival outcomes. Current evidence is limited by retrospective studies with selection bias requiring future standardised prospective trials.

One-hour vs Two-hour Postprandial Glucose Targets and Fetomaternal Outcomes in Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

OBJECTIVE

The optimal time and target for postprandial glucose (PPG) measurement in gestational diabetes mellitus (GDM) remain unclear. This systematic review and meta-analysis evaluated whether targeting 1-hour PPG (1 hPG) vs 2-hour PPG (2 hPG) altered fetomaternal outcomes in GDM.

METHODS

Studies that compared pregnancy outcomes in women undergoing 1 hPG vs 2 hPG monitoring in GDM were identified through comprehensive search of electronic databases. Primary outcomes analyzed were large-for-gestational age (LGA) and macrosomia. Secondary outcomes included low birthweight (LBW), neonatal intensive-care unit admission, neonatal hypoglycemia, cesarean section (CS), pre-eclampsia, gestational age at delivery, and preterm delivery.

RESULTS

Six articles that compared 1 hPG<140 mg/dL (7.8 mmol/L) vs 2 hPG <120 mg/dL (7.2 mmol/L) were analyzed. Additionally, 3 articles that assessed 1 hPG<120 mg/dL vs1 hPG<140 mg/dL were also examined. Targeting 1 hPG<140 mg/dL vs 2 hPG<120 mg/dL significantly lowered the risk of LGA [odds ratio (OR) 0.54; 95% confidence interval (CI): 0.32-0.93; P = .03] but not macrosomia [OR 0.45; 95%CI:0.19-1.06; P = .07]. There was no difference in other parameters such as birthweight [mean difference -61.77g; 95%CI:-152.16-28.62; P = .018], LBW [OR 0.90; 95%CI:0.30-2.68;P = .85], neonatal hypoglycemia [OR 0.60; 95%CI:0.28-1.26; P = .18], gestational age at delivery [mean difference 0.20 weeks; 95%CI:-0.29-0.68; P = .43], CS [OR 0.99; 95%CI:0.46-2.12;P = .97], pre-eclampsia [OR 0.66;95% CI:.22-1.96; P = .46], or need for insulin therapy [OR 1.39; 95%CI:.79-2.43; P = .25]. More intensive 1 hPG target <120 mg/dL vs <140 mg/dl increased the risk of preterm delivery [OR 1.62; 95% CI:1.00-2.62; P = .05], without affecting birthweight, LGA, macrosomia, LBW, and CS.

CONCLUSION

Our findings suggest that targeting 1 hPG <140 mg/dL vs 2 hPG<120 mg/dL lowers the risk of LGA, but does not affect other parameters. A stricter target of 1 hPG<120 mg/dL can increase the risk of preterm delivery. Further studies to corroborate these findings are necessary.

Economic and developmental impacts of FDA designations: a systematic review and meta-analysis

INTRODUCTION

U.S. FDA designations: Breakthrough Therapy (BTD), Fast Track (FTD), Orphan Drug (ODD), and Regenerative Medicine Advanced Therapy (RMAT) aim to expedite drug development, yet their combined economic and developmental effects have not been extensively studied. This systematic review evaluates their impacts on Day 1 cumulative average abnormal returns (CAAR) and timelines from Investigational New Drug submission to approval.

METHODS

A systematic search of PubMed, Scopus, ScienceDirect, GreyNet, OpenGrey, ProQuest, and Cochrane Library was conducted for articles published between January 1997 and September 2024. A random-effects model generated pooled estimates with 95% confidence intervals (CI), and heterogeneity was assessed using the Cochrane-Q and I2 statistic. Study quality was evaluated using Drummond's checklist and an adapted Barker checklist.

RESULTS

Twenty-five studies were included. The pooled Day 1 CAAR across designations was 6.12% (95% CI: 3.64-8.61). Subgroup analysis revealed FTD with the strongest immediate market impact (8.20%%, 95% CI: 4.38-12.03) and BTD with the shortest mean approval timeline (69.96 months, 95% CI: 60.25-79.67).

CONCLUSIONS

FDA designations provide economic advantages, especially for smaller companies, and can expedite approvals for high-priority therapies. Notable heterogeneity, particularly with RMAT, warrants further research to clarify how disease area and company size shape real-world outcomes.

REGISTRATION

ResearchRegistry ID11080.

Augmentation of trauma-focused psychotherapy for post-traumatic stress disorder: a protocol for a systematic review and meta-analysis

INTRODUCTION

Despite the established status of trauma-focused psychotherapy (TFP) as a first-line treatment for post-traumatic stress disorder (PTSD), a substantial proportion of individuals do not achieve clinically significant improvement or discontinue treatment. Exploring augmentation strategies to enhance treatment outcomes is essential to reduce the overall burden PTSD puts on individuals and society. This protocol outlines a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the efficacy of non-pharmacological augmentation strategies in addition to TFP for PTSD treatment.

METHODS AND ANALYSIS

We comprehensively searched PubMed, Embase, CENTRAL, PTSDpubs, PsycArticles, PsycINFO, PSYNDEX and CINAHL for RCTs without restrictions on publication dates or languages in October 2024. Study screening is currently ongoing. Additionally, we will perform forward and backward searches of the included studies and relevant reviews. Two reviewers will independently screen and select studies, extract data and assess the risk of bias. We will conduct a narrative review to qualitatively synthesise data and a meta-analysis to quantitatively compare the treatment efficacy of augmented TFP with TFP alone or TFP plus placebo. Primary outcomes will be both symptom severity and response rates. The secondary outcome will be dropout rates. We will explore sources of between-study heterogeneity and potential moderators through subgroup and meta-regression analyses. We will assess the overall quality of the included studies with the Grading of Recommendations Assessment, Development, and Evaluation system.

ETHICS AND DISSEMINATION

Ethical approval is not required. We intend to publish results in a peer-reviewed journal and provide materials and data through the Open Science Framework.

PROSPERO REGISTRATION NUMBER

CRD42024549435.

Continued Versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation: A Meta-Analysis

INTRODUCTION

A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it.

METHODS

A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05.

RESULTS

Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62-1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43-1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42-1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47-1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74-1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79-1.20; P = 0.80) compared with TAVR with interrupted OAC.

CONCLUSIONS

In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.

Sulfadoxine-pyrimethamine alone or with azithromycin for the intermittent preventive treatment of malaria in pregnancy: protocol for a systematic review and meta-analysis

INTRODUCTION

Increasing Plasmodium resistance levels to sulfadoxine-pyrimethamine (SP) threaten the effectiveness of intermittent preventive treatment in pregnancy (IPTp) and have prompted the evaluation of alternative strategies. Azithromycin (AZ) could have add-on effects on malaria and treat sexually transmitted infections (STIs), both conditions described as major causes of adverse pregnancy outcomes (APO). Inconsistent findings on the utility of AZ for the prevention of APO were reported; however, thus far, no comprehensive meta-analytic synthesis of data has been published. This review aims to investigate the effects of SP+AZ administered in women as IPTp on the risk of low birth weight in malaria-endemic areas.

METHODS AND ANALYSIS

Eligible studies will be identified through a pre-established search strategy in several electronic databases (Medline, Cochrane Library, Web of Science, EMBASE, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and AJOL) and will comprise peer-reviewed papers reporting original data on the effects of SP+AZ on the risk of APO. Only randomised controlled trials published until 30 September 2024 in English or French will be included. IPTp with SP+AZ regimens (intervention) will be compared with IPTp with SP alone or with a placebo (control). As primary outcomes, data on the frequency of low birth weight will be collected. Secondary outcomes include the rates of stillbirth, preterm birth, miscarriage and neonatal death. Data will be extracted independently by two reviewers using a predefined extraction form. If the data quality allows for quantitative synthesis, a fixed-effects meta-analysis will be conducted if there is low inter-study heterogeneity. Otherwise, the random-effects meta-analysis will be conducted to take into account uncertainty in pooled estimates that could be due to inter-study heterogeneity. The review protocol was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) guidelines.

ETHICS AND DISSEMINATION

Ethical clearance is not needed as the data will be from already published studies in which informed consent and ethical approval were obtained by primary investigators. Our dissemination plan includes the publication in a peer-reviewed journal as well as conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020149592.

Transcranial direct current stimulation combined with motor training for motor symptoms in Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

We aimed to compare the acute and retention effects of motor training alone versus its combination with transcranial direct current stimulation (tDCS) on motor symptoms in Parkinson's disease (PD) patients.

METHOD

Two independent reviewers searched for randomized controlled trials that applied motor training with active tDCS versus sham tDCS with motor function as an outcome measure for patients with PD. Random-effects meta-analyses were conducted to calculate standardized mean differences between the effects of motor training with active tDCS versus sham tDCS on motor function. A total of 16 randomized controlled trials (344 PD patients) were eligible for meta-analysis, resulting in 75 motor function comparisons for data synthesis.

RESULTS

Motor training with active tDCS showed positive acute effects on overall motor function compared to motor training with sham tDCS, particularly improving step length and gait speed. Moderator variable analyses indicated that these acute effects persisted regardless of the number of sessions or the targeted brain regions for tDCS. Meta-regression analysis showed that a higher proportion of female participants and shorter PD duration were associated with greater acute effects. However, no positive retention effects of motor training with active tDCS on overall motor function were observed.

CONCLUSIONS

Our results suggest that combining motor training with tDCS improves motor function, particularly in gait-related parameters, in PD patients. However, these effects were not sustained over time, highlighting the temporary nature of the benefits. Sex differences may influence the acute effects of combined motor training and tDCS interventions.

The Effects of Robots on Children with Autism Spectrum Disorder: A Meta-analysis

This study aimed to evaluate the effectiveness of robotic interventions in fostering the development of children with Autism Spectrum Disorder (ASD) and to identify key factors influencing these effects through a meta-analysis. A meta-analysis was conducted on 14 studies published between 2015 and 2024, incorporating 58 independent effect sizes and data from 408 children with ASD. A random-effects model was used to compute overall effect sizes, and moderator analyses were performed to examine factors influencing the impact of robotic interventions. The meta-analysis revealed that robotic interventions had a substantial positive impact on the development of children with ASD, with an overall effect size of d = 0.829 (95% CI = [0.657, 1.000]), indicating a large effect. Significant variability in effect sizes was observed based on the functional role of robots, specific developmental domains assessed, geographical regions, experimental design, and the inclusion of control groups. Notably, the effect size decreased as teacher involvement in interventions diminished. Additionally, meta-regression analysis showed that longer instructional session durations were positively associated with intervention effectiveness. Robotic interventions are effective in supporting the development of children with ASD, particularly when teachers are actively involved and instructional sessions are of sufficient duration. Future research should focus on optimizing intervention protocols and exploring the impact of different robot functionalities and regional contexts.

Educational outcomes of emerging teaching methods in undergraduate nursing education: a systematic review and meta-analysis protocol

INTRODUCTION

Undergraduate nursing education is essential in preparing competent and compassionate healthcare professionals capable of addressing the complex challenges in today's healthcare landscape. This protocol proposes a systematic review of the educational outcomes of virtual/augmented reality, flipped classrooms, team-based learning and gamification compared with traditional or didactic methods in undergraduate nursing education.

METHODS AND ANALYSIS

A systematic review protocol based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines will be conducted. Experimental and observational studies published from 2014 through 2024 will be identified by searching the electronic databases PubMed, Scopus, Embase, Web of Science and CINAHL that compare emerging with traditional or didactic teaching methods among undergraduate nursing students. Two reviewers will independently assess titles and abstracts to identify relevant studies based on eligibility criteria. Two additional reviewers will extract data from full-text articles that meet these criteria, evaluate the risk of bias and assess the quality of the selected studies. The meta-analysis will include effect size, heterogeneity, subgroup analyses and publication bias tests.

ETHICS AND DISSEMINATION

Ethics approval is not required. The publication will be in peer-reviewed journals and presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42024618288.

Prophylactic cranial irradiation in resected early stage small cell lung cancer: an updated systematic review and meta-analysis

BACKGROUND

The use of prophylactic cranial irradiation (PCI) in early stage small cell lung cancer (SCLC) patients post-surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of PCI in resected early stage SCLC patients.

METHODS

Relevant literature was reviewed through PubMed, Cochrane, and Embase databases. The pooled hazard ratios (HRs) for overall survival (OS) were analyzed for the overall population, as well as for pathologically node-negative (pN0) and pathologically node-positive (pN+) patients. We also assessed the pooled HRs for brain metastasis-free survival (BMFS) in all patients. Sensitivity analyses were conducted to validate these results.

RESULTS

A total of 13 retrospective studies were included, encompassing 3,530 postoperative SCLC patients, of whom 880 received PCI treatment. In the overall patient population, PCI significantly improved OS compared to non-PCI group (HR: 0.66, 95% CI 0.58-0.74, p < 0.001). For pN0 patients, there was no significant OS benefit from PCI (HR: 0.85, 95% CI 0.65-1.10, p = 0.22). In contrast, pN + patients showed a significant OS improvement with PCI (HR: 0.52, 95% CI 0.41-0.66, p < 0.001). Furthermore, PCI significantly improved BMFS in all patients (HR: 0.42, 95% CI 0.29-0.60, p < 0.001). Sensitivity analyses confirmed the stability of these results.

CONCLUSIONS

PCI was associated with a significant improvement in OS and BMFS in resected early stage SCLC patients. The benefits of PCI were particularly pronounced in pN + patients, whereas pN0 patients did not experience a significant OS benefit. These findings supported the selective use of PCI based on nodal status to optimize treatment outcomes in postoperative SCLC patients.

Effect of Exercise Training on Apolipoproteins: Meta-analysis and Trial Sequence Analysis

We conducted a systematic review and meta-analysis of the effect of exercise training on common lipid subunits. We systematically searched PubMed, Web of Science and the Cochrane Library of Controlled Trials for randomized, controlled trials of exercise training versus sedentary controls that reported lipid subunits including apolipoprotein-AI, apolipoprotein-AII, apolipoprotein-B, high density cholesterol-2, high density cholesterol-3 and lipoprotein (a) up until January 31, 2024. Our search identified 2,363 potential studies. We included 25 studies with 34 intervention groups, and a total of 1,429 participants, 775 exercise training and 654 control. We found significant favourable anti-atherogenic changes in apolipoprotein-AI with a mean difference of 8.17 mg/dL and a 95% confidence interval of 5.80-10.55, lipoprotein (a) with a mean difference of -2.52 mg/dL and a 95% confidence interval of -4.33 to -0.72), apolipoprotein-B with a mean difference of -0.11 mg/dL and a 95% confidence interval 0f -0.19 to -0.04, and high density cholesterol-2 with a mean difference of 1.28 mg/dL and a 95% CI of 0.28-2.28. Our trial sequence analysis showed that futility was achieved for apolipoprotein-AI, but not for lipoprotein (a), apolipoprotein-B and high density cholesterol-2. The minimal clinically important differences for apolipoprotein-AI, lipoprotein (a), apolipoprotein-B and high density cholesterol-2 were 0.76, 0.46, 0.02 and 0.26 mg/dL, respectively. Analyses of apolipoprotein-AII and high density cholesterol-3 were not significant and these trial sequence analyses failed to show futility. Exercise training produces significant improvements in apolipoprotein-AI, lipoprotein (a), apolipoprotein-B and high density cholesterol-2, with the minimal clinically important differences being achieved. The effect of exercise training on apolipoprotein-AII and high density cholesterol-3 is unclear.

Association between tobacco use and recurrent aphthous stomatitis: a systematic review protocol

OBJECTIVE

The objective of this review is to assess whether tobacco use is a risk factor for recurrent aphthous stomatitis (RAS).

INTRODUCTION

RAS is a common oral condition that presents as oral ulcers. Tobacco use is generally considered a risk factor for several types of oral lesions; however, literature is divided on the effect of tobacco use on RAS.

INCLUSION CRITERIA

Primary studies reporting the association of tobacco use with RAS will be considered. There will be no restrictions on age, type of tobacco used, year of publication, or location. Only studies with clinically diagnosed cases of RAS will be included.

METHODS

This systematic review will include cross-sectional, case control, cohort, and experimental studies. The review will be undertaken according to the JBI methodology for risk factor reviews. A comprehensive search will be conducted in MEDLINE, CINAHL, PsycINFO, Scopus, Open Dentistry, Web of Science, Embase, and Google Scholar. The study selection process will involve evaluating citations for eligibility, assessing methodological quality using JBI risk of bias tools, and extracting data from studies using a customized data extraction tool. Quantitative data synthesis will involve summary measures including odds ratio and relative risk.

REVIEW REGISTRATION

PROSPERO CRD42024544566.

Impact of flipped classroom method in physical education on the intrinsic motivation, self-efficacy, and learning satisfaction: A meta-analysis

BACKGROUND

Flipped classroom (FC) is a novel teaching method. To assess its effectiveness in teaching physical education in schools, a systematic review and meta-analysis were conducted with the aim of exploring the Impact of FC method in PE on the intrinsic motivation, self-efficacy, and learning satisfaction.

METHODS

As of February 2025, a comprehensive search was conducted in the Web of Science (WoS) and China National Knowledge Infrastructure (CNKI) databases to identify studies pertaining to FC style PE instruction and its impact on students' intrinsic motivation, self-efficacy, and learning satisfaction.

RESULTS

Total 13 studies were included in this study. The results demonstrated that, compared to traditional teaching methods, the FC model significantly improved intrinsic motivation, self-efficacy, and learning satisfaction. These findings underscore the notable positive impact of the FC approach on multiple educational outcomes. Subgroup analyses revealed that the FC model significantly enhanced students' intrinsic motivation across different countries, various PE subjects, differing class sizes, and diverse student populations. In terms of learning satisfaction, the FC approach demonstrated positive effects in subgroups involving Chinese participants, PE subjects focused on dance, and varying class sizes.

CONCLUSION

Integrating the FC model into school PE classes has been shown to enhance students' intrinsic motivation, self-efficacy, and learning satisfaction. However, further high-quality research is essential to solidify and extend these findings.

Comparison of Hybrid Surgery and Two-Level ACDF in Treating Consecutive Cervical Degenerative Disc Disease: A Systematic Review and Meta-Analysis

Study DesignSystematic review and meta-analysis.ObjectiveThis meta-analysis aimed to compare hybrid surgery (HS) and two-level anterior cervical discectomy and fusion (ACDF) in the treatment of consecutive two-level cervical degenerative disc disease (CDDD).MethodsComprehensive searches were conducted in PubMed, Embase, and Web of Science. Extracted data from the selected studies included operative time, intra-operative blood loss, C2-C7 range of motion (C2-C7 ROM), superior adjacent segment range of motion (SAS ROM), inferior adjacent segment range of motion (IAS ROM), complication incidence, neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score. Meta-analysis was conducted using RevMan 5.3.ResultsA total of 626 patients from 11 studies who underwent either HS or two-level ACDF for CDDD were analyzed. Compared to ACDF in the non-ROI-C cage group, HS better preserved post-operative and final follow-up C2-C7 ROM (post-operation: MD 10.08, 95% CI 6.58 to 13.58, P < 0.01; final follow-up: MD 7.62, 95% CI 5.83 to 9.42, P < 0.01). HS significantly reduced post-operative and final follow-up SAS ROM and IAS ROM at the final follow-up. Additionally, HS resulted in less intraoperative blood loss than ACDF when blood loss reached 90 mL or more. Analysis of functional scores (NDI, JOA, and VAS), operative time, and complication rates showed no significant differences between HS and ACDF.ConclusionHS achieved better radiographic outcomes compared to two-level ACDF, with comparable clinical outcomes, reduced intraoperative blood loss, and a similar complication rate. However, further high-quality randomized controlled trials are needed.

The Impact of Prophylactic Negative Wound Pressure Treatment (NWPT) on Surgical Site Occurrences After Gynecologic Cancer Surgery: A Meta-Analysis of Randomized Controlled and Observational Cohort Studies

Background: Surgical site infections (SSIs) remain a serious problem following abdominal surgery due to gynecologic malignancies leading to increased hospitalization, high costs, and delays in adjuvant treatments; thus, SSIs affect overall survival. The aim of the present meta-analysis was to investigate the impact of closed incision-negative pressure wound treatment (ci-NPWT) systems on postoperative surgical site occurrences (SSOs) after gynecologic oncology surgery. Methods: The present meta-analysis was designed using the PRISMA guidelines. A search in several databases was conducted from inception until March 2025. Results: Overall, five studies were included; these studies enrolled 1174 patients in total, where 412 were treated with ci-NPWT systems and 762 were treated with conventional gauze. Patients treated with ci-NPWT systems presented with lower SSI rates (OR 0.40, 95% CI 0.15-1.10, p = 0.08), lower fascial dehiscence rates (OR 0.72, 95% CI 0.21-2.42, p = 0.59), and lower seroma formation rates (OR 0.70, 95% CI 0.25-1.93, p = 0.49), although statistical significance was not reached in all comparisons. On the other hand, patients treated with ci-NPWT systems also presented with higher postoperative hematoma formation rates (OR 1.38, 95% CI 0.32-5.99, p = 0.66), although statistical significance was not reached. Preoperative patient characteristics, operative parameters, and cancer characteristics were similar among the two study groups. Conclusions: The prophylactic use of ci-NPWT systems showed promising results in reducing postoperative SSOs after gynecologic cancer surgery. Nevertheless, prospectively designed studies are needed in the future to reach robust evidence that would enable the wide implementation of such devices in routine clinical practice.

The chronic effects of change of direction during repeated-sprint training on jumping, sprinting, and change-of-direction abilities in players: a systematic review and meta-analysis

Objectives

This systematic review and meta-analysis aimed to compare the effects of repeated sprint training with one change of direction (RS-OCOD) and multidirectional changes of direction (RS-MCOD) on players' jumping, sprinting, and change-of-direction (COD) ability.

Methods

Following PRISMA guidelines, 15 randomized controlled trials involving 223 players were analyzed. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Heterogeneity (I 2 statistic), publication bias (funnel plots and Egger's test), and sensitivity analyses were conducted. Subgroup analyses differentiated RS-OCOD and RS-MCOD outcomes.

Results

RS-COD training significantly improved countermovement jump (CMJ) (SMD = -0.68, 95% CI [-1.04 to -0.34]), 20-40 m sprinting ability (SMD = 0.70 [0.39, 1.01]), and COD ability (SMD = 0.77 [0.39, 1.16]). RS-MCOD demonstrated superior effects on 20-40 m sprinting ability (large effect: SMD = 0.97) and COD ability (large effect: SMD = 0.97), while RS-OCOD showed greater benefits for CMJ (large effect: SMD = -0.92). High heterogeneity (I 2 > 70%) was observed in 5 m/10 m sprint analyses, attributed to methodological diversity and age variability. Prediction intervals indicated potential overestimation of RS-MCOD effects.

Conclusion

RS-OCOD can significantly enhance a player's CMJ ability, while RS-MCOD can notably improve sprinting and COD abilities. These findings advocate for the incorporation of RS-COD into training programs to boost competitive performance. However, the effectiveness of RS-COD may vary based on the number and complexity of directional changes incorporated into the training regimen. Among them, RS-MCOD is prioritized for sports requiring frequent directional changes, whereas RS-OCOD enhances vertical jump performance in explosive sports.

The Impact of Yoga Practices on Body Composition and Vital Signs in Children and Adolescents With Obesity: A Systematic Review and Meta-Analysis

INTRODUCTION

Clear recommendations for treating childhood obesity include family involvement, improving diet quality, reducing portion sizes, increasing physical activity, and decreasing sedentary behaviors.

METHODS

This systematic review and meta-analysis aimed to provide evidence the effects of yoga interventions on BMI, weight, body composition, and vital signs in children or adolescents with overweight/obesity. This study searched the PubMed, Web of Science, and EBSCO databases to include all studies published up to June 2024. Methodological quality was assessed with the RoB 2. Randomized or nonrandomized controlled studies were included. The standardized mean difference with a 95% confidence interval was calculated. Heterogeneity was analyzed using the I2 test and Q statistic. Publication bias was assessed with the Egger regression test.

RESULTS

This meta-analysis included nine studies. Pooled evidence found that yoga significantly reduces BMI and body fat percentage in children or young people with overweight/obesity.

CONCLUSION

In conclusion, findings derived from pooled data yoga intervention is an effective method for weight management in children and adolescents with obesity. Additionally, considering that yoga is a calming and mind-body-based intervention, it is recommended that future studies also examine the psychological effects of yoga in children and adolescents with obesity.