Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range

Erector spinae plane block versus quadratus lumborum block for abdominal surgery: A systematic review and meta-analysis

BACKGROUND

The erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are two novel interfascial plane block techniques with possible analgesic effects for both incisional and visceral pain. However, the results of the intercomparison of the two techniques for analgesia after abdominal surgery remain controversial.

METHODS

A systematic literature search was performed on five databases for randomized controlled trials comparing the analgesic efficacy of ESPB and QLB in abdominal surgery. The primary outcome was the 24 h postoperative intravenous IV morphine-equivalent consumption. A meta-analysis was performed using a random-effects model, with subgroup analyses based on the types of surgery and approaches of QLB.

RESULTS

The 24 h postoperative IV morphine-equivalent consumption was lower in patients receiving ESPB than in those receiving QLB (MD -2.307 mg; 95% CI ‒4.577 to -0.038; p = 0.046; and I2 = 96.5%), though the reduction did not reach clinically meaningful difference. Static and dynamic pain at different postoperative time points, the time to first rescue analgesia, and the incidence of PONV showed no significant difference between the two groups. However, the QLB group demonstrated a significantly prolonged time in performing the block compared to the ESPB group (MD -2.985 min; 95% CI -4.608 to -1.363; p < 0.001; and I2 = 97.5%).

CONCLUSIONS

Based on the available evidence from a systematic search of databases, the single-shot ESPB exhibits similar analgesic effects as QLB in abdominal surgery. The incidence of PONV was similar between the two techniques, with no block-related complications identified though QLB might be a more technically challenging approach than ESPB.

Effectiveness of physiotherapy modalities on persisting dyspnoea in long COVID: A systematic review and meta-analysis

BACKGROUND

Dyspnoea is often found months and years later in the "long-covid" syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness.

METHODS

We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464). We selected comparative trials including adults with persistent breathlessness following COVID-19, regardless of the initial severity, for whom physiotherapy was implemented as a treatment for dyspnoea. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the PEDro Scale.

RESULTS

19 studies that included 1292 adults fulfilled the inclusion criteria, of which 15 were randomised controlled trials and 4 non-randomised controlled trials. As for the rehabilitation modalities, 6 studies used respiratory muscle training, 6 studies used low to moderate intensity rehabilitation, 6 used high intensity rehabilitation and one used passive rehabilitation. The methods used between and within each group differed greatly, leading to an expected high heterogeneity of results. Nethertheless the random-effects model found a significant difference favouring physiotherapy (SMD -0.63, 95 CI [-1.03; -0.24], p < 0.001, I2 = 88 %). Subgroup analysis showed a significant effect in the high intensity rehabilitation group alone, with null heterogeneity.

CONCLUSION

In people suffering from dyspnoea following a SARS-CoV-2 infection, physiotherapy and especially pulmonary rehabilitation may help alleviate respiratory symptoms. Future studies will need to provide more consistent rehabilitation methods and better descriptions of them so as to reveal clear effects and avoid the confusion caused by using too many rehabilitation modalities.

The Impact of Metabolic and Bariatric Surgery on Diabetic Kidney Disease in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis

We aimed to determine the effect of metabolic and bariatric surgery (MBS) on the improvement of diabetic nephropathy (DN) in patients with obesity and type 2 diabetes (T2DM). A systematic search was performed in the PubMed, Embase, Scopus, and Web of Science databases. Meta-analysis of 31 studies with 2594 patients showed that urine albumin-to-creatinine ratio (UACR) was significantly reduced with a mean difference of - 28.19 mg/g (95% CI - 41.17, - 15.21, P-value < 0.001). In addition, subgroup analysis of studies showed a significant decrease after Roux-en-Y gastric bypass (RYGB) but not after sleeve gastrectomy (SG). These results suggest that MBS may lead to better kidney function and improvement in DN.

Mechanically assisted walking with body weight support results in more independent walking and better walking ability compared with usual walking training in non-ambulatory adults early after stroke: a systematic review

QUESTIONS

In subacute, non-ambulatory individuals after stroke, does mechanically assisted walking with body weight support result in more independent walking or better walking ability than usual walking training in the short term? Are any benefits maintained in the longer term? Is it detrimental to walking in terms of walking speed?

DESIGN

A systematic review with meta-analysis of randomised studies with a Physiotherapy Evidence Database (PEDro) score > 4.

PARTICIPANTS

Non-ambulatory adults ≤ 12 weeks after stroke.

INTERVENTION

Any type of mechanically assisted walking with body weight support.

OUTCOME MEASURES

Independent walking (ie, proportion of independent walkers), walking ability (eg, 0 to 5 Functional Ambulation Category, FAC) and walking speed.

RESULTS

Fifteen studies involving 1,014 participants (mean PEDro score 6.4) were included. In the short term, mechanically assisted walking with body weight support resulted in more independent walking (RD 0.19, 95% CI 0.11 to 0.26) and better walking ability (MD 0.8 on the FAC, 95% CI 0.5 to 1.0) compared with the same amount of usual walking training. In the longer term, it resulted in better walking ability (MD 0.6 on the FAC, 95% CI 0.2 to 1.1). Mechanically assisted walking with body weight support does not appear to be detrimental to walking speed in the short term (MD 0.13 m/s, 95% CI 0.03 to 0.22) or longer term (MD 0.11 m/s, 95% CI 0.00 to 0.22).

CONCLUSION

This review provides high-certainty evidence that mechanically assisted walking with body weight support results in more independent walking and better walking ability in individuals with stroke who are non-ambulatory subacutely compared with usual walking training. Given the importance of achieving walking in the short term, clinicians are encouraged to use this intervention.

REGISTRATION

PROSPERO CRD42024549678.

Angiogenesis inhibitors effects on overall survival and progression-free survival in newly diagnosed primary glioblastoma multiforme: a meta-analysis of twelve randomized clinical trials

BACKGROUND

Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Typically treated with initial surgical resection, and chemoradiotherapy, despite current treatments, patients typically survive only 12-14 months, necessitating new therapeutic approaches. Our meta-analysis evaluates combining antiangiogenic medications with chemoradiotherapy versus using chemoradiotherapy alone in treating newly diagnosed GBM.

METHODS

A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus, Cochrane and the Web of Science databases. The search aimed to identify studies reporting overall survival (OS), progression-free survival (PFS), and hazard ratio (HR) with corresponding confidence intervals (CIs) in patients with newly diagnosed GBM. We employed random-effect meta-analysis.

RESULTS

Twelve randomized clinical trials (RCTs) involved 3,309 patients included in the study. The findings showed that angiogenesis inhibitors significantly prolonged PFS [HR 0.85, 95% CI (0.73, 0.99), p-value = 0.04], while there was no significant difference on OS [HR 1.014, 95%CI (0.89, 1.15), p-value = 0.84]. Bevacizumab (BEV) exhibited the highest [HR 0.67, 95% CI (0.56, 0.79), p-value < 0.0001] and thalidomide exhibited the lowest [HR 1.46, 95% CI (1.004, 2.1), p-value = 0.048] improvements of PFS. Meta-regression revealed that age, white race, study sample size, infection, vascular disease complications, KPS > 60, biopsy, gross and subtotal resection can significantly influenced the PFS, while only the year of publication affected OS.

CONCLUSIONS

The current study showed that improve the PFS with no significant effect on OS. Our findings may provide some evidence for decision-making regarding the utilization of angiogenesis inhibitors for the treatment of adult patients with newly diagnosed GBM.

Efficacy and safety of tirofiban in acute ischemic stroke due to intracranial atherosclerotic disease for patients undergoing endovascular treatment: a systematic review and meta-analysis

PURPOSE

Tirofiban has emerged as an adjunct therapy for acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, its benefits for AIS patients with intracranial atherosclerotic disease (ICAD) remains unclear. This meta-analysis evaluates its efficacy and safety in ICAD-related AIS patients undergoing EVT.

METHODS

We searched PubMed, Cochrane, and Embase up to September, 2024, for studies comparing tirofiban to placebo or no intervention in ICAD-related AIS. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes included 90-day mRS 0-1, mRS score at 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, and symptomatic/non-symptomatic intracranial hemorrhage (ICH). Subgroup analyses evaluated tirofiban administration routes (intravenous, intra-arterial, or combined).

RESULTS

Thirteen studies comprising 3,572 patients were included. Intravenous tirofiban significantly increased mRS 0-2 (RR 1.26 [95% CI 1.13; 1.42]; p < 0.0001, I²= 0%), mRS 0-1(RR 1.24 [95% CI 1.05; 1.45]; p = 0.0098, I² = 0%), reduced mRS score by 0.58 points ([95% CI -0.99; -0.17]; p = 0.006, I²= 66%) and decreased mortality (RR 0.68 [95% CI 0.57; 0.80]; p < 0.0001, I²= 8%) at 90 days compared to control. Tirofiban overall reduced postprocedural reocclusion relative to control (RR 0.36 [95% CI 0.14; 0.94]; p = 0.036, I²= 73%). No significant differences were observed in successful reperfusion or ICH.

CONCLUSION

Intravenous tirofiban demonstrated an efficacy and safety profile, improving functional recovery and reducing mortality. Tirofiban overall reduced postprocedural reocclusion compared to control. No significant differences were found between groups in successful reperfusion or ICH. These findings support tirofiban as a safe and effective EVT adjunct.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO (CRD42024606522).

Neurofilament light and glial fibrillary acidic protein in mood and anxiety disorders: A systematic review and meta-analysis

Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are biomarkers of neuronal injury measurable in cerebrospinal fluid (CSF) and blood. Despite their potential as diagnostic tests for neurodegenerative disorders, it is unclear how they behave in mood and anxiety disorders. We conducted a systematic review and meta-analysis to investigate whether NfL and GFAP concentrations were altered in adults with mood and anxiety disorders compared to healthy controls. We searched PubMed, Web of Science, PsycINFO, MEDLINE and Embase through August 20, 2024, and assessed relevant studies and their risk of bias. The primary outcome was the standardised mean difference (SMD) and 95 % confidence interval (95 % CI) of NfL and GFAP concentrations. Twenty-nine studies comprising 2,962 individuals (927majordepression,804bipolardisorder,and1,231controls). When we compared individuals with major depression and healthy controls, there was no difference in NfL nor GFAP levels. In individuals with bipolar disorder, NfL was significantly elevated compared to controls (SMD = 0.53; 95 % CI: 0.20, 0.85; p = 0.005). Only one study reported on NfL levels anxiety disorders. Our study informs clinicians about how to interpret these emerging biomarkers in determining whether a person's symptoms are caused by a neurodegenerative or mood disorder. The mild elevation of NfL in bipolar disorder may suggest underlying neuroaxonal injury, warranting further research into its clinical and prognostic significance.

Vitamin B12 Status in Vegan and Vegetarian Seventh-Day Adventists: A Systematic Review and Meta-Analysis of Serum Levels and Dietary Intake

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the vitamin B12 status and intake of Seventh-day Adventists following a plant-based diet and compare it with omnivore controls to investigate their susceptibility for vitamin B12 deficiency.

DATA SOURCE

Peer-reviewed articles were identified through a comprehensive search in PubMed, Scopus, and Google Scholar databases from inception up to the year 2024 using specific keywords related to vitamin B12 and Seventh-day Adventists.

STUDY INCLUSION AND EXCLUSION CRITERIA

Observational studies published in the English language were included if they reported on vitamin B12 status or intake among plant-based Adventists and compared it with omnivore controls who may or may not have been Adventists. Studies that did not present distinguishable results for vegetarian/vegan from omnivore Adventists or only reported on food item intake without specific vitamin B12 data were excluded.

DATA EXTRACTION

Two independent reviewers extracted data on study characteristics, vitamin B12 intake, and serum levels using a customised data extraction form, resolving discrepancies through consultation with a third reviewer.

DATA SYNTHESIS

A meta-analysis was conducted using random-effect models due to anticipated heterogeneity, without any subgroup analysis due to the low number of studies. Sensitivity analysis was performed using the 'leave-on-out' method to assess individual study influence on overall effect size and heterogeneity.

RESULTS

Four studies met inclusion criteria, encompassing 1994 participants. Meta-analysis showed no significant differences in serum vitamin B12 levels (MD: -9.85 pmol/L; 95% CI: -45.64 to 25.94 pmol/L; P = 0.54, I2 = 50%) or daily intake (MD: 3.31 mcg/d; 95% CI: -4.70 to 11.32 mcg/d; P = 0.42, I2 = 90%) between plant-based Adventists and omnivore controls, although there was high heterogeneity between the studies.

CONCLUSION

Adventists following a vegan or vegetarian diet did not demonstrate increased risk of vitamin B12 deficiency due to the widespread consumption of fortified foods and supplements. The findings underscore the importance of supplementation and the consumption of fortified foods for maintaining adequate B12 status among vegan or vegetarian Adventists but highlight the need for further studies to confirm these observations in diverse geographical areas.

12-mm Versus 10-mm Metallic Stents for Malignant Biliary Obstructions: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Endoscopic drainage of malignant biliary obstruction using metal stents is widely used to treat obstructive jaundice. However, the occurrence of stent occlusion or migration raises the hypothesis using stents with larger diameters may be associated with better outcomes.

METHODS

PubMed, Embase, and Cochrane databases were systematically searched for studies comparing 10-mm vs. 12-mm covered metallic stents for recurrent unresectable biliary obstruction. The primary outcomes were recurrent biliary obstruction (RBO) and time to RBO (TRBO). Statistical analyses were performed using R software version 4.3.1. The risk ratio (RR) was used for binary outcomes, with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I2 statistics.

RESULTS

We included five studies-one randomized clinical trial and four cohort studies-totaling 520 patients. Among these, 280 received 10-mm stents, while 240 were treated with 12-mm stents. The 12-mm stent is associated with a greater TRBO (HR 1.72; 95% CI 1.36 to 2.18), lower incidence of RBO (RR 0.59; 95% CI 0.44 to 0.78; I2=34%), and stent obstruction (RR 0.52; 95% CI 0.34 to 0.81; I2=33%). No significant differences were found for stent migration and adverse events rate between groups.

CONCLUSION

The 12-mm metallic stents significantly increase stent patency and reduce the incidence of RBO and stent obstruction in managing recurrent unresectable biliary obstruction, with no differences regarding stent migration and adverse events compared to 10-mm stents.

Comparison of different monitors for measurement of nociception during general anaesthesia: a network meta-analysis of randomised controlled trials

BACKGROUND

To avoid underdosing or overdosing of analgesic medications, a variety of nociception monitors that use distinct techniques have been developed to quantify nociception during general anaesthesia. Although prior meta-analyses have examined the behaviour of nociception monitors vs standard care protocols, they did not include the potentially valuable data for monitor-to-monitor comparisons. In order to capture these data fully and compare the behaviour of these monitors, we conducted a systematic search and network meta-analysis.

METHODS

We performed a Bayesian network meta-analysis on data obtained from a systematic search within PubMed, Embase, Web of Science, Cochrane Library, and EmCare databases. The search was aimed to detect relevant RCTs on the use of nociception monitoring versus standard care or versus other nociception devices(s) during general anaesthesia in adult patients. The primary endpoint was intraoperative opioid consumption, for which we calculated the standardised mean difference (SMD) of morphine equivalents (MEs). Secondary endpoints included postoperative opioid consumption and nausea or vomiting, extubation time, postoperative pain score, and time to discharge readiness. The risk of bias was assessed using the revised Cochrane Risk of Bias tool for randomised trials (RoB 2.0).

RESULTS

Thirty-eight RCTs, including 3412 patients and studying five different types of nociception monitors, were included in the analyses: Nociception Level Monitor (NOL), Analgesia Nociception Index (ANI), Surgical Plethysmographic Index (SPI), Pupillometry (pupillary pain index [PPI] or pupil dilation reflex [PDR]), and the beat-by-beat cardiovascular depth of anaesthesia index (CARDEAN). Pupillometry showed a significant reduction in intraoperative opioid consumption compared with standard care (SMD -2.44 ME; 95% credible interval [CrI] -4.35 to -0.52), and compared with SPI (SMD -2.99 ME; 95% CrI -5.15 to -0.81). With respect to monitors other than pupillometry, no significant differences in opioid consumption were detected in comparison with standard care or other monitors. Pupillometry was associated with a longer time to discharge readiness from the PACU, whereas NOL was associated with shorter extubation times. No relevant differences in other secondary outcomes were found.

CONCLUSIONS

Apart from pupillometry, no monitors demonstrated a significant effect on intraoperative opioid consumption. Secondary outcomes indicate limited clinical benefit for patients when using these monitors.

Hemodynamic Impact of the Trendelenburg Position: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients.

DESIGN

Systematic literature review and meta-analysis using PubMed and Medline.

SETTING

All prospective interventional studies comparing the hemodynamic characteristics of patients in the horizontal supine position and Trendelenburg position.

MEASUREMENTS AND MAIN RESULTS

A total of 16 studies including 333 patients were found. The Trendelenburg position led to a statistically significant 11% increase in stroke volume compared with the supine position (mean difference [MD] = 8.27, 95% confidence interval [CI]: 1.79; 14.76, p = 0.012). A decrease in stroke volume variation (MD = -1.36, 95% CI: 2.26; -0.46, p = 0.003) and heart rate (MD = -1.65, 95% CI: -2.86; -0.44, p = 0.008) and an increase in cardiac output (MD = 0.33, 95% CI: 0.1; 0.57, p = 0.006), mean arterial pressure (standardized MD, = 0.42, 95% CI: 0.1; 0.74, p = 0.011), central venous pressure (MD = 4.13, 95% CI: 2.42; 5.84, p < 0.001), mean pulmonary artery pressure (MD = 4.25, 95% CI: 2.69; 5.81, p < 0.001), and left ventricular end-diastolic volume (MD = 16.89, 95% CI: 3.17; 30.61, p = 0.016) were found.

CONCLUSIONS

The Trendelenburg position significantly increases stroke volume and improves multiple hemodynamic parameters in adult patients. These results confirm the position's potential clinical relevance in hemodynamic management and suggest the possibility of a tailored application in selected clinical settings. The duration of the beneficial effects of the Trendelenburg position and the possible side effects should be the focus of further investigation.

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. The authors conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on posthysterectomy recovery.

METHODS

This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to 27 July 2023. The authors identified RCTs involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery scores.

RESULTS

Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 h following hysterectomy, as well as postoperative opioid consumption within 24 h and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration posthysterectomy.

CONCLUSION

Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Endoscopic ultrasound-guided versus percutaneous liver biopsy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Percutaneous liver biopsy (PC-LB) has long been the usual method for acquisition of liver tissue. Recently, endoscopic ultrasound-guided liver biopsy (EUS-LB) has gained popularity as an alternative modality. We aimed to compare the efficacy and safety of EUS-LB versus PC-LB.

METHODS

We systematically searched PubMed, Embase, and the Cochrane Library databases for randomized controlled trials (RCTs) comparing EUS-LB with PC-LB published until October 20, 2023. The primary outcome was diagnostic adequacy. Secondary outcomes were: the number of complete portal tracts (CPTs), longest sample length (LSL), total sample length (TSL), post-procedure pain scores, and adverse events (AEs), including overall AEs and AEs excluding minor post-procedure symptoms. We compared binary outcomes using risk ratios (RRs) and continuous outcomes using the mean difference (MD) or standardized mean difference (SMD), with 95%CIs.

RESULTS

Four RCTs (258 patients) were included. The EUS-LB group presented lower post-procedure pain scores (SMD -0.58, 95%CI -0.95 to -0.22) than the PC-LB group. Both groups performed similarly in terms of diagnostic adequacy (RR 1.0, 95%CI 0.96 to 1.04), number of CPTs (MD 2.57, 95%CI -4.09 to 9.22), LSL (MD -2.91 mm, 95%CI -5.86 to 0.03), TSL (MD 4.16 mm, 95%CI -10.12 to 18.45), overall AEs (RR 0.54, 95%CI 0.20 to 1.46), and AEs excluding minor post-procedure symptoms (RR 1.65, 95%CI 0.21 to 13.02).

CONCLUSIONS

This meta-analysis suggests that EUS-LB is as safe and effective as PC-LB and is associated with lower post-procedure pain scores.Registration on PROSPERO: CRD42023469469.

Intensive Versus Standard Blood Pressure Management after Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Prospective clinical studies on blood pressure (BP) management targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) have recently been published. Our objective was to assess the impact on clinical outcomes of BP management guided by established systolic BP (SBP) targets within the first 24 hours after successful EVT. Four randomized controlled trials (RCTs) including 1556 participants across 5 SBP target settings identified from 5 databases up to September 6, 2023 were included in this systematic review and meta-analysis. All the intensive SBP target groups in these RCTs were combined to facilitate head-to-head comparisons. Patients receiving intensive SBP management had lower risk of 90-day functional independence as assessed by the modified Rankin scale score (relative risk [RR], 0.81; 95% confidence interval [CI], 0.72 to 0.91; I2 , 12%), excellent outcomes (RR,0.86; 95% CI, 0.75 to 0.99; I2 , 7%), favorable outcomes (RR, 0.85; 95% CI, 0.78 to 0.92; I2 , 0%), and quality of life (standardized mean difference, -0.22; 95% CI, -0.35 to -0.10; I 2 ,0%). There were no differences in the probability of any intracerebral hemorrhage (RR, 1.04; 95% CI, 0.92 to 1.19; I2 ,0%), symptomatic intracerebral hemorrhage (RR, 1.10; 95% CI, 0.76 to 1.60; I2 , 0%), stroke-related death (RR, 1.16; 95% CI, 0.80 to 1.68; I2 , 0%), or parenchymal hematoma (RR, 1.71; 95% CI, 0.74 to 3.98; I2 , 47%) between SBP targets. This meta-analysis provides evidence from RCTs suggesting that intensive SBP control (target<160 mm Hg) may be detrimental to clinical outcomes in AIS patients with successful reperfusion after EVT.

Comparison of the recovery profile of sufentanil and remifentanil in total intravenous anesthesia: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Remifentanil is a short-acting opioid and can be administered during surgery without the risk of delayed postoperative recovery but concerns about hyperalgesia and the shortages of remifentanil lead anesthetists to consider long-acting opioids for Total Intravenous Anesthesia (TIVA). Sufentanil is a more potent opioid with a longer context-sensitive half-life but can promote good postoperative analgesia due to its residual effect. This meta-analysis aimed to compare the recovery profile of remifentanil and sufentanil for TIVA.

METHODS

The search strategy was performed in PubMed, CENTRAL, and Web of Science for RCTs comparing sufentanil and remifentanil as part of TIVA in adults undergoing noncardiac surgery. Risk of bias and the quality of evidence were performed using RoB2 and GRADEpro, respectively. The primary outcome was time to tracheal extubation. Secondary analyses included postoperative analgesia, respiratory depression, and Postoperative Nausea and Vomiting (PONV).

RESULTS

Sufentanil increases the time to extubate, MD = 4.29 min; 95% CI: 2.33 to 6.26; p = 0.001. It also reduces the need for postoperative rescue analgesia, logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005. There were no significant differences between both opioids for PONV, logOR = 0.50; 95% CI: -0.10 to 1.10; p = 0.10 and respiratory depression, logOR = 1.21; 95% CI: -0.42 to 2.84; p = 0.15.

CONCLUSION

Sufentanil delays the time to tracheal extubation compared with remifentanil but is associated with a reduced need for postoperative rescue analgesia. No significant differences were observed between the two opioids in terms of postoperative respiratory depression or PONV.

Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis

OBJECTIVES

To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility.

MATERIALS AND METHODS

MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value.

RESULTS

Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001).

CONCLUSIONS

OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.

Effects of probiotic treatment on the prognosis of patients with sepsis: a systematic review

BACKGROUND

Sepsis, a common acute and critical disease, leads to 11 million deaths annually worldwide. Probiotics are living microorganisms that are beneficial to the host and may benefit sepsis outcomes, but their effects are still inconclusive. This study aimed to evaluate the overall effect of probiotics on the prognosis of patients with sepsis.

DATA RESOURCES

We searched several sources for published/presented studies, including PubMed, EMBASE, Web of Science, the Cochrane Library and the US National Library of Medicine Clinical Trials Register (www.clinicaltrials.gov) updated through July 30, 2023, to identify all relevant randomized controlled trials (RCTs) or observational studies that assessed the effectiveness of probiotics or synbiotics in patients with sepsis and reported mortality. We focused primarily on mortality during the study period and analyzed secondary outcomes, including 28-day mortality, in-intensive care unit (ICU) mortality and other outcomes.

RESULTS

Data from 405 patients in five RCTs and 108 patients in one cohort study were included in the analysis. The overall quality of the studies was satisfactory, but clinical heterogeneity existed. All adult studies reported a tendency for probiotics to reduce the mortality of patients with sepsis, and most studies reported a decreasing trend in the incidence of infectious complications, length of ICU stay and duration of antibiotic use. There was only one RCT involving children.

CONCLUSION

Probiotics show promise for improving the prognosis of patients with sepsis, including reducing mortality and the incidence of infectious complications, particularly in adult patients. Despite the limited number of studies, especially in children, these findings will be encouraging for clinical practice in the treatment of sepsis and suggest that gut microbiota-targeted therapy may improve the prognosis of patients with sepsis.

Efficacy and safety of the Valsalva maneuver in relieving venipuncture pain in children and adults: A systematic review and meta-analysis

Venipuncture is a common invasive clinical procedure, and pain management during puncture has been of interest to healthcare professionals. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of the Valsalva maneuver (VM) for the relief of venipuncture pain in children and adults. PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP database, and CBM were searched from inception to December 2023 for all available randomized controlled trials (RCTs) that evaluated the impact of VM on venipuncture. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Continuous variables were analyzed by mean differences (MD) or standardized mean differences (SMD), whereas dichotomous variables were analyzed by risk ratios (RR). A total of 22 studies involving 1740 participants were included. The pooled results showed that VM relieved pain intensity during venipuncture in children (SMD = -0.89, 95% CI = -1.47 to -0.30, p = 0.003) and adults (SMD = -1.11, 95% CI = -1.46 to -0.77, p < 0.00001), reduced anxiety intensity (SMD = -1.07, 95% CI = -1.68 to -0.47, p = 0.0005), and shortened puncture time (MD = -13.52, 95% CI = -21.14 to -5.90, p = 0.0005). There was no significant difference in the success rate of venous cannulation, MAP, HR, or incidence of adverse events in subjects who performed VM compared to controls. VM was an effective and safe method of pain management that reduced pain intensity during venipuncture in children and adults without significant adverse effects. The results of this meta-analysis need to be further validated by more rigorous and larger RCTs.

Brain-Derived Neurotrophic Factor (BDNF) as a Potential Biomarker in Brain Glioma: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review and meta-analysis evaluates peripheral and CNS BDNF levels in glioma patients.

METHODS

Following PRISMA guidelines, we systematically searched databases for studies measuring BDNF in glioma patients and controls. After screening and data extraction, we conducted quality assessment, meta-analysis, and meta-regression.

RESULTS

Eight studies were included. Meta-analysis showed significantly reduced plasma BDNF levels in glioma patients versus controls (SMD: -1.0026; 95% CI: [-1.5284, -0.4769], p = 0.0002). High-grade gliomas had lower plasma BDNF (p = 0.0288). Tissue BDNF levels were higher in glioma patients (SMD: 1.9513; 95% CI: [0.7365, 3.1661], p = 0.0016) and correlated with tumor grade (p = 0.0122). Plasma BDNF levels negatively correlated with patient age (p = 0.0244) and positively with female percentage (p = 0.0007).

CONCLUSION

BDNF is a promising biomarker in glioma, showing significant changes in plasma and tissue levels correlating with tumor grade, patient age, and gender.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal artery occlusion: a meta-analysis

PURPOSE

The goal of this meta-analysis is to examine the association between Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in patients with Retinal Artery Occlusion (RAO). The analysis aims to provide insight into the potential of NLR and PLR as inflammatory biomarkers for RAO.

METHODS

Following PRISMA guidelines, a systematic search in PubMed, Embase, and Scopus identified eight eligible studies. The analysis assessed serum NLR and PLR levels in RAO and non-RAO groups by employing standardized mean differences (SMDs). Sensitivity analyses and publication bias were examined. The diagnostic performance of these markers was evaluated with a quantitative synthesis.

RESULTS

The meta-analysis, involving 1,444 participants, demonstrated significantly elevated NLR (SMD = 0.88, 95% CI: 0.49-1.28, P < 0.001) and PLR (SMD = 0.45, 95% CI: 0.16-0.73, P < 0.001) levels in individuals with RAO. Significant heterogeneity was noted. Sensitivity analysis showed robustness and no significant publication bias was found. Summary results of diagnostic performance revealed promising discriminatory power for NLR and PLR.

CONCLUSIONS

The results support a possible connection between systemic inflammation, as indicated by NLR and PLR, and the occurrence of RAO. Although there was heterogeneity, sensitivity analyses showed the findings to be robust. While immediate diagnostic applications are limited, understanding the role of NLR and PLR in the pathological process of RAO provides valuable insights for developing future predictive models, risk management approaches, and treatment strategies. Further research exploring mechanistic insights and conducting prospective studies is warranted to validate their clinical utility.

KEY MESSAGES

What is known Retinal artery occlusion (RAO) is a serious condition with potential links to systemic inflammation and thrombosis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging inflammatory markers. What is new This is the first meta-analysis examining the association between NLR, PLR and RAO. Elevated NLR and PLR levels were observed in patients with RAO compared to controls. NLR and PLR show potential as indicators of systemic inflammation in RAO pathogenesis.

Effectiveness of macrolides as add-on therapy to beta-lactams in community-acquired pneumonia: A meta-analysis of randomized controlled trials

PURPOSE

This study aims to evaluate whether adding macrolides (MAC) to beta-lactam (BL) monotherapy in the treatment of community-acquired pneumonia (CAP) offers clinical benefits that justify the potential disadvantages or side effects.

METHODS

We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing BL monotherapy to combination therapy with BL and MAC for the in-hospital treatment of CAP. We pooled mean differences (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CI).

RESULTS

Six RCTs with 2661 participants (52% receiving combination therapy), revealed no significant difference in in-hospital mortality (RR 0.99; 95% CI 0.78 to 1.25; p = 0.94; I2 = 0%), 90-day mortality (RR 1.03; 95% CI 0.82 to 1.29; p = 0.83; I2 = 13%), or 30-day mortality (RR 0.90; 75% CI 0.63 to 1.29; p = 0.58; I2 = 54%). Additionally, no significant differences were observed in the length of hospital stay (MD 0.51; 95% CI - 0.50 to 1.51; p = 0.33; I2 = 63%) or respiratory insufficiency (RR 0.63; 95% CI 0.29 to 1.35; p = 0.24; I2 = 74%). However, combination therapy significantly improved the treatment success rate (RR 1.17; 95% CI 1.04 to 1.32; p = 0.009; I2 = 0%).

CONCLUSION

Our findings suggest that BL + MAC therapy should not be used in all cases of hospitalized patients with CAP.

PROSPERO ID

CRD42024516383 - Data of registration: 03/03/2024.

Performance of Convolutional Neural Network Models in Meningioma Segmentation in Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

BACKGROUND

Meningioma, the most common primary brain tumor, presents significant challenges in MRI-based diagnosis and treatment planning due to its diverse manifestations. Convolutional Neural Networks (CNNs) have shown promise in improving the accuracy and efficiency of meningioma segmentation from MRI scans. This systematic review and meta-analysis assess the effectiveness of CNN models in segmenting meningioma using MRI.

METHODS

Following the PRISMA guidelines, we searched PubMed, Embase, and Web of Science from their inception to December 20, 2023, to identify studies that used CNN models for meningioma segmentation in MRI. Methodological quality of the included studies was assessed using the CLAIM and QUADAS-2 tools. The primary variable was segmentation accuracy, which was evaluated using the Sørensen-Dice coefficient. Meta-analysis, subgroup analysis, and meta-regression were performed to investigate the effects of MRI sequence, CNN architecture, and training dataset size on model performance.

RESULTS

Nine studies, comprising 4,828 patients, were included in the analysis. The pooled Dice score across all studies was 89% (95% CI: 87-90%). Internal validation studies yielded a pooled Dice score of 88% (95% CI: 85-91%), while external validation studies reported a pooled Dice score of 89% (95% CI: 88-90%). Models trained on multiple MRI sequences consistently outperformed those trained on single sequences. Meta-regression indicated that training dataset size did not significantly influence segmentation accuracy.

CONCLUSION

CNN models are highly effective for meningioma segmentation in MRI, particularly during the use of diverse datasets from multiple MRI sequences. This finding highlights the importance of data quality and imaging sequence selection in the development of CNN models. Standardization of MRI data acquisition and preprocessing may improve the performance of CNN models, thereby facilitating their clinical adoption for the optimal diagnosis and treatment of meningioma.

The Effect of Distance Education on Self-care in Patients With Heart Failure in the Chronic or Stable Phase: A Systematic Review and Meta-analysis

BACKGROUND

Health education is important for self-care in patients with heart failure. However, the evidence for the effect of distance education as an intervention to deliver instruction for patients after discharge through digital devices on self-care is limited.

OBJECTIVES

In this study, our aim was to explore the effect of distance education on self-care in patients with heart failure.

METHODS

We searched 11 electronic databases and 3 trial registries for randomized controlled trials with low risk of bias and high-quality evidence to compare the effect of usual and distance education on self-care. Quality appraisal was performed using the Cochrane Risk of Bias Tool. Using the Review Manager 5.4 tool, a meta-analysis was conducted. Certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

RESULTS

Fifteen articles were eligible for this study. Compared with usual education, distance education improved self-care maintenance (mean difference [MD], 6.62; 95% confidence interval [CI], 3.93-9.31; GRADE, moderate quality), self-care management (MD, 5.10; 95% CI, 3.25-6.95; GRADE, high quality), self-care confidence (MD, 6.66; 95% CI, 4.82-8.49; GRADE, high quality), heart failure knowledge (MD, 0.78; 95% CI, 0.01-1.56; GRADE, moderate quality), and quality of life (MD, -5.35; 95% CI, -8.73 to -1.97; GRADE, moderate quality). Subgroup analysis revealed distance education was more effective than usual education in self-care when the intervention was conducted for 1 to 6 months, more than 3 times per month, and a single intervention lasting more than 30 minutes.

CONCLUSIONS

This review shows the benefits of distance education on self-care, heart failure knowledge, and quality of life of patients with heart failure. The intervention duration, frequency, and duration of a single intervention could have affected the intervention effect.

Comparative Efficacy of Neuromodulatory Strategies for Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis

OBJECTIVE

The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE).

METHODS

We searched electronic repositories, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, their ensuing open-label extension studies, and prospective studies focusing on surgical or neuromodulation interventions for people with DRE. We used seizure frequency reduction as the primary outcome. A single-arm meta-analysis synthesized data across all studies to assess treatment effectiveness at multiple time points. A network meta-analysis evaluated the efficacy of diverse therapies in randomized controlled trials. Grading of Recommendations, Assessment, Development, and Evaluations was applied to evaluate the overall quality of the evidence.

RESULTS

Twenty-eight studies representing 2936 individuals underwent 10 treatments were included. Based on the cumulative ranking in the network meta-analysis, the top 3 neuromodulatory options were deep brain stimulation (DBS) with 27% probability, responsive neurostimulation (RNS) with 22.91%, and transcranial direct current stimulation with 24.31%. In the single-arm meta-analysis, in the short-to-medium term, seizure control is more effective with RNS than with invasive vagus nerve stimulation (inVNS), which in turn is slightly more effective than DBS, though the differences are minimal. However, in the long term, inVNS appears to be less effective than both DBS and RNS. Trigeminal nerve stimulation, transcranial magnetic stimulation, and transcranial alternating current stimulation did not demonstrate significant seizure frequency reduction.

CONCLUSIONS

Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy.

Effects of liraglutide on body composition in people living with obesity or overweight: A systematic review

AIM

To evaluate the effect of liraglutide on body composition in people living with obesity or overweight.

METHODS

A systematic search was conducted in PubMed, Embase, and Cochrane Library databases up to June 10, 2024. Randomized controlled trials (RCTs) comparing liraglutide to placebo and reporting body composition outcomes were included.

RESULTS

Data from 15 studies involving 960 participants were analyzed. Liraglutide consistently demonstrated significant reductions in total weight, fat mass, and visceral adipose tissue (VAT) compared to placebo across the included studies. VAT reductions ranged from 12.49 % to 23 %, highlighting liraglutide's effectiveness in targeting visceral fat, a key factor in cardiometabolic risk. Fat mass reductions were also substantial and consistent, reinforcing the efficacy of liraglutide in improving overall body composition. In contrast, lean mass outcomes were more variable, with some studies reporting preservation or even gains in lean mass, while others indicated losses.

CONCLUSIONS

Liraglutide effectively reduces fat mass and VAT, supporting its use in managing obesity and related cardiometabolic risks. However, the inability to accurately calculate lean and fat mass proportions underscores the need for standardized reporting and availability of individual-level data. Future research should prioritize these elements and include muscle function assessments to better evaluate the clinical impacts of GLP-1 receptor agonists on body composition.

Network meta-analysis of the efficacy of endoscopic cardia peripheral tissue scar formation (ECSF) in the treatment of gastroesophageal reflux disease

Endoscopic antireflux therapy is widely used in clinical practice. Peroral endoscopic cardial constriction (PECC), antireflux mucosal intervention (ARMI), and radiofrequency ablation (RF) possess analogous antireflux mechanisms. This comprehensive systematic review and meta-analysis aimed to evaluate and compare the safety and effectiveness of antireflux therapy during endoscopic cardia peripheral tissue scar formation (ECSF) procedures. We comprehensively searched the Web of Science, PubMed, Embase, China National Knowledge Infrastructure, and Wan-Fang databases for articles published from January 1990 to January 2024. Network meta-analysis (NMA) was used to assess the outcomes, with outcome metrics including the Gastroesophageal Reflux Questionnaire (GERD-Q) score, proton pump inhibitor discontinuation rate, pH <4.2 percent acid reflux time (AET), lower esophageal pressure (LES pressure), DeMeester score, adverse events, and patient satisfaction. Twenty studies involving 1219 patients were included. PECC was significantly superior to RF in lowering the patients' postoperative GERD-Q scores(MD = -2.34, 95% confidence interval (CI): [-3.02, -1.66]), augmentation of LES pressures(MD = 3.22, 95% CI: [1.21, 5.23]), and having a lower incidence of serious adverse events. ARMI was preferable to PECC (MD = -2.87, 95% CI [-4.23, -1.51])and RF (MD = -1.12, 95% CI [-1.79, -0.54]) in reducing the AET percentage, but was not as effective as PECC in lowering GERD-Q scores(MD = -1.50, 95% CI [-2.47, -0.53]). The incidence of adverse effects was less than 10% for all interventions, with most of them mildly self-resolving. Each ECSF procedure resulted in a favorable outcome in patients with GERD. Considering the safety and efficacy of treatment, PECC was the most favorable choice among ECSF procedures.

Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis

OBJECTIVE

Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.

DATA SOURCES

PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.

STUDY SELECTION

RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.

DATA EXTRACTION

Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).

DATA SYNTHESIS

Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, -0.94; 95% CrI, -1.51 to -0.44), HF/bilateral hemisphere (bi-hemi) (SMD, -2.59; 95% CrI, -3.50 to -1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, -0.79; 95% CrI, -1.55 to -0.10), HF/bilateral cerebellar (bi-CRB) (SMD, -1.02; 95% CrI, -1.83 to -0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, -2.72; 95% CrI, -4.12 to -1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, -1.36; 95% CrI, -2.86 to -0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, -2.68; 95% CrI, -4.26 to -1.26). However, rTMS failed to improve swallowing function in chronic stage.

CONCLUSIONS

This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.

Effects of glucocorticoids on postoperative delirium in patients undergoing elective non-cardiac surgery:A systematic review and meta-analysis

Background

Postoperative delirium (POD) is common postoperative complications in non-cardiac surgery. While delirium prophylaxis has not yielded unequivocal support. The clinical effects of glucocorticoids on POD remains unclear.

Objective

To evaluate the effects of glucocorticoids on postoperative delirium (POD) in patients undergoing non-cardiac surgery.

Design

Systematic review with meta-analysis.

Methods

In strict accordance with the PRISMA statement, a systematic literature search was undertaken across PubMed, EMBASE, Web of Science and Cochrane Library databases in May 2023. We updated the search results on June 28, 2024. We used the Grading of the Recommendation Assessment, Development, and Evaluation (GRADE) system to evaluate the quality of evidence.

Results

This meta-analysis included twelve randomized controlled trials involving 1044 participants undergoing non-cardiac surgery. Compared with the control group, glucocorticoids significantly reduced the incidence of POD in patients undergoing non-cardiac surgery (RR:0.50, 95%CI:0.41 to 0.60, P < 0.00001, I2 = 26 %, GRADE = high). Meanwhile, glucocorticoids was associated with reducing the severity of POD (RR: -0.67, 95%CI: -1.10 to -0.23, P = 0.003, I2 = 89 %, GRADE = low). However, there were no significant differences with regards to patients receiving antipsychotic drug (RR: 0.91, 95%CI:0.43 to 1.92, P = 0.80, I2 = 0 %, GRADE = moderate), length of hospital stay (RR: -0.52, 95%CI: -1.41 to 0.36, P = 0.24, I2 = 0 %, GRADE = moderate), 30-day postoperative mortality (RR: 0.70, 95%CI:0.23 to 2.15, P = 0.54, I2 = 0 %, GRADE = low) and postoperative infection (RR: 0.87 95%CI: 0.58 to 1.30, P = 0.50, I2 = 33 %, GRADE = moderate).

Conclusions

This systematic review and meta-analysis suggests that glucocorticoids reduce the incidence of POD among adults and children undergoing non-cardiac surgery and mitigate the severity of POD in adults, which indicates that glucocorticoids exhibit preventive or therapeutic effects on POD.

Registration

CRD42023426836 (PROSPERO).

Postoperative Outcomes After Robotic Liver Resection of Caudate Lobe: A Systematic Review

Background and Objectives: Resection of the caudate lobe of the liver is considered a highly challenging surgical procedure due to the deep anatomic location of this segment and the relationships with major vessels. There is no clear evidence about the safety and effectiveness of robotic resection of the caudate lobe. The aim of this systematic review was to report data about the safety, technical feasibility, and postoperative outcomes of robotic caudate lobectomy. Materials and Methods: A systematic review of the MEDLINE and SCOPUS databases was undertaken, including studies published until 19 December 2024. Results: A total of 5 studies including 110 patients were selected. Of these surgeries, 56.3% were performed for malignant tumors. Tumor size varied significantly between 0.9 and 7.7 cm in the largest diameter. The mean operative time was 184.5 min (range 70-522 min), and the estimated blood loss was 95.5 mL (range 10-1500 mL). The median hospital length of stay was 4.2 days (range 2-19 days) and no cases of conversion to open were reported. All the patients underwent R0 resection. In total, 24 out of 110 patients (21.8%) developed postoperative complications, with 1.8% of all patients developing a major complication (Clavien-Dindo classification ≥ III). No perioperative deaths were reported by the included studies. Conclusions: Few retrospective studies investigating the outcomes of robotic resection of the caudate lobe are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic caudate lobectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings.

Predictive value of platelet parameters for bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate the predictive value of platelet (PLT) parameters for bronchopulmonary dysplasia (BPD) in preterm infants.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies on PLT parameters predicting BPD in preterm infants from inception to December 2023. The Newcastle-Ottawa Scale was adopted to judge the article's quality. RevMan 5.4 was utilized for Meta-analysis, and Stata/SE 15.1 was applied for sensitivity analysis and Egger regression test.

RESULTS

Ten studies were included, including 1637 preterm infants, of which 540 were diagnosed with BPD. Meta-analysis showed that PLTs (SMD = -0.98, 95% CI [-1.57, -0.38], P = .001), mean platelet volume (MPV) (SMD = 0.67, 95% CI [0.19, 1.15], P = .006), and PMI (SMD = -0.47, 95% CI [-0.65, -0.28], P < .00001) could assist in predicting BPD in preterm infants. Subgroup analyses showed that PLT parameters 3 days after birth had better predictive performance for BPD in preterm infants. Sensitivity analysis implied no significant change in the results after excluding the studies 1 by 1, suggesting robust results of meta-analysis. There was a significant publication bias in the enrolled studies (P < .001).

CONCLUSION

PLT, MPV, and PMI have a predictive value for BPD in preterm infants.

Effects of growth hormone replacement therapy in childhood-onset craniopharyngioma: an updated systematic review and meta-analysis

PURPOSE

Craniopharyngiomas (CPs) often lead to growth hormone deficiency (GHD) in children. Growth hormone replacement therapy (GHRT) is essential for managing GHD but its impact on body mass index (BMI) and metabolic outcomes is controversial. Concerns exist that GHRT might contribute to tumor recurrence, with guidelines varying on when to start therapy post-surgery. This updated systematic review and meta-analysis explores the effects and timing of GHRT in children post-craniopharyngioma surgery.

METHODS

We systematically searched PubMed, Embase, and Cochrane Library databases. Included studies compared the effects of GHRT in childhood-onset craniopharyngioma patients who received GHRT versus those who did not. Random-effects meta-analyses were used to pool relative risk (RR) or mean difference (MD) for each outcome. Heterogeneity was assessed using the I² statistic. This study is registered with PROSPERO (CRD42024498082).

RESULTS

We included 11 studies in the meta-analysis. No differences in tumor progression/recurrence were found between the GHRT and no GHRT groups (RR 0.77, 95% CI 0.56-1.05, p = 0.10). The impact of timing of GHRT is less clear because of limited data and high heterogeneity. There were no differences in BMI between the GHRT and no GHRT (MD -0.94, 95% CI -1.88,0.00, p = 0.05). Two studies reported that GHRT might improve lipid profiles.

CONCLUSION

Our study suggests that GHRT does not increase the risk of tumor progression/recurrence in CP patients. GHRT can improve linear growth, but its effects on the BMI and lipid profiles remain inconclusive, requiring further studies.

Emerging Therapeutic Modalities and Pharmacotherapies in Neuropathic Pain Management: A Systematic Review and Meta-Analysis of Parallel Randomized Controlled Trials

Background: Neuropathic pain (NP) is a chronic condition caused by abnormal neuronal excitability in the nervous system. Current treatments for NP are often ineffective or poorly tolerated. Hence, we reviewed the efficacy and safety of novel drugs or devices that target neuronal excitability in NP patients compared with placebo, sham, or usual care interventions. Methods: Six databases were searched for parallel randomized controlled trials (RCTs) reporting novel devices (rTMS, SCS, and TENS) or drugs (EMA401, capsaicin 8% patch, and Sativex) for NP. Data were extracted and quality was assessed using the ROB2 tool. The random-effects inverse variance method was used for analysis. Results: In our review of 30 RCTs with 4251 participants, device-based interventions were found to be more effective in reducing pain scores than control interventions (SMD = -1.27, 95% CI: -1.92 to -0.62). However, high heterogeneity was seen (p < 0.01, I 2 = 91%), attributable to the etiology of NP (R 2 = 58.84%) and year of publication (R 2 = 49.49%). Funding source and type of control comparator were ruled out as cause of heterogeneity. Although drug interventions did not differ from placebo interventions in absolute pain reduction (SMD = -1.21, 95% CI: -3.55 to 1.13), when comparing relative change in pain intensity from baseline, drug interventions were found to be effective (SMD = 0.29, 95% CI: 0.04-0.55). Asymmetry in the funnel plot was visualized, suggesting publication bias. Certainty of evidence was very low according to GRADE assessment. Conclusions: Our review indicates that device-based interventions are more effective than control interventions in reducing pain intensity in NP. Nevertheless, available evidence is limited due to heterogeneity and publication bias, prompting the need for more high-quality RCTs to confirm the efficacy and safety of these interventions.

Upper extremity function and disability recovery with vibration therapy after stroke: a systematic review and meta-analysis of RCTs

BACKGROUND

This study aimed to investigate the therapeutic effects of vibration therapy for improving upper extremity motor impairment, function, and disability recovery in people with stroke.

DESIGN

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, the Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Knowledge Resource Integrated Database, and Google Scholar were searched from inception to May 31, 2024. Randomized controlled trials (RCTs) that evaluated the effects of vibration therapy on upper extremity motor impairment, function, and disability recovery post-stroke were analyzed.

SETTING AND PARTICIPANTS

Participants with a diagnosis of stroke with hemiplegia (or hemiparesis) were recruited.

METHODS

Methodological quality assessment was performed using the PEDro quality score. Upper extremity motor impairment, function, and disability were the primary outcomes. Upper extremity motor impairment was measured using the Fugl-Meyer Assessment scale and other methods. Upper extremity functions were evaluated using the Wolf Motor Function test or other tools assessing manipulative activities. Disability was assessed using the Functional Independence Measure, Barthel index, and other methods.

RESULTS

Overall, 30 RCTs including 1621 people with stroke were selected. Compared with the control, vibration therapy exerted significant effects on upper extremity motor impairment [standardized mean difference (SMD) = 1.19; p < 0.00001)], function (SMD = 0.62; p < 0.00001), and disability recovery (SMD = 1.01; p < 0.00001). The subgroup analysis revealed that focal vibration therapy (SMD = 2.14) had favorable effects on disability recovery compared with whole-body vibration therapy (SMD = 2.0). Interventions lasting 4-8 weeks showed significant improvements in motor impairment (SMD = 1.19), motor function (SMD = 0.57), and disability (SMD = 0.84); additionally, the effects of vibration therapy combined with conventional rehabilitation (SMD = 1.03) were superior to those of vibration therapy alone (SMD = 0.21).

CONCLUSIONS

Vibration therapy may be a reliable rehabilitation program to improve upper extremity motor functions and disabilities. Furthermore, vibration therapy should be performed at the earliest possibility after stroke for at least 4-8 weeks. Trial registration The protocol of this study was registered with PROSPERO (Registration number: CRD42022301119).

Incidence and risk factors for acute kidney injury in children with nephrotic syndrome: a meta-analysis

Background

Nephrotic syndrome (NS) is a prevalent kidney disease in children. Acute kidney injury (AKI) is a severe complication of NS and has the potential to be life-threatening.

Objective

The aim of this study was to analyze the prevalence and risk factors of AKI in children with NS, and to provide an evidence-based medical basis for the early identification of high-risk children in the clinic.

Methods

A comprehensive search was conducted in publicly available databases, namely PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering the period from the inception of each database until May 2024. The analysis involved examining basic characteristics (age, sex), the concomitant diseases (hypertension, infections), NS disease characteristics (steroid susceptibility classification, pathologic classification), laboratory test (e.g., serum albumin), and the use of nephrotoxic drugs. Traditional and network meta-analyses were performed for analysis.

Results

A total of 11 studies were included in the analysis, revealing an incidence of AKI of 29% (95% CI: 23%-37%). The analysis of factors indicated that the age of NS onset [standardized mean difference (SMD): 0.31; 95% confidence interval (CI): 0.08, 0.54; p = 0.009], sex [odds ratio (OR): 1.49; 95% CI: 1.03, 2.16; p = 0.035], serum albumin level (SMD: -0.43; 95% CI: -0.85, -0.02; p = 0.041), response to steroid treatment (OR: 0.52; 95% CI: 0.33, 0.80; p = 0.003), infection (OR: 3.60; 95% CI: 1.91, 6.78; p < 0.001), hypertension (OR: 4.02; 95% CI: 2.94, 5.51; p < 0.001), and nephrotoxic drug application (OR: 4.43; 95% CI: 1.86, 10.53; p = 0.001), were all significantly associated with the incidence of AKI. Furthermore, the results of the network meta-analysis suggested that the pathologic type of minor glomerular abnormalities (MGA)/diffuse mesangial proliferation (DMP), the type of infrequent relapses (IFRNS)/steroid-sensitive NS (SSNS), and the use of diuretic medications were associated with a relatively low risk of AKI occurrence.

Conclusion

Factors upon admission of children with NS are associated with the onset of AKI. Emphasis should be placed on populations with a heightened risk of AKI in clinical practice. Further research is warranted to confirm the findings due to the limitations of this study.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO (CRD42024571170).

Comparison of immediate and staged complete revascularization in patients with acute coronary syndrome and multivessel coronary disease: a systematic review and meta-analysis

BACKGROUND

The optimal timing of complete revascularization (CR) in patients with acute coronary syndrome (ACS) and multivessel disease (MVD) is still debated. The safety and efficacy of immediate and staged CR (ICR vs. SCR) in this patient group were thus compared.

METHODS AND RESULTS

PubMed, Embase, and CENTRAL were systematically searched to identify randomized controlled trials of CR strategies for MVD. Studies comparing cardiovascular benefits between ICR and SCR in ACS patients with MVD were included. Short- and long-term outcomes were compared using random-effect risk ratios (RRs). The analysis included seven studies with 3445 patients. The ICR and SCR groups showed comparable risks of all-cause death at 1 year (RR: 1.18; 95% CI: 0.72 to 1.95), but the risk increased at 1 month in ICR patients (RR: 2.35; 95% CI: 1.12 to 4.91). ICR reduced the risk of myocardial infarction (MI, RR: 0.54; 95% CI: 0.33 to 0.90) and target vessel revascularization (TVR, RR: 0.62; 95% CI: 0.45 to 0.85) at 1 year.

CONCLUSION

The all-cause death rates were comparable between ICR and SCR strategies. CR at index procedure could reduce MI and TVR rates at 1 year (46% and 38%, respectively). Future studies need to obtain more precise evidence and identify the cardiovascular benefits of these two strategies.

CLINICAL TRIAL NUMBER

Not applicable.

Efficacy and safety of various regional nerve blocks for postoperative analgesia in paediatric patients undergoing developmental dysplasia of the hip surgery: a protocol for systematic review and network meta-analysis

INTRODUCTION

Alleviating postoperative pain from developmental dysplasia of the hip (DDH) surgery is beneficial for paediatric patients. The most commonly used anaesthetic approach currently is general anaesthesia combined with regional nerve blocks. Existing research primarily focuses on studies comparing regional nerve blocks with placebo controls, or studies comparing two different regional nerve blocking techniques. However, the conclusions from these studies offer limited assistance to clinicians in selecting the safest and most effective nerve block. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the efficacy and safety of different regional nerve blocks in managing postoperative pain in children undergoing surgery for DDH.

METHODS AND ANALYSIS

We will systematically search the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials via Ovid, as well as the Chinese databases CNKI and Wanfang. We will comprehensively search from the inception of each database to April 2024 and will include randomised controlled trials without restrictions on language or publication status. The primary outcome are postoperative pain scores at 4 hours following surgery. The quality of all included trials will be assessed using version 2 of the Cochrane Randomised Trial Risk of Bias Tool. We will employ the GeMTC package in R software for both direct and indirect comparisons within a Bayesian framework using a random effects model. Additionally, the Confidence in Network Meta-Analysis method will be employed to assess the quality of evidence.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study, as it exclusively involves the compilation of published data. We plan to submit our review to academic conferences and peer-reviewed scholarly journals.

PROSPERO REGISTRATION NUMBER

CRD42024527459.

Prognostic value of anion gap for patients with heart failure: a systematic review and meta-analysis

BACKGROUND

Heart failure (HF) is among the cardiovascular diseases with high morbidity and mortality worldwide. Due to the high burden of HF, finding easy-to-use prognostic factors has become important. Studies have investigated the correlation between anion gap (AG) and the HF prognosis. In this systematic review and meta-analysis, we aimed to evaluate the association between AG association with HF prognosis.

METHODS

PubMed, Embase, Scopus, and the Web of Science were systematically searched for studies evaluating AG in HF prognosis. Standardized mean difference (SMD) and pooled hazard ratio (HR) in addition to 95% confidence intervals (CIs) were calculated using random-effect meta-analyses to compare survivors vs. non-survivors.

RESULTS

Nine studies were included in this systematic review. In a random-effect meta-analysis comparing AG levels in those who died and survivors, non-survivors had significantly higher levels of AG (SMD 0.57, 95% CI 0.42 to 0.71, P < 0.0001, I2 = 46.4%). Meta-analysis of HRs for assessment of mortality revealed that high AG levels had significantly higher hazards of mortality, compared with low AG group (HR 1.64, 95% CI 1.35 to 1.99, P < 0.0001). Finally, a study investigated the association between intensive care unit (ICU) length of stay and AG in patients with HF which showed no significant association.

CONCLUSION

This study found that higher AG levels are associated with higher mortality in patients with HF which could be used in clinical settings and for patient management due to its ease of measurement and calculation. If confirmed in future studies, using this easy-to-measure index in clinical settings could provide useful information for clinicians in determining the risk of HF patients.

CLINICAL TRIAL NUMBER

Not applicable.

Increased Lateral Femoral Condyle Ratio Is Associated With a Greater Risk of Anterior Cruciate Ligament Injury and Concomitant Anterolateral Ligament and Meniscus Injuries

PURPOSE

To investigate whether lateral femoral condyle ratio (LFCR) and lateral femoral condyle index (LFCI) were associated with a greater risk of anterior cruciate ligament (ACL) injury and concomitant injuries.

METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to April 1, 2024. Studies evaluating the association between LFCR or LFCI and ACL injury were included. The following data were extracted: first author's name, study design, level of evidence, information of participants, radiologic method of measurement, and mean values for LFCR and LFCI. The quality assessment followed the Methodological Index for Non-Randomized Studies tool. The literature search, data extraction, and quality assessment were conducted by 2 authors independently.

RESULTS

A total of 14 studies comprising 2,386 participants were included. Notably, 11 studies explored the association between LFCR and ACL. Six studies showed that the mean LFCR in ACL injury group (range, 62.65%-70.1%) was significantly greater than control group (range, 59.3%-66.8%). Five studies reported that the increased LFCR was associated with a greater risk of concomitant anterolateral ligament injury and meniscal tear. However, 2 studies reported no significant association between LFCR and ACL reconstruction revision, with a mean LFCR ranging from 62.5% to 64.4% in the ACL reconstruction revision group and 62.8% to 64.2% in the primary ACL group. In addition, 2 studies reported that decreased LFCI was associated with a greater risk of ACL injury ranging from 0.60 to 0.78 for the ACL injury group and 0.60 to 0.85 for controls.

CONCLUSIONS

Increased LFCR was associated with a greater risk of ACL injury and concomitant anterolateral ligament injuries and meniscal tears. Furthermore, decreased LFCI was associated with a higher risk of ACL injury.

LEVEL OF EVIDENCE

Level III, systematic review of Level III studies.

Factors affecting posaconazole plasma concentrations: a meta-analysis and systematic review

Background

Posaconazole is a potent antifungal agent widely used to manage invasive fungal infections, especially in immunocompromised individuals. Achieving optimal therapeutic concentrations of posaconazole can be challenging due to interpatient variability, the availability of multiple formulations, and various dosing strategies.

Methods

We conducted a systematic search of PubMed, EMBASE, and the Cochrane Library to identify studies evaluating factors that influence blood concentrations of posaconazole. The primary outcome was the assessment of posaconazole concentrations in relation to various influencing factors, including age, sex, drug interactions, disease state, administered dose, and formulation.

Results

Our analysis included 46 studies involving a total of 8,505 patients. Co-administration of drugs that affect posaconazole metabolism significantly reduced its concentrations. High-fat meals, age, and sex did not have a significant impact on posaconazole oral suspension (POS) concentrations. Diarrhea substantially decreased concentrations of both delayed-release tablets (DRT) and POS. Neither vomiting nor mucositis significantly affected POS concentrations. Acid-suppressing agents, such as H2 receptor antagonists and proton pump inhibitors, notably decreased POS concentrations but had no significant effect on DRT. Comparative studies of different dosage forms revealed significantly higher concentrations with DRT compared to POS.

Conclusion

DRT maintain more stable concentrations than POS and are not affected by acid-suppressing drugs. Given the significant fluctuations in posaconazole concentrations, patients experiencing diarrhea require close monitoring.

Systematic Review Registration

PROSPERO, Identifier CRD42023428822 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023428822).

Effects of anti-inflammatory dietary supplements on pelvic pain in females with endometriosis: A GRADE-assessed systematic review and meta-analysis of RCTs

BACKGROUND

Endometriosis, the most perplexing gynecologic condition, impairs the quality of life because it is usually accompanied by persistent severe acyclic pelvic pain and infertility as its two main symptoms. The majority economic burden of endometriosis is due to infertility and pelvic pain. Therefore, alleviating pelvic pain in patients with endometriosis is a necessity.

OBJECTIVES

The present systematic review and meta-analysis aimed to summarize evidence about the effects of anti-inflammatory dietary supplements on pelvic pain in females with endometriosis.

SEARCH STRATEGY

PubMed, Scopus, and Web of Science as online databases were systematically searched by relevant keywords up to December 2023.

SELECTION CRITERIA

Randomized controlled clinical trials (RCTs) with either a parallel or crossover design conducted in adults with endometriosis were selected.

DATA COLLECTION AND ANALYSIS

Random effect analysis was used to run meta-analysis. Subgroup analyses were run to detect heterogeneity sources. Quality assessment was done by revised Cochrane Collaboration tool II. The certainty of evidence was evaluated by the GRADE tool.

MAIN RESULTS

A significant decrease in pelvic pain following supplementation with anti-inflammatory dietary supplements was detected. Also, anti-inflammatory dietary supplements could significantly decline pelvic pain in patients with endometriosis when the age of the participants was ≥32 years, the duration of supplementation was >8 weeks, the type of intervention was anti-inflammatory vitamins, the stage of endometriosis of study participants was > II, and baseline body mass index (BMI) of the participants was >23 kg/m2.

CONCLUSIONS

Use of anti-inflammatory dietary supplements in females with endometriosis results in a remarkable decrease in pelvic pain.

Analgesic efficacy and safety of erector spinae plane block versus serratus anterior plane block in breast surgery-a meta-analysis and systematic review of randomized controlled trials

BACKGROUND

Mastectomy and breast-conserving surgery are key interventions for breast cancer, a leading cause of cancer-related mortality in women. Many undergoing breast surgery experience postoperative pain compromising their functionality and quality of life. While multiple pain management strategies are available, evidence comparing the erector spinae (ESPB) and serratus anterior plane blocks (SAPB) for improving post-surgical pain management in breast cancer surgery patients is limited. Therefore, we investigated the efficacy and safety of these two regional anesthesia techniques.

METHODS

After PROSPERO registration, we systematically searched PubMed, Google Scholar, and Cochrane Library until May 2024. Risk ratios (RR) were calculated for dichotomous outcomes and standard mean differences (SMD) or mean differences (MD) were computed for continuous data. RevMan Review Manager 5.4.1 was used for the data analysis and generation of forest plots as well as funnel plots. The Cochrane Risk of Bias tool 2.0 (18) and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines were used to appraise and evaluate the evidence (19).

RESULTS

A total of 9 randomized control trials enrolling 550 patients were included. Static pain scores at 0, 6, 8, 12, and 24 h after surgery, dynamic pain scores computed at 0, 8, 12, and 24 h after surgery and area under the curve (AUC) static pain score at all time points between 0 and 24 h (SMD (HKSJ 95% CI) - 0.27 [- 0.99, 0.45]) did not significantly vary with either plane block. Postoperative morphine consumption in the first 24 h and the number of patients requesting analgesia were significantly greater in those receiving SAPB [MD: - 1.41 (95% C.I. - 2.70, - 0.13), p = 0.03] and [RR: 1.28 (95% C.I. 1.00, 1.63), p = 0.05], respectively. The time to first postoperative analgesic use was significantly greater among those administered ESPB [MD: 1.55 h, (95% C.I. 1.02, 2.09), p < 0.01]. Patient satisfaction scores and the incidence of nausea and vomiting were similar across both groups.

CONCLUSIONS

While pain scores with either block are comparable, ESPB reduces postoperative morphine consumption and may be the favorable option in breast cancer patients undergoing surgery.

Circulating irisin levels in patients with MAFLD: an updated systematic review and meta-analysis

Objective

Current research suggests that irisin is closely linked to the pathogenesis and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). This systematic review and meta-analysis updates our previous meta-analysis and further explores the relevance between circulating irisin levels and MAFLD.

Methods

Nine databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, Weipu, CBM, Clinicaltrials.gov and gray literature) were retrieved as of 1st August, 2024. The standardized mean difference (SMD) and 95% confidence interval (CI) represent pooled effect size. We used the Newcastle-Ottawa Scale to evaluate the quality of articles and the certainty of evidence assessed by GRADE system. All statistical analyses were performed using RevMan 5.3 and Stata 12(Stata Corporation, yi TX).

Results

Fifteen case-control studies were included. Circulating irisin levels in the MAFLD group were markedly lower than those in the healthy group (SMD=-1.04 [-1.93, -0.14]). Subgroup analyses by race, age, severity and T2DM revealed that circulating irisin levels were lower in the MAFLD group compared to those in the healthy controls in the Asian population (SMD=-1.38 [-2.44, -0.31], P<0.05) and in those above 50 years old (SMD=-2.23 [-3.64, -0.81], P<0.05) and higher in the mild MAFLD groups than those in moderate to severe MAFLD groups (SMD = 11.68 [9.05, 14.31], P<0.05). And the circulating irisin levels in MAFLD patients with T2DM were significantly lower than those in healthy group (SMD = -2.90 [-4.49, -1.30]). ELISA kits from different companies also presented different relationships.

Conclusions

There were significantly lower circulating irisin levels in the MAFLD group than in the healthy control group. Although these results differed from our previous results, there is no denying that circulating irisin levels are closely associated with the advancement of MAFLD.

Constant-Torque Stretching in Ankle Contractures Results in Greater Changes in Range of Motion Than Constant-Angle or Dynamic Stretching: A Systematic Review and Meta-analysis

OBJECTIVES

To investigate the acute (directly poststretching) and long-term (≥1 week of treatment) effects of stretching type, duration, and intensity on joint range of motion (ROM) and stiffness in ankle contractures.

DATA SOURCES

PubMed, Embase.com, Clarivate Analytics/Web of Science Core Collection, EBSCO/SPORTDiscus, and EBSCO/CINAHL were searched for studies published in English from inception until September 12, 2023.

STUDY SELECTION

Fifty-five studies that met the inclusion criteria were included, covering observational, controlled and noncontrolled studies.

DATA EXTRACTION

Pre- and post-treatment ankle ROM and stiffness, and stretching duration, intensity, and type were extracted from each eligible treatment group by 1 reviewer.

DATA SYNTHESIS

Most studies did not quantify stretching intensity and its effect was not tested. For the acute effects on ROM, 15 effect sizes were obtained from 11 studies. ROM increased more after constant-torque (95% confidence interval [CI] [1.35, 2.15]) than after constant-angle (95% CI [0.44, 1.40] or dynamic stretching (95% CI [0.50, 1.01]), F=11.99, P=.004, I2=0%, and increased with duration (95% CI [0.00, 0.05]), F=5.12, P=.011, I2=55%. Acute effects on joint stiffness could not be assessed. For the long-term effects, 54 and 12 effect sizes were estimated from 44 and 10 studies, for ROM and stiffness, respectively. No effect of stretching duration on either outcome was found (F=0.32, P=.57, I2=78% and F=0.74, P=.409, I2=5%, respectively). No effect of stretching type on stiffness was found (F=0.02, P=.888, I2=0%). Not enough information was available to assess the long-term effects of stretch type.

CONCLUSIONS

We conclude that constant-torque stretching acutely increases ROM more than constant-angle and dynamic stretching. To assess if these superior acute effects result in more substantial adaptations over time, future long-term studies should define stretching type more clearly. Also, torque and angle during stretching should be recorded as measures of intensity in future studies.

Cardiac Myosin Inhibitors for Obstructive Hypertrophic Cardiomyopathy: A Meta-analysis of Randomized Placebo-Controlled Trials

BACKGROUND

Cardiac myosin inhibitors (CMI) have emerged as the first disease-specific, noninvasive therapy with promising results in patients with hypertrophic cardiomyopathy. However, its role in obstructive hypertrophic cardiomyopathy (oHCM) remains uncertain, especially in secondary endpoints of randomized controlled trials (RCTs).

METHODS

We systematically searched PubMed, Embase, Web of Science, and Clinicaltrials.gov from inception to June 2024 for RCTs comparing CMI versus placebo in patients with oHCM. We applied a random-effects model to evaluate efficacy and safety outcomes and primary or secondary outcomes of RCTs.

RESULTS

We included five RCTs comprising 767 patients, of whom 402 (52.5%) were randomized to CMI. Relative to placebo, CMI were associated with a higher rate of improvement of at least one New York Heart Association (NYHA) functional class [risk ratio (RR) 2.33; 95% confidence interval (CI) 1.92-2.82]. In addition, CMI reduced resting left ventricular outflow tract (LVOT) [mean difference (MD) - 42.51 mmHg; 95% CI - 59.27 to - 25.75] and the provoked LVOT gradients (MD - 46.12 mmHg; 95% CI - 55.70 to - 36.54). However, CMI significantly increased the risk of reaching a left ventricular ejection fraction below 50% (RR 4.80; 95% CI 1.42-16.20), affecting 8% of patients during long-term follow-up of up to 120 weeks. There was no significant interaction across subgroups of class representatives, pointing to a class effect. The benefit-risk analysis indicated a larger benefit for NYHA class improvement than risk for systolic dysfunction.

CONCLUSION

In patients with oHCM, mavacamten and aficamten as a class improve clinical and hemodynamic endpoints compared with placebo, albeit with a higher incidence of a reduction in left ventricular ejection fraction.

REGISTRATION

PROSPERO CRD42023468079.

Mid-term and Long-term Outcomes of Endovenous Laser Ablation Utilizing a 1470 nm Laser a Systematic Review and Meta-Analysis

PURPOSE

We sought to investigate the mid-term and long-term efficacy of 1470 nm endovenous laser ablation (EVLA).

MATERIAL AND METHODS

We conducted a systematic research on PubMed, Scopus, and Web of science for articles published by January 2024. The primary endpoints were truncal vein and great saphenous vein (GSV) occlusion.

RESULTS

Fifteen studies, 4 randomized controlled trials (RCTs), 5 prospective, and 6 retrospective case series, including 2064 patients and 2125 truncal veins (1862 GSV) were included. The pooled truncal vein occlusion estimates at 2, 3, and 5 years were 93.51% (95% confidence interval [CI]: 90.01, 95.84), 89.60% (95% CI: 82.75, 93.93), 88.94% (95% CI: 81.59, 93.58). The pooled GSV occlusion at 2, 3, and 5 years were 93.90% (95% CI: 90.30, 96.21), 93.01% (95% CI: 82.80, 97.36), and 89.06% (95% CI: 80.55, 94.12), respectively. The pooled deep vein thrombosis (DVT) and burn estimates were 1.42% (95% CI: 0.87, 2.31) and 2.64% (95% CI: 1.19, 5.75), respectively. The pooled overall and permanent neurologic complication estimates were 4.33% (95% CI: 1.62, 11.12) and 1.70% (95% CI: 0.69, 4.13), respectively. The pooled Venous Clinical Severity Score (VCSS) reduction by the end of follow-up was, mean difference (MD), 4.96 (95% CI: 3.87, 6.05). Meta-regression analysis including linear endovenous energy density (LEED) values ranging from 69 to 101.7 J/cm elucidated a statistically significant positive association between LEED and GSV occlusion at the 2-year (β=0.0977, p=0.02), 3-year (β=0.2021, p<0.01) and 5-year (β=0.0534, p=0.01) follow-up intervals.

CONCLUSION

This review has displayed satisfactory medium and long-term truncal and GSV occlusion outcomes for the 1470 nm device. In addition, a positive association between GSV occlusion and LEED was identified, persisting through the 2-year, 3-year, and 5-year follow-up intervals. Despite these favorable findings further research is imperative, focusing not only on technical aspects, such as vein occlusion but also on critical clinical parameters, including varicose vein recurrence, to comprehensively evaluate the effectiveness and durability of EVLA.

CLINICAL IMPACT

This review demonstrated the efficacy and safety of the 1470 nm EVLA device in the treatment of lower limb venous insufficiency over the medium- and long-term periods, further substantiating its continued use. Moreover, the consistent positive association between linear endovenous energy density (LEED) and occlusion outcomes across the five-year follow-up interval highlighted the critical role of LEED in optimizing long-term clinical results, potentially offering valuable insights for practitioners.

Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis

Rationale: Low arousal threshold and poor muscle responsiveness are common determinants of obstructive sleep apnea (OSA). Hypnotics were hypothesized as an alternative OSA treatment via raising the arousal threshold and possibly genioglossus responsiveness. Objectives: To examine the effect of common hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. Methods: We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for randomized clinical trials, and we ran meta-analyses to determine the effect of oral hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. The Grades of Recommendation Assessment, Development and Evaluation was used to rate the quality of evidence (QoE). The association between post-treatment apnea-hypopnea index (AHI) and arousal threshold percentage reductions was explored in individual patient data meta-analyses (overall sample and low arousal threshold subgroups). Measurements and Main Results: On the basis of our analysis (27 studies; 25 for AHI, 11 for arousal threshold, 4 for genioglossus responsiveness), hypnotics minimally raised arousal threshold (mean difference [95% confidence interval], 2.7 [1.5, 3.8] cm H2O epiglottic pressure swings; moderate QoE) but did not change OSA severity (-1.4 [-3.5, 0.7] events/h; moderate QoE). Individual patient data meta-analysis (N = 114) showed no association between changes in arousal threshold and AHI, independent of arousal threshold subgrouping. However, people with very low arousal threshold or those who exhibited a 0-25% arousal threshold increase from placebo experienced the greatest, yet still modest, post-treatment AHI reductions (∼10%). Hypnotics did not affect genioglossus responsiveness (high QoE). Conclusions: Further research testing or clinical use of hypnotics as OSA alternative treatments should be discouraged, unless in the presence of comorbid insomnia or as part of combination therapy in individuals with very low arousal threshold.

Efficacy and safety of cysteamine 5% cream for the management of melasma: a systematic review and meta-analysis of randomized controlled trials

Currently, hydroquinone serves as topical treatment of choice for melasma. However, its long-term use was associated with melanocyte toxicity. Cysteamine is an aminothiol that possesses antioxidant and depigmenting properties, therefore potentially suitable for treating melasma. This study aims to analyze the efficacy and safety of cysteamine 5% cream for the management of melasma. A comprehensive search was conducted on the Europe PMC, Medline, Scopus, and Cochrane Library databases up until June 22nd, 2024. This review incorporates randomized controlled trials (RCTs) that examines the comparison between cysteamine and placebo or hydroquinone in melasma patients. We employed random-effect models to analyze the odds ratio and standardized mean difference (SMD) for presentation of the outcomes. A total of 7 RCTs were incorporated. The results of our meta-analysis showed cysteamine 5% was more effective than placebo in reducing the Melasma Area and Severity Index (SMD - 0.84; 95% CI - 1.19, - 0.49, p < 0.00001, I2 = 0%), but showed no significant difference when compared with hydroquinone 4% (SMD 0.16; 95% CI - 0.22, 0.53, p = 0.42, I2 = 55%). In terms of safety, the incidence of adverse events (AEs) like erythema, irritation, burning, itching, and dryness were higher in the cysteamine 5% than placebo. However, the incidence of these AEs was similar between cysteamine 5% and hydroquinone 4%. This study suggests that cysteamine 5% cream may become suitable alternative of topical hydroquinone for the management of melasma due to similar efficacy and safety profile.

Effects of prophylactic nebulized antibiotics on the prevention of ICU-acquired pneumonia: a systematic review and meta-analysis

Objective

To evaluate the efficacy and safety of prophylactic nebulized antibiotics in preventing intensive care unit (ICU)-acquired pneumonia through a meta-analysis.

Methods

Randomized controlled trials (RCTs) investigating the potential reduction in the incidence of ICU-acquired pneumonia through prophylactic nebulized antibiotics were collected by searching the PubMed, Embase, and Cochrane Library databases from their inception to January 23, 2024. The primary endpoint was the incidence of ICU-acquired pneumonia, while the secondary endpoints included mortality, length of ICU stay, mechanical ventilation days, and nebulization-related side effects. Statistical analyses were performed using RevMan 5.3 and STATA 14.0 software.

Results

A total of six RCTs were included in the analysis, involving 1,287 patients (636 patients in the study group received prophylactic antibiotic therapy, including Polymyxin B, Tobramycin, Ceftazidime, Colistimethate sodium, and amikacin; 651 patients in the control group primarily received saline). The results indicated that prophylactic nebulized antibiotic therapy significantly reduced the incidence of ICU-acquired pneumonia compared to that in the control group (odds ratio (OR) = 0.57, 95% confidence interval (CI) [0.43-0.74], P < 0.0001). No significant difference was observed in the mortality rate between the treatment and control groups (OR = 0.86, 95% CI [0.68-1.10], P = 0.24). Prophylactic nebulized antibiotic therapy also did not significantly reduce the length of ICU stay (MD = 0.2 days; 95% CI [-0.81 to 1.20], P = 0.70) or the number of mechanical ventilation days (MD = 0.43 days; 95% CI [-0.47 to 1.33], P = 0.35). Additionally, there was no evidence that prophylactic nebulized antibiotic therapy contributed to the development of multiple drug-resistant (MDR) bacterial pneumonia or increased the incidence of associated side effects, such as airway spasms.

Conclusions

This meta-analysis suggests that ICU-acquired pneumonia can be prevented by prophylactic nebulized antibiotic therapy in critically ill patients without increasing the risk of MDR bacterial infections or airway spasms. However, the reduction in the incidence of ICU-acquired pneumonia did not result in significant improvements in mortality or length of ICU stay.

A systematic review and meta-analysis comparing the short-term efficacy of the KangDuo surgical robot with the da Vinci robotic system in radical prostatectomy

To determine the efficacy and adverse consequences between KangDuo and Da Vincii surgical robotic systems in facilitating radical prostatectomy. All the papers, that were included in the current analysis, were identified with PubMed, Embase, and the Cochrane Library through October 1, 2024. To make the comparison easier, only the English-language articles have been used for the analysis and only those focusing on comparing the use of the KangDuo and da Vinci robotic systems in radical prostatectomy were used. There are several avenues of bias when considering articles to include, when selecting the articles for this study to adopt the RCTs and cohort studies and excluding the others, the bias selection targeted was minimal. For the systematic review, 1 cohort study was found as well as 2 RCTs were found that involved 150 adult patients assigned to undergo urological surgery. Of those, 76 patients operated by the Kang Duo robotic system, and the remaining 74 patients operated by the Da Vinci system. In conclusion from this study, it was noted that though there was an increase in the operative time used in the KangDuo system, the estimated blood loss, number of days needed to stay in hospital, and the incidences of postoperative complications were comparable to the other system. Compared to the da Vinci robotic system, the KangDuo robotic system, while associated with longer operative times for radical prostatectomy, showed no significant difference in perioperative or short-term outcomes. In addition, the KangDuo system is more cost-effective and easier to implement in developing countries or other regions. However, further high-quality studies are needed to confirm these findings.

Microplastics stimulated soil bacterial alpha diversity and nitrogen cycle: A global hierarchical meta-analysis

Microplastics (MPs) pollution is recognized as a global emerging threat with serious potential impacts on ecosystems. Our meta-analysis was conducted based on 117 carefully selected publications, from which 2160 datasets were extracted. These publications described experiments in which MPs were added to soil (in laboratory or greenhouse experiments or in the field) after which the soil microbial community was analyzed and compared to a control group. From these publications, we extracted 1315 observations on soil bacterial alpha diversity and richness indices and 845 datasets on gene abundance of bacterial genes related to the soil nitrogen cycle. These data were analyzed using a multiple hierarchical mixed effects meta-analysis. The mean effect of microplastic exposure was a significant decrease of soil bacterial community diversity and richness. We explored these responses for different regulators, namely MPs addition rates, particle size and plastic type, soil texture and land use, and study type. Of the bacterial processes involved in the soil nitrogen cycle, MPs addition significantly promoted assimilation of ammonium, nitrogen fixation and urea decomposition, but significantly inhibited nitrification. These results suggest that MPs contamination may have considerable impacts on soil bacterial community structure and function as well as on the soil nitrogen cycle.