Estimating the mean and variance from the median, range, and the size of a sample

Understanding Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): a comprehensive meta-analysis of clinical characteristics, management, and prognosis compared to MI with the Obstructive Coronary Artery (MIOCA)

BACKGROUND

MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) represents a unique subset of acute coronary syndrome, distinct from MIOCA (Myocardial Infarction with Obstructive Coronary Arteries) and a control group. This study systematically compares their prevalence, clinical characteristics, management strategies, and outcomes to improve understanding and treatment approaches.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines across multiple databases up to 2024. STATA 17 was used for statistical analyses, and the Newcastle-Ottawa Scale was employed to assess study quality.

RESULTS

One-hundred and twelve studies, including 5,908,768 patients, were analyzed. The pooled prevalence of MINOCA among patients undergoing coronary angiography was 8.92% (95% CI: 8.90-8.94). MINOCA patients were generally younger, predominantly female, and more likely to present with atypical chest pain and dyspnea compared to MIOCA patients. Laboratory findings showed higher levels of CRP, BNP, and fibrinogen in MINOCA patients, suggesting inflammation and microvascular dysfunction as key mechanisms. In contrast, MIOCA patients had higher rates of diabetes and dyslipidemia, highlighting differences in pathophysiological processes. Medication use differed between the groups, with MINOCA patients more likely to be prescribed anticoagulants and β-blockers. Prognostically, MINOCA patients experienced significantly lower rates of adverse short- and long-term outcomes, including major adverse cardiac events (MACE) and cardiovascular death, compared to MIOCA patients.

CONCLUSIONS

This study demonstrated that patients with MINOCA have a better prognosis compared to those with MIOCA and are at a lower risk of serious cardiac events. Based on the findings of this study, we emphasize that microcirculation and vascular spasm are the main mechanisms involved in MINOCA. Considering these findings, it is suggested that a better management strategy for MINOCA patients can be established by precisely defining diagnostic criteria and focusing on anti-inflammatory treatments and risk factor control.

The Effect of 17β-Estradiol Plus Norethisterone Acetate on Estradiol, Testosterone, IGF-1 and SHBG in Postmenopausal Women: A Meta-Analysis of Randomized Controlled Trials

We conducted this meta-analysis of randomized controlled trials (RCTs) with the aim of assessing the effect of 17β-estradiol plus norethisterone acetate on estradiol, testosterone, IGF-1, and SHBG in postmenopausal women. To our knowledge, this is the first meta-analysis of RCTs to assess these effects. Databases including the Web of Science, PubMed/Medline, Scopus, and EMBASE were searched to identify publications up to July 2024. The results were reported as weighted mean difference (WMD) and 95% confidence intervals (CI) generated by using a random-effects model according to the Der-Simonian-Laird model. Fifteen publications were included in current meta-analysis. Overall results from the random-effects model manifested a significant increase in estradiol (WMD: 55.30 pg/ml, 95% CI: 39.32, 7128, p<0.001) and SHBG (WMD: 18.48 nmol/l, 95% CI: 3.64, 33.33, p=0.015) levels, a significant decrease in FSH (WMD: -41.55 IU/l, 95% CI: -53.17, -29.92, p<0.001) and testosterone (WMD: -4.29 ng/dl, 95% CI: -5.38, -3.21, p=0.000) levels, and a non-significant decrease in IGF-1 levels (WMD: -9.70 μg/l, 95% CI: -34.21, 14.80, p=0.438) after treatment with 17β-estradiol plus norethisterone acetate on postmenopausal women. In conclusion, 17β-estradiol plus norethisterone acetate in postmenopausal women increases estradiol and SHBG concentrations and decreases FSH and testosterone concentrations, with no statistically significant effect on IGF-1.

Is isocaloric intermittent fasting superior to calorie restriction? A systematic review and meta-analysis of RCTs

BACKGROUND AND AIM

Intermittent fasting (IF) has been demonstrated to enhance human health through several mechanisms. However, it is still unclear whether those health benefits are independent of caloric restriction (CR)-induced weight loss. This systematic review and meta-analysis aimed to compare isocaloric IF and CR regarding anthropometric measurements, adherence, metabolic profile, inflammatory biomarkers, and adipokines in adults and elderlies.

METHODS AND RESULTS

Comprehensive research was conducted usin four major databases including Embase, PubMed, Scopus, and Google Scholar without date restriction. Mean differences of the change from baseline ± change SD were calculated as the differences between IF and CR groups. Subgroup analysis was performed according to intervention duration (short-, medium-, and long-term). To determine the reliability of our findings, GRADE assessment was performed. As a result, 20 RCTs were included in this systematic review and meta-analysis. IF groups had significant reductions in fat mass (kg) (P = 0.006) and Interleukin-6 (P < 0.00001) in the short term and fat mass (%) (P = 0.0002), waist circumference (P = 0.005), fasting blood insulin (P < 0.00001) and HOMA-IR (P = 0.04) in the long term. CR groups had significantly lower hunger (P = 0.003), fatigue (P = 0.04), and TG (P = 0.03).

CONCLUSIONS

IF may be an effective alternative to CR but is not superior to CR in enhancing human health. Due to the low number of long-term studies, future studies should focus on conducting longitudinal randomized trials comparing IF and CR in different populations, age groups, and IF patterns.

The effect of total and partial meal replacements on obesity: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The objective of this study was to conduct a comprehensive investigation into the effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin.

METHODS

A systematic search was conducted in five databases using established keywords. The random-effects model analysis was used to provide pooled weighted mean difference and 95% confidence intervals (CI).

RESULTS

Seventy studies were included in this article. The pooled findings showed that body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72, p < 0.001), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after total and partial MRs compared to control group. However, no significant effect was observed on leptin (WMD: -3.37 ng/mL, 95% CI: -8.23 to 1.49) compared to the control group. Moreover, subgroup analyses indicated that impact of Total MRs on anthropometric factors was greater in comparison to Partial MRs.

CONCLUSIONS

Consequently, it appears that MRs, along with other lifestyle factors, can lead to significant weight loss.

Economic impact of individualized antimicrobial dose optimization in the critically ill patient in Spain

Objective

To estimate the economic impact of individualized dose optimization guided by antimicrobial therapeutic drug monitoring (TDM) in Spain, compared to no monitoring.

Methods

A cost analysis of antibiotic treatment of critically ill patients, with and without TDM, was performed using a probabilistic Markov model (with second-order Monte Carlo simulations). Three scenarios were analyzed based on three published meta-analyses (Analysis 1: Pai Mangalore, 2022; Analysis 2: Sanz-Codina, 2023; Analysis 3: Takahashi, 2023).

Results

TDM, compared to the no-TDM option, generated according to the meta-analysis, a per patient expenditure of €195 (95%CI €194; €197) in analysis 1 or savings of -€301 (95%CI -€300; -€304) and -€685 (95%CI -€685; -€684) in analyses 2 and 3. The probability of TDM (vs. no-TDM) generating savings would be 39.4%, 63.5% and 79.7% in analyses 1, 2 and 3, respectively. This discrepancy in the results is due to methodological differences, in particular in the cure rate with TDM (vs. no-TDM) obtained in the meta-analyses: 12.2%, 16.6% and 16.0% more in analyses 1, 2 and 3, respectively.

Conclusion

In critically ill patients undergoing antimicrobial therapy TDM, there is an increased likelihood of cure. However, the currently available data are not conclusive on the economic impact of such a therapeutic effect.

Fetal brain development in fetal growth restriction using MRI: a systematic review

BACKGROUND

This systematic review investigates potential differences in brain development between growth restricted (FGR)-fetuses compared to appropriate for gestational age (AGA) fetuses using MRI.

METHODS

PubMed, Embase, Cochrane Library and Web of Science databases were searched from 1985 to 2023. FGR was defined as an estimated fetal weight (EFW) < p10 and/or an abdominal circumference (AC) < p10, or 20% reduction in EFW or AC using a minimum interval of two weeks. Outcomes included volumetrics, biometrics, apparent diffusion coefficients (ADC), 1H-MRS-metabolites, and oxygenation of the fetal brain. Risk of bias was assessed using Newcastle-Ottawa Scale (NOS). A meta-analysis was conducted on variables when reported in at least three studies, calculating the mean difference (MD) with a 95% confidence interval (CI).

RESULTS

Twenty-nine studies were included after three-phase screening, 13 used the FGR consensus definition according to the Delphi procedure. Total brain volume and cerebellar volume were significantly reduced in FGR fetuses (n = 183; 74) when compared to AGA fetuses (n = 283; 166) with a MD of -30.84 cm3 (p < 0.01) and - 2.24 cm3 (p < 0.01). ADC values in the frontal white matter (FWM), occipital white matter (OWM), temporal white matter (TWM), thalami, centrum semiovale (CSO), basal ganglia, pons and cerebellum, significantly lower in growth restricted fetuses (-0.07 × 10-3 mm2/s (p < 0.01); -0.06 × 10-3 mm2/s (p < 0.01); -0.07 × 10-3 mm2/s (p < 0.01); -0.10 × 10-3 mm2/s (p < 0.01); -0.06 × 10-3 mm2/s (p < 0.01); -0.07 × 10-3 mm2/s (p < 0.01); -0.07 × 10-3 mm2/s (p < 0.01); -0.02 × 10-3 mm2/s (p < 0.01); respectively). 1H-MRS showed reduced levels of N-acetyl aspartate (NAA): Choline (Cho) and NAA: Creatine(CR) levels in the frontal lobe and central brain tissue, whilst contradictive findings concerning Cho: Cr and Inositol(Ino): Cho ratios were found. Two studies investigated the cerebral hemodynamic changes in FGR fetuses showing no difference in fractional moving blood volume, similar venous blood oxygenation in the superior sagittal sinus and no difference in T2* in the fetal brain.

DISCUSSION

MRI provides additional information on fetal brain development in a growth restricted population. Smaller total brain and cerebellar volumes and lower ADC values in the FWM, OWM, TWM, thalami, CSO, basal ganglia, pons and cerebellum have been observed in FGR. These conclusions are drawn on relatively small sample sizes with high heterogeneity resulting from diverse study populations and MRI techniques. Furthermore, how these findings correlate to long-term neurocognitive abnormalities associated with FGR remains to be elucidated. A large cohort study comparing brain maturation, myelination, metabolic and hemodynamic status between brain-sparing FGR fetuses to healthy age-matched controls is needed.

Neurofilament Light Chain in Cerebrospinal Fluid and Blood in Multiple System Atrophy: A Systematic Review and Meta-Analysis

Background/Objectives: Multiple system atrophy (MSA) presents a challenging diagnosis due to its clinical overlap with other neurodegenerative disorders, especially other α-synucleinopathies. The main purpose of this systematic review and meta-analysis was to assess neurofilament light chain (NfL) differences in the CSF and blood of patients with MSA versus the healthy control group (HC), patients with Parkinson's disease (PD) and patients with Lewy body dementia (LBD). Secondarily, the diagnostic metrics of CSF and circulating NfL in MSA versus HC, PD, LBD, progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) were discussed. Methods: MEDLINE and EMBASE were thoroughly searched for relevant case-control studies. Standardized mean differences (SMDs) were calculated separately for CSF and blood NfL per comparison. Statistical heterogeneity was assessed based on the Q and I^2 statistics. Results: Twenty-five relevant studies were retrieved. Quantitative syntheses revealed elevated CSF and circulating NfL levels in individuals with MSA versus HC [SMD = 1.80 (95%CI = 1.66, 1.94) and SMD = 2.00 (95%CI = 1.36, 2.63), respectively] versus PD [SMD = 1.65 (95%CI = 1.26, 2.03) and SMD = 1.63 (95%CI = 0.84, 2.43), respectively] as well as versus LBD [SMD = 1.17, (95%CI = 0.71, 1.63) and SMD = 0.65 (95%CI = 0.30, 1.00), respectively]. Diagnostic accuracy was outstanding for CSF and blood NfL in MSA versus HC and PD, and it was moderate in MSA versus LBD. On the other hand, it was suboptimal in MSA vs. PSP and CBD. Conclusions: Both CSF and circulating NfL levels are elevated in MSA compared to HC, PD and LBD. To achieve optimal diagnostic properties, further work is required in the standardization of processes and the establishment of reference NfL intervals and/or thresholds.

Comparison study of two anastomosis techniques in right hemicolectomy: a systematic review and pooling up analysis

PURPOSE

This study aims to compare side-to-side anastomosis (SSA) and end-to-side anastomosis (ESA) in laparoscopic right hemicolectomy from multiple perspectives to guide the selection of the optimal anastomotic technique.

METHODS

This review was pre-registered with PROSPERO (CRD42024614418). A comprehensive literature search was performed using Embase, PubMed, Cochrane Library, and China Biology Medicine (CBM). The primary outcome was anastomotic complications, and secondary outcomes included non-anastomotic complications, short-term prognosis, and surgical parameters.

RESULTS

A total of 18 articles involving 14,555 participants were included in this systematic review and meta-analysis. No significant difference was found between SSA and ESA regarding overall anastomotic complications (OR = 1.14, 95% CI = 0.81 to 1.62, P = 0.45). However, SSA showed advantages in reducing postoperative anastomotic bleeding (OR = 0.64, 95% CI = 0.45 to 0.90, P = 0.01), while ESA appeared more favorable for reducing anastomotic leakage (AL) (OR = 1.29, 95% CI = 0.97 to 1.73, P = 0.08) and intestinal obstruction (OR = 1.20, 95% CI = 0.99 to 1.47, P = 0.07), though these differences were not statistically significant. No significant differences were found in non-anastomotic complications, short-term prognosis, or surgical parameters.

CONCLUSION

Current clinical evidence suggests that SSA is more effective than ESA in reducing postoperative anastomotic bleeding during right hemicolectomy for cancer. However, no significant differences were observed between the two techniques regarding overall anastomotic.

Doctor when can I drive? A systematic review and meta-analysis of brake reaction time in patients returning to driving after hip arthroscopy for femoroacetabular impingement (FAI)

BACKGROUND

A common question from patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is when they may return to driving.

PURPOSE

We aimed to perform a formal systematic review and meta-analysis to address this issue.

METHODS

A systematic review and meta-analysis followed PRISMA guidelines. Databases searched included OVID, EMBASE, and COCHRANE through July 2024 for articles with keywords and MeSH terms like "Hip arthroscopy," "Femoroacetabular Impingement," "total brake response time," and "reaction time" related to driving. Titles and full articles were reviewed for quality and relevance. Statistical analysis was done using Review Manager Version 5.4.A total of 39 articles were reviewed, with 5 meeting inclusion criteria. All selected articles used brake reaction time (BRT) as an outcome measure. A meta-analysis compared pre- and postoperative BRT values. Data were analysed for the right and left hips combined, followed by a subgroup analysis by laterality. BRT values were divided into preoperative and 2, 4, 6, and 8 weeks postoperative periods.

RESULTS

The studies assessed 160 patients, with 142 undergoing hip arthroscopy for FAI. The mean age was 32.75 ± 9.4 years, with a male-to-female ratio of 73:69. The right hip was affected in 68% of patients. Preoperative BRT ranged from 566 to 1960 milliseconds, while postoperative BRT ranged from 567 to 1860 milliseconds between week 2 and week 12.

CONCLUSIONS

BRTs returned to baseline or control values and continued to improve 4 weeks post-surgery for FAI. It is safe to recommend a return to driving at 4 weeks after hip arthroscopy for FAI.

Monocyte-related markers as predictors of immune checkpoint inhibitor efficacy and immune-related adverse events: a systematic review and meta-analysis

The efficacy and off-target effects of immune checkpoint inhibitors (ICI) in cancer treatment vary among patients. Monocytes likely contribute to this heterogeneous response due to their crucial role in immune homeostasis. We conducted a systematic review and meta-analysis to evaluate the impact of monocytes on ICI efficacy and immune-related adverse events (irAEs) in patients with cancer. We systematically searched PubMed, Web of Science, and Embase for clinical studies from January 2000 to December 2023. Articles were included if they mentioned cancer, ICI, monocytes, or any monocyte-related terminology. Animal studies and studies where ICIs were combined with other biologics were excluded, except for studies where two ICIs were used. This systematic review was registered with PROSPERO (CRD42023396297) prior to data extraction and analysis. Monocyte-related markers, such as absolute monocyte count (AMC), monocyte/lymphocyte ratio (MLR), specific monocyte subpopulations, and m-MDSCs were assessed in relation to ICI efficacy and safety. Bayesian meta-analysis was conducted for AMC and MLR. The risk of bias assessment was done using the Cochrane-ROBINS-I tool. Out of 5787 studies identified in our search, 155 eligible studies report peripheral blood monocyte-related markers as predictors of response to ICI, and 32 of these studies describe irAEs. Overall, based on 63 studies, a high MLR was a prognostic biomarker for short progression-free survival (PFS) and overall survival (OS) hazard ratio (HR): 1.5 (95% CI: 1.21-1.88) and 1.52 (95% CI:1.13-2.08), respectively. The increased percentage of classical monocytes was an unfavorable predictor of survival, while low baseline rates of monocytic myeloid-derived suppressor cells (m-MDSCs) were favorable. Elevated intermediate monocyte frequencies were associated but not significantly correlated with the development of irAEs. Baseline monocyte phenotyping may serve as a composite biomarker of response to ICI; however, more data is needed regarding irAEs. Monocyte-related variables may aid in risk assessment and treatment decision strategies for patients receiving ICI in terms of both efficacy and safety.

The effects of ursodeoxycholic acid on cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Chronic diseases such as obesity, hypertension, and metabolic syndrome are major health concerns worldwide. Ursodeoxycholic acid (UDCA) is a bile acid that is naturally produced in the liver and has been used for the treatment of various liver disorders. In this systematic review and meta-analysis, we investigated how UDCA might affect inflammation, blood pressure, and obesity.

METHODS

Five major databases were searched from inception to August 2024. The investigated outcomes included body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). A random effect was carried out to estimate pooled weighted mean difference (WMD) with 95% confidence intervals (CI). The registration code is CRD42023428064.

RESULTS

Of the 7912 articles in the initial search, 12 were included in the systematic review and meta-analysis. UDCA consumption significantly decreased BMI (WMD: -0.29 kg/m2, 95% CI: -0.58, -0.01, P = 0.044), and DBP (WMD: -2.16 mmHg, 95% CI: -3.66, -0.66, P = 0.005). It also increased SBP (WMD: 5.50 mmHg, 95% CI: 3.65, 7.35, P < 0.001); however, it was not associated with weight loss (WMD: -0.3 kg, 95% CI: -1.3, 0.71, P = 0.561). Our systematic review showed that UDCA consumption has no effect on IL-6 and TNF-α.

CONCLUSION

This systematic review and meta-analysis suggest that UDCA supplementation may improve BMI and DBP, whereas it may increase SBP and have no effect on weight or inflammation. Further long-term and well-designed RCTs are needed to further assess and confirm these results.

The Diagnostic Role of the Platelet-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis

Ovarian cancer is among the most lethal gynecologic malignancies, often diagnosed at advanced stages due to a lack of effective screening tools. Recent studies suggest that the platelet-to-lymphocyte ratio (PLR), an indicator of systemic inflammation, may serve as a potential biomarker for diagnosing and staging ovarian cancer. We conducted a systematic review and meta-analysis, adhering to PRISMA guidelines. We searched the PubMed/Medline, Scopus, Web of Science, and EMBASE databases. We pooled data using a random-effects model to assess the sensitivity, specificity, and diagnostic performance of PLR in ovarian cancer. The meta-analysis of 22 studies comprising 5740 participants showed significantly elevated platelet-to-lymphocyte ratio (PLR) values in ovarian cancer patients compared to healthy controls, with a mean difference of 46.84 (p < 0.001). Additionally, PLR demonstrated utility in distinguishing benign from malignant lesions and early-stage from advanced-stage ovarian cancer. While PLR shows potential as a cost-effective and accessible biomarker for ovarian cancer diagnosis and staging, its diagnostic accuracy remains moderate. Therefore, combining PLR with other diagnostic tools enhances clinical decision-making.

Diagnostic and prognostic value of cystatin C in acute coronary syndrome: An up-to-date meta-analysis

BACKGROUND

The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke.

METHODS

The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1, 2024. the meta-analysis using a random effects model.

RESULTS

CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = -0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond.

CONCLUSIONS

CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice.

Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials

OBJECTIVE

To address the comparative effectiveness of common interventional procedures for chronic non-cancer (axial or radicular) spine pain.

DESIGN

Systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs).

DATA SOURCES

Medline, Embase, CINAHL, CENTRAL, and Web of Science from inception to 24 January 2023.

STUDY SELECTION

RCTs that enrolled patients with chronic non-cancer spine pain, randomised to receive a commonly used interventional procedure versus sham procedure, usual care, or another interventional procedure.

DATA EXTRACTION AND SYNTHESIS

Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.

RESULTS

Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses. All subsequent effects refer to comparisons with sham procedures. For chronic axial spine pain, the following probably provide little to no difference in pain relief (moderate certainty evidence): epidural injection of local anaesthetic (weighted mean difference (WMD) 0.28 cm on a 10 cm visual analogue scale (95% CI -1.18 to 1.75)), epidural injection of local anaesthetic and steroids (WMD 0.20 (-1.11 to 1.51)), and joint-targeted steroid injection (WMD 0.83 (-0.26 to 1.93)). Intramuscular injection of local anaesthetic (WMD -0.53 (-1.97 to 0.92)), epidural steroid injection (WMD 0.39 (-0.94 to 1.71)), joint-targeted injection of local anaesthetic (WMD 0.63 (-0.57 to 1.83)), and joint-targeted injection of local anaesthetic with steroids (WMD 0.22 (-0.42 to 0.87)) may provide little to no difference in pain relief (low certainty evidence); intramuscular injection of local anaesthetic with steroids may increase pain (WMD 1.82 (-0.29 to 3.93)) (low certainty evidence). Evidence for joint radiofrequency ablation proved of very low certainty.For chronic radicular spine pain, epidural injection of local anaesthetic and steroids (WMD -0.49 (-1.54 to 0.55)) and radiofrequency of dorsal root ganglion (WMD 0.15 (-0.98 to 1.28)) probably provide little to no difference in pain relief (moderate certainty evidence). Epidural injection of local anaesthetic (WMD -0.26 (-1.37 to 0.84)) and epidural injection of steroids (WMD -0.56 (-1.30 to 0.17)) may result in little to no difference in pain relief (low certainty evidence).

CONCLUSION

Our NMA of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief.

REGISTRATION

PROSPERO (CRD42020170667).

Microfocused Ultrasound With Visualization (MFU-V) Effectiveness and Safety: A Systematic Review and Meta-Analysis

Microfocused ultrasound with visualization (MFU-V) is an advanced, noninvasive cosmetic procedure widely performed for skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patient satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates with random effects models and corresponding 95% confidence intervals were calculated. Out of 4019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81%-94%; I2: 63%, n = 411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73%-91%; I2: 64%, n = 312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61%-94%; I²: 52%, n = 326), and 62% (95% CI: 37%-82%; I²: 3%, n = 172) when "neutral" as a response option was provided for patients. Skin quality (eg, wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35; I2: 97%, n = 785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patient satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive may result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Comparison of Efficacy and Safety of Parenteral vs Oral Route of Vitamin B12 Supplementation for the Treatment of Vitamin B12 Deficiency Anemia in Children: A Systematic Review

CONTEXT

Vitamin B12 deficiency in children is treated with either parenteral or oral supplementation. Although the efficacy of supplementation is reportedly comparable for the 2 routes in adults, there is limited data for children.

OBJECTIVE

The objective of this review was to compare the efficacy and safety of parenteral vs oral B12 supplementation in children with vitamin B12 deficiency anemia.

DATA SOURCES

A comprehensive literature search was conducted in PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, four Clinical Trials Registries, and 2 gray literature databases, for randomized controlled trials (RCTs) comparing the parenteral vs oral routes of administering B12 in children with vitamin B12 deficiency anemia.

DATA EXTRACTION

Among 6467 citations screened, there was only 1 eligible RCT, in which children with vitamin B12 deficiency anemia received 1 dose of 1000 µg parenterally before being randomized to either parenteral or oral therapy.

DATA ANALYSIS

After 3 months, the parenteral route resulted in higher B12 levels compared with the oral route (median [IQR]: 653 [459, 835] vs 506 [399, 726] pg/mL). The changes from baseline in vitamin B12 levels (median [IQR]: 600 [389, 775] vs 399 [313, 606] pg/mL, P = .016) and hemoglobin (2.7 [0.4, 4.6] vs 0.5 [-0.1, 1.2] g/dL, P = .001) were also significantly greater with the parenteral route. There was no data on safety. In terms of quality, the RCT was judged to be at "high risk of bias."

CONCLUSION

Limited evidence from a single, methodologically weak RCT suggested that the parenteral route is more efficacious than the oral route. However, considering the limitations in quality and quantity of the available evidence, this should be interpreted with caution.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42024526597.

Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies

BACKGROUND

Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.

METHODS

A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.

RESULTS

Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD -3.45, 95% CI [-5.20, -1.60]; P = 0.0003 and SMD -2.39, 95% CI [-4.01, -0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD -4.66; 95% CI, -7.95 to -1.36; p = 0.006; SMD -3.77; 95% CI, -5.69 to -1.85; p = 0.0001, SMD -3.34 95% CI [-5.13, -1.56]; p = 0.0002, and SMD -3.43; 95% CI, -5.74 to -1.12; p = 0.004, respectively).

DISCUSSION

LB moderately decreased pain scores 24-72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.

LEVEL OF EVIDENCE

I.

Laparoscopic radical antegrade modular pancreatosplenectomy vesus laparoscopic distal pancreatosplenectomy for left-sided pancreatic cancer: a systematic review and meta-analysis

Objective

We aimed to compare the perioperative outcomes and postoperative complications of laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) versus laparoscopic distal pancreatosplenectomy (L-DPS) for left-sided pancreatic cancer through a meta-analysis.

Methods

A systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were performed. Literature searches were conducted in PubMed, Web of Science, Cochrane Library, and Embase for studies published from their inception up to June 14th, 2024.

Results

A total of three retrospective studies involving 242 patients were included in this meta-analysis, with 116 patients in the L-RAMPS group and 126 in the L-DPS group. The meta-analysis results indicated that L-RAMPS was associated with the retrieval of more lymph nodes (MD: 3.06; 95% CI: 2.51 to 3.62, p < 0.00001) and longer operative time (MD: 20.05; 95% CI: 13.97 to 26.12, p < 0.00001) compared to L-DPS for left-sided pancreatic cancer patients. However, no significant differences were observed between the two groups in terms of R0 resection margins, the incidence of pancreatic fistula (Grade B and C), postpancreatectomy hemorrhage, or postoperative complications (Clavien-Dindo Grades II and III).

Conclusions

In patients with left-sided pancreatic cancer, L-RAMPS resulted in the retrieval of more lymph nodes, a longer operative time, and a similar incidence of postoperative complications compared to L-DPS. Larger sample sizes, extended follow-up periods, and well-conducted randomized controlled trials are needed to further validate these findings.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=558977, identifier CRD42024558977.

Effectiveness of educational interventions to promote safe handling of pesticides: protocol for a systematic review and meta-analysis

INTRODUCTION

Appropriate use of pesticides minimises harm to human health and the environment. Despite regulations and restrictions on use, however, many farmers still use highly toxic pesticides in ways that endanger their health and the environment. Many pesticide users know little about the health effects of these chemicals or how to handle them safely. A systematic review will collate evidence of the effectiveness of educational interventions among farmers regarding health hazards and the safe handling of pesticides. The review aims to summarise the impact of educational interventions on knowledge and reported behaviour of pesticide users and to identify characteristics of more effective interventions.

METHODS AND ANALYSIS

We will search MEDLINE, LILACS, AGRICOLA, IMBIOMED, SciELO, Web of Science, Scopus, Embase databases and from the grey literature, Open Grey and WHO to identify potentially eligible studies. We will consider randomised and non-randomised controlled trials that evaluated the impact of educational interventions among farmers about the safe use of pesticides. We will include studies published between 2000 and 2024 in English, Spanish and Portuguese and consider outcomes of knowledge about pesticide health effects, knowledge about safe handling of pesticides and reported behaviour when handling pesticides. A meta-analysis of eligible studies, using a random-effects model, will estimate the impact of educational interventions on the outcomes as the difference between the intervention group and the control group at the last point of measurement. We will assess heterogeneity using the χ2 test and I2 statistic, conduct a sensitivity analysis by removing each study from the meta-analysis and evaluate publication bias with a funnel plot and Begg and Egger tests. Subgroup analyses will examine the impact of different kinds of educational interventions.

ETHICS AND DISSEMINATION

Ethics approval is not required as no information from individuals are collected. The results will be published in a peer-reviewed journal or disseminated at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42023413028.

Safety and efficacy of purely endoscopic microvascular decompression for trigeminal neuralgia: systematic review and single arm meta-analysis

Microscopic microvascular decompression(M-MVD) is considered the gold standard treatment for primary trigeminal neuralgia and presents excellent long-term pain control rates. Despite the effectiveness of M-MVD, the use of endoscopy in these procedures has proven to be a promising approach. To evaluate the safety and efficacy of purely endoscopic microvascular decompression (E-MVD). A systematic review of the literature was performed using the PubMed, Scopus, Embase, and Cochrane databases. The primary outcome was satisfactory pain relief in short-term (0-30 days), mid-term (mean follow-up >/= 12 months) and long-term (mean follow-up >/= 24 months). Secondary outcomes were CSF leak, facial weakness, hearing loss, facial numbness, the rate of intraoperative identification of the offending vessel(s), mortality, length of stay and operative time. Inclusion criteria were studies including only patient submitted to E-MVD. Exclusion were secondary trigeminal neuralgia and mean follow-up < 12 months. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with leave-one-out test. Thirteen articles met the inclusion criteria, comprising a total of 1336 patients. Patients submitted to E-MVD had mean satisfactory pain relief rates of 92.93% (95% CI: 89.52-96.34% I2 = 86%), 88.54% (95% CI: 83.73-93.54% I2 = 87%) and 83.38% (95% CI: 76.58-90.17% I2 = 83%) in the short-term, mid-term and long-term follow-ups, respectively. Furthermore, the incidence of postoperative complications was low, including CSF leak (1.29% (95% CI: 0.32-2.26% I2 = 20%)), facial weakness (0.50% (95% CI: 0.00-1.79% I2 = 60%)), hearing loss (0.81% (95% CI: 0.05-1.57% I2 = 7%)) and facial numbness (3.84% (95% CI: 1.95-6.20% I2 = 54%)). There was no mortality related to the procedure (0% (95% CI: 0-0%; I2 = 0%)). The offending vessel(s) were identified in 99.57% of the cases (95% CI: 98.17-100.00% I2 = 67%)). Our meta-analysis revealed that E-MVD is a safe and effective procedure for the treatment of primary trigeminal neuralgia. Further studies are necessary to compare its usefulness to the traditional M-MVD approach.

Vitamin B12, folate, and homocysteine levels in children and adolescents with obesity: a systematic review and meta-analysis

Background and aims

Childhood and adolescent obesity is a global public health concern. Obesity induces several metabolic disturbances. Several studies have explored the association of vitamin B12, folate, and homocysteine (Hcy) with obesity. This study aimed to synthesize the available evidence regarding the differences in serum levels of vitamin B12, Hcy, and folate among children or adolescents with and without obesity.

Methods

A random-effects meta-analysis using the Sidik-Jonkman method and corrected 95% confidence interval (CI) using the truncated Knapp-Hartung standard errors was used for all meta-analyses. Standardized mean difference (SMD) with the corresponding 95% CI was used as the only effect size. The Cochran's Q test and the I2 statistic were used to evaluate between-study heterogeneity. Publication bias was assessed using funnel plots and the Egger test.

Results

Twenty studies were included with a combined study population of 7,791 patients. There were no significant differences between children/adolescents with and without obesity with respect to serum vitamin B12 levels (SMD: -0.24; 95% CI: -0.53 to 0.06; p > 0.05, I2 = 74.93%) and folate levels (SMD: -0.12; 95% CI: -0.29 to 0.06; p > 0.05, I2 = 19.6%). However, children/adolescents with obesity had significantly higher Hcy levels compared to counterparts without obesity (SMD: 0.77; 95% CI: 0.39 to 1.14; p < 0.001, I2 = 86.4%).

Conclusion

Children and adolescents with obesity had higher Hcy levels than those without obesity. However, no significant differences were found for vitamin B12 and folate levels. Hcy may play a role in the development of obesity in this population.

The analgesic effects of quadratus lumborum block versus caudal block for pediatric patients undergoing abdominal surgery: a systematic review and meta-analysis

Background

Since children cannot express pain, postoperative pain treatment for them is relatively lacking. In this meta-analysis, we compared the postoperative analgesic effects of quadratus lumborum block (QLB) and caudal block (CB) in surgeries involving the lower abdomen, inguinal region, and urogenital system in children.

Objective

This review examined the postoperative analgesic effects of QLB and CB in pediatric patients (0-18 years of age) undergoing abdominal surgery. The primary endpoint was the rate of postoperative rescue analgesia, defined as the proportion of patients who returned to acetaminophen, ibuprofen, and other analgesics when the pain score was greater than the protocol preset value within 24 h after surgery. Secondary outcomes included resting pain scores (0-10) at 30 min, 4 h, 12 h, and 24 h after surgery. Other secondary outcome measures were the time of first rescue analgesia, the incidence of PONV, and the incidence of postoperative complications, such as post-block infection, anaphylaxis to local anesthesia and hematoma.

Evidence review

We systematically reviewed Pubmed, Central, EMBASE, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts for randomized controlled trials that compared these blocks and reported the rate of postoperative rescue analgesia.

Findings

Seven RCTs (444 patients) were included in the final analysis. In pediatric abdominal surgery, compared with CB, QLB could reduce the rate of postoperative rescue analgesia within 24 h after surgery (RR = 0.37; 95% CI = 0.26 to 0.51; P < 0.01). The pain score in the QLB group at 4 (SMD = -0.11; 95% CI = -0.21 to -0.01; P = 0.02) and 12 h (SMD = -0.11; 95% CI = -0.22 to 0.00; P = 0.06) after surgery was lower, but at 0.5(SMD = 0.42; 95% CI = 0.34 to 0.50; P < 0.01) and 24 h (SMD = 0.30; 95% CI = 0.03 to 0.58; P = 0.03) was higher than that in the CB group. Of note, these pain score differences were not clinically significant. In addition, there was no significant difference in the incidence of complications or side effects between the QLB and the CB group (RR = 0.94; 95% CI = 0.59 to 1.48; P = 0.77).

Conclusion

In conclusion, QLB might have a better postoperative analgesic effect for lower abdominal surgery than CB in pediatric patients. However, due to the relatively few RCTs identified and significant heterogeneity, further research in the future is needed to prove these findings.

Systematic Review Registration

identifier (CRD 42023441447).

Effect of the hour-1 bundle on clinical outcomes in patients with sepsis and septic shock: A protocol for systematic review and meta-analysis

BACKGROUND

According to the 2018 bundle guidelines of the Surviving Sepsis Campaign, many emergency departments and intensive care units currently adopt the hour-1 bundle as a standard practice for sepsis management. However, recent studies on the hour-1 bundle for sepsis treatment have yielded inconsistent results, raising questions and challenges about its clinical efficacy.

AIM

This study will conduct a systematic review and meta-analysis to compare the impact of the hour-1 bundle and non-hour-1 bundle on the clinical outcomes in patients with sepsis and septic shock.

METHODS

The protocol was prepared according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol (PRISMA-P) statement. The systematic review will be carried out in line with the statement of PRISMA. The following electronic databases will be searched: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science. All clinical studies comparing the impact of the hour-1 bundle and non-hour-1 bundle on clinical outcomes in patients with sepsis and septic shock will be included. All stages of the literature search, study selection, data extraction, and quality assessment will be conducted independently by two reviewers. Any disagreements between the two reviewers will be resolved by discussion or arbitration by a third reviewer. The primary outcome will be short-term mortality, which involves in-hospital, 28-day, 30-day, and 90-day mortality corresponding to the definition used in each study. For quality assessment, the risk of bias specified by the Cochrane Collaboration and the methodological index for non-randomized studies will be used for randomized control trials (RCTs) and non-RCTs, respectively. Data synthesis will be performed via Review Manager 5.1.0.

EXPECTED RESULTS

This systematic review will integrate all relevant studies to quantitatively estimate the effect size and clarify the role of the hour-1 bundle in sepsis management, contributing new evidence-based guidance to the field.

SYSTEMATIC REVIEW REGISTRATION

Protocol registration and reporting: PROSPERO CRD42024579314.

The effect of magnesium supplementation on serum concentration of lipid profile: an updated systematic review and dose-response meta-analysis on randomized controlled trials

BACKGROUND

Some evidence suggests magnesium might reduce serum levels of lipid profile. Due to the significance of this matter on hand, we centralized our aim to conduct a systematic review and meta-analysis to interrogate the effect of magnesium supplementation on serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) in the general population aged ≥ 18 years.

METHODS

In line with conducting this study first, relevant articles were found through searching databases, including five databases: Cochrane Library, ClinicalTrials.gov, ISI Web of Science, Scopus, and PubMed until January 2024. Following fulfilling the first aim, their mean differences and standard deviations were calculated to conduct the meta-analysis. Ultimately, an assessment of the statistical heterogeneity of intervention effects was performed using I-squared statistics and Cochran's Q test.

RESULTS

Regarding serum levels of TC, TG, LDL-C, and HDL-C, twenty-one, twenty-three, twenty, and twenty-five studies were included in the meta-analysis. The pooled estimates showed no significant differences in serum levels of TC, TG, and LDL-C between the magnesium group and comparison group (weighted mean difference (WMD) = 0.34 mg/dl, 95% confidence interval (CI): -1.75 to 2.43, P = 0.749, I2 = 99.1%; WMD=-2.06 mg/dl, 95% CI: -6.35 to 2.23, P = 0.346, I2 = 99.1; WMD = 1.71 mg/dl, 95% CI: -0.81 to 4.24, P = 0.183, I2 = 99.4, respectively). However, magnesium significantly increased HDL-C (WMD = 1.21 mg/dl, 95% CI: 0.58 to 1.85, P < 0.001, I2 = 99.5).

CONCLUSION

In conclusion, our study showed that magnesium significantly increased HDL-C levels. However, due to high heterogeneity, we must note that more research is needed to make robust recommendations regarding magnesium supplementation in clinical practice.

REGISTRY NUMBER

This study was registered in PROSPERO under the protocol number CRD42024505142.

Effective dietary interventions during pregnancy: a systematic review and meta-analysis of behavior change techniques to promote healthy eating

Improving dietary intake during pregnancy can mitigate adverse consequences for women and their children. The effective techniques and features for supporting and sustaining dietary change during pregnancy and postpartum are minimally reported. The primary aims of this systematic review and meta-analysis were to summarise the effectiveness of dietary interventions for pregnant woman, identify which behaviour change techniques (BCTs) and intervention features were most frequently used and determine which were most effective at improving dietary intake. Six databases were searched to identify randomised control trials (RCTs) reporting on dietary intake in pregnant women over the age of sixteen, with an active intervention group compared to a control group receiving usual care or less intensive interventions. The Cochrane Risk of Bias Tool 1 was used to assess study validity. BCTs were coded by two authors using Michie et al.'s BCT taxonomy V1. A random effect model assessed intervention effects on indices of dietary quality and food groups (fruit, vegetables, grains and cereals, meat, and dairy) in relation to the use of BCTs and intervention features. Thirty- seven RCTs met the inclusion criteria. High heterogeneity was observed across intervention characteristics and measures of fidelity. Only half of the available BCTs were used, with eleven used once. The BCT category Reward and threat was successful in improving dietary quality and vegetable intake, whilst 'Action planning' (1.4) from the category Goals and planning significantly improved dietary quality. Interventions delivered by a nutrition professional and those that included group sessions improved dietary quality more than those delivered by other health professionals, research staff, or application-delivered interventions and delivered via other modalities. Future dietary interventions during pregnancy should incorporate and report on BCTs used in the intervention. Successful design elements for improving antenatal dietary intake may include multimodal interventions delivered by nutrition professionals and the use of Rewards and Goal setting.

Evaluation of efficacy and safety of perioperative albumin administration in major non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Studies suggested that restrictive fluid therapy during major surgery could be associated with better post-operative outcomes. The albumin uses in the perioperative period has been the subject of numerous studies with a still controversial efficacy and safety profile. This study aimed to assess the efficacy and safety of perioperative albumin use during major non-cardiac surgery.

EVIDENCE ACQUISITION

This study was registered in PROSPERO (ID: CRD42022353278). We performed an electronic search of the relevant literature from 2000 until 2023. The primary endpoint was the incidence of moderate postoperative complications (defined by a Clavien-Dindo classification grade ≥2). Secondary endpoints were intraoperative fluid balance, intraoperative blood loss, postoperative wound infection and acute kidney injury (AKI).

EVIDENCE SYNTHESIS

We identified four relevant studies involving 426 patients (213 patients in the albumin group versus 213 patients in the control group). The meta-analysis did not reveal any significant difference between both group regarding the incidence of postoperative moderate complications even after subgroup analyses based on intraoperative or postoperative albumin administration (OR=1.23, 95% CI 0.73, 2.08, P=0.44). No difference was found for intraoperative fluid balance (MD=-190.83, 95% CI -408.67, 27.02, P=0.09), intraoperative blood loss (MD=-27.54, 95% CI -225.55, 170.48, P=0.79) and postoperative wound infection (OR=1.91, 95% CI 0.98, 3.73, P=0.06). Moreover, albumin administration was not associated with a significant increase of AKI incidence (OR=2.02, 95% CI 0.90, 4.53, P=0.09).

CONCLUSIONS

Perioperative use of albumin during major non-cardiac surgery did not result in an increased incidence of moderate postoperative complications.

Differences Between Adolescent Depression and Healthy Controls in Biomarkers Associated With Immune or Inflammatory Processes: A Systematic Review and Meta-Analysis

OBJECTIVE

Adolescent depression is a highly prevalent and disabling mental disorder with unclear pathophysiology and unfavorable treatment outcomes. Recent efforts have been focusing on searching for biomarkers as specific indicators of adolescent depression. We performed a systematic literature review and meta-analysis, specifically including studies with healthy control groups as an inclusion criterion. This approach helps to avoid confounding factors and provides more accurate results regarding the inflammatory and immune biomarkers associated with adolescent depression.

METHODS

Three electronic databases were searched for studies comparing the means and changes in the biomarkers between depressed adolescent patients and healthy controls published in English until February 2024. Two authors independently performed the screening, quality assessment, and data extraction of the studies. A meta-analysis was conducted on outcomes reported by two or more studies using a random-effects model and presented Forrest plots and test statistics (I2) for heterogeneity analysis.

RESULTS

Nine studies were included in the review, including seven case-control studies and two cross-sectional studies. These studies included 24 target biomarkers, 13 of which were quantified in 2 or more studies. Compared to the healthy controls, the depressed adolescents had significantly higher values in ten indicators. Additionally, the depressed adolescents had lower procalcitonin levels than the healthy controls. The two groups showed no significant differences in the remaining 13 biomarkers.

CONCLUSION

Our findings offer fresh insights into the pathophysiology of inflammatory and immune aspects of adolescent depression and provide helpful guidance in developing targeted and effective intervention and prevention strategies to address adolescent depression.

Association of chronic exercise with markers of cardiometabolic health: a systematic review and meta-analysis

BACKGROUND

The impact of chronic exercise on cardiometabolic risk is a crucial aspect of public health. However, limited knowledge exists regarding differences in cardiometabolic parameters between older athletes, older controls, and sedentary or active young controls.

METHODS

A comprehensive search in major databases until October 2024 was conducted for studies comparing older athletes with older controls or with both sedentary and active younger adults. Mean differences (MDs) with 95 % confidence intervals were used for data reporting.

RESULTS

From 25,910 screened studies, 61 studies including 75 cohorts were deemed of good quality, encompassing 1393 older athletes, 1369 older controls, 402 young sedentary controls, and 283 young active individuals. In comparison to older controls, older athletes exhibited significantly improved vascular parameters (systolic [MD=-5.04 mmHg] and diastolic [MD=-2.03 mmHg] blood pressure), cardiac (heart rate frequency [MD=-10.41 bpm]), and metabolic parameters (serum cholesterol profile). Conversely, when compared to young sedentary controls, older athletes displayed a less favorable blood pressure and metabolic (cholesterol, glucose) profile. Similar trends were observed when comparing older athletes to young active controls. Sensitivity and meta-regression analyses suggested that exercise lasting over 30 years might offer partial benefits for several markers of cholesterol and VO2max.

CONCLUSIONS

Long-term exercise is linked to a more optimal cardiometabolic profile, although it may not fully replicate the metabolic and cardiovascular health markers observed in younger individuals.

Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis

CONTEXT

Various non-pharmacological therapies (NPTs) have been found to be helpful for depression in women with breast cancer (BC). However, the relative efficacy of different NPTs in women with BC during different treatment phases is unclear.

OBJECTIVES

To conduct a systematic review and network meta-analysis (NMA) to compare the relative efficacy of various NPTs for improving depression in women with BC during the inter-/post-treatment periods.

METHODS

We searched eight databases (Embase, PubMed, PsycINFO, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and WanFang Database) to identify relevant randomized controlled trials published in English and Chinese from their inception to 31 January 2024. We assessed the methodological quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. NMA was conducted using a frequentist approach. The surface under the cumulative ranking (SUCRA) probabilities were used to rank the NPTs.

RESULTS

A total of 41 articles involving 5408 participants studied 18 NPTs. Based on NMA, in the intertreatment phase, mindfulness-based cognitive therapy (MBCT), psychological education, virtual reality (VR) and yoga significantly improved depression in women with BC. MBCT, psychological education, and VR were the three most effective NPTs in this period. In the post-treatment phase, mindfulness-based stress reduction significantly improved depression in women with BC, which was the most effective NPTs in this period. Based on the GRADE framework, most results were rated as "high" to "very low" for the confidence of evidence.

CONCLUSIONS

Our study confirmed the efficacy of several NPTs for depression in women with BC during inter-/post-treatment phases. These results should inform future clinical decisions and guidelines for depression in women with BC.

Efficacy and safety of psilocybin in the treatment of Major Depressive Disorder (MDD): A dose-response network meta-analysis of randomized placebo-controlled clinical trials

Selecting the optimal dose of psilocybin for treating Major Depressive Disorder (MDD) and Treatment-Resistant Depression (TRD) is crucial for clinical development and regulatory approval. This meta-analysis evaluates psilocybin's efficacy and safety in treating MDD to determine the optimal dose and timing for clinical trials. A systematic review and Dose-Response Network Meta-Analysis (NMA) of Randomized Placebo-Controlled Clinical Trials (RCTs) registered with PROSPERO was conducted. Databases searched included Embase, PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar, up to July 2024. The PICOS framework defined eligibility criteria: P: adult patients with MDD; I: psilocybin; C: placebo; O: changes in MADRS scores at Days 2, 8 and 15, and adverse events; S: RCT. Independent researchers performed data extraction and bias assessment. From 5419 search results, three RCTs involving 389 patients were included. Psilocybin significantly reduced symptoms compared to placebo at Day 8 (MD = -7.42; 95 % CI:10.07 to -4.78; p < 0.001) and Day 15 (MD = -9.55; 95 % CI:12.44 to -6.65; p < 0.001), without significant effects on Day 2. The NMA indicated that a 25 mg dose was the most effective, with a SUCRA value of 92.25 %, compared to doses of 0.215 mg/kg and 10 mg. However, psilocybin was associated with a higher risk of adverse events, particularly nausea (RR = 8.35; p < 0.001). This meta-analysis supports psilocybin's efficacy in treating MDD, particularly at a 25 mg dose, showing a time-dependent therapeutic effect. The recommended timing of efficacy evaluation by regulatory authorities is validated by this evidence, underscoring its importance in clinical trial design for psychedelic substances.

Editor's Choice - Short and Midterm Outcomes of Percutaneous Deep Venous Arterialisation for No Option Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

OBJECTIVE

Percutaneous deep venous arterialisation (pDVA) is a state of the art technique for treating patients with chronic limb threatening ischaemia (CLTI) with no conventional option for revascularisation. There are limited large scale data examining the clinical effectiveness of pDVA for patients with end stage CLTI.

DATA SOURCES

MEDLINE, Embase, Google Scholar, and Cochrane databases.

REVIEW METHODS

Four databases were searched from January 2018 to June 2024 to identify studies investigating the feasibility and clinical outcomes of pDVA for patients with CLTI with no conventional revascularisation options. Meta-analysis of time to event outcomes (mean ± standard deviation) was performed for amputation free survival as the primary outcome, and freedom from amputation and overall survival as secondary outcomes. Other secondary outcomes (mean and 95% confidence interval [CI]) were procedural success rate, patency, re-intervention, and complete wound healing.

RESULTS

Ten non-randomised studies were included with 351 patients. The mean patient age was 70.3 years, and 67.6% were male. Most procedures used the posterior tibial artery. The aggregated rate of amputation free survival at six and twelve months (five studies, 260 patients) was 72.6 ± 2.8% and 66.0 ± 3.1%, respectively, while the overall survival at six and twelve months (five studies, 260 patients) was 85.0 ± 2.3% and 77.7 ± 2.9%, respectively. The procedural success rate (nine studies, 330 patients) was 95.5% (95% CI 92.4 - 98.7%). Primary and secondary patency at six months (four studies, 241 patients) was 23.4% (95% CI 13.6 - 33.2%) and 54.9% (95% CI 34.3 - 75.5%), respectively. The rates of re-intervention (four studies, 190 patients) and complete wound healing (five studies, 190 patients) at twelve months were 41.7% (95% CI 25.7 - 57.7%) and 46.0% (95% CI 31.7 - 60.3%), respectively.

CONCLUSION

This meta-analysis demonstrated acceptable feasibility for no option CLTI at highly specialised institutions for patients undergoing pDVA. Meta-analysis of time to event outcomes revealed that pDVA provides reasonable amputation free survival for up to twelve months, albeit with a overall low certainty of evidence. Wider adoption of pDVA may be considered in selected patients with CLTI, although its clinical impact and cost effectiveness require further evaluation.

Meal replacements on obesity and leptin: a systematic review and meta-analysis

The global prevalence of obesity and overweight is a significant concern in the field of public health. Numerous interventional studies have been conducted to assess the possible meal replacements (MRs) effect on anthropometric indicators and indices and laboratory test that reflect obesity. However, there are no comprehensive results in this field. The study aim was to understand the possible effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin levels. A systematic search was conducted in five electronic databases in order to find randomized clinical trials (RCTs) that examined the possible MRs effect on obesity. Analyses were performed in R software, version 4.2.1. The random-effects model analysis was used to provide pooled mean difference and 95% confidence intervals (95% CI). Seventy studies were included. Body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after MRs compared to control. No significant effect was observed on leptin (WMD: -3.37 ng/ml, 95% CI: -8.23 to 1.49). Subgroup analyses indicated that impact of total MRs on anthropometric factors was greater in comparison to partial MRs. Considering other lifestyle factors, MRs can lead to anthropometric indicators and indices reduction.

Comparing Open, Laparoscopic and Robotic Liver Resection for Metastatic Colorectal Cancer-A Systematic Review and Network Meta-Analysis

Colorectal liver metastases (CRLM) can be surgically managed through open resections (OLR), laparoscopic resections (LLR), or robotic liver resections (RLR). However, there is ongoing uncertainty regarding the safety and effectiveness of minimally invasive approaches like LLR and RLR. This study aims to clarify these issues by conducting a network meta-analysis (NMA) to compare outcomes across OLR, LLR and RLR for patients with CRLM. Following the PRISMA-NMA guidelines, the meta-analysis included 13 studies with a combined total of 6582 patients. Of these, 50.6% underwent LLR, 45.3% underwent OLR, and 4.1% underwent RLR. The analysis found no significant differences in R0 resection rates between LLR (odds ratio [OR] 1.03, 95% confidence interval [CI]: 0.84-1.26) and RLR (OR 1.57, 95% CI: 0.98-2.51) when compared to OLR. Additionally, there were no significant differences in disease-free survival (DFS) and overall survival (OS) at 1, 3, and 5 years. Despite these findings, both LLR and RLR were associated with reduced postoperative complication rates (RLR: OR 0.52, 95% CI: 0.32-0.86; LLR: OR 0.50, 95% CI: 0.37-0.68). However, patients undergoing LLR were more likely to require conversion to open surgery compared to those undergoing RLR (OR: 12.46, 95% CI: 2.64-58.67). Furthermore, RLR was associated with a reduced need for blood transfusions (OR: 0.13, 95% CI: 0.05-0.32), and LLR resulted in shorter hospital stays (mean difference: -6.66 days, 95% CI: -11.6 to -1.88 days). This study demonstrates the oncological safety of LLR and RLR approaches for CRLM relative to OLR, with enhanced perioperative outcomes anticipated following minimally invasive resections of CRLM.

Effects of Preoperative Oral Carbohydrates on Recovery After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials

PURPOSE

The objective of this meta-analysis was to evaluate the efficacy of administering preoperative oral carbohydrates (CHO) compared to a control treatment in improving postoperative recovery outcomes for patients undergoing laparoscopic cholecystectomy (LC).

DESIGN

A meta-analysis of randomized controlled trials.

METHODS

Through systematic searches in PubMed, Embase, and the Cochrane Library, randomized controlled trials focusing on preoperative oral carbohydrates for patients undergoing LC were collected. Data analysis was conducted using the Revman 5.3 software.

FINDINGS

The meta-analysis incorporated 19 randomized studies, with a total of 1,568 participants. Meta-analysis results indicated that patients receiving CHO reported notably lower postoperative pain compared to those fasting (P = .006) or on placebo (P = .003). Furthermore, a significant reduction in preoperative hunger was observed in the CHO group compared to the controls (P = .002). A notable difference was also identified in the postoperative Homeostasis Model Assessment-IR changes between the CHO and control groups (P = .02). No significant variations were observed in thirst, postoperative nausea and vomiting, insulin level alterations, glucose level changes, duration of hospital stay, or recovery quality.

CONCLUSIONS

Preoperative oral carbohydrates may alleviate hunger and pain, and attenuate postoperative insulin resistance more effectively than either overnight fasting or placebo in patients undergoing LC.

Roux-en-Y gastric bypass versus duodenal switch in patients with body mass index ≥50 kg/m2: a systematic review and meta-analysis

Currently, there is no consensus on the best bariatric surgery type for patients with body mass index (BMI) ≥50 kg/m2. This systematic review and meta-analysis aimed to compare outcomes of duodenal switch (DS) and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, resolution of obesity-related comorbidities, and complications among patients with a BMI ≥50 kg/m2. A systematic search was conducted across databases including PubMed, Embase, Scopus, and Web of Science to include studies that compared outcomes of DS and RYGB in patients with BMI ≥50 kg/m2. A meta-analysis was carried out, alongside subgroup analyses based on the type of study and duration of follow-up. Twelve articles were included in this study (2678 patients, follow-up: 1-15 years). Patients with DS had 7.31 kg/m2 higher BMI loss (95% CI: 5.59-9.03, P < .001) and 9.9% more total weight loss (95% CI: 4.47-15.28%, P < .001) compared with RYGB. The rate of complications, reoperation, mortality, and remission of comorbidities including diabetes, hypertension, dyslipidemia, and obstructive sleep apnea was not significantly different between DS and RYGB. Rate of malnutrition was 8.3% in the DS group compared with 1.2% in RYGB (OR: 5.53, 95% CI: 1.35-22.44, P = .02). In addition, 5.4% DS patients needed revisional surgery for malnutrition versus none in RYGB (OR: 6.1, 95% CI: 1.03-36.33, P = .05), and 24.6% of DS patients developed gallbladder disease needed cholecystectomy versus 4.5% after RYGB (OR: 6.36, 95% CI: 1.70-23.82, P = .01). DS leads to significantly higher BMI and total weight loss in patients with BMI ≥50 kg/m2 but may be associated with a higher rate of major malnutrition and needed revisional surgery. These should be considered in surgical planning.

Meningioma En Plaque Associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of the Literature with Case Presentation

BACKGROUND

Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature.

METHODS

Following PRISMA guidelines, a systematic search was conducted in PubMed and Embase databases. Keywords and standardized index terms related to MEP were used. The search was performed without restriction on the publication date. Screening, data extraction, and quality assessment were carried out. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed.

RESULTS

The search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a mean age of 50.1 ± 11.62 years. Proptosis was the most common symptom (95%), followed by visual impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case of a patient with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy in 15.7%, and 1 patient received primary radiotherapy, and 8 patients were closely followed up with no intervention.

CONCLUSIONS

MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access.

Tranexamic Acid With Acid Suppression Versus Acid Suppression Alone as Therapy for Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Studies have reported the benefits of tranexamic acid (TXA) in controlling bleeding across various conditions. However, the effect of TXA in upper gastrointestinal bleeding (UGIB) remains controversial, and its therapeutic impact when combined with acid suppression, particularly proton pump inhibitors (PPIs), which are considered first-line therapy for bleeding peptic ulcers, has not been reported.

METHODS

We systematically searched PubMed, Embase, and Google Scholar from January 1987 to June 2024 using predefined keywords to identify RCTs meeting our inclusion criteria, including details of TXA dosage, route of administration, and choice of acid suppressants. Data from selected trials were extracted, and a meta-analysis was performed using random-effects modeling.

RESULTS

Six trials with 709 participants were included. Baseline patient characteristics in the selected trials were balanced. The rebleeding rate, mortality, need for blood transfusion, units of blood transfused, and need for salvage therapy were compared. The TXA with acid suppression group significantly reduced the risk of rebleeding (RR: 0.63, 95% CI: 0.41-0.96), units of blood transfused (mean difference: -1.08, 95% CI: -1.44 to -0.71), and the need for salvage therapy (RR: 0.28, 95% CI: 0.12-0.64). No significant difference was observed in mortality rate (RR: 0.74) and need for blood transfusion (RR: 1.01) between the two groups, but outcomes favored the TXA and acid suppression group.

CONCLUSIONS

We suggest combining TXA with acid suppression as a first-line therapy for UGIB patients. Further trials should be conducted to determine the optimal dose and route of TXA administration for better care.

Peripheral nerve stimulation for lower-limb postoperative recovery: A systematic review and meta-analysis of randomized controlled trials

Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications. Although peripheral nerve stimulation (PNS) is a promising non-pharmacological approach that has been used in lower-limb postoperative recovery, the clinical efficacy of PNS remains inconclusive. This study systematically searched three databases (PubMed, Embase, and Cochrane Library) for randomized controlled trials (RCTs) that examined the treatment effects of PNSs in patients who underwent lower-limb orthopedic surgery up to September 29, 2023. Two investigators independently identified studies, extracted data, and conducted meta-analyses with Review Manager 5.4. The outcomes were pain relief (measured by reductions in pain intensity and analgesic consumption) and functional improvements (range of motion [ROM] and length of hospitalization [LOH]). A total of 633 patients including 321 in the experimental groups and 312 in the control groups from eight RCTs were included. PNS showed no significant effect on pain intensity, while analgesic consumption was marginally significantly reduced in the experimental group. Furthermore, no significant differences were observed regarding functional improvements in ROM or LOH after the intervention. Although PNS had no significant effect on pain relief or functional improvements, the intervention exhibited a marginally significant reduction in analgesic consumption. Future trials should be conducted with larger sample sizes, longer follow-up periods, and more varied stimulation parameters.

Efficacy and safety of fluorescence navigation combined with 3D imaging in precise liver resection: A systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the effectiveness and safety of fluorescence navigation combined with three-dimensional imaging (FN&3DI) technology in precise liver resection.

METHODS

A systematic search was conducted in the PubMed, Web of Science, Embase, and Cochrane Library databases for all English-language publications on fluorescence-guided navigation combined with three-dimensional (3D) imaging technology-assisted precise liver resection, with a cutoff date of July 2024. After assessing the quality of the included studies and extracting relevant data, a meta-analysis was performed using Stata 12.0 software.

RESULTS

A total of 6 studies involving 451 patients were included in this study, with 207 patients in the FN&3DI group and 244 patients in the conventional surgery (CS) group. The meta-analysis results showed that the FN&3DI group exhibited significantly lower values than the CS group in terms of intraoperative blood loss [mean difference (MD) = -97.90, 95 % confidence intervals (CI) = -151.15 to -44.66, P = 0.000], intraoperative blood transfusion rates [odds ratios (OR) = 2.96, 95 % CI = 1.71-5.10, P = 0.000], hospital stay (MD = -0.91, 95 % CI = -1.78 to -0.04, P = 0.041), and overall postoperative complications (OR = 1.68, 95 % CI = 1.11 to 2.53, P = 0.014). However, the FN&3DI group exhibited significantly longer surgery time (MD = 57.36, 95 % CI = 13.31-101.40, P = 0.011), but no statistically significant difference was noted in conversion rate, R0 resection margins, and postoperative recurrence between the two groups.

CONCLUSION

Fluorescence navigation combined with 3D imaging technology is safe and feasible for guiding precise liver resection.

Noninfectious Complications of Dorsal Root Ganglion Stimulation: A Systematic Review and Meta-Analysis

INTRODUCTION

Dorsal root ganglion stimulation (DRGS) has emerged as a promising treatment for chronic neuropathic pain. However, its safety and complications are not fully understood, with existing literature primarily based on case reports, observational studies, and data base analyses. This systematic review and meta-analysis aims to assess the prevalence of noninfectious complications associated with DRGS, focusing on the trial phase, postimplantation period, and revisions, while identifying risk factors for these outcomes.

MATERIALS AND METHODS

This systematic review adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews database. A comprehensive search was conducted across multiple data bases in June 2023. Studies included randomized and nonrandomized trials, and cohort studies involving ≥20 patients with DRGS. The exclusion criteria were studies that did not differentiate DRGS-specific complications, focused solely on infections, lacked sufficient data for prevalence estimation, or presented only subanalyses from larger studies. A meta-analysis of proportions was performed to estimate the overall prevalence of complications.

RESULTS

Thirteen studies with 634 participants were included. The pooled prevalence of all complications was 37% (95% CI: 19%-57%), with device-related complications being the most common at 27% (95% CI: 15%-42%). Lead fractures and migrations were the most frequently reported device-related complications with, respectively, 6% (95% CI: 2%-12%) and 6% (95% CI: 2%-10%). Procedure-related complications had a pooled prevalence of 1% (95% CI: 0%-5%), with dural puncture being the most common. The prevalence of DRGS explantations was 12%, primarily due to insufficient pain relief.

CONCLUSIONS

DRGS shows a safety profile comparable to that of spinal cord stimulation, with similar rates of lead migrations and fractures. Improvements in surgical techniques, technology, and clinician expertise are expected to reduce complications. Future research should standardize reporting practices and detail implantation techniques to better understand and refine best practices in DRGS implantation.

Coagulopathy at admission in traumatic brain injury and its association with hematoma progression: A systematic review and meta-analysis of 2411 patients

Progressive hemorrhagic injury (PHI) is a frequent complication of traumatic brain injury (TBI). This study aims to investigate the impact of coagulation factors (platelet [PLT], prothrombin time [PT], activated partial thromboplastin time [aPTT], international normalized ratio 1, fibrinogen [Fg], D-dimer [Dd], and fibrin [Fib]) at admission and PHI development through a comprehensive systematic review and meta-analysis based on PRISMA 2020 guideline. Databases including PubMed, Scopus, Web of Science, and Embase were searched up to March 2024. Controlled observational studies examining the relationship between coagulation tests at admission and PHI in isolated TBI cases were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist, and statistical analyses were performed using Stata software, employing Hedge's g to measure effect sizes. Sixteen studies encompassing 2411 TBI patients were included. Significant associations were found between decreased PLT (g = -0.243, P = 0.007), increased aPTT (g = 0.117, P = 0.037), increased INR (g = 0.217, P = 0.0202), elevated Dd levels (g = 1.57, P = 0.0084), and decreased Fg levels (g = -0.26, P = 0.0001) with the risk of developing PHI. PT showed no significant effect on PHI risk (g = 0.19, P = 0.0372). Our results suggest that elevated INR, Dd levels, and aPTT are linked to an increased risk of PHI. Conversely, higher PLT and Fg levels appear to be associated with a reduced PHI risk. Notably, Dd demonstrated stronger predictive power for PHI.

Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis

BACKGROUND

Safety-netting advice (SNA) can help in the management of acutely ill children.

AIM

To assess the effectiveness of different SNA methods on antibiotic prescription and consumption in acutely ill children.

DESIGN AND SETTING

Systematic review and network meta-analysis of randomised controlled trials, cluster randomised trials, non-randomised studies of interventions, and controlled before-after studies in ambulatory care in high-income countries.

METHOD

MEDLINE, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched (22 January 2024). Risk of bias (RoB) was assessed with Cochrane's RoB 2 tool, the Revised Cochrane Tool for Cluster-Randomised Trials, and the Risk Of Bias In Non-randomised Studies - of Interventions tool. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis approach. Sensitivity analyses and network meta-regression were performed.

RESULTS

In total, 30 studies (20 interventions) were included. Compared with usual care, paper SNA may reduce: antibiotic prescribing (odds ratio [OR] 0.66, 95% confidence interval [CI] = 0.53 to 0.82, I 2 = 92%, very low certainty, three studies, 35 988 participants), especially when combined with oral SNA (OR 0.40, 95% CI = 0.08 to 2.00, P-score = 0.86); antibiotic consumption (OR 0.39, 95% CI = 0.27 to 0.58, low RoB, one study, 509 participants); and return visits (OR 0.74, 95% CI = 0.63 to 0.87). Compared with usual care, video SNA, read-only websites, oral SNA, and web-based SNA (in descending order of effectiveness) may increase parental knowledge (ORs 2.33-4.52), while paper SNA may not (ORs 1.18-1.62). Similarly, compared with usual care, video SNA and web-based modules may improve parental satisfaction (ORs 1.94-4.08), while paper SNA may not (OR 1.85, 95% CI = 0.48 to 7.08).

CONCLUSION

Paper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA may improve parental knowledge, whereas video SNA and web-based modules may increase parental satisfaction.

Review article: Electronic screening and brief intervention for alcohol-related trauma: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.

Effect of antiepileptic drug monotherapy on endogenous sex hormonal profile in men and women with epilepsy

OBJECTIVE

To assess the alterations of endogenous sex hormone profiles in patients with epilepsy (PWE) on different antiepileptic drug (AED) monotherapies compared to healthy controls and drug naïve PWE (DNPWE).

METHODS

Four databases MEDLINE, EMBASE, SCOPUS, and CENTRAL were searched for analytical observational/intervention studies on the assessment of endogenous sex hormones in PWE compared to healthy controls and DNPWE. Two researchers reviewed the title/abstract, and full-text articles for the selection of the studies independently. Extracted data included information on study details, participant demographics, interventions, method of assessment and study results. The study outcomes were used to calculate the standard mean differences (SMD) and 95% confidence interval (CI) as effect size for assessing differences in the endogenous sex hormone levels between the treatment group and control/DNPWE.

RESULTS

Among 5888 publications retrieved, 33 studies were included. Enzyme-inducing AEDs (EIAEDs) such as phenytoin (men: SMD = 1.36; 95%CI = 1.06,1.66) and carbamazepine (men: SMD = 0.71; 95%CI = 0.39, 1.04 and women: SMD = 0.54; 95%CI = 0.25, 0.83) and weak-EIAED oxcarbazepine (men: SMD = 0.62; 95%CI = 0.26,0.99) increased the SHBG levels in PWE compared to control. The same trend was observed when comparing it to DNPWE. No significant changes in SHBG were observed for non-EIAEDs valproic acid, lamotrigine and levetiracetam in men. Lamotrigine significantly reduced SHBG in women (SMD = -0.50; 95%CI = -0.85, -0.16) compared to controls. Testosterone (T) levels were significantly reduced for both carbamazepine (SMD = -0.39; 95%CI = -0.67, -0.11) and valproic acid (SMD = -0.48; 95%CI = -0.74, -0.21) treated men compared to control.

SIGNIFICANCE

Our findings emphasize the importance of screening the endogenous sex hormonal profile in PWE on AED monotherapies to evaluate the associated endocrine-related perturbations which may impact reproductive functions.

Economic Analysis of Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism

BACKGROUND

Pulmonary embolism is associated with a significant burden of morbidity, mortality, and health care costs. Catheter-directed thrombolysis has emerged as a promising option for patients with intermediate-risk pulmonary embolism which aims to improve outcomes over standard anticoagulation.

METHODS

We constructed a decision-analytic model comparing the cost-effectiveness of catheter-directed thrombolysis to anticoagulation alone for the management of intermediate-risk pulmonary embolism. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. The main outcome was ICER (US dollars/deaths averted).

RESULTS

In the base case analysis, derived using systemic lysis data, the cost associated with catheter-directed thrombolysis was estimated at $22,353 with a probability of survival at 1 month of 0.984. For the anticoagulation alone strategy, the cost was $25,060, and the probability of survival at 1 month was 0.958. Overall, catheter-directed thrombolysis resulted in savings of $104,089 per death averted (ICER,-$104,089 per death averted). Sensitivity analysis revealed that catheter-directed thrombolysis would no longer be cost-effective when its associated mortality is greater than 0.042. In the probabilistic analysis, at a willingness-to-pay of $100,000, catheter-directed thrombolysis had a 63% chance of being cost-effective, and in cost-effectiveness acceptability curves, it was cost-effective in 63%-78% of simulations for a willingness to pay ranging from $0 to $100,000.

CONCLUSIONS

If the assumptions made in our model are shown to be accurate then CDT would be cost-effective and may lead to considerable cost savings if used where clinically appropriate.

Hemorrhoidal Artery Ligation (HAL) vs. Rubber Band Ligation (RBL) for Second- and Third-Degree Hemorrhoids: A Systematic Review and Meta-Analysis

This systematic review investigates the outcomes of rubber band ligation (RBL) vs. hemorrhoidal artery ligation (HAL) for second and third-degree hemorrhoids. This review was designed, performed, and reported as per the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature databases, including PubMed, Cochrane, Science Direct, and Google Scholar, were searched for studies comparing rubber band ligation vs. hemorrhoidal artery ligation for second- and third-degree hemorrhoids. The primary outcome was the recurrence of hemorrhoids, while post-operative bleeding, post-operative pain, surgical site infection, and success rate were the secondary outcomes. The literature search and inclusion criteria identified five studies (n=953) comparing HAL (n=548) vs. RBL (n=405). The recurrence rate was higher in the RBL group (28.4%) compared to the HAL group (19.3%) (odds ratio {OR}: 0.57, p=0.001). The two groups showed comparable results regarding post-operative pain (OR: 0.77, p=0.77), post-operative bleeding (OR: 1.48, p=0.44), and surgical site infection (risk difference: 0.00, p=0.67). Moreover, the short-term success rate was 85% in HAL compared to 86% in RBL (p=0.71). Rubber band ligation and hemorrhoidal artery ligation showed comparable short-term outcomes regarding symptom treatment, post-operative bleeding, and pain. However, HAL was superior in terms of recurrence rate.

Transcatheter or surgical treatment of paravalvular leaks: A meta-analysis of 13 studies and 2003 patients

Background

Significant paravalvular leak is a rare but serious complication of heart valve replacement, leading to symptomatic heart failure and hemolysis. Due to the paucity of comparative data between surgical and transcatheter paravalvular leak correction, we performed a systematic review and meta-analysis of available studies.

Methods

Studies comparing transcatheter and surgical treatment of paravalvular leak were systematically identified. Short-term all-cause mortality was the primary outcome. Technical and procedural success, 30-day persistence of significant paravalvular leak, length of hospital stay and long-term mortality, persistence of symptoms and paravalvular leak were the main secondary endpoints.

Results

Thirteen studies with 2003 patients were included, treating in most of the cases a mitral prothesis. Transcatheter closure was associated with lower short-term mortality rate (30 days OR 0.28, 95 % CI 0.18-0.42, p < 0.001) compared to surgical treatment. Technical and procedural success did not differ among the two groups. 30-day and long-term rates of persistence of moderate or severe paravalvular leak were higher in the transcatheter group (OR 3.56, 95 % CI 1.49-8.49, p = 0.004 and OR 2.20, 95 % CI 1.27-3.81, p = 0.005 respectively). Long-term death and re-hospitalization events did not differ among the two treatment modalities. The mean difference in days of length of stay was significantly lower in the transcatheter group (mean difference -9.66, 95 % CI -12.37 to -6.94, p < 0.001).

Conclusion

Transcatheter closure of paravalvular leaks is associated with lower short-term mortality rates but higher persistence of moderate-severe paravalvular leak and heart failure symptoms at short and long-term follow-up compared to surgical treatment.

Effects of selected dietary supplements on migraine prophylaxis: A systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND

The existing evidence on the effect of dietary supplements for preventing migraines has generated conflicting results.

METHODS

We assessed alterations in migraine clinical features corresponding to the intake of dietary supplements. Our main outcomes included the frequency (number of attacks), duration (in hours), the severity (intensity) and the monthly migraine days. Using a dose-response meta-analysis, we estimated the dose-dependent impact. The certainty of evidence was evaluated using the GRADE tool.

RESULTS

Finally, twenty-two trials were included in the systematic review and meta-analysis. Magnesium supplementation reduced migraine attacks (mean difference (MD) = -2.51), severity (MD = -0.88), and the monthly migraine days (MD = -1.66) compared with the control group. CoQ10 decreased the frequency (MD = -1.73), severity (MD = -1.35), and duration of migraine (MD = -1.72). Riboflavin decreased attack frequency (MD = -1.34). Alpha-lipoic acid decreased attack frequency (MD = -1.24) and severity (MD = -0.38). Probiotics decreased the frequency (MD = -1.16), severity (MD = -1.07) and the monthly migraine days (MD = -3.02). Vitamin D reduced migraine frequency (MD = -1.69) and the monthly migraine days (MD = -2.41). In adults, compared with placebo, these supplements did not significantly affect other outcomes, and omega-3 supplementation did not yield a statistically significant reduction in any of these outcomes.

CONCLUSION

The use of certain dietary supplements has resulted in a significant decrease in migraine prophylaxis. Further clinical trials of high quality appear to be beneficial.

Stylet-driven leads versus lumenless pacing leads in patients with left bundle branch area pacing: A systematic review and meta-analysis

BACKGROUND

Despite advancements in lead designs for optimum left bundle branch area pacing (LBBAP), limited data exist on the performance of stylet-driven leads (SDLs).

OBJECTIVE

This meta-analysis sought to compare the performance and safety of SDLs in comparison with lumenless leads (LLLs) following LBBAP.

METHODS

Systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that compared the outcomes of SDLs during LBBAP compared with LLLs. Study outcomes included periprocedural parameters, pacing metrics, and complications.

RESULTS

A total of 6 studies involving 3991 participants were included. LBBAP procedural success was comparable between SDLs and LLLs (90.2% and 90.5%, respectively). Compared with LLLs, SDLs appeared to result in shortened procedural (-11.50 minutes) and fluoroscopy (-2.56 minutes) times, along with increased capture threshold and reduced lead impedance at implantation. However, paced QRS, R-wave amplitude, capture threshold, and lead impedance remained comparable between both groups during follow-up. The number of lead-implantation attempts was similar between SDLs and LLLs (2.6 ± 1.0 vs 2.2 ± 0.6). Lead dislodgement and lead-related complications (except septal perforation) occurred mostly in the SDL group. No statistical differences were found in life-threatening complications.

CONCLUSION

SDLs demonstrated comparable effectiveness in achieving LBBAP, exhibiting similar success rates, mean attempts for lead placement, and pacing parameters, although they were associated with a higher overall incidence of lead-related complications. The reduced overall procedural and fluoroscopy time may be attributed to the ability of SDLs' different delivery sheath selections in identifying the optimal anatomical site, rather than being lead specific.