A Comparison of Fixed-Effects and Random-Effects Models for Multivariate Meta-Analysis Using an SEM Approach

Effects of game-based digital interventions for mental disorders: A meta-analysis

With increasing research attention on game-based digital interventions for mental disorders, a number of studies have been conducted to explore the effectiveness of digital game-based interventions on mental disorders. However, findings from previous research were inconsistent. Thus, we conducted a comprehensive meta-analytic review of the effectiveness of game-based digital interventions for mental disorders. By searching the articles in databases, we identified 53 studies in which 2433 participants were involved, and 282 effect sizes were extracted. Among the 53 studies, 14 employed within-group (pre/post) designs, and the remaining 39 utilized controlled trial designs. Using a three-level random-effects meta-analytic model, a medium effect size of game-based digital interventions (g = 0.47, 95 % CI: 0.33, 0.61) was revealed in the controlled trial designs and a close-to-medium effect size (g = 0.45, 95 % CI: 0.32, 0.58) was found in the within-group (pre/post) designs, indicating close-to-medium-sized efficacy of game-based digital interventions for mental disorders. Moderator analyses showed that age in the controlled trial designs had contributed to the heterogeneity in previous studies, suggesting that interventions might be more effective for the elderly. However, given that only a limited number of studies were focused on the elderly, more studies with older participants should be conducted in the future to provide more robust evidence and explore the mechanisms of how digital gaming interventions can be more effective in improving mental disorders symptoms.

The impact of 25-hydroxyvitamin D and calcium on risk of age-related macular degeneration: a Mendelian randomization study

BACKGROUND

The relationships between 25-hydroxyvitamin D [25(OH)D] and calcium and age-related macular degeneration (AMD) are unclear.

OBJECTIVES

This study aimed to investigate the causal role of 25(OH)D concentrations, calcium concentrations, and dietary supplements use of vitamin D and calcium on risk of AMD and its subtypes.

METHODS

Independent genetic variants associated with 25(OH)D and calcium concentrations were used as instrumental variables in published genome-wide association studies (GWASs) of European ancestry. The bidirectional 2-sample Mendelian randomization (MR) analyses were performed using summary-level data from the UK Biobank and FinnGen datasets. Sensitivity analyses were conducted to ensure the robustness of the MR results. The meta-analyses were conducted using both fixed-effect and random-effect models to provide comprehensive and reliable estimates.

RESULTS

A standard deviation increase in calcium concentrations was linked to a 14%, 17%, and 13% reduction in the likelihood of developing AMD (95% confidence interval [CI]: 0.77, 0.97), wet AMD (95% CI: 0.73, 0.95), and dry AMD (95% CI: 0.75, 1.00), respectively. No significant causal relationships were detected between genetically predicted 25(OH)D concentrations and AMD and its subtypes (all P > 0.05). The combined analyses showed that higher calcium concentrations were associated with a reduced risk of overall AMD, with an odds ratio of 0.89 (95% CI: 0.81, 0.98).

CONCLUSIONS

This study provides evidence supporting the causal relationship between calcium concentrations and risk of AMD and its subtypes, which may have important implications for the prevention, monitoring, and treatment of AMD.

Pooled-analysis of tadalafil and tamsulosin for ureteral calculi

Objective

Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10 mm in length.

Methods

Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected.

Results

A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5 mg or 10 mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5 mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001].

Conclusion

Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10 mm with a favorable safety profile.

Effects of sigmoidoscopy screening (including colonoscopy) on colorectal cancer: A meta-analysis based on randomized controlled trials

Background

This study aimed to investigate the role of endoscopy screening in colorectal cancer (CRC).

Methods

Up to January 2023, databases were searched for studies related to sigmoidoscopy and colonoscopy screening. The incidence of CRC, and/or CRC mortality were the main observation outcomes.

Results

A total of 5 randomized controlled trials (RCTs) published from 2017 to 2022 were included. Among them, four studies used sigmoidoscopy screening and one study involved colonoscopy screening. Statistical results showed that the incidence (RR: 0.78, p < 0.001) and mortality (RR: 0.75, p < 0.001) of CRC were significantly lower in the screening group than in the control group. Further, a subgroup analysis of CRC site indicated that the incidence and mortality of CRC in the screening group were significantly lower than those in the non-screened group, regardless of distal CRC (Incidence: RR: 0.66, p < 0.001; Mortality: RR: 0.62, p < 0.001) or proximal CRC (Incidence: RR: 0.94, p = 0.038; Mortality: RR: 0.89, p = 0.038). In terms of gender, compared with the non-screening group, both males (Incidence: RR: 0.73, p < 0.001; Mortality: RR: 0.68, p < 0.001) and females (Incidence: RR: 0.85, p < 0.001; Mortality: RR: 0.85, p = 0.017), the screening group had a significant decrease in the incidence and mortality of CRC.

Conclusion

This meta-analysis demonstrated that sigmoidoscopy screening (including colonoscopy) could effectively reduce the incidence and mortality of CRC.

Efficacy and safety of neuromodulation for apathy in patients with Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Non-pharmacological interventions, including noninvasive neuromodulation, may alleviate apathy in individuals with Alzheimer's disease. This systematic review and meta-analysis investigated the efficacy and safety of neuromodulation for apathy in elderly patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI).

METHODS

The Cochrane Central Register of Controlled Trials, EMBASE, and PubMed databases were searched for randomized controlled trials (RCTs) of neuromodulation for apathy in AD or MCI. The primary outcome was change in apathy based on the Apathy Evaluation Scale. Secondary outcomes were change in global cognition and trial discontinuation.

RESULTS

The meta-analysis included four RCTs involving 89 patients (aged 65.6-80.5 years) with apathy in AD or MCI. Findings showed no significant improvement in apathy (SMD = 0.57, 95% CI = -0.22-1.36; P = 0.16) or global cognition (SMD = 0.83, 95% CI = -0.11-1.78; P = 0.08) with neuromodulation compared to sham. Subgroup analyses showed significant improvement in apathy with high-frequency rTMS at 120% RMT compared to sham (SMD = 1.36, [95% CI = 0.61-2.12]; P = 0.0004), but not with rTMS at 80% RMT. For global cognition, high-frequency rTMS resulted in significant enhancement (SMD = 1.34 [95% CI = 0.59-2.10]; P = 0.0005), but no notable difference was observed with tDCS compared to sham. There was no significant difference in trial discontinuation in patients with AD or MCI treated with neuromodulation compared to sham.

CONCLUSION

High-frequency rTMS at 120% RMT for four weeks may be efficacious and safe for the treatment of apathy in elderly patients with AD or MCI. High-frequency rTMS may also improve global cognition in these patients. This implies rTMS has potential as an intervention for apathy in AD and MCI. Large well conducted RCTs are warranted to explore this effect further.

Association between statins exposure and risk of skin cancer: an updated meta-analysis

This study aimed to investigate the relationship between statin (lipophilic statin and hydrophilic statin) exposure and the risk of skin cancer. The incidence of skin cancer under statin exposure was used as the primary outcome, and the relevant studies were screened from Web of Science, PubMed, Cochrane Library, and EBSCO electronic database until September 2022. Ten observational studies and two randomized controlled trials (RCTs) were included. The statistical results indicated that in lipophilic statins, the exposed group had a higher risk of skin cancer than the non-exposed group (OR: 1.09, P = 0.003). However, compared with the non-exposed group, there was no significant difference between hydrophilic statins exposure and the incidence of skin cancer (OR: 1.02, P = 0.341). Further subgroup analysis of the subtypes of statins revealed that compared with the non-exposed group, exposure to lovastatin (OR: 1.18, P = 0.048) or simvastatin (OR: 1.11, P < 0.001) was a risk factor for skin cancer. Besides, subgroup analysis based on the subtypes of skin cancer demonstrated that the risks of melanoma (OR: 1.13, P = 0.009), basal cell carcinoma (BCC) (OR: 1.05, P = 0.036), and squamous cell carcinoma (SCC) (OR: 1.13, P = 0.026) under lipophilic statin exposure were significantly higher than those in the non-exposed group. On the contrary, compared with the non-exposed group, the risk of BCC was significantly reduced under the exposure of hydrophilic statins (OR: 0.93, P = 0.031). This study showed that the relationship between statin exposure and skin cancer risk was affected by the subtypes of statins and skin cancer subtypes.

A Meta-Analysis of Influencing Factors on the Activity of BiVO4-Based Photocatalysts

With the continuous advancement of global industrialization, a large amount of organic and inorganic pollutants have been discharged into the environment, which is essential for human survival. Consequently, the issue of water environment pollution has become increasingly severe. Photocatalytic technology is widely used to degrade water pollutants due to its strong oxidizing performance and non-polluting characteristics, and BiVO4-based photocatalysts are one of the ideal raw materials for photocatalytic reactions. However, a comprehensive global analysis of the factors influencing the photocatalytic performance of BiVO4-based photocatalysts is currently lacking. Here, we performed a meta-analysis to investigate the differences in specific surface area, kinetic constants, and the pollutant degradation performance of BiVO4-based photocatalysts under different preparation and degradation conditions. It was found that under the loading condition, all the performances of the photocatalysts can be attributed to the single BiVO4 photocatalyst. Moreover, loading could lead to an increase in the specific surface area of the material, thereby providing more adsorption sites for photocatalysis and ultimately enhancing the photocatalytic performance. Overall, the construct heterojunction and loaded nanomaterials exhibit a superior performance for BiVO4-based photocatalysts with 136.4% and 90.1% improvement, respectively. Additionally, within a certain range, the photocatalytic performance increases with the reaction time and temperature.

Association between insulin-like growth factor-1 and cardiovascular events: a systematic review and dose-response meta-analysis of cohort studies

BACKGROUND

Insulin-like growth factor-1 (IGF-1) has increasingly been reported as linked to cardiovascular (CV) events; however, reported results have been inconsistent, and no meta-analysis has been undertaken to quantitatively assess this association.

METHODS

We searched PubMed, Embase, and Web of Science databases for cohort articles published up to December 1, 2020. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (CIs) of CV events in relation to IGF-1. Restricted cubic splines were used to model the dose-response association.

RESULTS

We identified 11 articles (thirteen cohort studies) covering a total of 22,995 participants and 3040 CV events in this meta-analysis. The risk of overall CV events reduced by 16% from the highest to the lowest IGF-1 levels (RR 0.83, 95% CI 0.72-0.95), while the occurrence of CV events reduced by 28% (RR 0.72, 95% CI 0.56-0.92), but not for CV deaths, however (RR 1.00, 95% CI 0.65-1.55). We also found linear associations between IGF-1 levels and CV events. With each per 45 μg/mL IGF-1 increase, the pooled RRs were 0.91 (95% CI 0.86-0.96), 0.91 (95% CI 0.85-0.97) and 0.91 (95% CI 0.84-0.98) for overall CV events, for the occurrence of CV events, and for CV deaths, respectively.

CONCLUSIONS

Our findings based on cohort studies support the contention that any increase in IGF-1 is helpful in reducing the overall risk of CV events. As an important biomarker for assessing the likelihood of CV events, IGF-1 appears to offer a promising prognostic approach for aiding prevention.

Association between the severity of metabolic dysfunction-associated fatty liver disease and the risk of colorectal neoplasm: a systematic review and meta-analysis

Background

The severity of metabolic dysfunction-associated fatty liver disease (MAFLD) reportedly plays a part in the etiology of colorectal tumors. However, there is no consensus.

Methods

Studies relevant with the impact of MAFLD severity on the risk of colorectal neoplasms published before 24th April 2022 were screened. The pooled odds ratio (OR) with corresponding 95% confidence intervals (95% CI) was obtained using standard and cumulative meta-analyses. Subgroup, meta-regression, and sensitivity analyses were carried out to identify heterogeneity.

Results

Fourteen studies with data from 37,824 MAFLD patients were included. The prevalence of colorectal neoplasms escalated with the progression of MAFLD compared to simple steatosis (OR = 1.93; 95% CI = 1.42–2.62). The magnitude and direction of the effect on these outcomes remained largely constant over time. Even after limiting the meta-analysis to 8 studies with available adjusted OR (aOR), the findings still suggested that MAFLD severity was positively related to colorectal neoplasms (aOR = 3.03; 95% CI = 2.02–4.53). Severe MAFLD was more likely to cause left colon tumors (OR = 3.86, 95% CI = 2.16–6.91) than right colon neoplasms (OR = 1.94, 95% CI = 1.15–3.28).

Conclusion

The severity of MAFLD was independently related to colorectal neoplasms and severe MAFLD was more likely to cause left colon tumors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-022-01659-1.

Optimal parameter determination of repetitive transcranial magnetic stimulation for treating treatment-resistant depression: A network meta-analysis of randomized controlled trials

BACKGROUND

Many studies have shown the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). However, the choice of different parameters has been a challenging issue.

METHODS

PubMed, Cochrane, and Embase databases were searched for relevant studies until June 20, 2022. The treatment efficacy was evaluated by the relative risk (RR) using the pairwise test for response and remission rates. Subgroup and sensitivity analyses were conducted to explore the primary outcome differences and to assess the reliability of the results.

RESULTS

Thirty-seven trials comprising 2120 participants with TRD were included. The more efficacious interventions compared to sham controls included high-frequency left followed by low-frequency right sup-threshold (HFL-LFR-sup-rTMS, RR = 5.29, 95% CI: 1.24-22.50), high-frequency left sup-threshold (HFL-sup-rTMS, RR = 2.97, 95% CI: 1.74-5.05), low-frequency right sup-threshold (LFR-sup-rTMS, RR = 2.72, 95% CI: 1.50-4.90), low-frequency right followed by high-frequency left sup-threshold (LFR-HFL-sup-rTMS, RR = 2.71, 95% CI: 1.62-4.53), and high-frequency left sub-threshold (HFL-sub-rTMS, RR = 1.91, 95% CI: 1.18-3.10) rTMS. The estimated relative ranking of treatments suggested that HFL-LFR-sup-rTMS (84.4%) might be the most efficacious among all rTMS strategies. No treatments showed a lower acceptability than the sham control.

LIMITATIONS

Subgroup analysis was not conducted to compare the efficacy of rTMS treatment between bipolar and unipolar depression, and small-study effects possibly introduced bias.

CONCLUSION

Treatment with HFL-LFR-sup-rTMS, HFL-sup-rTMS, LFR-sup-rTMS, LFR-HFL-sup-rTMS, or HFL-sub-rTMS is more efficacious than the sham control. HFL-LFR-sup-rTMS and HFL-sup-rTMS may be the two best among the most efficacious rTMS treatments.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022334481].

Association of infant antibiotic exposure and risk of childhood asthma: A meta-analysis

Background

Infant antibiotic exposure may be associated with childhood asthma development.

Objective

To examine and detail this association considering potential confounders.

Study design

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for publications from January 2011 to March 2021. Eligible studies were independently reviewed to extract data and assess quality. Random effect model was used to pool odds ratio (OR) and corresponding 95% confidence intervals (CIs).

Results

A total of 52 studies were included. The association of infant antibiotic exposure and childhood asthma was statistically significant for overall analysis (OR, 1.37; 95% CI, 1.29-1.45) and for studies that addressed reverse causation (RC) and confounding by indication (CbI) (1.19; 95% CI, 1.11-1.28). Significance remained after stratification by adjustment for maternal antibiotic exposure, medical consultation, sex, smoke exposure, parental allergy, birth weight, and delivery mode. In detailed analyses, macrolides (OR, 1.56; 95% CI, 1.31-1.86), antibiotic course≥5 (OR, 1.79; 95% CI, 1.36-2.36), exposure within 1 week of birth (OR, 1.82; 95% CI, 1.34-2.47), asthma developed among 1-3 years (OR, 1.84; 95% CI, 1.63-2.08), short time lag between exposure and asthma onset (OR, 2.05; 95% CI, 1.91-2.20), persistent asthma (OR, 2.61; 95% CI, 1.49-4.59), and atopic asthma (OR, 2.14; 95% CI, 1.58-2.90) showed higher pooled estimates.

Conclusion

Infant antibiotic exposure is associated with increased risk of childhood asthma considering confounding, and the association varied with different settings of exposure and outcomes. This highlights the need for prevention of asthma after early antibiotic exposure. Heterogeneity among studies called for caution when interpretation.