Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation

Systematic review and meta-analysis on the association of metabolic syndrome in women with overactive bladder

AIMS

A systematic review and meta-analysis were performed to determine the association of metabolic syndrome (METS) in women with and without overactive bladder (OAB).

METHODS

PRISMA guidelines were followed and the protocol was registered at PROSPERO (CRD42024606398). We searched PubMed, Embase, Cochrane Library, and LILACS databases to obtain relevant articles for studies reporting METS outcomes related to OAB published through October 2024. A meta-analysis was performed of available studies using random effect models. Results are reported as mean difference (MD), standardized MD (SMD), or odds ratio (OR) and their 95% confidence interval (CI). Heterogeneity was described with the I2 statistic. The quality of studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Of the 108 non-duplicated retrieved citations, after successive selection, four case-control studies with low or moderate risk of bias reported information about the association of METS in women assessed with the 8-item OAB Symptom Bother Scale. OAB patients displayed higher body mass index (BMI, MD: 3.27, 95% CI: 2.12, 4.43), waist circumference (MD: 7.96, 95% CI: 4.41, 11.52), fasting blood glucose (SMD: 1.26, 95% CI: 0.18, 2.34), triglycerides (SMD: 0.24, 95% CI: 0.01, 0.47), and LDL-cholesterol (SMD: 0.30, 95%CI: 0.06, 0.54) levels. In addition to low HDL-cholesterol levels (SMD: -0.40, 95% CI: -0.74, -0.06) compared to the control group. There were no significant differences in circulating total cholesterol levels and rates of hypertension, hysterectomy, postmenopausal status, and constipation in women with and without OAB.

CONCLUSION

Women with OAB display associations with age, BMI, waist circumference, and METS factors.

Atherogenic index of plasma and the clinical outcome of patients with acute coronary syndrome: a meta-analysis

BACKGROUND

The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS.

MATERIALS AND METHODS

Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity.

RESULTS

Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity.

CONCLUSION

A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.

Improving quercetin bioavailability: A systematic review and meta-analysis of human intervention studies

This systematic review evaluated a total of 31 included human intervention studies that have assessed methods to improve quercetin bioavailability from different formulations and food matrices using urine or blood samples up to July 2024. The bioavailability of quercetin in humans was affected by several factors. 1) Chemical structure: Quercetin-3-O-oligoglucosides exhibited 2-fold higher bioavailability than quercetin-3-O-glucoside, 10-fold higher than quercetin-3-O-rutinoside and ∼ 20-fold higher than quercetin aglycone. 2) Modification of physicochemical properties: In comparison to quercetin aglycone, the quercetin-3-O-glucoside-γ-cyclodextrin inclusion complex showed a 10.8-fold increase in bioavailability, while the self-emulsifying fenugreek galactomannans and lecithin encapsulation, and lecithin phytosome, showed a 62- and 20.1-fold increase, respectively. 3) Food matrix effects: the addition of dietary fats and fibre increased bioavailability by ∼2-fold. This review summarises key factors that enhance quercetin bioavailability, contributing to the development of more effective and practical quercetin supplements or functional foods for better bioactivity of quercetin in humans.

Patient and informal caregiver-centered nursing interventions for adults with heart failure: A systematic review and meta-analysis

BACKGROUND

Heart failure management requires active participation in self-care by both patients and family caregivers as a dyad.

OBJECTIVE

This systematic review and meta-analysis aimed to examine the impact of dyadic self-care interventions on patient outcomes in heart failure management.

METHODS

We searched databases including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, and Wanfang through May 14, 2024. Following PRISMA guidelines, we used the Cochrane Risk of Bias tool for quality assessment and Review Manager 5.4 for data analysis.

RESULTS

Twenty studies (18 Randomized Controlled Trials, 2 quasi-experimental) involving 3,266 patients and 3,091 family caregivers were included. Dyadic self-care interventions showed significant effects on patients' self-care maintenance (MD: 9.07, 95 % CI: 6.17-11.98) and management (MD: 5.03, 95 % CI: 3.96-6.10) across all time periods. Self-care confidence improved only in short-term (MD: 6.32, 95 % CI: 5.32-7.32) and medium-term (MD: 4.23, 95 % CI: 0.26-8.20). Quality of life improved only in short-term. The interventions reduced readmission rates and healthcare costs but showed no effect on mortality, anxiety, or depression.

CONCLUSIONS

Dyadic interventions effectively reduced readmissions and improved quality of life in heart failure management. Future research should focus on sustainable, cost-effective strategies for long-term outcomes.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings support implementing dyadic interventions while emphasizing the need for continued focus on mental health and sustained support. Further research on caregiver outcomes is warranted.

Relationship between Helicobacter pylori infection and programmed death-ligand 1 in gastric cancer: A meta-analysis

BACKGROUND

Gastric cancer (GC) is one of the most common malignancies worldwide, and Helicobacter pylori (HP) infection is a well-established risk factor for its development. Programmed death-ligand 1 (PD-L1) expression is a crucial biomarker for predicting the efficacy of immune checkpoint inhibitors in cancer treatment. While HP infection and PD-L1 expression in GC may be linked, the relationship between them remains unclear, in part because there have been conflicting results reported from various studies.

AIM

To perform a meta-analysis to assess the relationship between HP and PD-L1 expression in patients with GC.

METHODS

A systematic literature review was conducted using PubMed, Embase, Cochrane Library, and Web of Science databases. Observational studies that examined the association between HP infection and PD-L1 expression in patients with GC were included. Odds ratios and 95% confidence intervals were calculated to estimate the association. Heterogeneity was assessed using Cochrane’s Q test and I² statistic. A random-effects model was used due to significant heterogeneity across studies.

RESULTS

Fourteen studies involving a total of 3069 patients with GC were included. The pooled analysis showed a significant association between HP infection and increased PD-L1 expression in GC tissues (odd ratio = 1.69, 95% confidence interval: 1.24-2.29, P < 0.001, I² = 59%). Sensitivity analyses confirmed the robustness of these findings. Subgroup analyses did not show significant variation based on geographic region, sample size, or method of PD-L1 assessment. Publication bias was minimal, as shown by funnel plots and Egger’s regression test.

CONCLUSION

HP infection is associated with increased PD-L1 expression in GC, suggesting that HP status may influence the response to programmed cell death protein 1/PD-L1 blockade therapy.

Efficacy of beta-blocker agents on clinical outcomes in patients with thoracic aortic aneurysm: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Studies investigating the efficacy of β-blocker agents for patients with thoracic aortic aneurysm (TAA) have produced heterogeneous and conflicting results. We assess the effects of β-blockers on clinical outcomes in patients with TAA.

METHODS

A systematic literature search was performed through Ovid MEDLINE, EMBASE, Web of Science, Pubmed and Cochrane CENTRAL, all from inception to April 30, 2024. Randomized controlled trials (RCTs) exploring the effect of β-blocker agents in patients with TAA were considered for inclusion, with no population restriction. Inverse variance-weighted random-effects model was used. The overall risk of bias assessment was conducted by Cochrane Risk of Bias 2 tool. The primary outcome was aortic events during follow-up.

RESULTS

We included a total of 161 patients with TAA (mean age, 27.6 years; 80 [49.7 %] male, mean follow-up 6.7 years) in 4 RCTs. The pooled risk ratio in the β-blocker arm for aortic events was 0.74 [95 % CI (0.20; 2.71), I2: 0 %, p = 0.64, low certainty of evidence (CoE)] when compared to placebo or no treatment in patients with TAA. The pooled risk ratios for aortic dissection or death (all-cause mortality) or in the β-blocker arm were 0.45 (95 % CI (0.10; 1.98), I2: 0 %, p = 0.29, low CoE) and 0.58 (95 % CI (0.15; 2.24), I2: 0 %, p = 0.43, low CoE), respectively. The risks of aortic dissection, rupture, or death were comparable, regardless of agent, disease, and age.

CONCLUSION

We found no evidence of benefit from β-blocker treatment for patients with TAA. More robust RCTs are needed to establish evidence-based recommendations.

Effects of exercise therapy with blood flow restriction on shoulder strength: protocol for a systematic review and meta-analysis

INTRODUCTION

Blood flow restriction therapy (BFRT) has gained attention for its capacity to induce substantial muscle hypertrophy and strength gains even when employing relatively minimal loads. Strength training is of significant importance in the rehabilitation of patients experiencing shoulder pain, which may arise from a multitude of sources, including rotator cuff injuries, tendinopathies or postsurgical recovery. However, traditional resistance training can be challenging for these individuals due to the presence of pain and functional limitations. In this regard, BFRT in conjunction with low-load strength training may prove an efficacious alternative. The integration of BFRT into rehabilitation protocols for shoulder pain could provide a viable pathway to improving muscle strength and facilitating recovery while minimising the risk of exacerbating pain or injury. The primary objective of this study is to conduct a systematic review of the effects of training with BFRT of the upper limb on shoulder strength.

METHODS AND ANALYSIS

A comprehensive database search will be conducted across multiple platforms, including PubMed, Scopus, Ovid, Web of Science, EBSCO, Cochrane Central, PEDro and Google Scholar, using predefined key terms without any language restriction. The particular focus of the study will be clinical trials with a controlled group that assess the impact of BFRT on upper extremity, neck and trunk muscles in both healthy individuals and patients. The primary outcome measure will be shoulder strength and power in different directions. The Cochrane Collaboration's Risk of Bias 2 tool will be employed for the purpose of evaluating the risk of bias inherent to the studies in question. A meta-analysis will be conducted using Stata software. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be employed to evaluate the quality of evidence for the primary outcomes.

ETHICS AND DISSEMINATION

The previously published papers will be used for all analyses in this study. Results will be disseminated through professional networks, presentations at conferences and publication in a peer-reviewed journal. No ethics approval is required.

PROSPERO REGISTRATION NUMBER

CRD42024605189.

Efficacy of mobile health interventions in the conservative management of chronic low back pain in low- and middle-income countries: a systematic review, meta-analysis, and trial sequential analysis

Chronic low back pain (CLBP) is a major global health issue, particularly severe in low- and middle-income countries (LMICs), where health care resources and accessibility are limited. Mobile health (mHealth) interventions offer a promising solution by leveraging technology to deliver health care services remotely. This review aims to evaluate the effectiveness of mHealth interventions in managing CLBP in LMICs. A comprehensive search of electronic databases was performed for studies published until June 2024, evaluating mHealth interventions for CLBP in LMICs. Primary outcomes measured were pain intensity and disability, while secondary outcomes included quality of life (QoL). Risk of bias was assessed using Cochrane risk-of-bias tool (RoB2), and quality of evidence was evaluated using GRADE. Robustness of meta-analysis results was assessed via trial sequential analysis (TSA). Seven studies met the inclusion criteria. The mHealth interventions significantly reduced the overall pain intensity (MD = -1.11, 95% CI: -1.75, -0.46) and disability (MD = -6.59, 95% CI: -10.65, -2.54). Subgroup analysis indicated greater effectiveness of short-term interventions (<6 weeks) in reducing pain and Oswestry disability index (ODI) vs long-term interventions (>6 weeks). mHealth interventions notably reduced pain and ODI scores vs unsupervised programs but showed no significant difference compared to in-person programs. The z-score line remained within TSA boundaries. mHealth interventions show potential in reducing pain and disability among patients with CLBP in LMICs, although with inconclusive impact on QoL. The high heterogeneity and limited number of studies underscore the need for further research with greater sample size to validate these findings and explore the long-term benefits and implementation challenges of mHealth in resource-constrained settings.

Disruptions of resting-state functional connectivity in post-stroke motor dysfunctions: a meta-analysis

This study aims to unravel the consistent abnormalities in functional connectivity (FC) with the primary motor cortex (M1) for post-stroke motor dysfunctions and the dynamic shifts of FC across distinct phases (acute/subacute/chronic) following stroke onset. Eleven studies with 269 stroke patients and 257 healthy controls (HCs) were included after screening articles in PubMed, Web of Science, and Embase. Voxel-wise meta-analysis and subgroup analysis on three phases after stroke onset were applied using the anisotropic effect size-signed differential mapping toolbox. Additionally, a M1-seeded FC analysis from an independent dataset with 29 stroke patients and 40 HCs was applied to validate the results of the meta-analyses. The abnormal connectivity with M1 in patients with post-stroke motor dysfunctions extended beyond motor-related regions to non-motor domains. A consistent interhemispheric connectivity reduction between M1 and motor-related regions emerged as a hallmark, persisting across different phases after stroke onset. These alterations were largely replicable through validation analysis. Our findings indicated the imbalance of connectivity in patients with post-stroke motor dysfunctions.

Effect of prone positioning in adult patients receiving veno-venous extracorporeal membrane oxygenation: A meta-analysis

OBJECTIVE

To investigate the effects of prone positioning during extracorporeal membrane oxygenation (ECMO) and its effects on short-term and long-term survival.

METHODS

A computerized search was performed for all studies in PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2023, including prospective and retrospective clinical studies of ECMO-treated patients with or without prone positioning. Titles, abstracts, and full-text articles were screened in duplicate by two investigators. The primary outcome was short-term survival (survival at discharge or 1-month survival). The secondary outcomes included long-term survival (60-day survival, 90-day survival), ECMO duration, length of intensive care unit (ICU) stay and ECMO weaning.

RESULTS

Fifteen studies with 2608 patients were included, most of which were retrospective. The effect of prone versus non-prone positioning in ECMO patients was OR =  1.32; 95% CI, 0.88-1.97; P =  0.18 for short-term survival from the original data. The effects of prone positioning during ECMO were a significant increase in 28-day survival (OR = 2.54; 95% CI 1.71-3.76; P < 0.00001) and survival at discharge (OR = 1.49; 95% CI 1.11-2.00; P = 0.009), which appeared in the non-COVID-19 patient group. Furthermore, the short-term effects of prone ventilation in ECMO patients were also improved in the matching analysis (OR = 1.66; 95% CI, 1.23-2.23; P = 0.0008), but did not in the long-term survival rate (OR = 1.57; 95% CI, 0.90-2.76; P = 0.11). The durations of ECMO (OR = 1.99; 95% CI, 1.99-2.70; P < 0.00001) and ICU stay (OR = 1.17; 95% CI, 0.58-1.75; P < 0.0001) were significantly different between the prone group and the non-prone group.

CONCLUSION

Prone position ventilation during ECMO confers no significant advantage in improving long-term survival and only slightly benefits short-term survival. Therefore, the prone position during ECMO should be carefully considered because further randomized clinical trials on this subject are needed.

State of the Art of Immune Checkpoint Inhibitors in Unresectable Pancreatic Cancer: A Comprehensive Systematic Review

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape for several malignancies, but their efficacy in unresectable pancreatic adenocarcinoma remains uncertain. This systematic review aimed to evaluate the effectiveness and safety of ICIs in this context, focusing on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and toxicity. A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Scopus identified 34 eligible studies, including randomized controlled trials and observational cohorts. Quantitative synthesis involved 21 studies comprising 937 patients, with additional qualitative analyses on biomarker-driven subgroups and early-phase trials. The median OS across studies was 8.65 months, while the median PFS was 2.55 months. The ORR and DCR were 16.2% and 50.3%, respectively, with grade ≥3 treatment-related adverse events occurring in 22% of patients. Promising outcomes were observed in MSI-H/dMMR populations, although these represented only 1-2% of cases. Combination strategies with chemotherapy demonstrated synergistic potential but lacked definitive evidence due to heterogeneity and the absence of phase III trials. ICIs showed a manageable toxicity profile, highlighting their feasibility in selected patients. Future research should focus on overcoming tumor microenvironment barriers and identifying biomarkers to optimize responsiveness and expand the applicability of ICIs in pancreatic cancer.

Temporomandibular disorder prevalence in malocclusion patients: a meta-analysis

OBJECTIVES

This study investigated the prevalence of temporomandibular disorders (TMD) in patients with malocclusion through a systematic review and meta-analysis.

MATERIALS AND METHODS

A comprehensive literature search was conducted up to November 15, 2024. Cross-sectional studies providing data on TMD prevalence among malocclusion patients were included. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. A random-effects model was used for meta-analysis, with subgroup and meta-regression analyses to explore heterogeneity. Sensitivity analyses were performed to evaluate result robustness.

RESULTS

Thirty-two studies were included, showing an overall TMD prevalence of 43% (95% CI: 35%-50%; I2 = 97.9%). Prevalence was higher in females (44%) than males (33%) and in adults (42%) than adolescents (39%). Among malocclusion types, Class II (40%) and posterior unilateral crossbite (59%) had the highest TMD prevalence. Sensitivity analysis confirmed the robustness of findings, though diagnostic criteria variations contributed to heterogeneity.

CONCLUSIONS

The prevalence of TMD in malocclusion patients was 43%, with higher rates in females, adults, and specific malocclusion types such as Class II, open bite, overjet, and crossbite. Variations in diagnostic criteria and malocclusion classification contributed to heterogeneity, emphasizing the need to consider individual patient characteristics when assessing TMD risk. Standardized diagnostic criteria, representative sampling, and multilingual search strategies are essential for future research to minimize bias and improve data reliability.

Cost of illness analysis of frailty for older adults: a systematic review and meta-analysis

PURPOSE

The increasing burden of out-of-pocket expenses borne by older adults with frailty can be a considerable challenge in efforts toward improving societal health. This study estimated the cost of frailty for older adults by employing cost of illness theory.

METHODS

Five electronic databases were searched (without any language or year restriction) for relevant articles from their inception to April 2024. Studies investigating the cost of frailty and prefrailty for older adults (aged ≥ 60 years) were included.

RESULTS

A total of 51 studies were included. The findings revealed that frailty significantly increased mean total costs by US$3286 and US$4653 compared with the costs for individuals with prefrailty and robustness, respectively. The cost difference between the prefrailty and robust groups was US$2729. The increases in indirect costs did not significantly differ between the prefrailty and robust groups or between the frailty and robust groups. The total cost by setting was significantly increased in the frailty group relative to the prefrailty and robust groups. The results stratified by continent or region revealed that only the frailty and prefrailty groups in North America experienced significant increases in total costs relative to the robust group. However, in the Asia-Pacific region and Europe, no significant results were noted.

CONCLUSIONS

This is the first meta-analysis to employ cost of illness theory to investigate the cost of frailty. Our findings can help providers of health-care services and professional workers develop effective and comprehensive intervention plans and services that can be provided for older adults with frailty.

Triglyceride-glucose-body mass index and the incidence of cardiovascular diseases: a meta-analysis of cohort studies

BACKGROUND

Numerous studies have shown that insulin resistance (IR) is closely related to the pathogenesis of cardiovascular disease (CVD). This study aims to summarize the correlation between the triglyceride-glucose-body mass index (TyG-BMI index), a novel surrogate indicator of insulin resistance, and the incidence of CVD in patients without CVD at baseline through meta-analysis.

METHOD

Cohort studies assessing multivariate-corrected hazard ratios (HRs) for associations between the TyG-BMI index and cardiovascular disease (CVD) were obtained by searching PubMed, Cochrane Library, EMBASE, and Web of Science. Results were combined using a random-effects model to account for heterogeneity among the included studies. Robust error meta-regression was used to fit the nonlinear dose-response relationship. Statistical analysis was performed using Review Manager 5.4 and STATA 18.0.

RESULT

Ten cohort studies involving a total of 871,728 subjects were included. The results indicated that Compared with the lowest TyG-BMI index category, the highest TyG-BMI index was related to a higher incidence of cardiovascular diseases (CVD) (HR = 1.62; 95% confidence interval (CI): 1.35-1.95; I2 = 94%),coronary artery disease (CAD) (HR = 1.69; 95% (CI): 1.23-2.31; I2 = 94%). stroke(HR = 1.57; 95% (CI): 1.11-2.23; I2 = 94%).In the dose-response analysis, there was a linear association of the TyG-BMI index with the risk of CVD (Pnonlinear = 0.223), CAD (Pnonlinear = 0.693), and stroke (Pnonlinear = 0.122)No significant effects were observed regarding participants' gender, length of follow-up, sample size or mean age(P > 0.05).

CONCLUSION

Higher TyG-BMI may be independently associated with an increased risk of CVD in individuals without CVD at baseline. Numerous cohort studies are needed to further validate and elucidate the pathologic role between Tyg-BMI and CVD and to determine whether it can be incorporated into CVD risk prediction tools to enhance predictive accuracy.

Pooled prevalence and subgroup variations of Tetralogy of Fallot among children and adolescents with congenital heart defect in Sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

Tetralogy of Fallot is one of the critical congenital heart defects needing intervention within the first year of life.

OBJECTIVE

This review aims to systematically assess the prevalence of Tetralogy of Fallot among children and adolescents with congenital heart defects in Sub-Saharan Africa from January 2000 to January 2024.

METHODS

All original observational studies focused on children and adolescent population diagnosed with congenital heart defects within Sub-Saharan Africa; reported the primary outcome of interest were included. Prisma guidelines were utilized to perform this systematic review and meta-analysis. Electronic databases including Medline (PubMed), Scopus, Google Scholar, and African Index Medicus were searched. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence of Tetralogy of Fallot.

RESULTS

Thirty-one studies included encompassing a total of 11,265 participants from 15 Sub-Saharan African countries with representation from Southern (4 studies, 619 participants), Central (5 studies, 2,220 participants), Eastern (11 studies, 3,384 participants), and Western (11 studies, 5,042 participants). Cross-sectional studies comprised (25 studies, 8,909 participants), and cohort design (6 studies, 2,356 participants). The analysis revealed a pooled prevalence of 10% (95% CI: 9%; 12%) with I2 (77%, p-value < 0.01). The subgroup analysis based on geographic regions revealed statistically significant difference.

CONCLUSIONS AND FUTURE IMPLICATIONS

The prevalence of Tetralogy of Fallot observed was found considerably higher compared to global estimate and reports of developed countries. In a subgroup analysis based on the geographic region, a surprisingly high prevalence was reported across all regions of Sub-Saharan Africa. The substantial disparities and high prevalence observed underscores the complex interplay of factors influencing occurrence of Tetralogy of Fallot. Identifying the true scope of Tetralogy of Fallot burden may help policymakers and healthcare providers to prioritize interventions, optimize resource allocation, and potentially improve its outcomes in Sub-Saharan Africa.

Triglyceride-glucose index and the prognosis of patients with heart failure: A meta-analysis

The triglyceride-glucose index (TyGI) is a novel indicator of insulin resistance, which has been associated with an increased risk of cardiovascular diseases. The aim of this meta-analysis was to determine the association between TyGI and the prognosis of patients with heart failure (HF). Cohort studies relevant to the aim of the meta-analysis were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data, incorporating the influence of between-study heterogeneity. Twelve studies involving 20,639 patients with HF were included. Pooled results showed that compared to patients with the lowest category of TyGI at baseline, those with the highest TyGI index were associated with a higher risk of all-cause mortality during follow-up (relative risk [RR] 1.71, 95% confidence interval [CI] 1.46 - 2.00; P < 0.001; I² = 55%). Sensitivity analyses limited to studies after adjustment for confounding factors showed similar results (RR 1.89, 95% CI 1.67 - 2.21; P < 0.001; I² = 13%). Subsequent meta-analyses also showed that a high TyGI at baseline was related to the incidence of cardiovascular death (RR 1.87, 95% CI 1.42 - 2.47; P < 0.001; I² = 57%), HF rehospitalization (RR 1.33, 95% CI 1.04 - 1.69; P < 0.02; I² = 46%), and major adverse cardiovascular events (RR 1.69, 95% CI 1.39 - 2.06; P < 0.001; I² = 17%) during follow-up. In conclusion, a high TyGI may be associated with a poor clinical prognosis for patients with HF.

Risk factors for the recurrence of atrial fibrillation after catheter ablation: a meta-analysis

BACKGROUND

The rate at which atrial fibrillation (AF) patients experience a return of symptoms after catheter ablation is significant, and there are multiple risk factors involved. This research intends to perform a meta-analysis to explore the risk factors connected to the recurrence of AF in patients following catheter ablation.

METHODS

The PubMed, Cochrane Library, WOS, Embase, SinoMed, CNKI, Wanfang, and VIP databases were explored for studies from January 1, 2000 to August 10, 2021, and research meeting the established inclusion requirements was chosen. Two authors separately gathered details regarding the study structure. The strength of the link between various risk factors and AF returning after CA was evaluated using odds ratios. All statistical evaluations were conducted with RevMan5.3 software.

RESULTS

In total, 44 articles and 62,674 patients were included. The OR for AF recurrence in patients with diabetes was 2.04 compared with the reference group (95% CI 1.51-2.76, p < 0.00001); that of lower left ventricular ejection fraction was 1.38 (95% CI 1.25-1.52, p < 0.00001); that of female was 1.34 (95% CI 1.18-1.52, p < 0.00001); that of increased age was 1.03 (95% CI 1.02-1.04, p < 0.00001); that of persistent AF was 1.72 (95% CI 1.58-1.87, p < 0.00001); that of AF duration over 2 years was 1.17 (95% CI 1.08-1.26, p < 0.00001); that of increased left atrial diameter (LAD) was 1.12 (95% CI 1.08-1.17, p < 0.00001); that of larger left atrial volume index (LAVi) was 1.02 (95% CI 1.01-1.03, p < 0.00001); that of higher hs-CRP was 1.19 (95% CI 1.04-1.36, p = 0.04); that of early recurrence (ER) was 3.22 (95% CI 2.74-3.77, p < 0.00001); and that of long ablation duration was 1.00 (95% CI 0.98-1.02, p = 0.72). Heterogeneity and slight publication bias were observed for each factor.

CONCLUSIONS

Evidence indicates that diabetes, low left ventricular ejection fraction, being female, older age, longer duration of atrial fibrillation, elevated high-sensitivity C-reactive protein levels, large left atrial dimension, large left atrial volume index, persistent atrial fibrillation, and exercise rehabilitation are factors that increase the chances of getting atrial fibrillation again after catheter ablation. However, the length of the ablation procedure does not relate to the recurrence of AF.

Comparison of Accuracy in Mandible-First and Maxilla-First Approaches in Bimaxillary Orthognathic Surgery: A Meta-Analysis

This meta-analysis compares the accuracy of mandible-first and maxilla-first approaches in bimaxillary orthognathic surgery to improve clinical decision-making. A systematic search was performed in PubMed, Web of Science, Embase, and Cochrane databases up to August 2024. The analysis included randomized controlled trials and cohort studies with a minimum of 10 patients. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and pooled effect estimates for continuous outcomes were calculated using weighted mean difference (WMD) with 95% CIs. Heterogeneity was assessed using Cochran I2 and Q statistics, with a random-effect model applied when I2 exceeded 50%. Seven studies involving 316 patients were included. The analysis showed no significant differences in vertical (WMD: -0.05, 95% CI: -0.57 to 0.48, P = 0.86), transverse (WMD: -0.17, 95% CI: -0.43 to 0.09, P = 0.21), and sagittal (WMD: -0.41, 95% CI: -0.98 to 0.15, P = 0.15) surgical errors between the two approaches. Rotational surgical errors were also similar, including pitch (WMD: 0.07, 95% CI: -0.11 to 0.25, P = 0.29), roll (WMD: 0.01, 95% CI: -0.18 to 0.25, P = 0.69), and yaw (WMD: 0.12, 95% CI: -0.56 to 0.81, P = 0.72). The findings suggest that there is no significant difference in surgical accuracy between mandible-first and maxilla-first approaches. Therefore, the choice of sequence should be based on patient-specific factors rather than a presumed advantage of one method over the other. Further research, including large-scale randomized controlled trials, is needed to confirm these results and evaluate long-term outcomes.

Meta-analysis and Mendelian randomization study on the association between exposure to chlorinated disinfection byproducts and preterm birth risk

OBJECTIVE

This study aims to investigate the correlation between exposure to disinfection byproducts of chlorination and preterm birth (PTB) through evidence-based medicine Meta-analysis and Mendelian randomization (MR) analysis.

STUDY DESIGN

Meta-analysis was conducted on 17 studies involving 1,251,426 neonates, revealing a higher risk of PTB with exposure to total trihalomethanes (TTHMs) and chloroform. Mendelian randomization (MR) analysis confirmed a causal relationship between chlorides and PTB.

RESULTS

TTHMs and chloroform were associated with increased PTB risk, while haloacetic acids showed no significant association. TTHMs were linked to small gestational age. Ethnicity and study design influenced heterogeneity.

CONCLUSIONS

Exposure to chlorination byproducts, particularly TTHMs and chloroform, poses a significant risk for PTB. MR analysis supports a causal relationship between chlorides and PTB, highlighting the importance of water disinfection byproduct control in preventing PTB.

Association between non-high-density lipoprotein cholesterol and type 2 diabetes: a systematic review and meta-analysis of cohort studies

Non-high-density lipoprotein cholesterol (non-HDL), a more readily available and reliable lipid parameter, is unclear in its association with type 2 diabetes (T2D). Previous studies assessing the relationship between non-HDL and T2D risk remains inconsistent results. We performed a meta-analysis to systematically evaluate this association. The PubMed, EMBASE, Medline, Web of Science, and Cochrane Library databases were systematically searched to find articles on "non-HDL" and "T2D" from inception to December 6, 2023. A random-effects model was used to calculate the effect estimates and 95% confidence intervals. Subgroup analyses and univariate Meta-regression were performed to explore sources of heterogeneity. The main exposure and outcome were non-HDL and T2D, respectively, in the general population. A total of 8 studies included 251,672 participants who met the inclusion criteria for this study. Meta-analysis showed that higher non-HDL increased the risk of T2D compared with the lower non-HDL group (total effect size: 1.16; 95% CI 1.079-1.251, p < 0.001). Subgroup analyses and Meta-regression of the association between non-HDL and T2D were not affected by region, proportion of men, sample size, or adjustment for confounders (including BMI, hypertension, waist circumference, and family history of diabetes). Higher non-HDL may be associated with an increased risk of T2D. Large prospective cohort studies are needed to validate these findings, and further studies are required in order to elucidate the underlying pathophysiologic mechanisms underlying the association between non-HDL and T2D.

Electrogastrography in Adult Gastroparesis: A Systematic Review and Meta-Analysis

BACKGROUND

Gastroparesis is a delay in gastric emptying without mechanical obstruction, lacking a clear pathophysiological mechanism, but with multiple histological abnormalities including loss of interstitial cells of Cajal, which may alter slow waves. We can assess slow waves with electrogastrography.

OBJECTIVES

To determine the prevalence and range of abnormalities in gastric slow waves in adults with gastroparesis using electrogastrography.

METHODS

We systematically searched Medline, Embase, LILACS, Web of Science, and Cochrane Register of Controlled Trials. We included studies with patients older than 18 years with gastroparesis, assessed using electrogastrography. We evaluated the percentage of duration of the recording in which the dominant power was in normogastria, tachygastria, and bradygastria; dominant frequency; power ratio; change in post-stimulus dominant power; and dominant frequency instability coefficient. Methodological quality was assessed using the Joanna Briggs Institute tool. Data were synthesized using narrative summary and meta-analysis.

RESULTS

A total of 3730 articles were reviewed, including 31 articles with 1545 patients and 340 controls. Compared to controls, gastroparetics patients had less normogastria (fasting: 50.3% versus 65.8%) (post-stimulus: 54.3% versus 66.5%), more bradygastria (fasting: 37.7% versus 13%) (post-stimulus: 31.9% versus 16.3%), and more tachygastria (fasting: 16.1% versus 4.6%) (post-stimulus: 18.3% versus 5.2%). Gastroparetics had less change in post-stimulus dominant power (1.45 dB versus 5.03 dB) and less power ratio (1.4 versus 5.26).

CONCLUSIONS

Gastroparetic patients present abnormalities in the frequency and changes in the post-stimulus power of slow waves, possibly secondary to a reduced number of interstitial cells of Cajal, as described in these patients.

Prevalence of Adverse Childhood Experiences in Child Population Samples: A Systematic Review and Meta-Analysis

Importance

Exposure to adverse childhood experiences (ACEs) before the age of 18 years is a major contributor to the global burden of disease and disability.

Objective

To meta-analyze data from samples with children 18 years or younger to estimate the average prevalence of ACEs, identify characteristics and contexts associated with higher or lower ACE exposure, and explore methodological factors that might influence these prevalence estimates.

Design, Setting, and Participants

Studies that were published between January 1, 1998 and February 19, 2024, were sourced from MEDLINE, PsycINFO, CINHAL, and Embase. Inclusion criteria required studies to report the prevalence of 0, 1, 2, 3, or 4 or more ACEs using an 8- or 10-item ACEs questionnaire (plus or minus 2 items), include population samples of children 18 years or younger, and be published in English. Data from 65 studies, representing 490 423 children from 18 countries, were extracted and synthesized using a multicategory prevalence meta-analysis. These data were analyzed from February 20, 2024, through May 17, 2024.

Main Outcomes and Measures

ACEs.

Results

The mean age of children across studies was 11.9 (SD, 4.3) years, the age range across samples was 0 to 18 years, and 50.5% were female. The estimated mean prevalences were 42.3% for 0 ACEs (95% CI, 25.3%-52.7%), 22.0% for 1 ACE (95% CI, 9.9%-32.7%), 12.7% for 2 ACEs (95% CI, 3.8%-22.3%), 8.1% for 3 ACEs (95% CI, 1.4%-16.8%), and 14.8% for 4 or more ACEs (95% CI, 5.1%-24.8%). The prevalence of 4 or more ACEs was higher among adolescents vs children (prevalence ratio, 1.16; 95% CI, 1.04-1.30), children in residential care (1.26; 95% CI, 1.10-1.43), with a history of juvenile offending (95% CI, 1.29; 1.24-1.34), and in Indigenous peoples (1.63; 95% CI, 1.28-2.08), as well as in studies where file review was the primary assessment method (1.29; 95% CI, 1.23-1.34). The prevalence of 0 ACEs was lower in questionnaire-based studies where children vs parents were informants (0.85; 95% CI, 0.80-0.90).

Conclusions

In this study, ACEs were prevalent among children with notable disparities across participant demographic characteristics and contexts. As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue. Effective early identification and prevention strategies, including targeted codesigned community interventions, can reduce the prevalence of ACEs and mitigate their severe effects, thereby minimizing the harmful health consequences of childhood adversity in future generations.

Prevalence and risk factors associated with birth asphyxia among neonates delivered in China: a systematic review and meta-analysis

BACKGROUND

Birth asphyxia is a critical condition caused by an insufficient oxygen supply during delivery, and it poses a major threat to the health of newborns. The present meta-analysis aimed to estimate the prevalence of birth asphyxia among neonates and identify its risk factors in China.

METHODS

PubMed, EMBASE, Scopus, Web of Science, the China Academic Journals (CNKI), the Chinese Biomedical Literature (CBM), the China Science and Technology Journal Database (VIP), and the WanFang database were searched for related publications. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with Stata 17.0 software to calculate the pooled prevalence of birth asphyxia among neonates delivered in China and to merge the odds ratios (ORs) of risk factors. Subgroup analysis was performed on the included studies. Publication bias was assessed by funnel plots and Egger's test.

RESULTS

Eighty studies were eligible for inclusion. The overall prevalence of birth asphyxia in newborns was 4.8% (95% CI, 4.5%-5.2%). In the subgroup analyses, the northern area presented the highest prevalence (5.1%; 95% CI, 4.1%-6.3%), followed by the southern area (4.1%; 95% CI, 3.3%-5.1%). The rural setting presented the highest prevalence (6%; 95% CI, 4.6%-7.4%), followed by the urban (4.2%; 95% CI, 4.6%-7.4%) and mixed (5.8%; 95% CI, 5.3%-6.3%) settings. The Apgar score demonstrated the highest prevalence (4.6%; 95% CI, 3.8%-5.4%), followed by the Apgar score with the umbilical artery blood pH (3.7%; 95% CI, 2.2%-5.7%). A significant difference in prevalence was found between studies with sample sizes greater than 5,000 (2.2%; 95% CI, 1.6%-3%) and those with 5,000 or fewer participants (6.2%; 95% CI, 5.5%-7.1%). Furthermore, there was a significant decrease in the incidence of birth asphyxia from 1995-2016 (4.9%; 95% CI, 4.2%-5.9%) to 2017-2023 (3.7%; 95% CI, 2.6%-5%). Placental abruption (OR = 5; 95% CI, 3.08-8.13), placenta previa (OR = 2.57; 95% CI, 1.84-3.58), advanced maternal age (OR = 3.94; 95% CI, 1.46-10.62), primigravida (OR = 5.33; 95% CI, 0.41-68.71), premature birth (OR = 3.36; 95% CI, 2.61-4.32), intrauterine distress (OR = 4.48; 95% CI, 3.47-5.80), stained amniotic fluid (OR = 3.28; 95% CI, 2.25-4.79), macrosomia (OR = 6.30; 95% CI, 0.61-65.22), foetal malformation (OR = 7.44; 95% CI, 1.46-38.02), breech birth (OR = 2.42; 95% CI, 1.24-4.73), caesarean section (OR = 1.72; 95% CI, 0.91-3.24), assisted delivery (OR = 13.62; 95% CI, 5.50-33.73), prolonged second stage of labour (OR = 1.43; 95% CI, 0.68-3.01), and malpresentation (OR = 4.20; 95% CI, 2.21-7.99) were major risk factors.

CONCLUSIONS

The prevalence of birth asphyxia among newborns in China is relatively high. In addition, 14 risk factors are related to neonatal birth asphyxia. Urgent attention needs to be focused on regionalized maternal and child management to address this problem in China.

Prevalence of emotional burnout among dietitians and nutritionists: a systematic review, meta-analysis, meta-regression, and a call for action

BACKGROUND AND OBJECTIVES

Despite anecdotal evidence pointing to the high prevalence of job stress and burnout among dietitians and nutritionists, few studies have been conducted on this topic. Moreover, most studies are from Western countries. The objective of the current study, based on systematic review, meta-analysis, and meta-regression, is aimed to provide systematically graded evidence to assess the prevalence of emotional burnout among dietitians and nutritionists across age, sex, and cultural backgrounds.

METHODS

Two reviewers independently conducted a systematic search from 1 January 2000, to 1 April 2024 and was later updated to 15 November 2024, across seven databases: EBSCOhost Research Platform, EMBASE, PubMed/MEDLINE, ProQuest, ScienceDirect, Scopus, and Web of Science. The DerSimonian-Laird method was utilized to pool the data in this meta-analysis. Data from a total of 12,166 dietitians and nutritionists were extracted from 16 datasets (published in twelve research reports) covering a period of approximately 25 years. We measured the pooled prevalence of global burnout syndrome and its individual symptoms among dietitians and nutritionists. Subgroup meta-analyses were also conducted to identify a comprehensive set of moderators, including participants' age and sex.

RESULTS

The prevalence of global burnout syndrome in dietitians and nutritionists (K = 10, N = 10,081) showed an overall prevalence rate of 40.43% [23.69; 59.74], I² = 99.3%, τ [95% CI] = 1.18 [0.84; 1.97], τ² [95% CI] = 1.38 [0.71; 3.89], H [95% CI] = 12.68 [11.70; 13.74]. The prevalence of burnout dimensions/individual symptoms in dietitians and nutritionists (K = 2, N = 695) is summarized as follows: emotional exhaustion (EE) at 26.11% [15.14; 41.17], I² = 84.0%, τ = 0.21, τ² = 0.46, Q = 6.25, p < 0.001; depersonalization (DP) at 6.59% [1.08; 31.22], I² = 95.0%, τ = 1.72, τ² = 1.31, Q = 20.18, p < 0.001; and personal accomplishment (PA) at 59.29% [39.81; 76.23], I² = 89.3%, τ = 0.29, τ² = 0.54, Q = 9.36, p < 0.001. Meta-regression showed no difference by age or sex, p = 0.80, and p = 0.20, respectively.

CONCLUSION

This meta-analysis revealed that the prevalence of burnout among dietitians and nutritionists is as high as in other medical professionals. Furthermore, age and sex were not significantly associated with emotional burnout among dietitians and nutritionists. This study provides the impetus for policy changes to improve dietitians' and nutritionists' working conditions, as well as the overall quality of nutrition care.

Association between vitamin D receptor gene polymorphism and essential hypertension: An updated systematic review, meta-analysis, and meta-regression

The association between Vitamin D Receptor (VDR) gene polymorphisms and essential hypertension (EH) remains controversial. We searched databases (Cochrane Library, EBSCO, EMBASE, LILACS, ProQuest, PubMed, Science Direct, Springer) for studies on VDR gene polymorphisms and EH until May 30, 2024, following PRISMA guidelines. RevMan 5.4.1 provided pooled odds ratio (OR) under Hardy-Weinberg Equilibrium based on allele, additive, dominant, and recessive genetic models. Meta-regression was performed using Comprehensive Meta Analysis V3. Twenty-two studies from thirteen countries were analyzed. The recessive model suggested lower EH risk in individuals with the recessive allele (bb) of BsmI (OR: 0.81; 95%CI, 0.69 to 0.94, p = 0.007; I2 = 35%, p = 0.13). No significant associations were found for FokI, ApaI, and TaqI polymorphisms. Methodological quality significantly influenced EH risk associated with the FokI polymorphism across allele, additive, and dominant models (All p<0.0005). Male proportion influenced EH risk in the additive model for the FokI polymorphism (p = 0.0235), while age impacted risk in the recessive model (p = 0.0327). FokI polymorphism's influence on EH risk varies by sex, age, and study quality. BsmI polymorphism is independently associated with lower EH risk in recessive homozygotes, with no significant associations found for ApaI and TaqI polymorphisms.

Safety and Accuracy of Guided Interradicular Miniscrew Insertion: A Systematic Review and Meta-Analysis

Background: Achieving ideal anchorage is crucial in orthodontics for controlled tooth movement. Miniscrews (MSs) have improved skeletal anchorage, but freehand placement poses risks like root damage and limited precision. Guided techniques, including radiographic guides and computer-assisted methods (static [sCAS] and dynamic [dCAS]), were developed to enhance accuracy and safety. Objective: This systematic review and meta-analysis aimed to evaluate the safety and accuracy of MS placement using different guidance approaches. Materials: A systematic search up to March 2024 identified studies on guided MS insertion, assessing safety (root contact/damage) and accuracy (angular, coronal, and apical deviations) of guided vs. freehand placement. Two reviewers assessed the risk of bias and study quality using RoB 2 for RCTs, NOS for cohort studies, and an adapted tool for pre-clinical studies. Random-effects meta-analysis was performed for studies with common parameters, and safety outcomes were pooled using logit-transformed proportions. Heterogeneity was evaluated with I² and χ² tests. Results: Eleven studies (652 MSs) were included, though no dCAS studies were analyzed. The only RCT had "some concerns" regarding risk of bias, cohort studies ranged from medium to low quality, and most pre-clinical studies had high bias risk. sCAS significantly reduced root damage compared to freehand methods (OR = 0.11; 95% CI: 0.04-0.36; p < 0.001; I² = 1%) and reduced angular and linear deviations. Due to heterogeneity, no quantitative synthesis of accuracy outcomes was performed. Conclusions: sCAS improves the safety and accuracy of MS insertion compared to freehand and radiographic guide methods. These results highlight the clinical benefits of sCAS in orthodontics. Future studies should refine protocols and explore dCAS for further accuracy improvements.

Association of Protein Intake with Sarcopenia and Related Indicators Among Korean Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

Due to variations in the standards for optimal protein intake and conflicting results across studies for Korean older adults, this study aimed to quantitatively integrate existing research on the association of protein intake with sarcopenia and related indicators in Koreans aged 65 and older through meta-analysis.

METHODS

A total of 23 studies were selected according to the study selection criteria (PICOS). Sixteen cross-sectional studies, 5 randomized controlled trials (RCTs), and 2 non-RCTs were included in the review, with 9 out of 23 studies included in the meta-analysis. We used fixed-effects models and performed subgroup and sensitivity analyses.

RESULTS

A meta-analysis found that the risk of sarcopenia was significantly higher in the <0.8 g/kg/day protein intake group compared to the 0.8-1.2 g/kg/day and ≥1.2 g/kg/day groups, with odds ratios (ORs) of 1.25 (95% confidence interval (CI), 1.10 to 1.42; I2 = 55%) and 1.79 (95% CI, 1.53 to 2.10; I2 = 71%), respectively. For low hand grip strength (HGS), the risk was higher in the <0.8 g/kg/day group compared to the 0.8-1.2 g/kg/day or ≥1.2 g/kg/day groups (OR 1.31; 95% CI, 1.03 to 1.65; I2 = 28%). No significant associations were found with other sarcopenia indicators, such as skeletal muscle mass, short physical performance battery score, balance test, gait speed, and timed up-and-go test.

CONCLUSIONS

Lower protein intake is associated with a higher risk of sarcopenia and low HGS in Korean older adults. To establish protein intake recommendations for the prevention and management of sarcopenia in this population, further well-designed RCTs incorporating both protein supplementation and resistance training are necessary.

Elucidating the bidirectional association between autoimmune diseases and depression: a systematic review and meta-analysis

QUESTION

Collective evidence for the bidirectional association between depression and autoimmune diseases (ADs) is scarce, especially for subgroups of patients with specific ADs. We conducted a meta-analysis to determine the incidence rates and relative risks (RRs) of depression among patients with ADs, and vice versa.

STUDY SELECTION AND ANALYSIS

PubMed, Embase, Web of Science, Ovid, PsycNet and Cochrane were searched up to 10 September 2024. Cohort studies evaluating longitudinal risks between ADs and depression were included. Incidence rates and RRs of depression among patients with ADs and vice versa were pooled.

FINDINGS

The analysis included 47 studies, involving over 40.77 million participants. The pooled incidence rate of depression among patients with ADs was 6.71% (95% CI 5.10% to 8.77%), with an RR of 1.85 (95% CI 1.57 to 2.19), higher in patients aged over 45 (2.30; 95% CI 1.62 to 3.26) and females (1.88; 95% CI 1.61 to 2.20). Conversely, the pooled incidence rate of ADs among depression was 0.54% (95% CI 0.24% to 1.19%), with an RR of 1.84 (95% CI 1.10 to 3.09). The incidence rate and RRs also varied across subgroups with the highest incidence rate in the musculoskeletal system and connective tissue (1.36; 95% CI 0.50 to 3.63) and RR in the genitourinary system (2.23; 95% CI 1.98 to 2.51).

CONCLUSIONS

This study identified a bidirectional association between depression and ADs, with higher RRs among patients aged over 45 and females. Especially higher risks were also found for specific types of ADs including endocrine, nutritional, and metabolic diseases, genitourinary system, and skin and subcutaneous tissue.

PROSPERO REGISTRATION NUMBER

CRD42024541053.

Effectiveness of preoperative ketamine gargle to reduce postoperative sore throat in adult patients undergoing surgery with endotracheal tube; systematic review and meta-analysis of randomized control trials

BACKGROUND

Postoperative sore throat is a frequent and distressing complication caused by airway instrumentation during general anesthesia. The discomfort can lead to immediate distress, delayed recovery and reduce patient satisfaction. The objective of this study was to determine the effectiveness of preoperative ketamine gargle on the occurrence of postoperative sore throat among adult patients who underwent surgery under general anesthesia with endotracheal tube.

METHOD

PubMed, Cochrane Library, Google Scholar, and World Clinical Trial Registry were searched to find the eligible randomized control trials comparing the effect of preoperative ketamine gargle and placebo gargle on the occurrence of postoperative sore throat after surgery with endotracheal tube in adult patients. We utilized Review Manager Version 5.4 to perform statistical analyses. Cochrane risk of bias tool for randomized control trials was used to assess the risk of bias of included studies. We explored heterogeneity using the I2 test. In addition to this, subgroup analysis, and sensitivity analysis was conducted to confirm the robustness of findings. The risk of publication bias was tested using funnel plot Pooled risk ratio along with 95% confidence interval (CI) was used to analyze the outcome.

RESULT

In the present systematic review and metanalysis, seventeen [17] randomized controlled trials (RCTs) with 1552 participants were included. Compared with placebo, preoperative ketamine gargle is effective to reduce postoperative sore throat (RR = 0.48; 95%CI [0.45, 0.52] in adult patients undergoing surgery under general anesthesia with endotracheal tube.

CONCLUSION

Preoperative ketamine gargle before induction of general anesthesia is effective to reduce the occurrence of postoperative sore throat in adult patients undergoing surgery under general anesthesia with an endotracheal tube. Further studies with large sample size, better study quality and optimal reporting could be conducted to determine the long-term efficacy and safety of ketamine gargle in different surgical populations.

Elucidating the role of physical exercises in alleviating stroke-associated homeostatic dysregulation: a systematic review and meta-analysis

Background

This study aimed to investigate the role of physical exercises as a non-pharmacological intervention for ameliorating post-stroke dysregulated homeostatic parameters.

Methods

Embase, PubMed, PEDro, ISI Web of Science and CENTRAL were searched until April 2024. Parallel randomised controlled trials (RCTs) analysing the effect of post-stroke physical exercises (PSPE) on homeostatic parameters such as blood glucose, oxygen consumption (VO2), high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic (SBP) and diastolic blood pressure (DBP) in individuals with stroke were selected.

Results

Sixteen RCTs (n=698) were included. PSPE reduced fasting glucose levels (MD=-0.22; 95% CI -0.22 to -0.02; p=0.00) and increased the VO2 (MD=2.51; 95% CI 1.65 to 3.37; p=0.00) and blood HDL levels (MD=0.07; 95% CI 0.00 to 0.13; p=0.00). However, we did not observe beneficial effects on LDL, SBP and DBP parameters. Further analyses demonstrated that both low and moderate exercises are more suitable for improving blood glucose and VO2 in this population.

Discussion

PSPE have the potential to improve dysregulated post-stroke parameters by reducing blood glucose levels and increasing VO2 and HDL levels. However, the small size and limited number of included studies limited the precision of our results. Further research is needed to comprehensively analyse the effects of PSPE, particularly on LDL levels and blood pressure.

PROSPERO registration number

CRD42023395715.

A Meta-Analysis on the Antimicrobial Effectiveness of Ozonated Water Treatments for Fresh Produce Washing-Effect of Ozonation Methods

Due to the lack of a pathogen-killing process, foodborne outbreaks from contaminated fresh produce have been increasing worldwide. Hence, it is increasingly recognized that the washing step with sanitizers is important to control microbial contamination. Ozonated water is suggested as a substitute for chlorine-based sanitizers, addressing concerns about the effectiveness and environmental impact of chlorine-based sanitizers. However, using ozone as a sanitizer in the fresh produce washing process is still challenging because of its unstable and inconsistent antimicrobial effectiveness under various testing conditions. A meta-analysis was focused on the comparison of antimicrobial effectiveness between different ozonation methods commonly adopted in laboratory settings, including stationary pre-ozonated water, agitated pre-ozonated water, and sparging. The meta-analysis showed that the sparging method results in the highest microbial log reduction compared to other methods. We further developed meta-regression models based on three ozonation methods to identify key processing variables influencing the antimicrobial effectiveness of ozonated water. Attempts were made to link key processing variables to ozone stability and the mass transport phenomena involved in the washing process. This research will contribute to designing and developing a washing process to increase fresh produce safety by identifying key factors in each ozonation method and facilitate interlaboratory comparison studies.

Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials

BACKGROUND

Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.

METHODS

Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving intravenous iron supplementation and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.

RESULTS

Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65-0.91, P=0.002, n=1955, I2=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4-10 (mean difference 0.17 g dl-1, 95% CI 0.06-0.29, n=1989) and >21 days (mean difference 0.66 g/dl-1, 95% CI 0.36-0.95, n=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4-10. There were no significant differences in other outcomes, including mortality.

CONCLUSIONS

Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.

SYSTEMATIC REVIEW PROTOCOL

CRD42024542206 (PROSPERO).

The clinical efficacy of powder air-polishing in the non-surgical treatment of peri-implant diseases: A systematic review and meta-analysis

Peri-implant diseases, characterized by inflammatory conditions affecting peri-implant tissues, encompass peri-implant mucositis and peri-implantitis. Peri-implant mucositis is an inflammatory lesion limited to the mucosa around an implant, while peri-implantitis extends from the mucosa to the supporting bone, causing a loss of osseointegration. For non-surgical treatments, we tested the null hypothesis that the presence or absence of air-polishing made no difference. The study focused on randomized controlled trials (RCTs) comparing air-polishing with mechanical or ultrasonic debridement, evaluating outcomes such as bleeding on probing (BOP), probing depth (PD), plaque index/plaque score (PI/PS), clinical attachment level (CAL), bone loss, and mucosal recession (MR). Two independent reviewers conducted data extraction and quality assessments, considering short-term (<6 months) and long-term (≥6 months) follow-up periods. After screening, ten articles were included in the meta-analysis. In nonsurgical peri-implant disease management, air-polishing moderately mitigated short-term PI/PS for peri-implant mucositis and showed a similar improvement in long-term BOP and bone loss for peri-implantitis compared to the control group. The Egger test found no evidence of publication bias except for the long-term PI/PS of peri-implant mucositis. Leave-one-out analysis confirmed the stability of the results. The findings highlight the need for future research with longer-term follow-up and high-quality, multi-center, large-sample RCTs.

Genetic insights into litter size in goats: A meta-analysis of KISS1 and BMP15 SNP variants

Litter size is a key trait in livestock breeding. The BMP15 and KISS1 genes have been studied in goats, but results on their association with litter size are inconsistent. The objective of this study was to employ a meta-analysis approach to investigate the genetic relationship between the BMP15 (g.735 G>A) and KISS1 (g.2540 C>T and g.2510 G>A) genes and litter size in goats. A total of five studies (including 12 breeds) were included for the g.735 G>A mutation, three studies (including nine breeds) for g.2540 C>T, and two studies (including six breeds) for g.2510 G>A in this meta-analysis. The meta-analysis was conducted under four different genetic models: recessive (GG + AG vs. AA), dominant (GG vs. AG + AA), additive (GG vs. AA) and codominant (GG + AA vs. AG) models of inheritance. Data were analyzed under either random or fixed effects models based on the estimates of I2 estimates. A sensitivity analysis was performed by removing one study at a time to determine the stability of the overall results. Funnel plots and the Egger regression tests were also used to assess the publication bias among studies. Significant associations (P< 0.05) were observed between the g.2540 C>T and g.2510 G>A loci and litter size in goats under the additive (SMD = -0.469, 95 % CI = -0.908 to -0.030, P-value = 0.036) and codominant (SMD = 0.147, 95 % CI = 0.003-0.291, P = 0.046) genetic models, respectively. Our results did not identify any significant association between g.735 G>A of BMP15 and litter size under the investigated genetic models.

Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials

Background

International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain.

Methods

Five databases (including MEDLINE, Embase, CINAHL, CENTRAL and PEDro were searched from inception until 22nd August 2024. Randomised controlled trials (RCTs) that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (>3 months but <12 months). The taxonomy recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group was used to categorise implementation strategies. Meta-analysis with a random-effects model was conducted where possible. This systematic review was prospectively registered in PROSPERO (registration number: CRD42023452969).

Findings

Twenty-seven RCTs with 32 reports were included. All strategies targeted healthcare professionals (7796 health professionals overseeing 34,890 patients with low back pain), and none targeted organisations. The most commonly used implementation strategies were educational materials (15/27) and educational meetings (14/27), although most studies (24/27) used more than one strategy ('multifaceted strategies'). In the medium-term, compared to no implementation, implementation strategies probably reduced the use of routine imaging (number of studies [N] = 7, odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.01-1.58, I 2  = 50%, moderate certainty evidence), but made no difference in reducing analgesic use (N = 4, OR = 1.05, 95% CI: 0.96-1.14, I 2  = 0%, high certainty evidence). Further, implementation strategies may make no difference to improve the rate of providing education/advice (N = 3, OR = 1.83, 95% CI: 0.87-3.87, I 2  = 95%, low certainty evidence), but this finding should be interpreted with caution because the sensitivity analysis showed a weak positive finding indicating unstable results that are likely to change with future research (N = 2, OR = 1.18, 95% CI: 1.04-1.35, I 2  = 0%, moderate certainty evidence). No difference was found when comparing one implementation strategy to another in the medium-term.

Interpretation

Implementing guideline recommendations delivered mixed effects in promoting guideline-concordant care for low back pain management.

Funding

There was no funding source for this review.

Body mass index and weight loss as risk factors for poor outcomes in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis

OBJECTIVE

The association between nutritional status and prognosis of idiopathic pulmonary fibrosis (IPF) remains unclear. This systematic review and meta-analysis aimed to explore the effect of body mass index (BMI) and weight loss on the prognosis of IPF patients.

METHODS

We accumulated studies on IPF, BMI, and weight loss from databases including PubMed, Embase, Web of science, Scopus, Ovid and Cochrane Library up to 4 August 2023. Using Cox proportional hazard regression model for subgroup analysis, hazard ratio (HR) and 95% confidence intervals (CI) for BMI in relation to mortality, acute exacerbation (AE), and hospitalization in IPF patients were calculated, and HR, odds ratio (OR), and 95% CI for weight loss corresponding to IPF patient mortality were assessed. Sensitivity analysis was peformed by eliminating every study one by one, and publication bias was judged by Egger's test and trim-and-fill method.

RESULTS

A total of 34 eligible studies involving 18,343 IPF patients were included in the meta-analysis. The pooled results by univariate Cox regression analysis showed that baseline BMI was a predictive factor for IPF mortality (HR = 0.93, 95%CI = [0.91, 0.94]). Furthermore, the results by the multivariable regression model indicated that baseline BMI was an independent risk factor for predicting IPF mortality (HR = 0.94, 95%CI = [0.91, 0.98]). Weight loss was identified as a risk factor for IPF mortality (HR = 2.74, 95% CI = [2.12, 3.54]; OR = 4.51, 95% CI = [1.72, 11.82]) and there was no predictive value of BMI for acute exacerbation (HR = 1.00, 95% CI= [0.93, 1.07]) or hospitalization (HR = 0.95, 95% CI = [0.89, 1.02]).

CONCLUSION

Low baseline BMI and weight loss in the course of IPF may indicate a high risk of mortality in patients with IPF, so it is meaningful to monitor and manage the nutritional status of IPF patients, and early intervention should be conducted for low BMI and weight loss.

The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis

Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.

A dose-response meta-analysis of the relationship between number of pregnancies and risk of gynecological cancers

BACKGROUND

Despite several investigations, the association between the number of pregnancies and gynecological cancers remains inconclusive. To address this issue, we conducted a dose-response meta-analysis of observational studies.

METHODS

We searched PubMed, Web of Science, and Scopus databases up to Jun 8, 2023, to identify observational studies that examined the association between the number of pregnancies and gynecologic cancers. To assess the heterogeneity across studies, we used the χ2 test and I2 statistics. We also explored the possibility of publication bias using Begg's and Egger's tests. The overall effect sizes were reported as odds ratios (ORs) with a 95% confidence interval (CI) using a random-effects model.

RESULTS

Out of the 87,255 studies initially identified, a total of 101 studies involving 8,230,754 participants were included in the final meta-analysis. Our analysis revealed a positive trend between the number of pregnancies and cervical cancer; however, this association was not found to be statistically significant except for fifth pregnancy. Conversely, our findings showed a significant decreasing trend between the number of pregnancies and the risk of endometrial and ovarian cancers. There was insufficient evidence to establish a relationship between the number of pregnancies and the risk of vaginal, vulvar, and fallopian tube cancers.

CONCLUSIONS

Our study found a positive trend between the number of pregnancies and cervical cancer and a significant decreasing trend between the number of pregnancies and endometrial and ovarian cancers. These findings may have implications for counseling women about their reproductive health and the potential risks and benefits of pregnancy.

A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers

OBJECTIVES

Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.

METHODS

We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2-statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio or odds ratio, accompanied by a 95% confidence interval (CI), using a random-effects model.

RESULTS

From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50 to 0.59) for cervical cancer, 0.82 (95% CI, 0.77 to 0.88) for ovarian cancer, and 0.96 (95% CI, 0.89 to 1.04) for uterine cancer.

CONCLUSIONS

Our findings suggest that experiencing one's initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.

Elevated serum lipoprotein(a) levels as a potential risk factor for diabetic retinopathy in type 2 diabetes: a meta-analysis

PURPOSE

This meta-analysis aimed to clarify the correlation between serum lipoprotein(a) [Lp(a)] levels and diabetic retinopathy (DR) in type 2 diabetes (T2D) individuals.

METHODS

We searched electronic databases, including PubMed, Web of Science, and Embase, for relevant observational studies evaluating the association between serum Lp(a) levels and the risk of DR. Odds ratios (ORs) with 95% confidence intervals (CIs) were summarized to indicate the association between a high Lp(a) and the risk of DR. Data were extracted and pooled using a random-effects model to account for variability among studies. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated through funnel plots and Egger's test.

RESULTS

Eleven observational studies were included. Compared to T2D patients of the lowest Lp(a) category, those of the highest Lp(a) category were associated with a higher risk of DR (OR: 2.05, 95% CI: 1.43-2.93, I2 = 83%, p < 0.001). Subgroup analyses suggested this association was predominantly observed in cross-sectional and case-control studies but not cohort studies (p for subgroup differences = 0.03). Additionally, the link between Lp(a) and DR was consistent across variables such as study country, Lp(a) cutoff values, analysis model (univariate or multivariate), and adjustment for concurrent medication use. A further meta-analysis suggested a significant relationship between elevated Lp(a) levels and proliferative DR (OR: 1.90, 95% CI: 1.03-3.48, I2 = 86%, p = 0.04).

CONCLUSION

Elevated serum Lp(a) levels are associated with an increased risk of DR in individuals with T2D.

Adequate antenatal care service utilizations after the onset of COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Background

The world faces great difficulty in continuing to provide essential maternity health care after the onset of COVID-19 pandemic Many women have trouble accessing maternity healthcare due to fear of infection. A decline in the utilization of maternity health services is suggested to worsen adequate antenatal care service utilization. Thus, this study aimed to determine the pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 in Ethiopia.

Methods

The searching of articles was carried out on Web of Science, Scopus, PubMed, CINHAL, Google Scholar, African journals online, and the institutional repository of Ethiopian universities. Using a Microsoft Excel standardized spreadsheet, the data were extracted. A random effect model was used to determine a pooled estimate of adequate antenatal care utilization. I 2 statistics were used to quantify the amount of heterogeneity. The evidence of publication bias was examined using Egger's regression test and a visual inspection of the funnel plot. Subgroup and sensitivity analyses were also carried out.

Results

Finally, this systematic review and meta-analysis included 11 eligible articles. The overall pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 pandemic in Ethiopia was 46.28% (95% CI: 35.32%-57.26%). There is a substantial amount of heterogeneity between studies (I 2 = 99.07%, p < 0.001). Pregnant women who visited antenatal care early were 10.9 times more likely to have adequate antenatal care utilization than those without early visits (AOR = 10.93, 95% CI: 7.2-14.66).

Conclusion

In this review, the percentage of women who utilized adequate antenatal care after the onset of COVID-19 pandemic in Ethiopia was less than half. Early antenatal care visit is an important factor to achieve adequate antenatal care service utilizations.

Systematic review registration

: CRD42023495279.

The clinical efficacy of laser in the nonsurgical treatment of peri-implantitis: a systematic review and meta-analysis

OBJECTIVE

To systematically assess studies regarding the efficacy of lasers in the nonsurgical treatment of peri-implantitis.

METHODS

Electronic and manual searches were performed by two reviewers independently. Randomized controlled trials (RCTs) comparing lasers vs. mechanical debridement or air abrasive on primary outcome (probing depth (PD)) and secondary outcomes (bone loss, bleeding on probing (BOP), clinical attachment level (CAL) and plaque index (PI)) were included. Data extraction and quality assessment were conducted independently. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. Publication bias, leave-one-out analysis and GRADE assessment were conducted.

RESULT

13 eligible publications were included in the review and 12 in the meta-analysis. Solid-state lasers significantly improved in PD (WMD = -0.39, 95% CI (-0.70, -0.09), p = 0.01, moderate-certainty evidence), BOP (SMD =-0.76, 95% CI (-1.23, -0.28), p = 0.002, moderate-certainty evidence) and CAL (WMD =-0.19, 95% CI (-0.39, -0.00), p = 0.05, moderate-certainty evidence), but not in bone loss (WMD = 0.03, 95% CI (-0.13, 0.18), p = 0.74, low-certainty evidence) and PI (SMD =-0.19, 95% CI (-0.42, 0.04), p = 0.11, moderate-certainty evidence) compared with the control group. However, the diode lasers showed no clinical advantages. No publication bias was detected, and leave-one-out analysis confirmed the robustness of findings.

CONCLUSION

In the nonsurgical treatment of peri-implantitis, solid-state lasers yielded positive influence in term of PD, BOP and CAL, while diode laser provided no beneficial effect. Future well-designed large RCTs are still needed, considering the limitations of included studies.

CLINICAL RELEVANCE

This review aimed to guide clinicians in choosing the appropriate laser for peri-implantitis, enhancing treatment strategies and attaining better outcomes.

Comparison of Therapeutic Effects Between Pulsed Field Ablation and Cryoballoon Ablation in the Treatment of Atrial Fibrillation: A Systematic Review and Meta-analysis

Pulsed field ablation (PFA) is a novel nonthermal ablation technique for the treatment of atrial fibrillation (AF) patients, with safety comparable to traditional catheter ablation surgery. The present study aims to evaluate and compare the procedural efficiency and safety profiles of PFA and cryoballoon ablation (CBA) in the management of AF. We performed a systematic search across PubMed, the Cochrane Library, and Embase databases, encompassing the literature up to February 2024, to inform our systematic review and meta-analysis. When assessing outcome indicators, the risk ratio and its corresponding 95% confidence interval (CI) were calculated for dichotomous variables. For continuous variables, the mean difference (MD) and the associated 95% CI were determined. In this scenario, a relative risk (RR) value of less than 1 and an MD value of less than 0 are deemed favorable for the PFA group. This could translate to a reduced likelihood of procedural complications or enhanced procedural performance within the PFA group. In this analysis, 9 observational studies encompassing 2875 patients with AF were included. Among these, 38% (n = 1105) were treated with PFA, while 62% (n = 1770) received CBA. The results indicated that PFA was associated with a significantly shorter procedural duration compared with CBA, with an MD of -10.49 minutes (95% CI, -15.50 to -5.49; P < 0.0001). Nevertheless, no statistically significant differences were observed when comparing the 2 treatment cohorts concerning fluoroscopy time (MD, 0.71; 95% CI, -0.45 to 1.86; P = 0.23) and the recurrence of atrial arrhythmias during follow-up (RR, 0.95; 95% CI, 0.78-1.14; P = 0.57). In terms of perioperative complications, the PFA group showed a significantly decreased risk of phrenic nerve palsy (RR, 0.15; 95% CI, 0.06-0.39; P < 0.0001) and an increased risk of cardiac tamponade (RR, 3.48; 95% CI, 1.26-9.66; P = 0.02) compared with the CBA group. No significant differences were noted between the PFA and CBA groups regarding the incidence of stroke/transient ischemic attack (RR, 0.99; 95% CI, 0.30-3.22; P = 0.99), vascular access complication (RR, 0.87; 95% CI, 0.36-2.10; P = 0.76), atrial esophageal fistula (RR, 0.33; 95% CI, 0.01-8.13; P = 0.50), and major or minor bleeding events (RR, 0.39; 95% CI, 0.09-1.74; P = 0.22). Our research results indicate that compared with CBA, PFA not only shortens the procedure time but also demonstrates noninferiority in terms of fluoroscopy duration and the recurrence rate of atrial arrhythmias. PFA and CBA have both demonstrated their respective advantages in perioperative complications.

Impact of Antenatal Corticosteroids on Cortisol and Glucose Homeostasis Levels in Preterm Neonates: A Meta-Analysis

Antenatal corticosteroids (ACS) are widely used to reduce respiratory distress syndrome (RDS) in preterm neonates, enhancing neonatal outcomes. However, the potential effects of ACS on other aspects of neonatal health, such as cortisol levels and glucose regulation, remain a concern. This study examines whether ACS administration impacts cortisol and glucose homeostasis in preterm infants by analyzing data from 14 selected studies. Using a random-effects model, we found no significant impact of ACS on cortisol levels (mean differences (MD) 2.23, confidence interval (CI) 5.26 to -0.80) or blood glucose levels (standard mean differences (SMD) 0.18, CI 0.00 to 0.35). Additionally, there was no notable difference in hypoglycemia risk between groups receiving ACS and those unexposed (odds ratio (OR) 1.46, CI 0.99 to 2.17). Subgroup and sensitivity analyses reinforced these findings, underscoring their robustness, and risk-of-bias assessment confirmed a low risk across the included studies. Our findings support the safety of ACS for cortisol and glucose levels in preterm infants, affirming its continued use for lung development while recommending vigilant blood glucose monitoring to manage potential hypoglycemia. These results provide essential insights for neonatal care protocols, contributing to the overall welfare of premature infants.

Effects of Yi Jin Jing on enhancing muscle strength and physical performance in older individuals: a systematic review and meta-analysis

Background

The aging population is rapidly increasing, leading to physical decline and higher risks of chronic diseases, including sarcopenia, which adversely affects muscle quality and strength. Yi Jin Jing (YJJ), a traditional Chinese exercise method, can enhance flexibility and strength, but evidence regarding its effectiveness in older adults is conflicting. This meta-analysis aims to systematically evaluate the effects of YJJ on muscle strength and physical performance in this demographic.

Methods

We searched seven electronic databases: China National Knowledge Infrastructure, Wanfang Data, Sinomed, Web of Science, PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs). Following PRISMA guidelines, we quantified the effects of YJJ on muscle strength (grip strength, isokinetic strength) and physical performance (chair sit-to-stand, squatting-to-standing, shoulder flexibility, sit-and-reach tests). Treatment effects were calculated using Hedges'g. The Cochrane tool assessed risk of bias, the PEDro scale evaluated methodological quality, and the GRADE method assessed evidence quality. Data analysis was conducted using Stata 17.0 software, utilizing standardized mean differences (SMD) and 95% confidence intervals (CIs).

Results

This meta-analysis included 10 RCTs involving 590 participants. The overall risk of bias was assessed to be low. The methodological quality of these studies was generally moderate, and the quality of the main results varied from low to moderate. The findings revealed that YJJ had considerable effects on the chair sit-to-stand test (Hedges'g = 1.06), squatting-to-standing test (Hedges'g = 1.08), and small to moderate effects on handgrip strength (Hedges'g = 0.25), 60°/s extensor peak torque (Hedges'g = 0.47), 60°/s extensor average power (Hedges'g = 0.31), 60°/s extensor total work (Hedges'g = 0.29), 60°/s flexor peak torque (Hedges'g = 0.42), 60°/s flexor average power (Hedges'g = 0.37), and 180°/s extensor peak torque (Hedges'g = 0.29), and left shoulder flexibility (Hedges'g = 0.4). However, there were no significant improvement effects in 180°/s extensor average power (Hedges'g = 0.19), 180°/s extensor total work (Hedges'g = 0.11), 180°/s flexor peak torque (Hedges'g = 0.01), 180°/s flexor average power (Hedges'g = -0.08), right shoulder flexibility (Hedges'g = 0.09), and sit-and-reach test (Hedges'g = 0.15).

Conclusion

YJJ significantly enhances specific aspects of physical performance, particularly chair sit-to-stand and squatting-to-standing tests, while showing small and moderate improvements in handgrip strength and knee muscle strength. However, it had no significant effects on other metrics, including shoulder flexibility and sit-and-reach tests.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530487, Registration number: CRD42024530487.

The effects of deep brain stimulation on sleep: a systematic review and meta-analysis

Background

Deep brain stimulation (DBS) is a standard treatment for movement disorders, epilepsy, and others, yet its influence on postprocedural sleep quality remains an under-researched topic.

Study Objectives

We performed a systematic review and meta-analysis of all DBS effects on sleep.

Methods

The use of preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) was utilized. We extracted demographic data, disease type/duration, DBS target, stimulation laterality (unilateral vs bilateral), follow-up lengths, and sleep pre/post-op measurements with polysomnography or across four standard sleep scales. The Cochrane methodology for evaluating RCTs was employed using the risk of bias assessments, data synthesis, and statistical methods, including forest plots (risk ratio; M-H random effects; 95% CI).

Results

Sixty-three studies were included in the overall analysis, representing 3022 patients. In a subgroup meta-analysis of subthalamic nucleus (STN) DBS for Parkinson's disease (PD), patients showed significant sleep improvement at three but not 12 months postoperatively with PDSS, at 12 but not 3 months with Epworth sleep scale, and at 6 months with nonmotor symptom scale. Pittsburgh sleep quality index (PSQI) showed no significant improvement in sleep at any time. Bilateral DBS showed significantly more improvement than unilateral DBS in the PSQI at 6 but not 3 months. Polysomnography showed significant sleep improvement at 1 week but not at 3 or 6 months. Most studies showed no significant sleep improvement for globus pallidus internus, centromedian thalamus, and ventral intermediate nucleus DBS.

Conclusions

STN-DBS for PD likely improves sleep; however, significant standardization in sleep scale outcome reporting and follow-up time is needed to effectively determine the target-dependent effects of DBS surgery on sleep.

Association between serum neuron-specific enolase at admission and the risk of delayed neuropsychiatric sequelae in adults with carbon monoxide poisoning: A meta-analysis

Delayed neuropsychiatric sequelae (DNS) significantly impact the quality of life in patients following acute carbon monoxide poisoning (COP). This systematic review and meta-analysis aimed to assess the relationship between serum neuron-specific enolase (NSE) levels at admission and the risk of DNS in adults after acute COP. Relevant observational studies with longitudinal follow-up were identified through searches in PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure databases. The random-effects model was used to aggregate results, accounting for potential heterogeneity. Nine cohort studies, including 1501 patients, were analyzed, with 254 (16.9%) developing DNS during follow-up. The pooled data indicated that elevated serum NSE in the early phase was linked to a higher risk of subsequent DNS (odds ratio per 1 ng/mL increase in NSE: 1.10, 95% confidence interval: 1.06 to 1.15, P < 0.001). Moderate heterogeneity (I2 = 46%) among the studies was entirely attributed to one study with the longest follow-up duration (22.3 months; I2 = 0% after excluding this study). Subgroup analyses based on country, study design, sample size, age, sex, admission carboxyhemoglobin levels, DNS incidence, follow-up duration, and quality score yielded consistent results (P for subgroup differences all > 0.05). In summary, high serum NSE levels in the early phase of acute COP are associated with an increased risk of developing DNS during follow-up.

Association between serum galectin-3 and chronic obstructive pulmonary disease: A meta-analysis

Chronic obstructive pulmonary disease (COPD) is a significant public health issue characterized by progressive and irreversible airflow limitation. The aim of this meta-analysis was to determine the association between changes in serum galectin-3 levels and COPD and to assess the relationship between serum galectin-3 levels and acute exacerbations of COPD (AECOPD). Relevant observational studies were retrieved from electronic databases, including PubMed, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI). A random-effects model was used to combine the data, incorporating the influence of between-study heterogeneity. Twelve case-control studies were included. The pooled results showed a significantly higher serum level of galectin-3 in patients with COPD compared to controls (standardized mean difference [SMD] 0.60; 95% confidence interval [CI] 0.40 - 0.80; P < 0.001; I2 = 68%). Further meta-analysis suggested higher levels of serum galectin-3 in patients with AECOPD compared to those with stable COPD (SMD 0.33; 95% CI 0.20 - 0.46; P < 0.001; I2 = 0%). Subgroup analyses according to the mean age of the participants, the proportion of males, and study quality scores did not significantly change the results (P for subgroup differences all > 0.05). In conclusion, patients with COPD were found to have higher serum levels of galectin-3, with levels further elevated in patients with AECOPD compared to those with stable COPD.

Circulating soluble suppression of tumorigenicity-2 and the recurrence of atrial fibrillation after catheter ablation: A meta-analysis

Soluble suppression of tumorigenicity-2 (sST-2), a marker of myocardial fibrosis and remodeling, has been related to the development of atrial fibrillation (AF). The aim of this meta-analysis was to evaluate the relationship between baseline serum sST-2 levels and the risk of AF recurrence after ablation. Relevant observational studies were retrieved from PubMed, Web of Science, Embase, Wanfang and China National Knowledge Infrastructure (CNKI). A random-effects model was used to combine the data, accounting for between-study heterogeneity. Fourteen prospective cohorts were included. Pooled results showed higher sST-2 levels before ablation in patients with AF recurrence compared to those without AF recurrence (standardized mean difference = 1.15, 95% confidence interval [CI] = 0.67 to 1.63, P < 0.001; I2 = 92%). Meta-regression analysis suggested that the proportion of patients with paroxysmal AF (PaAF) was positively related to the difference in serum sST-2 levels between patients with and without AF recurrence (coefficient = 0.033, P < 0.001). Subgroup analysis showed a more remarkable difference in serum sST-2 levels between patients with and without AF recurrence in studies where PaAF was ≥ 60% compared to those where it was < 60% (P = 0.007). Further analyses showed that high sST-2 levels before ablation were associated with an increased risk of AF recurrence (odds ratio [OR] per 1 ng/mL increment of sST-2 =1.05, OR for high versus low sST-2 = 1.73, both P values < 0.05). In conclusion, high sST-2 baseline levels may be associated with an increased risk of AF recurrence after catheter ablation.

Association between early exposure to famine and risk of renal impairment in adulthood: a systematic review and meta-analysis

Malnutrition early in life increases the later-life risk of noncommunicable diseases, and previous epidemiologic studies have found a link between famine and renal impairment, but no consensus has been reached. This meta-analysis and systematic review were conducted to assess the correlation between early-life famine exposure and the risk of developing renal impairment. Search in Embase, Scopus, Web of Science, PubMed, and Cochrane using keywords that report the correlation between early famine exposure and renal function indicators. RevMan and Stata software were used for data analysis. This meta-analysis contained twelve observational studies. The findings demonstrated a link between prenatal famine exposure and a higher risk of developing chronic kidney disease (CKD) (odds ratio (OR) = 1.73, 95% confidence interval (CI): 1.25, 2.39), a decreased estimated glomerular filtration rate (eGFR) (mean difference (MD) = -10.05, 95% CI: -11.64, -8.46), and increased serum creatinine (Scr) (MD = 0.02, 95% CI: 0.01, 0.03) compared to unexposed individuals. Famine exposure in childhood was associated with decreased eGFR (MD = -9.43, 95% CI: -12.01, -6.84) and increased Scr (MD = 0.03, 95% CI: 0.01, 0.04), but not with CKD (OR = 0.980, 95% CI: 0.53, 1.81). Famine exposure in adolescence and adulthood was associated with decreased eGFR (MD = -20.73, 95% CI: -22.40, -19.06). Evidence certainty was deemed to be of low or extremely low quality. Famine exposure early in life could pose a greater risk of developing renal impairment in adulthood, but this outcome may be driven by uncontrolled age differences between famine-births and post-famine-births (unexposed).