The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

The efficacy of platelet-rich plasma (PRP) alone or in combination with low intensity shock wave therapy (Li-SWT) in treating erectile dysfunction: a systematic review and meta-analysis of seven randomized controlled trials

BACKGROUND

The goal of this meta-analysis intended to identify the efficacy of platelet-rich plasma (PRP) alone or in combination with low intensity shock wave therapy (Li-SWT) as a therapy for erectile dysfunction (ED).

METHODS

This study integrated and analyzed the data using Cochrane method and GRADEpro GDT grading system. The registration number for this study was CRD42024618240.

RESULT

Seven randomized controlled trials with 660 patients were analyzed. The results indicated that compared with the control group, IIEF score of patients in the PRP group improved significantly at 12-week (p = 0.03) and 24-week (p = 0.0004), while there was no significant difference at 4-week. The PRP group had no significant advantages over the control group in terms of MCID and SEP Q3. For peak systolic velocity, patients in the PRP group demonstrated greater improvement than those in the control group (p < 0.00001). Subgroup analysis revealed that adding PRP regimen can considerably improve IIEF scores of ED patients compared to using Li-SWT alone (p < 0.0001).

CONCLUSION

PRP demonstrated a better efficacy in treating ED, especially during a follow-up period of 6 months. Compared with using Li-SWT alone, the addition of PRP can considerably improve the IIEF score of ED patients. These findings still required large-scale clinical trials for verification.

Improvement of endocrine and metabolic conditions in patients with polycystic ovary syndrome through acupuncture and its combined therapies: a systematic review and meta-analysis

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age that significantly impacts their reproductive health. Acupuncture and its combined therapies may have beneficial effects on the endocrine and metabolic states of women with PCOS. This systematic review and meta-analysis evaluated the treatment effects and potential mechanisms of acupuncture and its combined therapies compared to oral metformin in treating PCOS patients.

METHODS

The evaluation focused on three sets of outcomes: hormonal indicators, metabolic indicators, and body weight indicators. Studies that involved additional therapies beyond the specified interventions or included patients with other diseases were excluded. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved, and the Apriori algorithm to perform association rule analysis for the most effective interventions.

RESULTS

The study included 46 articles (51 studies) involving six interventions: acupuncture combined with metformin, acupuncture treatment, acupuncture with Chinese herbal medicine and metformin, acupuncture with Chinese herbal medicine, acupuncture combined with cupping, and auricular acupuncture combined with metformin showed significant improvements in all evaluated indicators. Data mining revealed the Stomach meridian of foot yangming was the most frequently used, and the most commonly used combination of points included CV4, SP6, and ST36.

CONCLUSIONS

This study suggests that acupuncture and its combined therapies may benefit PCOS. However, risk of bias and heterogeneity observed were noted. Future high-quality, rigorously designed randomized controlled trials are needed to confirm these findings and provide stronger clinical recommendations for acupuncture in PCOS treatment.

Efficacy and safety of intensive blood pressure control in patients over 60 years: A systematic review and meta-analysis

OBJECTIVES

To evaluate the efficacy and safety of intensive blood pressure control in patients over 60 years.

METHODS

Databases including PubMed, Embase and Cochrane library were searched from inception through February 1, 2024. Randomized controlled trials evaluating the efficacy or safety of intensive blood pressure control in patients over 60 years were included in the meta-analysis.

RESULTS

Intensive blood pressure control in individuals with mild hypertension has been shown to reduce the risk of heart failure, stroke, myocardial infarction, major cardiovascular events, cardiovascular mortality, and all-cause mortality. The benefits of intensive blood pressure control in patients with moderate to severe hypertension are comparable to those observed in individuals with mild hypertension, with the exception of a reduced impact on all-cause mortality and cardiovascular mortality. Compared with maintaining systolic blood pressure (SBP) above 140 mmHg, SBP below 140 mmHg is associated with a decreased risk of major cardiovascular events in patients aged over 70, as well as a reduced risk of stroke in patients aged 60-69. Furthermore, compared to maintaining SBP above 130 mmHg, SBP below 130 mmHg is linked to a lower risk of major cardiovascular events, heart failure and myocardial infarction in patients over 60, a reduced risk of stroke and cardiovascular mortality in patients aged 60-69, and a decreased risk of all-cause mortality in patients over 70. However, a lower baseline blood pressure or more aggressive blood pressure control may be associated with an increased risk of hypotension.

CONCLUSIONS

Patients with hypertension aged over 60 years can derive benefits from intensive blood pressure management without experiencing significant adverse events, aside from hypotension.

The efficacy of combined phototherapy with topical therapy in vitiligo: a network meta-analysis

BACKGROUND

The comparative effects of phototherapy and topical therapy in patients with vitiligo remain unclear. A network meta-analysis (NMA) was conducted to assess which combination therapy was more beneficial for patients with vitiligo.

METHODS

This study analyzed phototherapy, including narrowband ultraviolet B (NB-UVB) and 308-nm excimer laser/light (EL) combined with topical therapies. Randomized controlled trials were sourced from PubMed, Embase, and Cochrane Library. Data analysis was based on a random-effects model, and surface under the cumulative ranking (SUCRA) curves employed to assess the efficacy of the interventions.

RESULTS

This NMA included 27 trials, with a total of 2417 lesions (patches). According to the results of the SUCRA, for achieving ≥50% repigmentation, the top three combination therapies were phototherapy combined with antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5), while for ≥75% repigmentation, the leading therapies were phototherapy combined with antioxidants (SUCRA 89.0), calcineurin inhibitors (SUCRA 70.3), and fractional CO2 laser (SUCRA 63.6).

CONCLUSIONS

This meta-analysis suggests that combining phototherapy with topical antioxidants, corticosteroids, or calcineurin inhibitors may offer superior outcomes for vitiligo patients. This study provides a reference for clinicians to develop personalized treatment plans for patients with vitiligo.

Antrum Preservation Versus Antrum Resection in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

To compare the effects of laparoscopic sleeve gastrectomy (LSG) with antrum preservation (AP) and antrum resection (AR) on weight loss and postoperative complications.

METHODS

A meta-analysis of randomized controlled trials (RCTs) followed PRISMA guidelines. The databases searched included PubMed, Web of Science, Embase Medline, and the Cochrane Library up to October 2022. Extracted data included operation time, hospital stay, excess weight loss, total weight loss, body mass index (BMI), weight, and complications.

RESULTS

Eleven RCTs were included with 843 patients: 422 with AR and 421 with AP. The AR group exhibited higher total weight loss at 3 months (p = 0.02), 6 months (p < 0.001), and 1 year (p < 0.001) postoperatively. They also showed greater excess weight loss at 6 months (p < 0.001), 1 year (p < 0.001), and 2 years (p = 0.03). BMI reduction was more significant in the AR group at 3 (p = 0.007) and 6 months (p < 0.001). The AR group lost weight more rapidly at 3 months (p = 0.05), 6 months (p = 0.04), and 1 year (p < 0.001). No significant differences were found in operation time, hospital stay, bleeding, staple line disruption, Clavien-Dindo complications, or remission rates of diabetes, hypertension, arthritis/back pain, hyperlipidemia, or gastroesophageal reflux disease (p > 0.05).

CONCLUSION

LSG with AR offers better short-term weight loss than AP without increasing surgical complications, but the long-term effects and complications need further investigation in larger RCTs.

Efficacy and safety of compound glycyrrhizin in patients with alopecia areata: a systematic review and meta-analysis

BACKGROUND

Although compound glycyrrhizin (CG) has been widely used to alopecia areata (AA) in China, its efficacy and safety remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of CG for AA.

MATERIALS AND METHODS

Eight literature databases were retrieved from their inceptions to 29 February 2024 to identify the eligible randomized controlled trials comparing CG plus conventional treatments with conventional treatments alone for the treatment of AA. Risk ratio (RR), mean difference and 95% confidence interval (CI) were used to estimate the pooled results. RevMan 5.4 (Cochrane Collaboration, Copenhagen, Denmark) and Stata 12.0 software (StataCorp., College Station, TX) were used for statistical analysis.

RESULTS

A total of 23 eligible studies with 2219 patients were included. The pooled results revealed that CG plus conventional treatments was superior to conventional treatments alone in cure rate (RR = 1.60, 95%CI [1.47, 1.74], p < .001), total efficacy rate (RR = 1.37, 95%CI [1.29, 1.45], p < .001) and the Severity of Alopecia Tool (SALT) score, regardless of different conventional treatments, treatment courses and doses of CG. In terms of safety, a few patients suffered from adverse events (AEs), including oedema, elevated blood pressure and gastrointestinal tract discomfort, and the incidence of oedema was higher in the patients receiving CG (RR = 2.53, 95%CI [1.04, 6.19], p = .04).

CONCLUSIONS

The combination of CG and conventional treatments was effective and safe for patients with AA, and CG could promote hair regrowth with mild AEs.

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis of efficacy and safety

Background

Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.

Methods

On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.

Results

The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.

Conclusion

The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.

Efficacy of psychological interventions for complex post-traumatic stress disorder in adults exposed to complex traumas: A meta-analysis of randomized controlled trials

INTRODUCTION

Effective treatments for post-traumatic stress disorder (PTSD) have been established, but their applicability in complex post-traumatic stress disorder (CPTSD) is largely unknown.

METHODS

We searched Pubmed, Web of Science, PsycInfo, Embase, CNKI, wanfang data, and SinoMed databases to seek out studies assessing the impact of psychological therapies on CPTSD among individuals with complex trauma. The quality of studies was assessed using the Cochrane Risk of Bias tool, and the moderating influence of study characteristics on the effect was examined.

RESULTS

The pooled effect of psychotherapies compared with the control groups was significant, with PTSD (k = 27, g = -1.16, 95 % CI: -1.49 to -0.82), depression (k = 23, g = -1.12, 95%CI: -1.47 to -0.75), anxiety (k = 13, g = -1.25, 95%CI: -1.82 to -0.68), and dissociation (k = 7, g = -0.47, 95%CI: -0.74 to -0.19). At follow-up, the effect sizes decreased slightly, but there was still significant remission of symptoms except for anxiety and dissociation symptoms. Subgroup analysis and meta-regression showed that participants with childhood trauma had lower effects than those with other trauma types, and risk of bias and female proportion were the moderators. There were some indications of publication bias.

CONCLUSION

Psychological interventions for CPTSD showed significant effects after the intervention, and the effect was largely maintained during follow-up. Future studies could investigate how interventions can be further optimized and tailored to suit individuals' performance.

Tranexamic acid use in rotator cuff repair: A systematic review of perioperative outcomes

Background

Tranexamic acid (TXA) use has become the gold standard in total joint arthroplasty to limit intraoperative blood loss and transfusion rates. More recently, the indications for TXA have expanded to knee and shoulder arthroscopy with promising early results. However, the effectiveness of TXA during arthroscopic rotator cuff repair (RCR) is unclear. Therefore, the purpose of this study was to investigate perioperative outcomes following the use of TXA during RCR.

Methods

A systematic review was performed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, MEDLINE, Embase, and Cochrane databases in November 2024. Studies were assessed for quality of visual clarity, operative time, mean arterial pressure (MAP), volume of arthroscopy irrigation used, arthroscopic pump pressure, and clinical outcomes.

Results

A total of 12 clinical trials involving 999 patients were included. 9 studies reported on visual clarity and 6 of these reported improvements in visual clarity with TXA administration. Four studies reported improvements in postoperative pain, however outcomes varied greatly depending on when follow-up assessment occurred. A majority of studies did not report differences in operative time, irrigation volume, or postoperative swelling. There were no venous thromboembolism events reported in the included studies.

Conclusion

TXA dosing during RCR surgery may improve visual clarity, however its effect on other perioperative outcomes remains unclear.

Level of evidence

Level I.

Intravascular Imaging Improves Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions: A Meta-Analysis of Randomized Controlled Trials

Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.

Efficacy of catheter-based ultrasound renal denervation in the treatment of hypertension

BACKGROUND

Hypertension (HTN) is a prevalent chronic health condition that significantly increases the risk of cardiovascular diseases-associated mortalities. Despite the use of antihypertensive medications, numerous patients fail to achieve guideline-recommended blood pressure (BP) targets.

AIM

To evaluates the efficacy of catheter-based ultrasound renal denervation (uRDN) for the treatment of HTN.

METHODS

Relevant studies were identified through searches in PubMed, Embase, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure, with a cut-off date at April 1, 2024. A random-effects model was employed in this study to mitigate potential biases. The risk of bias for included studies was assessed using the Cochrane Risk of Bias assessment tool. Statistical analyses were conducted using Review Manager version 5.3. This meta-analysis incorporated four studies encompassing a total of 627 patients. The reporting bias of this study was deemed acceptable.

RESULTS

Compared to the Sham group, the uRDN group demonstrated a significant reduction in daytime ambulatory systolic BP (SBP) [mean difference (MD) -3.87 mmHg, 95% confidence interval (CI): -7.02 to -0.73, P = 0.02], office SBP (MD -4.13 mmHg, 95%CI: -7.15 to -1.12, P = 0.007), and home SBP (MD -5.51 mmHg, 95%CI: -8.47 to -2.55, P < 0.001). However, there was no statistically significant reduction observed in either 24-hour or nighttime ambulatory SBP levels. Subgroup analysis shows that uRDN can significantly reduce the SBP in patients with non-resistant HTN (MD -6.19 mmHg, MD -6.00 mmHg, MD -7.72 mmHg, MD -5.02 mmHg, MD -3.61 mmHg).

CONCLUSION

The current evidence suggests that uRDN may effectively reduce home, office, and daytime SBP in patients with HTN, particularly in those with non-resistant HTN.

A systematic review and meta-analysis of advanced oxidative protein products levels (AOPP) levels in endometriosis: Association with disease stage and clinical implications

Endometriosis is a common cause of chronic pelvic pain and lacks precise pathophysiological mechanisms. Advanced oxidation protein products (AOPPs), markers of oxidative stress and inflammation, are implicated in pain-related diseases and have been suggested to play a crucial role in endometriosis pathophysiology. We aim to assess the significance of AOPP in endometriosis by analyzing their levels across serum, follicular fluid, peritoneal fluid, and ovarian endometrioma tissue, and their association with different disease stages. A systematic review of articles published up to Nov 2024 examining AOPP levels in endometriosis patients compared to controls was conducted (PROSPERO: CRD42022343714). Using the Newcastle-Ottawa Scale (NOS), the quality and risk of bias of included studies were assessed, and publication bias was evaluated using Egger's and Begg's tests. The analysis 12 studies involving 561 control patients without endometriosis and 670 patients with endometriosis. Compared to controls, elevated AOPP levels were observed in endometriosis patients' serum and peritoneal fluid. Patients with type III/IV endometriosis exhibited higher AOPP levels in serum and plasma compared to control patients, suggesting a potential association with disease severity. The study underscores the potential of AOPP levels as biomarkers for endometriosis severity and proposes them as pharmacological targets for disease management, including pelvic pain treatment.

Comparing the effects of different non-pharmacological traditional Chinese medicine therapies on cancer survivors: A Bayesian Network Meta-analysis

OBJECTIVES

Several studies have demonstrated the positive impact of non-pharmacological Traditional Chinese Medicine (TCM) therapies on pain, fatigue, sleep quality, and quality of life in cancer survivors. However, no research has compared the effectiveness of these therapies. This study aims to compare various interventions and identify the most effective non-pharmacological TCM therapies to provide evidence-based recommendations for cancer survivors.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang Data. RCTs investigating the effects of Taichi, Qigong, acupuncture, acupressure, TCM emotional therapy, and mixed therapies as interventions for cancer survivors were screened was conducted. Data from the creation of the database to February 2025 were included. Two independent reviewers evaluated the study quality. A Bayesian Network Meta-analysis was conducted to carry out a random effects model.

RESULTS

Seventy-one RCTs involving 6473 patients were included in the analysis. Network meta-analysis showed significance for all five intervention therapies in pain control in cancer patients. The best efficacy was observed for acupressure (SMD=-1.1 [-1.55, -0.66]) and Taichi/Qigong (SMD=-1.08[-1.64, -0.53]), followed by TCM emotional therapy (SMD=-0.93 [-1.42, -0.44]) and acupuncture (SMD=-0.54 [-0.93, -0.15]), with the latter showing comparatively lower efficacy. None of the interventions demonstrated superior efficacy in improving fatigue compared to the control group. Mixed therapies (SMD=-1.36[-2.56, -0.28]) demonstrated the greatest effect in improving sleep quality. Taichi/Qigong (SMD=1.87 [0.96, 2.83]) demonstrated certain advantages in improving quality of life. However, acupuncture and TCM emotional therapy had no significant effect on sleep quality or overall quality of life.

CONCLUSION

The evidence from this study suggests that acupressure and Taichi/Qigong are recommended as the most effective therapies for pain relief and quality of life improvement, respectively. The efficacy of these therapies for fatigue remains inconclusive. However, due to the limited number of included studies and the high risk of bias, these results should be interpreted with caution. Future studies should include more rigorously designed high-quality randomized controlled trials to confirm their long-term efficacy and safety.

REGISTRATION

PROSPERO CRD42024601976.

EFFECTS OF LOW-LEVEL LIGHT THERAPY ON PAIN AND RELATED LESIONS IN PATIENTS WITH ORAL LICHEN PLANUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND

Oral lichen planus (OLP) is a relatively common immunological mucocutaneous disease that causes pain, burning sensations and poor quality of life. The use of low-level light therapy (LLLT) to treat OLP is still debated. This systematic review and meta-analysis aimed to systematically and quantitatively assess the efficacy of LLLT in the treatment of OLP.

METHODS

The PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science electronic databases were searched up to February 28, 2023, to identify randomized controlled trials (RCTs) examining the use of LLLT in OLP patients reporting pain or other outcomes. The mean difference (MD) or log risk ratio (log RR) with 95% confidence intervals (CIs) were estimated separately for each outcome to determine the effect sizes. Subgroup analysis was used to detect the sources of heterogeneity. Sensitivity analysis was used to test the robustness of the pooled results. Funnel plots, Egger's test, and Begg's test were used to test publication bias. All the statistical analyses were performed using Stata 16.0 software. A graph of risk of bias was drawn using RevMan 5.4.1 software for the assessment of bias.

RESULTS

A total of twelve RCTs were included in this systematic review, 7 of which were also included in the meta-analysis. Among the included studies, 1 had a low risk of bias, whereas 7 had an unclear risk of bias. The meta-analysis results indicated that LLLT significantly improved long-term analgesic efficacy (over 12 weeks posttreatment, measured by the visual analogue scale; MD = -1.20, 95% CI -2.01 to -0.38, P < .001), whereas no significant changes were observed in either the short term (MD = -0.68, 95% CI -1.38 to 0.01, P = .05) or the medium term (MD = -0.89, 95% CI -1.96 to 0.17, P = .10). Furthermore, LLLT improved the clinical severity of lesions (as assessed by the biopsy sign scores or reticular atrophic erosive scores; MD = -1.13, 95% CI -1.62 to -0.63, P < .001) and reduced the recurrence rate (log RR = -1.34, 95% CI -2.30 to -0.37, P = .01). Additionally, there were no statistically significant differences in the clinical response rate (measured by efficacy indices; log RR = -0.12, 95% CI -0.37 to 0.13, P = .35). No adverse events related to LLLT were reported.

CONCLUSION

LLLT appears to alleviate pain, enhance the clinical outcomes of OLP lesions, and lower the likelihood of relapse in OLP patients. Future research should focus on longer intervention courses, larger sample sizes, and multidisciplinary intervention designs.

SYSTEMATIC REVIEW REGISTRATION

This meta-analysis was registered on PROSPERO (CRD42023384852).

Azelnidipine and its role in decreasing urinary albumin creatinine ratio in people with type 2 diabetes and hypertension: a systematic review and meta-analysis

Purpose

Type 2 diabetes mellitus and hypertension frequently coexist, increasing the risk of cardiovascular and renal complications. Urinary Albumin Creatinine Ratio (UACR) serves as a crucial predictor of these outcomes. While renin-angiotensin system inhibitors are often initial therapy, evidence suggests a potential role for Azelnidipine, a non-dihydropyridine calcium channel blocker, in reducing UACR, especially in cases of persistent proteinuria despite optimal therapy. However, conflicting results from existing studies necessitate a comprehensive systematic review and meta-analysis to clarify Azelnidipine's (AZL) efficacy in reducing UACR in people with type 2 diabetes mellitus and hypertension.

Methods

This meta-analysis, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included randomized controlled trials (RCTs) published until January 15, 2024. Studies involving individuals with type 2 diabetes mellitus and hypertension were included, comparing AZL or AZL-containing regimens with other antihypertensive agents. The primary outcome was changes in UACR, with secondary outcomes including alterations in Glycated Hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and estimated glomerular filtration rate (eGFR).

Results

Six RCTs involving 731 participants were included. Meta-analysis revealed a significant reduction in UACR in the AZL group compared to controls (Mean Difference (MD) = -47.96; 95% Confidence Interval (CI): -79.56, -16.37; p = 0.003). AZL also significantly decreased HR (MD = -3.70; 95% CI: -6.66, -0.74; p = 0.01), while no significant changes were observed in HbA1c, SBP, DBP, or eGFR. Sensitivity analyses demonstrated the nuanced impacts of individual studies on results, highlighting the importance of careful interpretation.

Conclusion

This meta-analysis confirms AZL's efficacy in reducing UACR and HR in people with type 2 diabetes mellitus and hypertension.

Efficacy of melatonin on drug- or contrast-induced acute kidney injury: a systematic review and GRADE-assessed meta-analysis of experimental and clinical studies

OBJECTIVE

The objective of this systematic review and meta-analysis was to assess the efficacy of melatonin in drug- or contrast-induced AKI in preclinical and clinical studies.

METHODS

PubMed, Embase, Scopus, Web of Science (WOS), the Cochrane Database of Systematic Reviews (CDSR), and clinical trials.GOV from the beginning until August 1, 2024. On the basis of the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, the number of patients with and without AKI, and the means and SDs of the serum creatinine and BUN levels were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, standardized mean differences, risk ratios and risk differences. I2 and chi-square tests were used to assess heterogeneity between studies. Funnel plots, Egger tests and the trim-and-fill method were used to evaluate small study effects (publication bias). The risk of bias of the included clinical and preclinical studies was assessed via the Cochrane ROB tool and SYRCLE tool, respectively. The credibility of the results was evaluated via GRADE. Sensitivity analysis was performed via the one-out removal method.

RESULTS

We identified 1,696 nonduplicate records, of which the full texts of 159 articles were examined. Twenty-nine animal experimental studies and 5 clinical trials met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that melatonin was significantly effective at reducing the serum creatinine level (standardized mean difference: - 3.04; 95% CI - 3.904 to - 2.183, with 95% prediction interval: - 7.201 to 1.163) and the BUN level (standardized mean difference: - 3.464; 95% CI - 4.378 to - 2.549, with 95% prediction interval: - 7.839 to 0.911) in drug-induced AKI animal studies. Melatonin did not have a significant effect on the serum creatinine level (standardized mean difference: - 2.67; 95% CI - 9.69 to - 4.35, with 95% prediction interval: - 42.618 to 37.278) or the BUN level (standardized mean difference: - 1.77; 95% CI - 5.533 to - 1.994, with 95% prediction interval: -22.943 to 19.404) in contrast-induced AKI animal studies. Furthermore, in clinical studies, melatonin had no significant effect on reducing the serum creatinine level (standardized mean difference: 0.183; 95% CI - 1.309 to 1.675, with 95% prediction interval: - 7.975 to 8.340), BUN level (standardized mean difference: 0.206; 95% CI - 0.0871 to 1.283, with 95% prediction interval: - 5.115 to 5.528) or risk of AKI incidence (risk ratio: 0.877; 95% CI 0.46 to 1.64, with 95% prediction interval: - 0.238 to 3.174; risk difference: - 0.06 mg/dl; 95% CI - 0.259 to 0.40 mg/dl, with 95% prediction interval: - 0.467 to 0.348). There were no significant publication biases, and after sensitivity analysis, no considerable changes were observed, indicating the robustness of the results.

CONCLUSION

This meta-analysis indicates that melatonin may protect against drug-induced AKI in animal models but is not effective in clinical studies and that melatonin has no significant effect on contrast-induced AKI. Owing to the inconclusive results in clinical trials and very low certainty of evidence, further research with higher methodological quality is needed to reach a more certain conclusion.

Enhancing Groundstrokes Velocity and Accuracy in Post-pubertal and Adult Tennis Players: A Systematic Review of Interventions

This study aimed to gather a compilation of intervention studies that address whether there are ways to get post-pubertal and adult tennis players of intermediate or higher level to enhance the velocity and accuracy of their groundstrokes. After searching Web of Science, Scopus, and SportDiscus, 10 articles were analyzed. Findings from training protocol studies revealed that strength endurance sessions or medicine ball throws do not significantly affect the speed or accuracy of serves, forehands, and backhands. Similarly, wristbands with small weights used during on-court training also did not impact performance, without compromising technical tennis skills. However, a 6-week strength training program involving medicine ball throws or heavier rackets improved forehand stroke speed but reduced hitting accuracy. Additionally, vision training improved accuracy and speed in forehands, accuracy in backhands, and both accuracy and speed in serves. High-intensity interval training that included hitting drills did not improve stroke accuracy and temporarily reduced stroke speed and efficiency during sessions, although it increased maximal aerobic power. Notably, the use of motor imagery during recovery periods in high-intensity-interval-training helped maintain on-court performance. Proper training periodization leads to better adaptations and improvements. The studies also identified that grunting was found to improve stroke speed during forehand and backhand strokes without affecting perceived exertion, oxygen consumption, or fatigue. Regarding supplementation, a 10-week creatine regimen did not significantly affect serve speed, forehand speed, or backhand speed. These findings aim to optimize tennis players' performance by identifying effective training strategies.

Effect of Saffron (Crocus sativus) Supplementation on Oxidative Stress, Inflammatory Indices, and Renal and Liver Function Parameters in Patients With Type 2 Diabetes Mellitus: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Clinical Trials

CONTEXT

Clinical investigation has shown that the addition of saffron or crocin to standard antidiabetic medications improves a patient's metabolic profile, oxidative stress (OS), and inflammatory response. Despite a large number of studies examining the impact of saffron supplementation on OS, inflammation, and renal and liver function parameters, no systematic review or meta-analysis has been conducted to compile the outcomes in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE

The current systematic review and meta-analysis was performed to investigate the effect of saffron or crocin intake on OS, inflammation, and renal and liver function parameters in patients with T2DM.

DATA SOURCES

Online databases including PubMed, Scopus, ISI Web of Science, and Cochrane Library were searched up to December 2023.

DATA EXTRACTION

The mean differences and their respective SDs were extracted. Using a random-effects model, the pooled data were calculated as standardized mean difference (SMD) with 95% CI.

DATA ANALYSIS

17 eligible randomized controlled trials were included in this meta-analysis. The pooled findings showed that saffron supplementation remarkably decreased the levels of tumor necrosis factor-α (SMD: -0.37; 95% CI: -0.69 to -0.05; I2 = 40.77%, P = .15), interleukin-6 (IL-6) (SMD: -0.38; 95% CI: -0.65 to -0.10; I2 = 0%, P = .68), and malondialdehyde (MDA) (SMD: -0.36; 95% CI: -0.65 to -0.07; I2= 20.51%, P = .02) compared with the control. In addition, based on subgroup analyses, taking ≥100 mg of saffron daily in individuals with T2DM reduced the serum levels of IL-6 (SMD: -0.50; 95% CI: -0.90 to -0.10; I2 = 0%, P = .50) and MDA (SMD: -0.36; 95% CI: -0.68 to -0.03; I2 = 0, P = .97). Furthermore, the level of alanine transaminase was decreased (SMD: -0.43; 95% CI: -0.73 to -0.12; I2 = 0, P = .66) with a treatment period of <60 days of saffron or crocin supplementation.

CONCLUSION

Larger studies with more follow-up and higher doses of both saffron and crocin are needed in order to understand the efficacy and safety of these herbs for long-term use as routine therapies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023458119.

Impact of walnut consumption on glycemic control and anthropometric indices: a systematic review and meta-analysis of randomized controlled trials

Objectives

Previous studies have led to conflicting results regarding the effect of walnut consumption on glycemic control, and anthropometric indices. This study aimed to evaluate the efficacy of walnut consumption on serum levels of fasting blood sugar (FBS), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), weight and body mass index (BMI) through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

PubMed, Scopus, Web of Science, and the Cochrane databases were searched up to February 2023. Weighted mean difference (WMD) was analyzed using random effects models to assess the overall effect.

Results

A total of thirty-two RCTs were included in the systematic review and meta-analysis. Walnut supplementation was found to significantly reduce HOMA-IR (WMD = -0.29; 95% CI: -0.57, -0.01, P = 0.04), and body weight (WMD = -0.14 kg; 95% CI: -0.24, -0.04; P = 0.008). However, the meta-analysis showed that walnut supplementation did not have a significant effect on FBS (WMD = 0.62 mg/dL; 95% CI: -0.66, 1.91; P = 0.34), insulin levels (WMD = 1.27 mIU/ml; 95% CI: -0.59, 3.14; P = 0.18), HbA1C (WMD = 0.00%; 95% CI: -0.09, 0.10; P = 0.95), and BMI (WMD = -0.10 kg/m2; 95% CI: -0.40, 0.20; P = 0.50).

Conclusion

In conclusion, this study found a significant reduction in HOMA-IR levels and body weight with walnut supplementation, while other glycemic markers, and obesity-related indices did not change significantly. Future well-designed trials are needed to confirm these results.

The Efficacy of Dual-layer Stent Compared to Single-layer Stent in Carotid Revascularization: A Systematic Review and Meta-analysis

BACKGROUND

Prior studies have demonstrated the dual-layer stent (DLS) was associated with encouraging results in carotid revascularization. This meta-analysis aimed to study the comparative efficacy between DLS and single-layer stent (SLS).

METHODS

The studies were retrieved from PubMed, Embase, and Scopus up to June 2023. The methodological evaluation was performed using the corresponding scale. Pooled analysis was conducted using R Studio to calculate the effects, including odds ratio (OR) and mean difference (MD). Heterogeneity among results was assessed using the I2 statistic. Sensitivity analysis and subanalysis were also performed.

RESULTS

In this meta-analysis, nine articles comprising 1,127 patients who underwent carotid stenting (606 with DLS) were studied. No significant difference between DLS and SLS was found in stroke (at 30 days DLS: 4/555 vs. SLS: 11/496; OR 0.38, 95% confidence interval [CI] 0.14-1.03; at 12 months DLS: 1/249 vs. SLS: 4/152; OR 0.21, 95% CI 0.03-1.36), death (at 30 days DLS: 3/526 vs. SLS: 0/467; OR 0.80, 95% CI 0.20-3.11; at 12 months DLS: 5/249 vs. SLS: 3/152; OR 1.12, 95% CI 0.25-5.03), stroke/death (at 30 days DLS: 6/526 vs. SLS: 11/467; OR 0.43, 95% CI 0.16-1.17; at 12 months DLS: 6/249 vs. SLS: 7/152; OR 0.52, 95% CI 0.17-1.61), new lesions (DLS: 56/202 vs. SLS: 96/254; OR 0.62, 95% CI 0.28-1.40), lesion count (MD = -0.24, 95% CI -0.82-0.34), lesion diameter (MD = -0.03, 95% CI -1.21-1.15), in-stent restenosis (ISR; DLS: 5/204 vs. SLS: 8/190; OR 0.61, 95% CI 0.21-0.74) and acute thrombosis (DLS: 4/146 vs. SLS: 1/122; OR 2.03, 95% CI 0.31-13.26). Subgroup analysis indicated that CGuard and Casper had shown similar efficacy in preventing stroke, death, and new brain lesions.

CONCLUSION

DLS has shown comparable prognoses to the first-generation stent concerning stroke, stroke/death, new magnetic resonance imaging lesion incidence, lesion count, lesion diameter, ISR and acute thrombosis. Further randomized trials are warranted to demonstrate whether patients with high-risk carotid plaques can benefit significantly from DLS.

Emotion Regulation and Coping in Active Military Personnel: A Systematic Review

Emotions significantly impact decision-making, teamwork, stress management, and resilience in high-pressure occupations such as the military, emergency services and competitive sports, making effective emotion regulation (ER) essential to performance and mental health. However, there are considerable knowledge gaps about ER in active-service military populations, particularly regarding the measures used to quantify ER, the variables studied, and identified relationships. Synthesising this literature is critical to progressing the ER research toward realistic solutions to enhancing performance and mental health in this population. This systematic review aimed to explore measurement tools, the variables examined alongside ER, and the relationship between ER and performance and military variables in active-service military personnel. Preregistered (PROSPERO; CRD42023358657) and adhering to PRISMA guidelines, this review focused on English peer-reviewed publications on ER or coping strategies in active-service military populations without date restrictions. Scopus, Web of Science, Military database, Medline and PsycINFO were last searched on 12/10/2022. Two reviewers screened studies, conducted data extraction and risk of bias assessment. A tabular synthesis method was used to systematically organise study details, ER measures, strategies, performance and military variables, outcomes, and quality. The literature search yielded 5780 studies, 46 of which were deemed relevant. The review identified 17 measurement tools, with the Coping Orientation to Problems Experienced Inventory (COPE) and Emotion Regulation Questionnaire being the most used. Psychological factors such as personality, resilience, and stress were most frequently examined (54%), while performance variables were studied in 3 (6.5%) and military variables in 6 (13%) of the source studies. Of the 10 performance and military variables examined, 50% were identified as being at high risk of bias, 30% moderate risk and 20% low risk. This review highlights a scarcity of published research on ER and performance and military variables in active-service military members. Overall, studies suggest that ER may be associated with performance and military variables in varying contexts and capacity. The review examines the implications of these relationships in detail. However, these studies vary in quality, the measurement tools used, and the variables assessed alongside ER, making synthesis challenging. The high risk of bias identified suggests that the relationships with ER should be interpreted with caution. This review suggests a link between ER and performance and military outcomes, however further research is needed to understand this nuanced relationship in the military context.

An updated review on therapeutic strategies in coronary microvascular dysfunction

Coronary microvascular dysfunction (CMD) is well-known cause of angina, yet treatment options remain limited. This systematic review and meta-analysis examines the current literature and provides a contemporary evaluation of treatments using a stringent definition for CMD with accurate methods of microvascular assessment in accordance with recent consensus guidelines. Methods and Results: A search strategy was conducted independently by two authors (CK and RR). Studies were required to be prospective trials in adult patients with documented CMD by IC doppler wire, thermodilution techniques, or perfusion imaging via PET/MRI. CMD was defined as either coronary flow reserve (CFR)/myocardial perfusion reserve (MPR) < 2.5, and/or index of microvascular resistance (IMR) > 25. Methodological quality of studies was assessed via the Cochrane Risk of Bias tool. The primary and secondary endpoints were change in CFR/MPR/IMR and change in Seattle Angina Questionnaire (SAQ) scores respectively. Two-sided p-values were used and considered significant if p < 0.05. A total of 11,360 records were identified, from which 14 were included in this review covering 9 different treatments. Two treatments (quinapril and ranolazine) showed significant improvement in both CFR and angina. Three ranolazine trials were pooled in meta-analysis. The standardised mean difference showed a weak positive effect (0.24) with wide intervals (-0.21 to 0.26) which was not statistically significant (p = 0.20). We subsequently reviewed all treatments as mentioned in recent European consensus statements. Conclusions: The overall quality of evidence surrounding treatments for CMD is of "low", with lack of robust data highlighting the dire need for higher quality trials in this area.

PROTOCOL: Bereavement Interventions for Children and Adolescents: An Evidence and Gap Map of Primary Studies and Systematic Reviews

This is the protocol for a Campbell evidence and gap map. The objectives are as follows: (1) To identify and map all existing primary studies and systematic reviews (published and unpublished) on bereavement interventions/programmes for children and adolescents to create a live, searchable and publicly available EGM; (2) Provide a comprehensive descriptive overview of psychosocial outcomes targeted by bereavement interventions for children and adolescents; (3) Determine the characteristics of bereavement interventions targeted at children and adolescents, including age, location, duration, delivery, underlying theories, evaluation and target death.

Insights on psychedelics: A systematic review of therapeutic effects

BACKGROUND

Insight - a sudden change in understanding or perspective that feels true or reliable - is a common occurrence during psychedelic experiences, and often considered by clinicians and patients to be central to their therapeutic value. However, their occurrence and role has not been systematically assessed.

OBJECTIVES

We reviewed all peer-reviewed studies that published data on insight catalysed by a classic psychedelic at psychoactive levels to elucidate several aspects of psychedelic-catalysed insight, including its prevalence, relationship to dose, time-course, and relationship to therapeutic outcomes. Risk of bias was assessed regarding selection, reliability, causality, and transparency. PROSPERO registration: CRD42023405854 FINDINGS: The final database and key bibliography searches were completed on July 13, 2024. We screened 741 abstracts and included 98 studies (40 survey, 58 interventional). Insight was positively correlated with psychedelic dose, and was significantly higher following psychedelics in 43 of 46 (93 %) studies that presented a comparison to a placebo condition. Crucially, 25 of 29 studies (86 %) found that insight was associated with therapeutic improvement, and this relationship was often stronger than mystical-type experience, which has received more research attention.

INTERPRETATION

This review indicates that psychedelic-catalysed insight is associated with therapeutic improvement, suggesting its importance for clinical practice and for understanding the mechanisms of psychedelic therapy.

LIMITATIONS

Heterogeneous study designs and operationalisations of insight precluded a meta-analytic summary. Publication bias and selective reporting is possible, given insight was typically not a primary outcome of the included studies.

The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis

INTRODUCTION

Sarcopenia is associated with the loss of skeletal muscle function and mass. Nicotinamide precursors, such as nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR), have received attention for their potential to improve NAD+ levels and mitigate age-related sarcopenia in preliminary models, though evidence on their effects in older adults remains inconclusive.

METHODS

We searched PubMed, Cochrane Library, Web of Science, and Scopus to identify randomized controlled trials (RCTs), comparing NR or NMN vs. placebo. A random-effects meta-analysis was employed to determine their impact on measures of sarcopenia such as skeletal muscle index (SMI), handgrip strength (HGS) and gait speed. A narrative synthesis was used for 5-time chair stand test (5CST), short physical performance battery (SPPB), timed-up-and-go (TUG), 6-min walking distance (6MWD), leg and chest press 80% 1RM (repetition maximum) and thigh muscle mass.

RESULTS

Included participants had a mean age range from 60.9 to 83 years. NMN supplementation showed no significant effects on SMI (n = 3; mean difference (MD): -0.42, 95% confidence interval (CI): -0.99 - 0.14, I2 = 63%, p = 0.14), HGS (One study estimating left grip; n = 5; MD: 0.61, 95%CI: -0.89 - 2.10, I2 = 0%, p = 0.42; One study estimating right grip; n = 5; MD: 0.45, 95%CI: -1.06 - 1.96, I2 = 0%, p = 0.56), gait speed (n = 4; MD: -0.01, 95%CI: -0.08 - 0.06, I2 = 0%, p = 0.79), or 5CST (n = 2; MD: -0.21, 95%CI: -0.70 - 0.29, I2 = 11%, p = 0.41). Additionally, our narrative synthesis showed that NMN did not improve knee extension strength, SPPB, or thigh muscle mass. NR supplementation was associated with a longer 6MWD among individuals with peripheral artery disease. However, lower scores in the SPPB and slower 5CST were observed in those with mild cognitive impairment.

CONCLUSIONS

Current evidence does not support NMN and NR supplementation for preserving muscle mass and function in adults with mean age of over 60 years. Future research should explore supplementation dosage, NAD+ baseline deficiency, and combined interventions.

Stromal cell-based injection therapies for the treatment of knee osteoarthritis: A systematic review of level I randomized controlled trials

Objective

To systematically review randomized controlled trials (RCTs) to compare clinical outcomes of stromal cell-based injection therapies versus other non-operative treatment modalities for the treatment of knee osteoarthritis (OA).

Method

A systematic review was performed by searching PubMed, Cochrane Library, and EMBASE to locate RCTs, published since 2019, comparing stromal cell-based injection therapies versus other non-operative modalities for the treatment of knee OA. The search terms used were: knee AND osteoarthritis AND injection AND randomized.

Results

Seventeen studies (all Level I evidence) were included in this review with 972 patients undergoing treatment with stromal cell-based therapy (Intervention Group) and 651 patients in the control group (Control Group). Among the 17 studies, 7 used autologous adipose-derived mesenchymal stromal cells (MSCs) (ADMSCs), 2 studies used allogeneic ADMSCs, 4 used autologous bone marrow-derived MSCs (BMMSCs), 1 used allogeneic BMMSCs, 1 used allogeneic placental MSCs, 1 used umbilical cord-derived MSCs (UCMSCs), and 1 study used autologous ADMSCs, BMMSCs, or allogeneic UCMSCs. All but 3 studies reported significantly better clinical or radiological outcomes in the Intervention Group at final follow-up. A total of 5 and 3 studies reported adverse events occurring in the Intervention and the Control groups, respectively, but they were all self-limiting.

Conclusions

Patients undergoing treatment of knee OA with MSCs might be expected to experience improvements in clinical and radiological outcomes in comparison to other non-operative modalities. Additional studies with mid-to long-term outcomes are needed to better determine the efficacy and safety of MSCs for the treatment of knee OA.

Parent training programs for immigrant families in Europe: A systematic review and meta-analysis of randomized trials

This review analyzes randomized controlled studies that investigated parent training interventions in Europe. Included studies had to have utilized interventions based on social learning theory and enrolled immigrant families. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and the review was pre-registered with PROSPERO. A search of nine databases identified 8286 publications, seven of which fulfilled the inclusion criteria. These articles were published between 2010 and 2017. Since 1996, extremely few effective trials have been conducted in Europe. The meta-analysis revealed a small but significant overall effect for child problem behaviors and positive and negative parenting (effect size = 0.26, 0.24, and 0.20, respectively), compared with the control conditions, thus favoring parent training. Only some studies have addressed the migration or cultural issues in family life-a barrier to the development of future programs. This review highlights issues such as cultural adaptation and intersectionality to assist evaluators and planners in improving the practice of their professions and their knowledge base. We call for more evidence regarding the effects of parental programs on immigrant families living in Europe.

A Systematic Review and Meta-Analysis of Post-Cochlear Implant Vestibular Dysfunction: Round Window Versus Standard Cochleostomy Approaches

BACKGROUND

Two main techniques for cochlear implantation (CI) are commonly used: the standard cochleostomy (SCA) and the round window approach (RWA). Initially, the RWA was more utilized, followed by the SCA for cases with challenging visualization. Recent studies show that RWA is preferred due to SCA's risk of damaging cochlear structures.

AIM

We aim to compare post-CI complications between the RWA and SCA approaches.

METHODS

Five electronic databases were systematically searched to identify relevant studies. Eligibility screening was performed to determine inclusion criteria, and data extraction from the selected studies was conducted independently. Dichotomous outcomes were pooled as rate ratios (RR) and standard errors (SE), with significance determined by a p value >0.05 between CI subgroups. The generic inverse variance analysis method was applied with the employment of the random-effect model.

RESULTS

Our systematic review encompassed 82 studies, of which 58 were eligible for meta-analysis. Vertigo was documented in 10% of instances utilizing the RWA technique and in 8% of cases using the SCA method. Likewise, dizziness was noted in 18% of RWA cases and in 14% of SCA cases. The overall incidence of vestibular complications was 36% for RWA and 17% for SCA. However, statistical analysis revealed no significant differences between these approaches ( p < 0.05).

CONCLUSION

Both the RWA and the SCA approaches demonstrate comparable post-CI complication profiles concerning dizziness, vertigo, and overall vestibular complications, with the RWA approach showing slightly higher incidences. However, no significant difference was found between the two techniques.

The effectiveness of non-invasive brain stimulation in enhancing lower extremity function in children with spastic cerebral palsy: Protocol for a systematic review and meta-analysis

Non-invasive brain stimulation (NIBS) techniques have emerged as a promising non-pharmacological adjunct to neurorehabilitation. Children with Cerebral Palsy (CP) exhibit altered cortical excitability, and while CP remains incurable, physiotherapy combined with other interventions is essential for managing motor dysfunction. Although some studies have examined NIBS using various stimulation parameters, there is limited evidence regarding its effects on the lower extremities and optimal administration protocols. This review aims to evaluate the effectiveness of NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for the treatment of motor function in spastic cerebral palsy, specifically in the lower extremity. A systematic search will be conducted in databases including MEDLINE, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. The search strategy will follow the PICO framework (Participants, Intervention, Comparison, Outcomes), focusing on randomized controlled trials (RCTs). Two independent reviewers will manage screening, selection, data extraction, risk of bias assessment, and grading of evidence. This review will provide key insights into the effectiveness of NIBS for lower-extremity function in children with spastic CP, guiding future research and clinical applications.

The Effect of Nursing-Based Enhanced Recovery After Surgery on Quality of Life in Lung Cancer Patients Receiving Surgery: A Systematic Review and Meta-Analysis

Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary protocol aimed at reducing surgical stress and expediting postoperative recovery. This meta-analysis will provide a comprehensive examination of the implications of ERAS care for the quality of life (QOL) of postoperative Lung cancer (LC) patients. The literature databases were searched to identify randomized controlled trials that implemented an ERAS program for adult patients with LC who underwent surgical treatment and reported QOL results. Thirty-one studies were included in the analysis. ERAS/FTS significantly improved the overall QOL of postoperative LC patients according to the Short Form-36 (SF-36) score (mean difference (MD): 8.58; 95% confidence interval (CI): 6.17, 11.00; p < 0.001). For physical functioning, the ERAS/FTS significantly improved the SF-36 score (MD: 10.45; 95% CI: 7.41, 13.50; p < 0.001). In the role-physical dimension, the ERAS/FTS nurse strategy had a significant advantage in improving the role-physical score on the SF-36 scale (MD: 10.06; 95% CI: 7.00, 13.13; p < 0.001). The ERAS has a highly positive impact on QOL in postoperative LC patients, especially in the physical functioning and role-physical dimensions.

Examining the effect of Kuntai capsule combined with HRT in the treatment of premature ovarian insufficiency: A systematic review and meta?analysis

While Chinese herbal medicines have been used to treat premature ovarian insufficiency (POI), their efficacy is currently unclear. The present study aimed to review and evaluate the efficacy of the Kuntai capsule combined with hormone replacement therapy (HRT) in treating POI. The China National Knowledge Infrastructure, WanFang, Chinese Biomedical Literature, PubMed, Embase and Cochrane Library databases were searched from the inception of the database to 25th October 2020, for studies comparing the therapeutic effect of Kuntai capsule combined with HRT vs. HRT alone in women with POI. The Cochrane Risk of Bias assessment tool was used to assess the quality of the studies, and the results were reported as weighted mean differences (MD) with 95% confidence intervals (CI). The present study included 10 trials involving 742 women with POI. When compared with HRT alone, HRT combined with Kuntai capsule significantly increased the number of antral follicles (AFC) (MD=0.88; 95% CI, 0.48-1.29; P<0.00001), anti-Müllerian hormone (AMH) levels (MD=0.24, 95% CI, 0.13 to 0.35, P<0.00001) and significantly improved peri-menopausal symptoms [MD=-2.26; 95% CI, -3.77-(-0.75); P=0.003]. The combined treatment regimen significantly decreased the levels of follicle-stimulating hormone [MD=-5.60; 95% CI, -7.98-(-3.22); P<0.00001] and luteinizing hormone [MD=-2.42; 95% CI, -3.40-(-1.44), P<0.00001] and significantly increased the level of estradiol (MD=13.94; 95% CI, 4.16-23.71; P<0.00001). Therefore, the Kuntai capsule combined with HRT could potentially be used as a supplementary therapy to alleviate menstrual disorders and peri-menopausal symptoms and improve serum sex hormone levels in women with POI. The observed increase in the number of AFC in patients with POI treated with the combined therapy was indicative of improved ovarian reserve function. Therefore, combining the Kuntai capsule and HRT had am improved curative effect for POI treatment compared with HRT alone. However, as the present study was limited by the quality of the included reports, additional high-quality studies with extensive sample sizes are required to verify the findings.

Evaluating the efficacy and acceptability of non-invasive brain stimulation for generalized anxiety disorder: a systematic review and network meta-analysis

Non-invasive brain stimulation (NIBS) has the potential to treat generalized anxiety disorder (GAD). To assess the efficacy (response/remission/post-treatment continuous anxiety severity scores) and acceptability (failure to complete treatment for any reason) of NIBS, we searched PubMed, Web of Science, and the Cochrane Library (as of April 2024) for articles on NIBS for GAD and conducted a network meta-analysis of eight randomized trials (20 treatment arms, 405 participants). Data were pooled using standardized mean difference (SMD) and odds ratio (OR) with 95 % confidence interval (CI). Repetitive transcranial magnetic stimulation (rTMS) was the most widely studied treatment for GAD. The right dorsolateral prefrontal cortex (DLPFC) was the most common treatment target for GAD. High-frequency rTMS showed higher response rates (OR 291.40, 95 % CI 13.08 to 6490.21) and remission rates (OR 182.14, 95 % CI 8.72 to 3805.76) compared with other active therapies. Continuous theta burst stimulation (cTBS) greatly improved continuous post-treatment anxiety severity scores (SMD -2.56, 95 % CI -3.16 to -1.96). No significant differences in acceptability were found between the treatment strategies and the sham stimulation group. These findings provide evidence to consider NIBS techniques as alternative or adjunctive treatments for GAD.

Exploring Consent to Use Real-World Data in Lung Cancer Radiotherapy: Decision of a Citizens' Jury for an 'Informed Opt-Out' Approach

An emerging approach to complement randomised controlled trial (RCT) data in the development of radiotherapy treatments is to use routinely collected 'real-world' data (RWD). RWD is the data collected as standard-of-care about all patients during their usual cancer care pathway. Given the nature of this data, important questions remain about the permissibility and acceptability of using RWD in routine practice. We involved and engaged with patients, carers and the public in a two-day citizens' jury to understand their views and obtain decisions regarding two key issues: (1) preferred approaches to consent for the use of RWD within the context of patients receiving radiotherapy for lung cancer in RAPID-RT and (2) how RWD use should be best communicated to patients. Individual views were polled using questionnaires at various stages of the jury, whilst group discussion activities prompted further dialogue about the rationale behind choices of consent. Key decisions obtained from the jury include: (1) an opt-out approach to consent for the use of RWD; (2) the opt-out approach to consent should be informed. Furthermore, it was advised that information and communication regarding the consent process and use of RWD should be accessible, clear and available in a variety of formats. It is important that the consent process for patient data use is underpinned by principles of autonomy and transparency with clear channels of communication between those asking for and giving consent. Moreover, the process of seeking consent from patients should be proportionate to the risks presented from their participation.

Meta-analyses of executive function deficits in chemotherapy-treated rodent models

People diagnosed with cancer who undergo chemotherapy commonly encounter cognitive changes, particularly in executive functions (EFs). EFs support goal-directed behaviours, with EF deficits implicated in various neurocognitive impairments. We conducted five meta-analyses of the rodent models to investigate the impact of chemotherapy across five EF domains. A systematic search across PubMed, Web of Science, Scopus, and PsycINFO yielded 56 eligible papers. Our findings supported the clinical literature suggesting the selective impact of chemotherapy on different EF domains. Specifically, chemotherapy-treated animals performed significantly more poorly than controls in tasks assessing working memory, behavioural flexibility, and problem-solving, with no significant group differences in inhibition or attention. Subgroup analyses revealed that alkylating agents, antitumor antibiotics, and combination therapies were strongly associated with working memory deficits, whereas mitotic inhibitors were not. Rodent species, strain, age, sex, number of treatments, and time of behavioural assessment since the end of treatment did not moderate the drug effect on any assessed EF domains. To increase the generalisability and translational validity of the results, the overall reporting quality of animal studies needs to be improved with more details on randomisation, blinding, sample sizes, and criteria for animal exclusions.

Non-surgical management of peri-implantitis with photodynamic therapy: A systematic review and meta-analysis of clinical parameters and biomarkers

OBJECTIVE

To evaluate the clinical and biomarker outcomes of photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (MD) in the management of peri‑implantitis, and to compare its efficacy to MD alone or other non-surgical treatment modalities.

DATA AND SOURCES

Electronic searches in PubMed, Web of Science, and CENTRAL were conducted. 4675 studies published until November 2023 were screened. Clinical studies reporting on non-surgical treatments involving PDT were selected. Meta-analyses assessed clinical parameters (bleeding on probing [BOP], probing depth [PD], plaque index [PI], crestal bone loss [CBL], clinical attachment level [CAL]) and biomarkers.

STUDY SELECTION

A total of 25 studies were included. The meta-analysis of randomized controlled trials revealed that both MD alone and MD+PDT significantly improved clinical and biomarker outcomes compared to baseline. The addition of PDT provided greater improvements at 3 months for BOP (SMD:0.90; 95 % CI:1.53 to -0.28; p = 0.005), PD (SMD:1.15; 95 % CI:1.72 to -0.58; p < 0.0001), PI (SMD:0.74; 95 % CI:1.15 to -0.33; p = 0.0004) and CBL (SMD:0.38; 95 % CI:0.73 to -0.03; p = 0.04). The additional benefits of PDT were less pronounced on CAL, mucosal recession, and inflammatory biomarkers. No significant changes were observed over extended follow-up periods.

CONCLUSIONS

Adjunct PDT significantly enhanced clinical outcomes, particularly for the short-term, with the most notable benefits observed in BOP, PD, PI, and CBL reductions. However, additional benefits in CAL, mucosal recession, and inflammatory biomarkers outcomes remain limited. Standardized protocols and long-term studies are warranted.

CLINICAL SIGNIFICANCE

PDT as an adjunct in non-surgical peri-implantitis management improves short-term clinical outcomes, particularly for BOP, PD, PI, and CBL. The benefits of adjunctive use with mechanical debridement offer a promising and minimally invasive approach. Further long-term research is needed to establish its role in routine clinical practice.

Effectiveness of Botulinum Toxin A Injection for Hemiplegic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials

Hemiplegic shoulder pain (HSP) is a common post-stroke complication impairing function and quality of life. Botulinum toxin A (BTA), a neurotoxin that inhibits acetylcholine release and reduces spasticity, has been proposed for treating HSP, though its clinical effectiveness remains unclear. This meta-analysis aimed to evaluate BTA's efficacy in managing HSP. Nine randomized controlled trials involving 272 patients were included. Compared to placebo, BTA significantly reduced pain at 1 week (SMD = -0.93; 95% CI [-1.67, -0.19]; p = 0.01) and 4 weeks (SMD = -0.90; 95% CI [-1.51, -0.28]; p < 0.01), but not at 12 weeks. External rotation ROM improved at all time points, peaking at 4 weeks (WMD = 6.20; 95% CI [3.11, 9.30]; p < 0.01). Abduction ROM improved at 4 and 12 weeks. Spasticity decreased significantly throughout, with the largest reduction at 12 weeks (WMD = -0.78; 95% CI [-1.42, -0.14]; p = 0.02). Functional gains were noted at 4 weeks. However, these results should be interpreted cautiously due to small samples and heterogeneous injection protocols across studies. In conclusion, BTA is effective for short-term HSP management, particularly in relieving pain and improving motor function. Further large-scale trials with standardized methods are needed.

Efficacy of Customized Photorefractive Keratectomy With Cross-Linking Versus Cross-Linking Alone in Progressive Keratoconus: A Systematic Review and Meta-Analysis

TOPIC

This review evaluates the effectiveness and safety of combining cPRK with CXL versus CXL alone in improving visual outcomes for patients with progressive keratoconus.

DESIGN

Systematic review and meta-analysis.

CLINICAL RELEVANCE

Keratoconus leads to vision loss and affects quality of life. While CXL is the current standard for halting progression, it does not correct the visual impairment. This review explores whether adding cPRK to CXL offers better visual outcomes while maintaining the same safety, potentially refining treatment approaches.

METHODS

A systematic search of MEDLINE, PubMed, Cochrane Library and EMBASE was conducted through September 2024, following PRISMA guidelines. The initial study design aimed to include randomized controlled trials (RCTs) as well as comparative nonrandomized prospective or retrospective studies evaluating CXL+cPRK versus CXL alone, with a minimum follow-up of six months. However, only nonrandomized studies were retrieved. As a result, all included studies were assessed for the risk of bias using the ROBINS-I tool. The primary outcomes were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Secondary outcomes included refraction, corneal structure, and higher-order aberrations (HOA). Meta-analysis was performed using standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity was assessed using a random-effects model where necessary. Sensitivity analysis was conducted using a leave-one-out approach to assess the robustness of the results. This study is registered in the PROSPERO database (CRD42024594757).

RESULTS

Eight nonrandomized studies involving 731 eyes from 706 patients were analyzed. Compared to CXL alone, the combination of CXL+cPRK significantly improved postoperative UDVA (SMD = -0.39, 95% CI: -0.69 to -0.08, P = .01) and CDVA (SMD = -0.57, 95% CI: -0.96 to -0.18, P = .004), while also reducing refractive cylinder error. Additionally, CXL+cPRK led to reductions in coma, total HOA, coma-like aberrations, mean keratometry (KM), and central corneal thickness (CCT). No significant differences were observed between the groups in endothelial cell count (ECC). The rate of postoperative ectasia progression was comparable between both groups. All included studies exhibited at least one ROBINS-I domain at high risk of bias, particularly related to confounding. The heterogeneity observed in this analysis was primarily attributed to differences in surgical techniques, patient selection criteria, and study designs across the included studies.

CONCLUSIONS

Customized PRK combined with CXL provides superior postoperative visual acuity (UDVA, CDVA) and visual quality compared to CXL alone while maintaining the same corneal stability in the management of progressive keratoconus. Only nonrandomized studies could be retrieved for the purpose of the study.

Meta-analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) guidelines on multimodal strategies for the surgical treatment of obesity

BACKGROUND

Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity.

METHODS

We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL).

RESULTS

A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality.

CONCLUSIONS

MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

HIV, hepatitis, and syphilis self-testing among adolescents and young adults: A systematic review and meta-analysis

BACKGROUND

Adolescents and young adults (AYA) make up a significant share of the world's burden of HIV and other sexually transmitted infections (STI). Self-testing can increase testing coverage and strengthen the uptake of prevention and treatment services. We critically appraised the literature regarding HIV, hepatitis, and syphilis self-testing among AYA (age 10-24 years) and assessed its usability, feasibility, and acceptability.

METHODS

We conducted a systematic review, searching six databases between January 2010 and October 2023. We included all studies on HIV, hepatitis and syphilis self-testing in AYA. We used a random-effects meta-analysis to pool evidence across the three infections as evidence was deemed sufficiently similar. We summarised the uptake, proportion of first-time testers and linkage to care. Qualitative data were narratively synthesised.

FINDINGS

We identified 89 relevant studies. Most were conducted in Africa (57/89, 64 %) and lower-middle-income countries (34/89, 38 %). Our meta-analysis of 27 studies (n = 28,787 individuals) demonstrated that 79 % (95 % CI: 69-87 %, I2 = 99 %) of AYA who were offered HIV or syphilis self-test completed the test. Five studies (n = 4117) demonstrated 62 % (95 % CI: 53-71 %, I2 = 83 %) were first-time testers. No studies reported completion rates for hepatitis self-testing. In general, AYA were highly accepting of self-testing and found it easy to use.

INTERPRETATION

Self-testing is a safe, acceptable and effective way to increase access to HIV, hepatitis and syphilis testing in AYA. Given these features of self-testing, policies to increase its use should significantly improve testing and maximise their public health impact.

Chinese Expert Consensus on Integrated Chinese and Western Medicine for the Treatment of Tic Disorders

OBJECTIVE

Tic disorders are neurodevelopmental conditions that manifest in childhood or adolescence and can significantly impact the quality of life of affected children and their families to varying degrees. Integrated traditional Chinese and Western medicine treatment strategies have demonstrated more pronounced efficacy and better safety profiles. However, there is currently no standardized clinical expert consensus on this approach. To address this, the National Administration of Traditional Chinese Medicine initiated a project, and the China Association of Chinese Medicine assembled a team of authoritative domestic experts to develop this expert consensus, aiming to provide practical and feasible integrated treatment strategies for clinical practice.

METHODS

This consensus identified clinical issues through research, conducted literature reviews, and established evidence based on systematic evaluations. Expert surveys, two rounds of Delphi questionnaires, and expert consensus meetings were conducted to formulate a series of recommendations.

RESULTS

We established a multidisciplinary consensus development panel. Based on systematic literature reviews, Delphi questionnaires, and consensus meetings, ten clinical issues were identified. Ultimately, a series of recommendations were developed, considering the balance of benefits and risks, the certainty of evidence, clinical feasibility, accessibility, and clinical acceptability.

CONCLUSIONS

These recommendations comprehensively address key issues in the field of integrated traditional Chinese and Western medicine treatment, including indications for the use of Chinese or Western medicine alone or in combination, specific treatment protocols, methods for dose reduction and discontinuation, evaluation intervals, and the management of adverse reactions.

The role of self-efficacy in internet-based interventions for mental health: A systematic review and meta-analysis

Introduction

Internet-based interventions (IBI) increase access to evidence-based treatments for mental disorders, but knowledge of their mechanisms of change is limited. Self-efficacy, a key factor in psychotherapy, is especially relevant in IBI due to its self-help focus. We investigated self-efficacy and related constructs as outcomes, predictors/moderators, and mediators in randomized controlled trials.

Methods

A systematic search was conducted across PsycINFO, PubMed, CINAHL, and Web of Science. Two reviewers selected studies, extracted data, and assessed bias. Effects were quantified using random effect models and supplemented by narrative syntheses and box score visualizations.

Results

70 studies (N = 17,407 participants) were included. IBI showed moderate effects on self-efficacy in within (d = 0.47) and between (d = 0.46) comparisons, with guided interventions having the largest effect (d = 0.66). Findings on self-efficacy as a predictor/moderator were mixed, though some studies suggested individuals with lower self-efficacy benefit more. Self-efficacy emerged as a mediator through which IBI affected treatment outcomes.

Conclusion

Self-efficacy appears influential in IBI efficacy and may itself be a valuable treatment target. However, mixed results and methodological limitations in mediator studies highlight the need for further research, particularly on long-term effects.

Comparing fondaparinux and low molecular weight heparin for thromboprophylaxis after hip and knee arthroplasty: a systematic review and meta-analysis

Venous thromboembolism (VTE) remains a significant cause of perioperative morbidity and mortality despite the availability of prophylactic medications. There has been a debate about which thromboprophylaxis medication, Fondaparinux or low-molecular weight heparin (LMWH), is better after hip and knee arthroplasty. We have compared these two treatment regimens in our study. Electronic databases like PubMed, Cochrane, and ScienceDirect were searched from inception to August 2024. The weighted mean difference (WMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were pooled using the Review Manager software version 5.4.1, and a random effects model was employed. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool (ROB 2.0) were used to assess the quality of the included studies. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression. GRADE assessment was used to analyze the certainty of evidence. A total of 17 studies, 9 Cohorts, and 8 Randomized controlled trials (RCTs) pooling a total of 74 499 patients were included in this meta-analysis. Fondaparinux showed a statistically significant reduction in the risk of VTE [0.59; 95% confidence interval (CI): [0.48, 0.71]; P  < 0.00001; I2  = 36%] and deep venous thrombosis (DVT) (RR = 0.75, 95% CI: [0.56, 1.00]; P  = 0.05; I2  = 68%) compared to LMWH. Major bleeding (RR = 2.06, 95% CI: [1.19, 3.57]; P  = 0.01; I2  = 43%), surgical site bleeding (RR = 1.67, 95% CI: [1.04, 2.66]; P  = 0.03; I2  = 9%), and postoperative transfusions (RR = 1.07, 95% CI: [1.02, 1.12]; P  = 0.004; I2  = 0%) were significantly higher in the Fondaparinux group. Symptomatic VTE, pulmonary embolism, mortality, and operating time showed no significant difference between the two groups. In conclusion, Fondaparinux is superior to LMWH in VTE and DVT prophylaxis. However, it is associated with an increased risk of major bleeding, surgical site bleeding, and postoperative transfusions.

Sustained-release naltrexone for opioid dependence

BACKGROUND

Opioid dependence is a severe and often lifelong disorder with a high risk of overdose and premature death, as well as severe psychosocial difficulties. Sustained-release naltrexone is a treatment option that works by blocking the euphoric and overdose effects of opioids. When injected intramuscularly, naltrexone provides blockade for one month, while the blocking effects with implants can last for up to six months.

OBJECTIVES

To assess the benefits and harms of sustained-release naltrexone for the treatment of opioid dependence.

SEARCH METHODS

For this update, we searched the following databases from 2007 up to 20 December 2023: the Cochrane Drugs and Alcohol Specialised Register of Trials, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, ISI Web of Science, LILACS, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We manually searched the reference lists of identified studies, published reviews and relevant websites.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of injectable or implantable naltrexone with other treatment, no treatment or placebo in adults with opioid dependence.

DATA COLLECTION AND ANALYSIS

Primary outcomes were illicit opioid use, retention in treatment, treatment acceptability and adverse events. Secondary outcomes were opioid craving, recreational use of substances other than opioids, mental health, quality of life and criminal activity. We assessed the risk of bias using the Cochrane risk of bias tool (RoB 1). We combined the results of individual trials through meta-analysis where possible using a random-effects model. Two review authors independently assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We identified 22 studies (3416 participants) that met our inclusion criteria. Three studies compared sustained-release naltrexone with opioid agonist treatment, five with oral naltrexone, six with placebo, nine with treatment as usual and one with psychosocial intervention. Sustained-release naltrexone compared with opioid agonist treatment We found moderate-certainty evidence that sustained-release naltrexone probably increases in-treatment illicit opioid use slightly (risk ratio (RR) 1.15, 95% confidence interval (CI) 1.01 to 1.31; 1 study, 570 participants). The evidence is very uncertain about the effect of sustained-release naltrexone on retention in treatment (RR 1.17, 95% CI 0.78 to 1.76; 3 studies, 773 participants) and treatment acceptability (RR 0.92, 95% CI 0.73 to 1.16; 3 studies, 773 participants). There was low-certainty evidence that sustained-release naltrexone may increase serious adverse events slightly in comparison with opioid agonist treatment for serious adverse events (RR 1.40, 95% CI 0.92 to 2.11; 2 studies, 713 participants). Sustained-release naltrexone compared with oral naltrexone treatment We found low-certainty evidence that sustained-release naltrexone may reduce in-treatment illicit opioid use (RR 0.65, 95% CI 0.45 to 0.93; 1 study, 69 participants). The evidence is very uncertain about the effect of sustained-release naltrexone on retention in treatment (RR 2.40, 95% CI 1.64 to 3.52; 3 studies, 464 participants) and on serious adverse events (RR 1.25, 95% CI 0.46 to 3.36; 2 studies, 260 participants). There was low-certainty evidence that sustained-release naltrexone may result in little to no difference in treatment acceptability in comparison with oral naltrexone treatment (RR 1.00, 95% CI 0.99 to 1.01; 3 studies, 474 participants). Sustained-release naltrexone compared with placebo We found low-certainty evidence that sustained-release naltrexone may result in little to no difference in in-treatment illicit opioid use (RR 0.83, 95% CI 0.66 to 1.03; 3 studies, 443 participants), treatment acceptability (RR 1.00, 95% CI 0.98 to 1.02; 1 study, 204 participants) and serious adverse events (RR 0.74, 95% CI 0.17 to 3.23; 3 studies, 443 participants). The evidence is very uncertain about the effect of sustained-release naltrexone on retention in treatment in comparison with placebo (RR 2.10, 95% CI 1.23 to 3.60; 4 studies, 594 participants). Sustained-release naltrexone compared with treatment as usual We found high-certainty evidence that sustained-release naltrexone reduces in-treatment illicit opioid use (RR 0.72, 95% CI 0.57 to 0.90; 4 studies, 479 participants). There was low-certainty evidence that sustained-release naltrexone may result in little or no difference in retention in treatment (RR 1.20, 95% CI 0.79 to 1.82; 3 studies, 126 participants) and that it may result in a slight reduction in treatment acceptability (RR 0.79, 95% CI 0.69 to 0.90; 8 studies, 1094 participants). There was moderate-certainty evidence that sustained-release naltrexone probably reduces serious adverse events in comparison with treatment as usual (RR 0.59, 95% CI 0.36 to 0.95; 6 studies, 1009 participants). Our primary outcome measures were not reported for sustained-release naltrexone compared with psychosocial treatments. Amongst the most common methodological weaknesses were the risk of performance bias and imprecision due to few studies and small sample size for many outcomes.

AUTHORS' CONCLUSIONS

Sustained-release naltrexone may slightly increase illicit opioid use and serious adverse events compared to opioid agonists, with uncertain effects on retention and acceptability. It may reduce illicit opioid use compared to oral naltrexone but has uncertain effects on other outcomes. Compared to placebo, it may have little to no impact on key outcomes. Compared to treatment as usual, it reduces illicit opioid use and may reduce serious adverse events but has little effect on retention and slightly reduces acceptability. Significant gaps remain in the evidence on sustained-release naltrexone for opioid dependence. Future research should include comparisons with psychosocial treatments, larger and higher-quality studies, and analyses of differences between formulations and comparator treatments. Improved study designs are needed to reduce bias, and more inclusive research should address under-represented populations and synthetic opioid users. The lack of long-term outcome data limits understanding of sustained effects, highlighting the need for extended follow-up and exploration of diverse treatment settings and populations.

Effects of acupuncture-related therapies on pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer: a Bayesian network meta-analysis

BACKGROUND

This network meta-analysis aimed to assess the efficacy of different acupuncture-related therapies in improving pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET).

METHODS

Randomized controlled trials (RCTs) examining acupuncture-related therapies as adjuncts to IVF-ET were systematically searched in eight databases from inception until January 15, 2025. Dichotomous outcomes concerning efficacy were evaluated as odds risk (OR) and continuous data as mean difference (MD) and 95% credible intervals (CrI) utilizing R 4.1.2 and Stata 16.1.

RESULTS

Through a comprehensive literature search, we ultimately identified 96 RCTs that involved 14,736 participants and 15 interventions in this systematic analysis. Based on the clinical pregnancy rate outcome, warm acupuncture for three menstrual cycles before oocyte retrieval (WA-TTP, OR 3.56, 95% CrI 2.05 to 6.25, low certainty, SUCRA = 89.54%), acupuncture combined with moxibustion for three menstrual cycles before oocyte retrieval (AC + M-TTP, OR 3.31, 95% CrI 1.05 to 11.77, low certainty, SUCRA = 78.70%), and acupuncture for one menstrual cycle before oocyte retrieval (AC-OTP, OR 2.69, 95% CrI 1.76 to 4.09, moderate certainty, SUCRA = 77.98%) demonstrated potential superiority compared to false acupuncture or no treatment (F/N). Significant subgroup differences between clinical pregnancy rates were observed by subgroup analysis.

CONCLUSION

Acupuncture-related therapies can potentially enhance clinical pregnancy rates among women undergoing IVF-ET, with WA-TTP, AC + M-TTP, and AC-OTP demonstrating potential superiority. AC-TTP demonstrated a greater efficacy in improving live birth rates, increasing endometrial thickness, and reducing pulsation index. Our findings emphasize that acupuncture-related therapies with a limited number of sessions before or after embryo transfer show minimal clinical benefit except auricular acupressure.

Impact of sugar-sweetened beverages on salivary parameters: A systematic review & meta-analysis

INTRODUCTION

Sugar Sweetened Beverages (SSB) can significantly influence saliva leading to a more acidic environment which makes our oral cavity prone to various oral diseases. This study investigates the influence of SSBs on salivary parameters by analyzing the existing plethora of research.

OBJECTIVE

To systematically review and analyze the impact of SSBs on changes in salivary pH, flow rate and bacterial proliferation.

METHODOLOGY

Pubmed, Embase, EBSCO, Web of Science, and Cochrane databases were searched using the PECO strategy. Risk of Bias was assessed using Newcastle Ottawa Scale and Cochrane Risk of Bias assessment tools. Meta-analysis was conducted among the eligible studies using a random effects model.

RESULTS

A total of twenty eight studies were found eligible after a thorough PRISMA search in the databases. Many studies consistently demonstrated a rapid decline in salivary pH post-SSB consumption, creating an acidic environment conducive to enamel demineralization. Few studies also reported reduced salivary flow rate and prolonged oral clearance times. Increased proliferation of acidogenic bacteria and fungi was noted. Risk of bias was low overall, but a few studies reported limitations such as randomization bias and missing data.

CONCLUSION

Consumption of sugar sweetened beverages significantly impact salivary parameters, fostering an oral environment prone to diseases such as dental caries and periodontal infections. Public health interventions and policies are essential to reduce SSB consumption and promote oral health.

Sounds of comfort: the impact of music therapy on labor pain and anxiety in primigravida women during vaginal delivery: a systematic review and meta-analysis

BACKGROUND

Music therapy has been widely used in medical practices, demonstrating positive effects on diverse medical procedures. In the context of labor pain management, evidence suggests that music can positively influence pain perception and overall well-being during labor, serving as a distraction and stress reducer. This systematic review and meta-analysis aim to comprehensively evaluate the impact of music therapy on labor pain in primigravida women during vaginal delivery.

METHODS

Following PRISMA guidelines, a thorough literature search was conducted in Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials up to November 2023. Nine randomized control trials (RCTs) met the inclusion criteria, involving primigravida women undergoing vaginal delivery with music therapy intervention. Quality assessment was performed using the Cochrane Risk of Bias assessment tool.

RESULTS

A meta-analysis of the fixed effects was performed using mean differences (MD). Pooled analysis of Visual Analog Scale (VAS) scores revealed statistically significant reductions in pain intensity during latent (MD: - 0.73; 95% CI - 1.01; - 0.45); during the active phase (MD: - 0.56; 95% CI - 1.06; - 0.07) and the second stage (MD: - 0.69; 95% CI - 0.85; - 0.54). The findings indicated no statistically significant variances related to the integration of music therapy in addressing anxiety, both in the latent phase (MD: - 0.88; 95% CI - 1.86; -2.02) and the active phase of labor (MD: -0.30; 95% CI - 1.74; 1.13).

CONCLUSIONS

In conclusion, the collective evidence presented in this systematic review underscores the potential of music, especially for women giving for the first time. in mitigating labor pain and anxiety across different stages, offering a holistic approach to enhance the overall childbirth experience for women.

The safety and efficacy of remimazolam, ciprofol, and propofol anesthesia in endoscopy: a systematic review and network meta-analysis

BACKGROUND

While propofol remains widely used for endoscopic sedation, its cardiovascular depression and injection pain limitations have prompted exploration of novel agents (remimazolam, ciprofol). This study aimed to compare their safety and efficacy profiles systematically.

METHODS

We conducted a network meta-analysis to evaluate remimazolam, ciprofol, and propofol for gastrointestinal endoscopy. Bayesian random-effects models were used to estimate relative risks (RR) and mean differences (MD) with 95% credible intervals(CrI).

RESULTS

Forty-two randomized controlled trials (N = 10,540 patients) were included. Remimazolam demonstrated superior cardiovascular safety (RR = 0.44, 95%CrI 0.35-0.54 vs propofol) and lowest respiratory depression risk (RR = 0.36, 0.28-0.46). Propofol showed faster recovery (MD -14.22 min, -2.35 to -30.83 vs remimazolam). Both remimazolam (RR = 0.045) and ciprofol (RR = 0.054) significantly reduced injection pain versus propofol.

CONCLUSION

Remimazolam should be prioritized for high-risk patients (cardiovascular/respiratory comorbidities) despite slightly longer recovery times. Propofol remains suitable for low-risk procedures requiring rapid turnover, while ciprofol offers balanced efficacy for endoscopy.

TRIAL REGISTRATION

The study was registered with the UK National Institute for Health Research's PROSPERO platform (CRD42024569405; https://www.crd.york.ac.uk/prospero/ ).

The effects of various nutritional supplements in patients with chronic obstructive pulmonary disease: a network meta-analysis

OBJECTIVE

To evaluate the effectiveness of various nutritional supplements as interventions for patients with Chronic Obstructive Pulmonary Disease (COPD) using network meta-analysis.

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on nutritional supplements for COPD patients, with the search updated to March 24, 2025. The risk of bias for each included study was assessed using appropriate tools, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data synthesis was performed using R software, employing network meta-analysis methods to compare the relative efficacy of different nutritional interventions.

RESULTS

Thirty-seven studies involving 1975 COPD patients and 21 different nutritional supplements were analyzed. Butyrate [MD = 2.7, 95% CrI (1.0, 4.4)], Nanocurcumin [MD = 13, 95% CrI (5.4, 21)], and probiotics [MD = 7.1, 95% CrI (5.2, 9.1)] significantly improved Forced Expiratory Volume in One Second (FEV1). Nanocurcumin also slowed the decline in the ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity (FEV1/FVC) [MD = 12, 95% CrI (5.5, 18)]. For exercise endurance, coenzyme Q10 combined with creatine [MD = 63, 95% CrI (36, 90)], Melatonin (MLT) [MD = 46, 95% CrI (1.3, 92)], Nitrate [MD = 30, 95% CrI (19, 41)], and whey proteins [MD = 11, 95% CrI (9.2, 13)] significantly improved 6-minute walk distance (6MWD). Regarding dyspnea reduction, MLT [MD = -0.90, 95% CrI (-1.6, -0.21)] and Yam-Epimedium [MD = -1.3, 95% CrI (-1.9, -0.67)] significantly lowered modified Medical Research Council (mMRC) scores. In terms of quality of life, MLT [MD = -8, 95% CrI (-12, -4.2)], Vitamin D (VD) [MD = -2.5, 95% CrI (-3.1, -1.9)], and whey proteins [MD = -0.70, 95% CrI (-0.99, -0.41)] reduced COPD Assessment Test (CAT) scores. Additionally, AKL1 [MD = -9.2, 95% CrI (-18, -0.41)], creatine [MD = -9.6, 95% CrI (-17, -2.8)], and Yam-Epimedium [MD = -24, 95% CrI (-34, -13)] lowered St. George's Respiratory Questionnaire (SGRQ) scores. The Surface Under the Cumulative Ranking Curve (SUCRA) analysis showed Nanocurcumin ranked highest for improving FEV1/FVC, coenzyme Q10 combined with creatine for 6MWD, Yam-Epimedium for reducing dyspnea and SGRQ, and MLT for lowering CAT scores.

CONCLUSION

This analysis indicates that various nutritional supplements, including Nanocurcumin, butyrate, probiotics, coenzyme Q10 combined with creatine, MLT, nitrate, whey proteins, VD, AKL1, creatine, and Yam-Epimedium, can potentially benefit COPD patients, demonstrating differing levels of effectiveness. Specifically, Nanocurcumin may be the best choice for improving lung function; coenzyme Q10 combined with creatine may be the most effective for enhancing exercise endurance; Additionally, Yam-Epimedium is the most likely supplement to reduce the symptoms of dyspnea in COPD patients. Yam-Epimedium and MLT may be the most effective for improving quality of life and overall health status.