A basic introduction to fixed-effect and random-effects models for meta-analysis

Sleep and the Mediterranean diet: A systematic review and meta-analysis

We conducted the current systematic review and meta-analysis to critically review and synthesize available evidence regarding the association between sleep duration, sleep quality, and chronotype with the Mediterranean diet (MedDiet) among the general population using observational studies. Online databases, including PubMed, Scopus, and ISI Web of Science, were searched from the earliest available date until December 2024. We enrolled 62 studies with a total sample size of 328,493. The mean age and BMI of the participants in the enrolled studies ranged from 6.1 to 74.7 years and 18.1-32.1 kg/m2. Individuals with sufficient sleep duration (OR: 1.39; 95 % CI, 1.04, 1.85; P = 0.030; I2 = 97.89 %, PQ-test < 0.001), good-quality sleep (OR: 1.38; 95 % CI, 1.10, 1.73; P < 0.001; I2 = 93.83 %, PQ-test < 0.001), and earlier chronotype (OR: 1.74; 95 % CI, 1.21, 2.50; P = 0.002; I2 = 89.72 %, PQ-test < 0.001) had significantly increased odds of high MedDiet scores, compared to those with insufficient sleep duration, poor-quality sleep, and later chronotype, respectively. Our study revealed that sleep duration, sleep quality, and chronotype are lifestyle-related factors linked to MedDiet. However, more longitudinal studies and clinical trials are needed to investigate causality, mediating factors, and underlying mechanisms.

The effects of β-hydroxy-β-methylbutyrate supplementation in patients with sarcopenia: A systematic review and meta-analysis

OBJECTIVES

To undertake a systematic review and meta-analysis to examine the evidence base for the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in patients with sarcopenia.

DESIGN

Systematic review and meta-analysis.

METHODS

The literature was searched via the PubMed, MEDLINE, Web of Science, EMBASE, CINAHL, Scopus, WANFANG, CNKI and VIP databases, through 23rd February 2024. The inclusion criteria were: randomized controlled trials (RCTs); patients diagnosed with sarcopenia defined according to well-accepted clinical consensus; HMB as an intervention; outcomes on muscle mass and/or muscle strength and/or physical performance. Data extraction was completed by independent pairs of reviewers. Meta-analyses of continuous outcomes were performed on the extracted data. Standard mean difference (SMD) with 95 % confidence intervals (CIs) between treatment and control group were used to express intervention effect estimates of HMB for each study. Risk of bias was assessed according to Version 2 of the Cochrane tool for assessing risk of bias in randomized trials (ROB 2).

RESULTS

Of 196 records retrieved and screened, five RCTs met the eligibility criteria for qualitative and quantitative analysis, yielding 154, 359 and 359 participants for muscle mass, muscle strength, and physical performance, respectively. For the overall risk of bias, no studies were graded as "high risk of bias", one (20.0 %) as "some concerns", and four (80.0 %) as "low risk of bias" according to the ROB 2. The overall meta-analysis revealed a beneficial effect on muscle mass and strength, as demonstrated by a higher skeletal muscle mass index (SMD = 0.32; 95 % CI: [0.00,0.64]; Z value =1.98; P = 0.048), along with an elevated handgrip strength (SMD = 0.65; 95 % CI: [0.05, 1.25]; Z value = 2.12; P = 0.034) in the HMB intervention groups compared with the control groups. However, there was no evidence of a benefit on physical performance, assessed by gait speed (SMD = 0.19; 95 % CI: [-0.14, 0.53]; Z value = 1.14; P = 0.255).

CONCLUSION

Overall, although limited and requiring interpretation with utmost caution, current evidence indicates that HMB supplementation is beneficial for improving muscle mass and strength, but there is no evidence of a benefit on physical performance in patients with sarcopenia. In future, more well-designed HMB intervention trials should be conducted that include populations diagnosed with sarcopenia according to well-accepted clinical consensus.

Association of physical activity, sedentary behaviour, sleep and myopia in children and adolescents: a systematic review and dose-response meta-analysis

PURPOSE

This study aimed to systematically evaluate the dose-response relationships between physical activity (PA), sedentary behavior(SB) (including near work [NW] and screen time [ST]), sleep duration (SD), and myopia risk among children and adolescents.

DESIGN

Systematic review and dose-response meta-analysis.

METHODS

We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science up to November 19, 2024. Methodological quality was assessed using Joanna Briggs Institute (JBI) and ROBINS-I tools. Random-effects meta-analyses were used to estimate categorical and continuous dose-response relationships. Subgroup analyses and sensitivity analyses were performed to explore heterogeneity sources and test robustness.

RESULTS

A total of 45 observational studies (766,848 participants aged 5-19 years) were included. Categorical analyses showed that, compared with the lowest exposure categories, higher PA levels (highest: OR = 0.77, 95% CI: 0.63-0.96; intermediate: OR = 0.76, 95% CI: 0.63-0.93) and longer SD (highest: OR = 0.67, 95% CI: 0.48-0.92; intermediate: OR = 0.82, 95% CI: 0.73-0.92) significantly reduced myopia risk. Conversely, higher levels of NW (highest: OR = 1.71, 95% CI: 1.28-2.27; intermediate: OR = 1.34, 95% CI: 1.19-1.50) and ST (highest: OR = 1.59, 95% CI: 1.14-2.22; intermediate: OR = 1.29, 95% CI: 1.12-1.49) were associated with significantly increased risk. In the continuous dose-response meta-analysis, a linear association was observed between PA, ST, and myopia. Each additional hour of PA per day reduced the risk of myopia by 12%, while each additional hour of ST increased the risk by 31%. Nonlinear associations were found between NW, SD, and myopia. Among children and adolescents, 1.5 and 2.5 h/day of NW increased the risk of myopia by 25% and 29%, respectively. Although longer SD was associated with a reduced risk of myopia, this effect did not reach statistical significance at any exposure level.Subgroup analyses revealed that protective effects of PA were more evident in low- and middle-income countries, smaller sample sizes, and cross-sectional studies, while increased risks related to ST and NW were stronger in low-income settings. No subgroup significantly modified the association between SD and myopia risk.

CONCLUSION

Increasing PA, while limiting ST and NW, effectively reduces the risk of myopia among children and adolescents. The association between sleep duration and myopia remains inconclusive, warranting further investigation.

Ecological and Health Risk Mediated by Micro(nano)plastics Aging Process: Perspectives and Challenges

Aged micro(nano)plastics (MNPs) are normally the ultimate state of plastics in the environment after aging. The changes in the physical and chemical characteristics of aged MNPs significantly influence their environmental behavior by releasing additives, forming byproducts, and adsorbing contaminants. However, a systematic review is lacking on the effects of aged MNPs on ecological and human health regarding the increasing but scattered studies and results. This Review first summarizes the unique characteristics of aged MNPs and methods for quantifying their aging degree. Then we focused on the potential impacts on organisms, ecosystems, and human health, including the "Trojan horse" under real environmental conditions. Through combining meta-analysis and analytic hierarchy process (AHP) model, we demonstrated that, compared to virgin MNPs, aged MNPs would result in biomass decrease and oxidative stress increase on organisms and lead to total N/P decrease and greenhouse gas emissions increase on ecosystems while causing cell apoptosis, antioxidant system reaction, and inflammation in human health. Within the framework of ecological and human health risk assessment, we used the risk quotient (RQ) and physiologically based pharmacokinetic (PBK) models as examples to illustrate the importance of considering aging characteristics and the degree of MNPs in the process of data acquisition, model building, and formula evaluation. Given the ecological and health risks of aged MNPs, our urgent call for more studies of aged MNPs is to understand the potential hazards of MNPs in real-world environments.

Effect of environmental pollutants particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (NO) and ground level ozone (O3) on epilepsy

BACKGROUND

Epilepsy is a common condition that affects the brain and causes frequent seizures. Impaired brain biology is the world's fastest-growing brain disorder, and exposure to environmental pollutants is the leading cause of mental health impairment. The growing literature suggests that air pollution is an emerging cause of neurological diseases. However, the existing evidence on air pollution and epilepsy is inadequate. This study aimed to investigate the effect of environmental pollutants particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (NO) and ground-level ozone (O3) on epilepsy.

METHODS

This study recorded data on air pollutants and epilepsy using the electronic platforms Pub Med, Web of Science, Scopus, and Google Scholar. The keywords included for the literature search were based on two main aspects: exposure (air pollutants) and outcome (epilepsy). Initially, 78 articles and reports were identified, and after revising the abstracts and full articles, 06 studies were selected for a detailed analysis and discussion. The Odds Ratio (OR) and 95% confidence intervals (CIs) were extracted to investigate the impact between air pollutants and epilepsy. The effect of air pollution on epilepsy has been investigated through a compilation of six studies encompassing 371,515 individuals. The Cochrane chi-squared test (Chi2), fixed-effects design was used when I2 < 50% and P > 0.05; otherwise, a random-effects model was adopted.

RESULTS

The results revealed that exposure to PM2.5 and NO2 were positively and significantly associated with epilepsy (RR = 1.00; 95% CI: 1.00-1.01; p = 0.03), NO2 (RR = 1.03; 95% CI: 1.02-1.03; p < 0.01). However, no association was identified between PM10, SO2, CO, and O3 with epilepsy. The results suggest a potential association between air pollution exposure and epilepsy.

CONCLUSIONS

Air pollutants PM2.5 and NO2 increase the risk of epilepsy. The findings suggest that reducing levels of these pollutants could be a strategic approach to mitigate neurological health risks in populations worldwide. Further research is warranted to elucidate the mechanisms and causal relationships between air pollutants and epilepsy. Public health initiatives aimed at reducing air pollution levels and targeted interventions to protect vulnerable populations hold promise for alleviating the burden of epilepsy associated with environmental exposures.

Low-level light therapy and intense pulse light therapy in meibomian gland dysfunction. A systematic review and meta-analysis

BACKGROUND

Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease, affecting over a third of the global population. This disease is associated with ocular discomfort, reduced visual quality, and quality of life. Novel treatments like Intense Pulse Light (IPL) therapy and Low-Level Light Therapy (LLLT) have been reported to be useful in refractory MGD treatment. However, no systematic review has explored the utility of combining these two therapies.

METHODS

Medline, Embase, and CENTRAL databases were searched for articles on LLLT + IPL therapy in MGD. A meta-analysis of single means was conducted to assess clinical endpoints.

RESULTS

Analysis of 12 studies showed that LLLT + IPL therapy in MGD patients led to a significant decrease in Ocular Surface Disease Index score (MD: -22.8, 95 %CI: -29.1 to -16.5, I2 = 97.5 %, p < 0.001), and a significant increase in both Tear Break-up Time (MD: 2.2 s, 95 %CI: 0.9 s to 3.4 s, I2 = 98.6 %, p < 0.001) and Schirmer test (MD: 1.5 mm, 95 %CI: 0.6 mm to 2.5 mm, I2 = 0.0 %, p = 0.001) at ≤ 3 months post treatment. These improvements were sustained in a sensitivity analysis at endpoints ≥ 6 months post treatment. While the percentage of loss of meibomian gland area (n = 4, MD: -3.8 %, 95 %CI: -7.2 % to -0.4 %, I2 = 40.0 %, p = 0.031) was reported to be significantly reduced, this was not found to be sustained at endpoints ≥ 6 months post treatment (n = 2, MD: 5.9 %, 95 %CI: 1.8 % to 10.0 %, I2 = 0.0 %, p = 0.005) in two studies.

CONCLUSIONS

This meta-analysis provides quantitative evidence supporting the clinical efficacy of LLLT + IPL therapy in MGD. Future research should evaluate its long-term safety and efficacy and compare it with alternative treatments.

Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis

BACKGROUND

This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago.

METHODS

A comprehensive search was conducted on 3 June 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear-mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs).

RESULTS

We retrieved a total of 15 417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I2  = 94%) and 23.5 (95% CI 9.0-61.3; I2  = 100%) per 10 000 colonoscopies, respectively. The " > 80 years" group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I2  = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I2  = 0%) compared to the "65-80 years" group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I2  = 0%) and 27 (95% CI 9.0-81.0; I2  = 99%) per 10 000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I2  = 1%) and 16 (95% CI 8.1-31.3; I2  = 98%) per 10 000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10 000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10 000 colonoscopies). The prevalence of cardiopulmonary AEs in the elderly population is relatively high, although the definition used varies across different studies.

CONCLUSIONS

We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AE rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.

Estimating treatment effects from a randomized controlled trial with mid-trial design changes

BackgroundIn randomized controlled trials (RCTs), unplanned design modifications due to unexpected circumstances are seldom reported. Naively lumping data from pre- and post-design changes to estimate the size of the treatment effect, as planned in the original study, can introduce systematic bias and limit interpretability of the trial findings. There has been limited discussion on how to estimate the treatment effect when an RCT undergoes major design changes during the trial. Using our recently completed RCT, which underwent multiple design changes, as an example, we examined the statistical implications of design changes on the treatment effect estimates.MethodsOur example RCT aimed to test an advance care planning intervention targeting dementia patients and their surrogate decision-makers compared to usual care. The original trial underwent two major mid-trial design changes resulting in three smaller studies. The changes included altering the number of study arms and adding new recruitment sites, thus perturbing the initial statistical assumptions. We used a simulation study to mimic these design modifications in our RCT, generate independent patient-level data and evaluate naïve lumping of data, a two-stage fixed-effect and random-effect meta-analysis model to obtain an average effect size estimate from all studies. Standardized mean-difference and odds-ratio estimates at post-intervention were used as effect sizes for continuous and binary outcomes, respectively. The performance of the estimates from different methods were compared by studying their statistical properties (e.g. bias, mean squared error, and coverage probability of 95% confidence intervals).ResultsWhen between-design heterogeneity is negligible, the fixed- and random-effect meta-analysis models yielded accurate and precise effect-size estimates for both continuous and binary data. As between-design heterogeneity increased, the estimates from random meta-analysis methods indicated less bias and higher coverage probability compared to the naïve and fixed-effect methods, however the mean squared error was higher indicating greater uncertainty arising from a small number of studies. The between-study heterogeneity parameter was not precisely estimable due to fewer studies. With increasing sample sizes within each study, the effect-size estimates showed improved precision and statistical power.ConclusionsWhen a trial undergoes unplanned major design changes, the statistical approach to estimate the treatment effect needs to be determined carefully. Naïve lumping of data across designs is not appropriate even when the overall goal of the trial remains unchanged. Understanding the implications of the different aspects of design changes and accounting for them in the analysis of the data are essential for internal validity and reporting of the trial findings. Importantly, investigators must disclose the design changes clearly in their study reports.

Impact loading exercise induced osteogenesis from childhood to early adulthood in tennis players aged 8-30 years

Osteogenesis with impact-loading exercise is often assessed by the extra bone growth induced in the loaded arm of tennis players. We used PRISMA to explore % bone mineral content (BMC) and area (BA) asymmetry in players 8-30 years according to weekly training hours, age, sex, maturity, and bone segment. Proper statistics for 70 groups were extracted by two reviewers from 18 eligible studies of low risk of bias (< 35, STROBE) and good quality (> 70%). The quality of the review was high (AMSTAR, 81%). Using "random effects" we tested moderation-specific meta-comparisons and meta-regressions. The loaded bones % hypertrophy was higher in BMC (19%) than BA (10%), and, with BMC and BA merged, in boys (17%) than girls (13%), in humerus (19%) than radius-ulna (14%), and in pubertal (19%) players. Weekly training hours were more important (43%) than sex (17%), puberty (14%) and bone (15%) in BMC, and puberty (48%) was more important than weekly training hours (19%), sex (12%), and radius-ulna (5%) in BA. The loaded bones % hypertrophy correlated with weekly training hours highly (> 0.60) in all maturity groups for BMC and BA, and moderately (0.41) in early adults for BA; it also correlated with age (≥ 0.60) in children and peripubertal players, but not (0.037) with starting age. Impact loading exercise favors mineralization twice than bone expansion, while puberty favors bone expansion about three times more than mineralization. The bone gains are higher for boys than girls, and for peripubertal than older players. The bone growth implications are discussed considering limitations and future research.

Armed conflict and treatment interruptions: A systematic review and meta-analysis in Amhara, Ethiopia

BACKGROUND

Armed conflicts significantly disrupt healthcare systems, leading to infrastructure destruction, shortages of medical supplies, and reduced access to essential health services. The Amhara region has experienced prolonged conflict, raising concerns about its impact on healthcare delivery. Understanding the extent of these disruptions is crucial for informing policy responses and humanitarian interventions.

OBJECTIVES

This systematic review and meta-analysis aimed to assess the impact of armed conflict on healthcare delivery in the Amhara region.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Conducted between June 1 and July 10, 2024, this meta-analysis followed PRISMA guidelines. A comprehensive search was performed across PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, ScienceDirect, and the Cochrane Library. Eligible studies included English-language observational studies and grey literature addressing healthcare disruptions, infrastructure damage, and health crises. Data were analyzed using STATA Version 14, and study quality was assessed using a modified Newcastle-Ottawa Scale.

RESULTS

Twelve studies, encompassing 12,037,279 participants, were included. The pooled prevalence of health impacts was 76.71 % (95 % CI: 76.63-76.78). The conflict rendered 60 % of healthcare facilities nonfunctional, disrupted medical supplies for 70 % of the population, and reduced service availability by 80 %. Chronic disease management, mental health services, maternal care, and immunization programs experienced significant declines. Subgroup analyses indicated a higher prevalence of health impacts in studies published after 2022 (70.72 %) compared to those published before 2022 (28.35 %).

CONCLUSION

Armed conflict in the Amhara region has severely disrupted healthcare services, leading to facility closures, medical supply shortages, and significant declines in essential health services. Urgent interventions are required to restore healthcare infrastructure and services.

Transperineal prostate biopsy with freehand technique under local anaesthetic: A systematic review and meta-analysis

Background

Transperineal prostate biopsy (TPPB) under local anaesthesia is a widely employed biopsy method, and is currently endorsed by the European Association of Urology (EAU). This review aimed to assess the pooled detection rates of clinically significant prostate cancer using TPPB under local anaesthetic. Additionally, pain scores and complications were also reported.

Methods

Our search was conducted in line with the most recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations up to August 2024. The study was registered on PROSPERO under the ID: CRD42024588824. An electronic search was conducted of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases along with grey literature using the Google search engine.

Results

In total, there were 2881 patients included in this review. Biopsy histology results were reported in 11 studies comprising 2781 cases. We observed a clinically significant prostate cancer rate of 52% (95% CI 44%-60%) for studies that employed both a mix of systematic and targeted biopsies and 26% (95% CI 23%-30%) when systematic biopsies alone were taken. The pooled rate was 48% (95% CI 37%-59%), overall. Complications after prostate biopsies were reported by 9 studies with a combined 2688 patients. There were 61 patients (2.3%) who had Clavien-Dindo (CD) 1-2 complications and three patients (0.1%) who had CD 3-5 complications. The pooled rate of CD 1 and 2 complications was 2% (95% CI 1%-4%).

Conclusions

TPPB under local anaesthetic is a safe, efficacious and well-tolerated method of prostate biopsy when compared with other methods. Undertaking the procedure under local anaesthesia does not seem to lower cancer detection rates.

Prevalence of complications of buccal fat removal: A systematic review and meta-analysis

Removal of the buccal fat pad can be considered safe as long as there is a detailed analysis of anatomical landmarks. The objective of this study was to estimate the prevalence of intra- and postoperative complications resulting from buccal fat pad removal through a systematic review. The search strategy involved observational and/or interventional studies in humans that included at least one case of buccal fat pad removal with a description of the surgery, postoperative progress, and complications. Methodological quality assessment was performed using the JBI checklist. Study heterogeneity was assessed using the I2 test. In total, 12 studies were included. Out of 308 patients who underwent buccal fat pad removal, 81 experienced some form of complication, with an overall prevalence of 25% (95% CI = 0.04-0.46). Complications found in the data collection included edema (38.40%), trismus (30.09%), pain (19.41%), asymmetry (11.65%), facial nerve paralysis (0.97%), infection (0.48%), hematoma (0.48%), and unilateral emphysema (0.48%). All complications occurred in the postoperative period. There was high heterogeneity among the studies. One in four patients undergoing buccal fat pad removal experiences some form of postoperative complication. Consequently, the procedure should be recommended with caution because there is evidence for safety concerns and a lack of predictability in the evaluated studies.

Associations between vascular endothelial growth factor polymorphisms and response to 5-FU-based pharmaceutical therapy in esophageal squamous cell carcinoma: A meta-analysis

BACKGROUND AND AIMS

Vascular endothelial growth factor (VEGF) gene polymorphisms are associated with the response to pharmaceutical therapy in many cancers. This study aimed to investigate the effects of VEGF gene polymorphisms in esophageal squamous cell carcinoma patients receiving pharmaceutical therapy.

METHODS

This literature-based meta-analysis was performed with keywords related to VEGF gene polymorphisms and clinical response in esophageal squamous carcinoma patients receiving pharmaceutical therapy (including 5-FU, cisplatin, oxaliplatin, and calcium folinate). After a series of bias grading analyses and DerSimonian-Laird method analysis, odds ratios and 95% confidence intervals were calculated to examine the potential relationships. Sensitivity and subgroup analyses were subsequently performed to determine the major causes of heterogeneity.

RESULTS

Heterogeneity was dramatically reduced after the removal of one study from the analysis (I2 = 37%, P = 0.19). The remaining studies involved 5-FU-based treatment. The presence of VEGF G-1154A and VEGF-634C/G was found to be correlated with patient response to 5-FU/CDDP-based treatment, whereas VEGF-2549I/D was correlated with response to 5-FU/oxaliplatin-based treatment, and VEGF-936C/T was associated with both 5-FU/CDDP- and 5-FU/oxaliplatin-based treatment response.

CONCLUSION

VEGF gene polymorphisms affect the response of esophageal squamous carcinoma patients receiving pharmaceutical therapy, especially 5-FU-based treatments.

A Meta-Analysis of Artificial Intelligence Technologies Use and Loneliness: Examining the Influence of Physical Embodiment, Age Differences, and Effect Direction

Recent research has investigated the connection between artificial intelligence (AI) utilization and feelings of loneliness, yielding inconsistent outcomes. This meta-analysis aims to clarify this relationship by synthesizing data from 47 relevant studies across 21 publications. Findings indicate a generally significant positive correlation between AI use and loneliness (r = 0.163, p < 0.05). Specifically, interactions with physically embodied AI are marginally significantly associated with decreased loneliness (r = -0.266, p = 0.088), whereas engagement with physically disembodied AI is significantly linked to increased loneliness (r = 0.352, p < 0.001). Among older adults (aged 60 and above), AI use is significantly positively associated with loneliness (r = 0.352, p < 0.001), while no significant correlation is observed (r = 0.039, p = 0.659) in younger individuals (aged 35 and below). Furthermore, by incorporating positive attitudes toward AI, the study reveals that the influence of AI use in exacerbating loneliness outweighs the reverse impact, although both directions show significant positive relationships. These results enhance the understanding of how AI usage relates to loneliness and provide practical insights for addressing loneliness through AI technologies.

The use of enhanced recovery after surgery (ERAS) protocols in plastic surgery: A systematic review and meta-analysis of the literature

BACKGROUND

Enhanced recovery after surgery (ERAS) protocols, introduced in 1997, are evidence-based strategies designed to reduce postoperative stress and improve recovery through a multidisciplinary approach. This systematic review evaluated the use of ERAS in plastic surgery, focusing on opioid use, pain management, hospital stay, and patient outcomes.

METHODS

A literature search in PubMed/MEDLINE and Web of Science was conducted up to May 9, 2024, identifying 239 studies on ERAS in plastic surgery. Seventeen studies met the inclusion criteria, and 9 studies involving 1228 patients were included. Outcomes assessed were narcotic use, pain scores, hospital stay, and complications. Quality was assessed using the National Institute of Health (NIH) tool.

RESULTS

Among the 9 studies, 4 were included in a meta-analysis (600 participants). ERAS protocols were associated with a significantly shorter hospital stay (mean difference: -0.58 days, P = 0.003) with no heterogeneity. Opioid use decreased (mean difference: -85.5 morphine milligram equivalents [MME]), although the results were uncertain due to high heterogeneity (I² = 99.9). ERAS also showed lower pain scores within 24 h postsurgery, but with considerable variability (mean difference: -1.56, P = 0.27).

CONCLUSION

ERAS protocols reduce opioid consumption and hospital stays while maintaining or improving patient satisfaction in plastic surgery. Despite risks such as increased bleeding, the benefits suggest that ERAS enhances recovery. Future research should optimize protocols and address regional implementation challenges.

Systematic review and meta-analysis of peripheral blood inflammatory markers in hidradenitis Suppurativa

Despite the systemic inflammatory implications of hidradenitis suppurativa (HS), the relationship between systemic inflammatory markers and HS has not been definitively established in the existing literature. This review aimed to evaluate the relationship of peripheral blood inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) with the presence and severity of HS. A comprehensive search of the PubMed, Embase and Cochrane databases was conducted. Studies with data on these peripheral blood inflammatory markers in HS patients were included. A meta-analysis was performed using standardized mean differences to evaluate the association between these inflammatory markers and HS. Our study included 23 research articles that included 2623 cases and 22 015 controls. The results demonstrated that (1) CRP, ESR, NLR, and SII levels were significantly higher in HS patients than controls, and (2) CRP, ESR, PIV, and SII positively correlated with HS severity between Hurley stages I and II and II and III. NLR and PLR also correlated with severity between stages II and III. CRP, ESR, NLR and SII are significantly associated with the presence of HS, while CRP, ESR, SII, and PIV are important indicators of HS severity. NLR and PLR become particularly significant in groups with severe HS. Our results underscore the systemic inflammatory involvement in HS and suggest that these inflammatory markers could be valuable in clinical practice for screening and monitoring the progression of HS.

Impact of Molecular Testing on Surgical Decision-Making in Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis of Recent Advancements

Background: The management of indeterminate thyroid nodules (Bethesda III/IV) has evolved with molecular testing, aiming to reduce unnecessary surgeries. However, the comparative effectiveness of different platforms in influencing surgical decision-making remains unclear. This systematic review and meta-analysis evaluate the impact of molecular testing on surgical avoidance rates. Methods: A systematic literature search was conducted across eight electronic databases, including Embase, PubMed, and Cochrane Library, from January 2019 to December 2024, following PRISMA guidelines to encompass most recent advancements in the last 5 years. Studies evaluating Afirma Gene Expression Classifier (GEC), Afirma Genomic Sequencing Classifier (GSC), ThyroSeq V2, ThyroSeq V3, and ThyGenX/ThyraMIR were included. The primary outcome was surgical avoidance, analyzed using a random-effects model. Results: Thirty-one studies comprising 4464 indeterminate thyroid nodules met inclusion criteria. Pooled surgical avoidance rates varied across platforms: ThyroSeq V2 (50.3%, 95% CI: 20.8-79.6%), ThyroSeq V3 (62.5%, 95% CI: 54.8-70.0%), Afirma GEC (58.8%, 95% CI: 43.6-73.1%), Afirma GSC (50.6%, 95% CI: 34.3-66.8%), and ThyGenX/ThyraMIR (68.6%, 95% CI: 63.1-73.9%). ThyGenX/ThyraMIR had the highest surgical avoidance rate and lowest heterogeneity (I2 = 51.2%), while ThyroSeq showed improvement from V2 to V3. Conclusions: Molecular testing reduces unnecessary thyroid surgeries, with avoidance rates ranging from 50.3% to 68.6%. While ThyGenX/ThyraMIR showed the highest avoidance rate, its limited representation warrants cautious interpretation. Standardized protocols are needed to optimize clinical application. Further prospective studies should compare platforms and assess long-term outcomes and cost-effectiveness.

The effect of exercise training on quality of life in people with chronic kidney disease requiring dialysis. A systematic review with meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is a debilitating condition associated with poor health outcomes, including reduced quality of life (QoL), frequent hospitalisation and premature mortality.

AIM

This study aimed to determine the effect of exercise training on health-related QoL in individuals with CKD requiring dialysis, focusing on mental health scores. Secondary aims included analysing the effect of exercise modality, intensity, and delivery context to maximise exercise training benefits for QoL. Additionally, differences in mental component summary and physical component summary scores using CKD-specific generic QoL patient reported outcome measures were examined.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus up to November 14th, 2024, identified randomised controlled trials (RCTs) comparing exercise training to usual care in CKD patients requiring dialysis. Twenty-five RCTs met the inclusion criteria and were pooled for meta-analyses.

RESULTS

Pooled analysis revealed significant improvements in QoL scores for mental component summary (MD 3.33 [1.24, 5.41], p = 0.002) and physical component summary (MD 3.75, [2.28, 5.23], p < 0.00001) compared to the usual care. A statistically significant improvement in the mental component summary was found for aerobic training (p = 0.02) and resistance training (p = 0.04). Moderate intensity (p = 0.003), an intervention duration of 12-26 weeks (p = 0.0004), interdialytic delivery (p = 0.003), intradialytic delivery (p = 0.03) and supervised training (p = 0.002) all demonstrated statistically significant improvements in mental component summary. The short form (SF)-36 demonstrated significant improvements in mental component summary (MD 4.15 [1.54, 6.76], p = 0.002), while the kidney disease QoL patient-reported outcome measure did not show significant improvement (p = 0.33).

CONCLUSIONS

Supervised, inter-dialytic or intra-dialytic exercise, including aerobic or resistance training at a moderate intensity for up to 26 weeks, can significantly improve mental component summary scores in individuals with stage 5 CKD on dialysis.

Factors Influencing Health Care Technology Acceptance in Older Adults Based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology: Meta-Analysis

BACKGROUND

The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior.

OBJECTIVE

We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations.

METHODS

A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34% (14/41) of studies rated as good quality and 66% (27/41) as satisfactory.

RESULTS

Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I²=95.9%, 93.6%, and 95.3% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects.

CONCLUSIONS

The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations.

Effect and safety of perioperative ketamine/esketamine administration on postoperative pain and depression after breast cancer surgery: a systematic review and meta-analysis

Background

Patients with breast cancer experience varying degrees of pain, depression, and anxiety after surgery, which affect their postoperative recovery. Although ketamine/esketamine exhibit potential for opioid-sparing and controlling postoperative pain and depression, their effects on postoperative pain and depression remain unclear. This meta-analysis aimed to evaluate whether perioperative administration of ketamine/esketamine could reduce postoperative pain and depression, improve postoperative recovery, and reduce the incidence of adverse events in patients after breast cancer surgery.

Material and methods

PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials were searched from inception until June 2, 2024 for randomized controlled trials in English language on the effect of perioperative ketamine/esketamine on postoperative pain in patients undergoing breast cancer surgery. The primary outcome was the postoperative pain score, and the secondary outcomes were the postoperative depression score, quality of postoperative recovery, incidence of adverse events, and extubation time. The standardized mean difference and 95% confidence interval (CI) were calculated for continuous outcomes, and the risk ratio and 95% CI were calculated for binary variables.

Results

Seven studies involving 748 patients were included in this meta-analysis. No significant differences were found in postoperative pain scores at 2 h, 4 h, 1 day, 3 days, 7 days, and 3 months after surgery. Postoperative depression scores at 3 and 7 days after surgery were lower in the ketamine/esketamine group. The incidence of dizziness was lower in ketamine/esketamine group. No statistically significant differences were observed in postoperative depression scores at 30 days after surgery, quality of postoperative recovery at 1 and 3 days after surgery, extubation time, or the incidence of nausea, vomiting, and nightmares.

Conclusion

Perioperative ketamine/esketamine administration did not significantly reduce postoperative pain in patients undergoing breast cancer surgery; however, it may reduce depression within a short period after the surgery.

Clinical Trial Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42024572414, identifier CRD42024572414.

Effects of social norm feedback on adherence to clinical practice guidelines among healthcare workers and its characteristics in behavior change techniques: A systematic review and meta-analysis

BACKGROUND

Poor adherence to clinical practice guidelines among healthcare workers could have negative impacts on the effectiveness of care, patient health outcomes, and healthcare costs. Social norm feedback can be an essential means of achieving the intended intervention goals by providing information to the intervention target regarding the values, attitudes, or behaviors of the reference group or individual. However, there is a lack of consensus on the effectiveness of social norm feedback in improving adherence to clinical practice guidelines among healthcare workers. Therefore, this systematic review aimed to assess the effects of social norm feedback on adherence to clinical practice guidelines among healthcare workers and its characteristics in behavior change techniques.

METHODS

Searches of PubMed, Web of Science, Cochrane Central Register of Controlled Trials (via CENTRAL), EMBASE (via OVID), MEDLINE (via OVID), and Scopus were preformed to identify peer-reviewed studies published until February 29, 2024. Randomized controlled trials reporting social norm feedback interventions (social comparison, information about others' approval, credible source, social reward, and social incentive) to support compliance with clinical practice guidelines were included. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias 2.0 tool and the certainty of evidence was rated using the GRADE method. Pooled data were analyzed in Stata 17.0 using a random effects model meta-analysis.

RESULTS

A total of 31 articles (30 studies) were identified. Fifteen behavior change techniques were tested in the included studies. The three most commonly used behavior change techniques in clinical practice guidelines were social comparison, feedback on the outcome of behavior, and social support. A meta-analysis showed that social norm feedback appeared to be an effective strategy to improve adherence to clinical practice guidelines among healthcare workers, with a rate difference (RD) of 0.04 (95 % confidence interval [CI] 0.02-0.06). Credible source (RD 0.12, 95 % CI 0.06-0.19) and multiple social norms behavioral change techniques (RD 0.05, 95 % CI 0.04-0.06) seemed effective when combined with other behavioral change techniques, compared to the control condition. The certainty of evidence across the outcomes ranged from very low to high based on the GRADE approach.

CONCLUSION

Social norm feedback appears to be an effective method for improving adherence to clinical practice guidelines among healthcare workers. This review provides a broad understanding of how social norm feedback can be applied to improve adherence of healthcare workers to clinical practice guidelines, ultimately improving patient health and quality of care.

TRIAL REGISTRATION

PROSPERO CRD42023411582.

Ketone therapy improves cardiac function and structure in rodents with heart failure: A systematic review and meta-analysis

This meta-analysis aimed to quantitatively assess the effects of ketone intervention on cardiac function and structure in rodents with heart failure (HF). We hypothesized that ketone intervention could enhance the cardiac function and structure in HF. We systematically searched PubMed, Cochrane Library, and Embase databases for relevant studies up to April 13, 2024. Ketone therapy encompassed a ketogenic diet, ketone esters, medium-chain triglycerides, and β-hydroxybutyrate. The effect measures are mainly expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Our meta-analysis included 24 animal studies. Ketone therapy significantly improved left ventricular ejection fraction (SMD: 1.31, 95% CI: 0.79-1.82, I2 = 77%), cardiac output (SMD: 0.70, 95% CI: 0.28-1.11, I2 = 0%), and ameliorated myocardial hypertrophy (SMD: -1.95, 95% CI: -2.76 to -1.13, I2 = 76%), myocardial fibrosis (SMD: -0.87, 95% CI: -1.60 to -0.15, I2 = 68%), and ventricular remodeling in HF rodents. Subgroup analysis indicated that ketone intervention worsened myocardial fibrosis in non-HF rodents (SMD: 0.86, 95% CI: 0.09-1.63, I2 = 78%) and had no significant effect on cardiac function. Additionally, further subgroup analysis indicated that ketogenic diet significantly alleviated cardiac hypertrophy and fibrosis, whereas ketone esters did not yield significant effects. The effect of ketone on left ventricular ejection fraction strengthened with the duration of intervention. Our results suggested that ketone therapy significantly improved the cardiac systolic function and structure in rodents with HF, and had no effect in rodents non-HF. Thus, ketone intervention may be a promising treatment for HF patients.

Biological concentrations of DDT metabolites and breast cancer risk: an updated systematic review and meta-analysis

The question of whether dichlorodiphenyltrichloroethane (DDT) exposure is related to breast cancer (BC) remains unanswered, possibly due to methodological constraints in the studies that have been performed. We aimed to update and synthesize the available epidemiological evidence on the relationship of p,p'-DDT, o,p'-DDT and p,p'-dichlorodiphenyldichloroethylene (p,p'- DDE) biological concentrations with female BC, focusing in methodological characteristics not addressed in previous reviews. We conducted an overview of reviews and a systematic review and meta-analysis. We used six databases and one search engine to identify meta-analyses based on systematic reviews, pooled analyses, and individual studies published from January 2000 to December 2021. For the overview of reviews, we assessed meta-analyses' risk of bias and carried out a narrative synthesis. For the meta-analysis, we estimated summary association measures with fixed or random effects models for each compound stratifying for characteristics of interest. We estimated a positive summary association between p,p'- DDT biological concentrations and BC in prospective studies (nested case control) with >10 years of follow-up (sOR=1.41; 95 %CI: 1.06-1.88). Among retrospective studies (hospital or population-based case-control), BC was positively related with p,p'-DDE biological concentrations (sOR=1.15; 95 %CI: 1.02-1.30), and with p,p'-DDT in women with mean serum concentrations>100 ng/g (sOR=1.33; 95 %CI: 1.25-1.41). Moreover, we detected a positive association between o,p'-DDT and BC (sOR=2.24; 95 %CI: 2.15-2.34). Our results support a positive relationship between DDT exposure and BC, and are useful to reinforce its worldwide prohibition, since this pesticide is still used in some countries, has long persistence in the human body and disseminates to other geographic areas.

Effects of candidate genes on milk fat synthesis in ruminants: A meta-analysis

Milk fat content is a polygenic commercially important quantitative trait in ruminants. In recent decades, an increasing number of genes involved in milk fat synthesis have been identified through genome-wide association studies and validated using functional assays such as gene knockdown or overexpression. However, functional validation assays have been limited to small number of related genes, yielding insufficient data to fully understand the many different genes and biological processes in milk fat synthesis. To provide a comprehensive evaluation of the genes involved in milk fat synthesis, we performed a meta-analysis of 1, 395 effect sizes from 81 publications, which included 137 genes, spanning 4 ruminant species. In the studies analyzed knockdown/overexpression of candidate genes significantly reduced/increased Target Gene (Protein) and Related Gene (Protein) expression, and these effects were consistent across species. However, the effects of knockdown/overexpression of candidate genes across the different pathways of milk fat synthesis varied between species. Pathways related to milk fat synthesis, SREBP-, PPAR-, JAK-AKT- and the Insulin-pathway exhibited the largest effects on the synthesis of triglyceride, lipid droplet, cholesterol and unsaturated fatty acids, respectively. Key genes in these pathways, SREBPs (SREBP1, SREBF1), PPARs (PPARA, PPARD, PPARG), JAK2, STAT5α and INSIGs (INSIG1 and INSIG2) also have a greater effect on regulating the formation of triglyceride, cholesterol, lipid droplets and unsaturated fatty acids. Overall, our findings indicated that milk fat synthesis is regulated by multiple pathways and many different genes. Further studies are needed to confirm these findings and to understand the mechanisms underlying species- and pathway-specific responses during milk fat synthesis.

Cancer-related cognitive impairment in patients with hematologic malignancies after CAR T cell therapy: a systematic review and meta-analysis of prevalence

PURPOSE

Cancer-related cognitive impairment is one of the symptoms of neurotoxicity among patients receiving chimeric antigen receptor (CAR) T cell therapy. Evidence of the overall estimated prevalence of cancer-related cognitive impairment following CAR T-cell therapy among patients with hematologic malignancies at short-term and long-term follow-ups is lacking. This review aimed to summarize the cognitive functioning status and estimate the prevalence of cancer-related cognitive impairment at follow-up within 1 month, 1 to 12 months, and > 12 months after CAR T cell therapy.

METHODS

PubMed, Cochrane Library, EMBASE, CINAHL Plus, Web of Science, and PsycINFO via ProQuest from inception through August 2024. Studies that reported on cognitive impairment among patients receiving CAR T cell therapy with valid measures were included. Data on cognitive impairment prevalence were pooled using a random-effects model.

RESULTS

In total, 16 studies involving 1407 patients were included. The pooled cancer-related cognitive impairment prevalence rates assessed using neuropsychological tests at the follow-up timepoints (< 1 month, 1-12 months, and > 12 months) were 24% [95% prediction interval (PI) 16-33%], 33% (95%, PI 9-64%), and 35% (95%, PI 23-48%), respectively. The prevalence estimates assessed using other measures were ranging from 4 to 38% across different timepoints. The leave-one-out meta-analyses quantified the impact of these potential outliers on the estimation of the overall prevalence.

CONCLUSIONS

The findings stress the importance of developing targeted interventions to prevent or manage cognitive impairment in cancer patients during both short-term and long-term follow-up periods. This review also highlights the need for further research in this area to improve our understanding of the disease mechanisms and implement preventive strategies for managing cancer-related cognitive impairment.

A Framework for Quantitative Systems Pharmacology Model Execution

A mathematical model can be defined as a theoretical approximation of an observed pattern. The specific form of the model and the associated mathematical methods are typically dictated by the question(s) to be addressed by the model and the underlying data. In the context of research and development of new medicines, these questions often focus on the dose-exposure-response relationship.The general workflow for model development and application can be delineated in three major elements: defining the model, qualifying the model, and performing simulations. These elements may vary significantly depending on modeling objectives. Quantitative systems pharmacology (QSP) models address the formidable challenge of quantitatively and mechanistically characterizing human and animal biology, pathophysiology, and therapeutic intervention.QSP model development, by necessity, relies heavily on preexisting knowledge, requires a comprehensive understanding of current physiological concepts, and often makes use of heterogeneous and aggregated datasets from multiple sources. This reliance on diverse datasets presents an upfront challenge: the determination of an optimal model structure while balancing model complexity and uncertainty. Additionally, QSP model calibration is arduous due to data scarcity (particularly at the human subject level), which necessitates the use of a variety of parameter estimation approaches and sensitivity analyses, earlier in the modeling workflow as compared to, for example, population modeling. Finally, the interpretation of model-based predictions must be thoughtfully aligned with the data and the mathematical methods applied during model development.The purpose of this chapter is to provide readers with a high-level yet comprehensive overview of a QSP modeling workflow, with an emphasis on the various challenges encountered in this process. The workflow is centered around the construction of ordinary differential equation models and may be extended beyond this framework. It includes the fundamentals of systematic literature reviews, the selection of appropriate structural model equations, the analysis of system behavior, model qualification, and the application of various types of model-based simulations. The chapter concludes with details on existing software options suitable for implementing the described methodologies.This workflow may serve as a valuable resource to both newcomers and experienced QSP modelers, offering an introduction to the field as well as operating procedures and references for routine analyses.

The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis

Background/Objectives: Spinal cord injury (SCI) causes profound autonomic and endocrine dysfunctions, giving rise to adrenal insufficiency (AI), which is marked by a reduction in steroid hormone production. Left unaddressed, SCI-related AI (SCI-AI) can lead to life-threatening consequences such as severe hypotension and shock (i.e., adrenal crisis). However, symptoms are often non-specific, making AI challenging to distinguish from similar or overlapping cardiovascular conditions (e.g., orthostatic hypotension). Additionally, the etiology of SCI-AI remains unknown. This review aimed to synthesize the current literature reporting the prevalence, symptomology, and management of SCI-AI. Methods: A systematic search was performed to identify studies reporting AI following the cessation of glucocorticoid treatments in individuals with traumatic SCI. A random-effects meta-analysis was conducted to investigate the overall prevalence of SCI-AI. Results: Thirteen studies involving 545 individuals with traumatic SCI, most with cervical level injuries (n = 256), met the review criteria. A total of 4 studies were included in the meta-analysis. Primary analysis results indicated an SCI-AI pooled prevalence of 24.3% (event rate [ER] = 0.243, 95% confidence interval [CI] = 0.073-0.565, n = 4). Additional sensitivity analyses showed a pooled prevalence of 46.3% (ER = 0.463, 95%CI = 0.348-0.582, n = 2) and 10.8% (ER = 0.108, 95%CI = 0.025-0.368, n = 2) for case-control and retrospective cohort studies, respectively. High-dose glucocorticoid administration after SCI as well as the injury itself appear to contribute to the development of AI. Conclusions: The estimated prevalence of AI in people with traumatic SCI was high (24%). Prevalence was also greater among individuals with cervical SCI than those with lower-level lesions. Clinicians should be vigilant in recognizing the symptomatology and onset of SCI-AI. Further research elucidating its underlying pathophysiology is needed to optimize glucocorticoid administration for remediating AI in this vulnerable population.

Reduced Penetrance is Common Among Predicted Loss-of-Function Variants and is Likely Driven by Residual Allelic Activity

Loss-of-function genetic variants (LoFs) often result in severe phenotypes, including autosomal dominant diseases driven by haploinsufficiency. Due to low carrier frequencies, their penetrance is generally unknown but typically variable. Here, we investigate the penetrance of >6,000 predicted LoFs (pLoFs) linked to 91 haploinsufficient diseases using a cohort of ≈24,000 carriers with linked electronic health record data. We find evidence for widespread reduced penetrance, which persisted after accounting for variant annotation artifacts, missed diagnoses, and incomplete clinical data. We thus hypothesized that many pLoFs have incomplete penetrance, which may be driven by residual allelic activity. To test this, we trained machine learning models to predict pLoF penetrance using variant-specific genomic features that may correlate with incomplete loss-of-function. The models were predictive of pLoF penetrance across a range of diseases and variant types, including those with prior clinical evidence for pathogenicity. This suggests that many pLoFs have incomplete penetrance due to residual allelic activity, complicating disease prognostication in asymptomatic carriers.

Uncovering drug targets for cluster headache through proteome-wide Mendelian randomization analysis

BACKGROUND

Cluster headache (CH) is a highly disabling primary headache disorder with a complex underlying mechanism. However, there are currently no effective targeted therapeutic drugs available. Existing medications often have limited efficacy and numerous side effects, which frequently fail to meet clinical needs. This study aims to identify potential new therapeutic targets for CH through proteome-wide mendelian randomization (PWMR).

METHODS

We used PWMR to estimate the causal effects of plasma proteins on CH. This analysis integrated plasma protein quantitative trait loci (pQTL) data with genome-wide association study (GWAS) results of CH phenotypes. In addition, we conducted various sensitivity analyses, enrichment analyses, phenome-wide MR assessments, protein-protein interaction network construction, and mediation MR analyses to further validate the drug potential of the identified protein targets.

RESULTS

We identified 11 protein targets for CH (p < 2.41 × 10-5), with high-priority candidates exhibiting minimal side effects. Phenome-wide MR revealed novel targets-PXDNL, CCN4, PKD1, LGALS9, and MRC1-that show no significant disease-related adverse effects and interact with established preventive CH drug targets. Notably, PXDNL interacts with both acute and preventive CH drug targets. Furthermore, the causal effect of plasma proteins on CH is partially mediated by cortical surface area, with mediation proportions ranging from 3.2% to 10.0%.

CONCLUSIONS

We identified a set of potential protein targets for CH, characterized by rare side effects and a strong association with the biological mechanisms underlying the disorder. These findings offer valuable insights for the development of targeted drug therapies in the treatment of CH.

Effects of in-bed cycling in critically ill adults: A systematic review and meta-analysis of randomised clinical trials

BACKGROUND

Impairments in intensive care unit (ICU) survivors can last up to 5 years post-discharge. Finding effective treatments to palliate and prevent them is essential, and in-bed cycling is a way to palliate the effects of prolonged immobilisation.

OBJECTIVE

To evaluate the effects of in-bed cycling in critically ill adults regarding recovery status, mortality, physical performance and quality of life.

METHODS

We followed PRISMA 2020 guidelines. The search was conducted in Cinahl, Medline, Scopus and Web of Science from their inception to October 2024. We included randomised clinical trials with critically ill adults who performed in-bed cycling alone or with another treatment while in ICU, compared to no intervention, placebo, rehabilitation or standard care, assessing recovery status, mortality, physical performance or quality of life. Methodological quality and risk of bias were evaluated. A meta-analysis was performed.

RESULTS

Thirty-two studies were included in the review, and 22 studies in the meta-analysis. A total of 3,052 participants (≥18 years old) admitted to different types of ICUs were included. Results showed significant differences regarding ICU length of stay (n = 1,564; MD -0.93; 95 % CI -1.64 to -0.21; P = 0.01) and hospital length of stay (n = 1,189; MD -1.78; 95 % CI -3.16 to -0.41; P = 0.01), mechanical ventilation duration (n = 1,024; MD -0.51; 95 % CI -0.92 to -0.11; P = 0.01) and functional status (n = 400; MD 44.88; 95 % CI 3.11-86.65; P = 0.04) favouring in-bed cycling plus rehabilitation compared to rehabilitation. However, no significant differences were found regarding mortality, muscle strength, ICU-acquired weakness or quality of life. Different programme duration did not significantly affect hospital length of stay.

CONCLUSION

In-bed cycling plus rehabilitation significantly reduced ICU and hospital length of stay, mechanical ventilation duration and improved functional status compared to rehabilitation. Further research is needed to analyse long-term effects and standardise interventions.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022309311; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309311.

Sexual Dysfunction in Women With Eating Disorders: Systematic Review and Meta-Analysis

BACKGROUND

Eating disorders (EDs) are common mental health conditions that impact people globally. Sexual health problems are also widely researched across various contexts. This paper explores the connection between these two areas by conducting a meta-analysis to assess sexual dysfunction (SD) in women with EDs compared to healthy individuals.

METHODS

Multiple electronic databases were searched. Studies reporting mean scores of SD scales in women with EDs compared to women without these conditions, were included. The combined analyses used standardized mean deviations (SMDs), with relevant 95% confidence intervals (CIs). Each study was weighted using inverse variance models with random effects. The risk of publication bias was estimated.

RESULTS

From an initial pool of 2665 studies, 7 studies met inclusion criteria for the systematic review, involving 908 individuals. Out of these, five studies focussing on women with AN or BN were eligible for meta-analysis. No study involving the BED female group met the inclusion criteria to be included in the meta-analysis. The association between SD and AN showed a random-effects pooled SMD of -0.95 (95% CI = -1.40 to -0.50) with high heterogeneity (I2 = 78.32%, p = 0.01). For BN, this was of -0.51 (95% CI = -0.88 to -0.13) with no heterogeneity (I2 = 0.00%, p = 0.76). Sensitivity analyses showed that the overall effect is sensitive to the type of questionnaire used to measure the SD.

CONCLUSION

The results indicate that SD is more pronounced in women with AN than in those with BN. More studies with robust methodological designs are necessary to further investigate SD. The female BED group should be included in future studies focussing on SD. The findings suggest that sexual health interventions should target women with EDs, as these conditions have a significant impact on relationships and sexual satisfaction.

P2Y12 Inhibitor-Based Single Antiplatelet Therapy Versus Conventional Dual Antiplatelet Therapy After Newer-Generation Drug-Eluting Stent Implantation in Chronic and Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND

P2Y12 inhibitor-based single antiplatelet therapy (SAPT) after drug-eluting stent implantation reduces major bleeding without increasing the risk of major adverse cardiovascular and cerebral events compared with 12-month dual antiplatelet therapy (DAPT). The differential effects of P2Y12 inhibitor monotherapy compared with conventional DAPT in patients with chronic coronary syndromes versus acute coronary syndromes (ACS) remain uncertain.

METHODS AND RESULTS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing oral P2Y12 inhibitor-based SAPT after ≤3 months DAPT versus 12-month DAPT after newer-generation drug-eluting stent implantation. Patients were categorized based on baseline presentation (chronic coronary syndromes versus ACS). The co-primary end points were major bleeding and major adverse cardiovascular and cerebral events, a composite of all-cause death, myocardial infarction, or ischemic stroke. A total of 43 945 (ACS, 28 360, 65%) patients from 7 randomized controlled trials were included. At a median follow-up of 12 months, P2Y12 inhibitor-based SAPT was associated with a lower risk of major bleeding (risk ratio [RR], 0.63 [95% CI, 0.48-0.82]; P<0.001) compared with 12-month DAPT. The risk of major bleeding was significantly lower among patients with ACS (RR, 0.55 [95% CI, 0.40-0.75]; P<0.001). Compared with standard DAPT, P2Y12 inhibitor-based SAPT was associated with a similar risk of major adverse cardiovascular and cerebral events (RR, 0.98 [95%CI, 0.87-1.11]; P=0.74) among patients with chronic coronary syndromes and ACS. There was no significant interaction between treatment effect and baseline presentation.

CONCLUSIONS

Compared with 12-month DAPT, P2Y12 inhibitor-based SAPT after newer-generation drug-eluting stent implantation is associated with a lower risk of major bleeding without increasing the risk of major adverse cardiovascular and cerebral events, a difference primarily driven by patients with ACS.

REGISTRATION

URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023239341.

Performance of location-scale models in meta-analysis: A simulation study

Location-scale models in the field of meta-analysis allow researchers to simultaneously study the influence of moderator variables on the mean (location) and variance (scale) of the distribution of true effects. However, the increased complexity of such models can make model fitting challenging. Moreover, the statistical properties of the estimation and inference methods for such models have not been systematically examined in the meta-analytic context. We therefore conducted a Monte Carlo simulation study to compare different estimation methods (maximum or restricted maximum likelihood estimation), significance tests (Wald-type, permutation, and likelihood-ratio tests), and methods for constructing confidence intervals (Wald-type and profile-likelihood intervals) for the scale coefficients of such models. When restricted maximum likelihood estimation was used, slightly closer to nominal rejection rates and narrower confidence intervals were obtained. The permutation test yielded type I error rates closest to the nominal level, whereas the likelihood-ratio test obtained the highest statistical power. In most scenarios, profile-likelihood intervals showed lower coverage probabilities than the Wald-type method but closer to the nominal 95% level. Finally, slightly higher rejection rates and coverage probabilities were obtained when a dichotomous moderator was examined rather than a continuous one. Despite the need to use some constraints on the parameter space for the scale coefficients and the possibility of non-convergence of some procedures that may affect the fitting of the specified models, location-scale models proved to be a valid and useful tool for modeling the heterogeneity parameter in meta-analysis.

Comparative outcomes of endovascular vs. surgical treatment in craniocervical junction dural arteriovenous fistulas: A systematic review and meta-analysis

BACKGROUND

Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis.

METHODS

A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024.

RESULTS

Fifteen studies involving 266 patients were included. Of these, 143 (53.8 %) patients underwent surgical treatment alone and 123 (46.2 %) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8 %. Retreatment rate was 6.2 %. Periprocedural complications occurred in 21.6 % of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6 %. Retreatment rate was 46.7 %. Periprocedural complications occurred in 18.8 % of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, p = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, p < 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms.

CONCLUSION

Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.

Effect of Indocyanine Green-Guided Lymphadenectomy During Gastrectomy on Survival: Individual Patient Data Meta-Analysis

BACKGROUND

Indocyanine green-guided (ICG-guided) lymphadenectomy during gastrectomy for cancer has been proposed to enhance the accuracy of lymphadenectomy. The impact of ICG-guided lymphadenectomy on patient survival remains debated.

METHODS

The findings of the systematic review were reconstructed into an individual patient data (IDP) meta-analysis with restricted mean survival time difference (RMSTD). Overall survival (OS) and disease-free (DFS) survival were primary outcomes. RMSTD, standardized mead difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures.

RESULTS

Three studies (6325 patients) were included; 42% of patients underwent ICG-guided lymphadenectomy. The patients' age ranged from 47 to 72 years and 58% were males. Proximal, distal, and total gastrectomy were completed in 6.8%, 80.4%, and 12.8% of patients, respectively. The surgical approach was laparoscopic (62.3%) and robotic (37.7%). ICG-guided lymphadenectomy was associated with a higher number of harvested lymph nodes compared to non-ICG-guided lymphadenectomy (SMD 0.50; 95% CI 0.45-0.55). At the 42-month follow-up, OS and DFS estimates for ICG-guided vs. non-ICG-guided lymphadenectomy were 0.5 months (95% CI -0.01, 1.1) and 1.3 months (95% CI 0.39, 2.15), respectively.

CONCLUSIONS

Our analysis suggests that ICG-guided lymphadenectomy offers equivalent long-term OS and DFS compared to non-ICG-guided lymphadenectomy.

Effects of Lifestyle Interventions to Promote Physical Activity on Physical Activity and Glycated Hemoglobin in Patients with Type 2 Diabetes: a Systematic Review and Meta-Analysis

BACKGROUND

Numerous studies have explored the impact of controlled exercise interventions in type 2 diabetes, as physical activity can positively influence its progression. However, our understanding of how broader lifestyle interventions can effectively promote physical activity in practical real-world scenarios remains limited.

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the potential of lifestyle interventions targeting the promotion of physical activity on physical activity outcomes and glycated hemoglobin (HbA1c), providing a comprehensive understanding of both behavioral and clinical impacts.

METHODS

We performed a systematic review and meta-analysis, searching three databases and examined the study design, structure, and content of the lifestyle interventions. We assessed physical activity and HbA1c as endpoints and performed a multivariate meta-regression to explore physical activity's impact on HbA1c.

RESULTS

This review incorporated 13 studies (n = 5301 patients), with heterogeneity in intervention designs, components, and durations. Lifestyle interventions showed a slight increase in physical activity, equivalent to an average of 9.0 min more total physical activity per day (95% confidence interval 5.8, 12.2) and 1.7 min more moderate-to-vigorous physical activity per day (95% confidence interval 1.1, 2.3), irrespective of objective (e.g., accelerometers) or subjective measurement (e.g., questionnaires) method. However, HbA1c reduction through these interventions was minimal 0.09% (95% confidence interval - 0.20, 0.03). The effect of physical activity was - 0.04 (standard error = 0.05, 95% confidence interval - 0.15, 0.06), suggesting that physical activity does not act as a moderator for changes in HbA1c.

CONCLUSIONS

Lifestyle interventions effectively increase physical activity but have limited impact on HbA1c compared to controls. The role of physical activity as a moderator for changes in HbA1c remains uncertain. Further research is needed to enhance the efficacy of these interventions in reducing HbA1c in individuals with type 2 diabetes.

Streptococcal infection and its antimicrobial resistance profile associated with bovine mastitis in Ethiopia: a systematic review and meta-analysis

Background

In Ethiopia, bovine mastitis is a major problem affecting production, welfare, and public health. Streptococcus is a key pathogen that causes mastitis and is often treated with antimicrobials, which can lead to antimicrobial resistance. Nevertheless, the administration of antimicrobials can unintentionally facilitate the emergence of antimicrobial resistance. Thus, this study aimed to systematically review and estimate the pooled prevalence of streptococcal infection in bovine mastitis in Ethiopia, along with associated antimicrobial resistance profiles, to provide a comprehensive understanding of the current situation and guide effective treatment this bacteria.

Methods

This systematic review was carried out according to the PRISMA guidelines. To estimate the pooled proportion and resistance, a random effects model was utilized with R software. The databases used included SCOPUS, PubMed, HINARI, Web of Science, Google, and Google Scholar.

Results

Twenty-five articles were included in this meta-analysis. The overall pooled proportion of mastitis associated with Streptococcus spp. was 20% (95% CI: 17-23%). Significant heterogeneity was observed in the studies included (I2  = 87%; p < 0.01). Among the regions, the highest proportion was reported for South Nation, Nationality of Peoples Region (SNNPR) at 26%, followed by Amhara (24%), Oromia and Addis Abeba (19%), and Tigray (15%). The highest proportion of Streptococcus isolates was found in patients with clinical mastitis (24%). Among the major Streptococcus spp., Str. agalactiae had the highest pooled prevalence at 13%. The greatest prevalence of resistant Streptococcus was observed against penicillin (52%), followed by streptomycin, tetracycline, and ampicillin (42, 38, and 35%, respectively). According to the information provided by this meta-analysis, evidence-based risk management measures should be established to prevent and control streptococcal infection in dairy cattle. Monitoring and reporting of streptococcal mastitis and antimicrobial resistance are needed in Ethiopia's different regions. To minimize resistance, stricter guidelines should be implemented for antimicrobial use in dairy cattle, with a particular focus on reducing penicillin use.

A replicate crossover trial on the interindividual variability of sleep indices in response to acute exercise undertaken by healthy men

STUDY OBJECTIVES

Using the necessary replicate-crossover design, we investigated whether there is interindividual variability in home-assessed sleep in response to acute exercise.

METHODS

Eighteen healthy men (mean [SD]: 26[6] years) completed two identical control (8 hour laboratory rest, 08:45-16:45) and two identical exercise (7 hour laboratory rest; 1 hour laboratory treadmill run [62(7)% peak oxygen uptake], 15:15-16:15) trials in randomized sequences. Wrist-worn actigraphy (MotionWatch 8) measured home-based sleep (total sleep time, actual wake time, sleep latency, and sleep efficiency) two nights before (nights 1 and 2) and three nights after (nights 3-5) the exercise/control day. Pearson's correlation coefficients quantified the consistency of individual differences between the replicates of control-adjusted exercise responses to explore: (1) immediate (night 3 minus night 2); (2) delayed (night 5 minus night 2); and (3) overall (average post-intervention minus average pre-intervention) exercise-related effects. Within-participant linear mixed models and a random-effects between-participant meta-analysis estimated participant-by-trial response heterogeneity.

RESULTS

For all comparisons and sleep outcomes, the between-replicate correlations were nonsignificant, ranging from trivial to moderate (r range = -0.44 to 0.41, p ≥ .065). Participant-by-trial interactions were trivial. Individual differences SDs were small, prone to uncertainty around the estimates indicated by wide 95% confidence intervals, and did not provide support for true individual response heterogeneity. Meta-analyses of the between-participant, replicate-averaged condition effect revealed that, again, heterogeneity (τ) was negligible for most sleep outcomes.

CONCLUSIONS

Control-adjusted sleep in response to acute exercise was inconsistent when measured on repeated occasions. Interindividual differences in sleep in response to exercise were small compared with the natural (trial-to-trial) within-subject variability in sleep outcomes.

CLINICAL TRIALS INFORMATION

https://clinicaltrials.gov/study/NCT05022498. Registration number: NCT05022498.

Comparative efficacy and safety of talazoparib plus enzalutamide and other first-line treatments for metastatic castration-resistant prostate cancer

BACKGROUND

Talazoparib plus enzalutamide (TALA + ENZA) has demonstrated antitumor activity in the phase 3 clinical trial (TALAPRO-2; NCT03395197) as first-line (1L) therapy in men with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer (mCRPC). Although many active interventions are available, randomized controlled trials (RCTs) involving talazoparib have only been conducted to assess its efficacy and safety compared to enzalutamide. To estimate comparisons between all relevant interventions, indirect comparisons are needed.

OBJECTIVE

To estimate the comparative efficacy and safety of TALA + ENZA in 1L patients with mCRPC by conducting a systematic literature review and network meta-analyses (NMAs).

METHODS

Databases were searched using Ovid, along with several gray literature sources to identify RCTs evaluating treatments in 1L mCRPC (PROSPERO registration: CRD42021283512). Feasibility assessment evaluated trial suitability for NMA inclusion and Bayesian or frequentist NMAs were conducted for evaluable efficacy and safety outcomes, respectively.

RESULTS

Thirty-three RCTs met the eligibility criteria and were feasible for NMAs. Across multiple efficacy outcomes assessed, except for overall survival (OS), TALA + ENZA was ranked the most efficacious treatment. For OS, TALA + ENZA showed the second-highest probability of being the most effective treatment; second to docetaxel 50 mg plus prednisolone 10 mg. With respect to safety outcomes, TALA + ENZA, in general, showed increased rates of hematological adverse events.

CONCLUSIONS

TALA + ENZA showed favorable results across multiple efficacy endpoints, but not across hematological toxicities compared with other 1L treatments in asymptomatic or mildly symptomatic mCRPC in the all-comers patient population.

Meta-analyses of the global impact of non-antibiotic feed additives on livestock performance and health

INTRODUCTION

The impact of non-antibiotic feed additives on livestock performance and health is contingent upon a multitude of variables, including the animal species, dosage and type of feed additives, and duration of oral administration. However, there is a paucity of knowledge regarding the relationship between these factors and the performance of livestock animals.

OBJECTIVES

The objective of this study was to conduct a global meta-analysis based on a pool of empirical studies to investigate the effects of dietary additives on growth, production, blood metabolites, immunity, intestinal morphology, and the abundance of gut microbiota in livestock.

METHODS

A meta-regression coupled with dose-effect analysis was performed to ascertain the optimal dosage and feeding duration for the optimal body function. A total of 71 papers, estimating 1, 035 effect size across 9 species and 7 types of non-antibiotic feed additives were recruited in our meta-dataset.

RESULTS

Overall assessment confirmed that these additives in diet can significantly improve livestock production and immune function across species. Our findings indicated that the effects of additives on animal performance were more pronounced in herbivores than in omnivores. The dose-response results indicated that the overall optimal doses for antimicrobial peptides, enzymes, oligosaccharides, organic acids, phytogenic, probiotics and prebiotics were 100 mg/kg, 30 mg/kg, 200 mg/kg, 50 mg/kg, 200 mg/kg, 10⁶ CFU/kg, and 10 mg/kg, respectively. Oral administration of these additives for a 2-month period effectively improves livestock performance and health.

CONCLUSION

This evidence-based approach provides a foundation for implementing customized feeding strategies designed to optimize livestock performance, enhance immunity and reduce feed costs. Our assessment shows that these feed additives are promising alternatives to antibiotics in reducing the use of antibiotics. Furthermore, these findings suggest that the use of these feed additives can lead to evidence-based recommendations for practical feeding strategies, providing livestock producers with a sustainable and cost-effective approach to animal health management.

Effects of neostigmine on postoperative neurocognitive dysfunction: a systematic review and meta-analysis

Introduction

Postoperative neurocognitive dysfunction (PND) is a common and serious complication following surgery. Neostigmine, an acetylcholinesterase inhibitor commonly administered during anesthesia to reverse residual neuromuscular blockade, has been suggested in recent studies to potentially reduce the incidence of PND. However, findings have been inconsistent across studies. Therefore, this study conducts a systematic review and meta-analysis to evaluate the effect of neostigmine on PND.

Methods

We conducted a comprehensive literature search across multiple databases, including PubMed, EmBase, Web of Science, Cochrane Library, Scopus, SinoMed, and CNKI, to identify all relevant studies for inclusion. We included randomized controlled trials and cohort studies in our analysis. The risk of bias was assessed using the Risk of Bias 2 tool for randomized trials and the ROBINS-I tool for cohort studies.

Results

A total of 11 studies were included in this analysis, consisting of 8 randomized controlled trials and 3 cohort studies. The incidence of PND was significantly lower in the neostigmine group compared to the control group (log(OR): -0.54, 95% CI [-1.04, -0. 05]; OR: 0.58, 95% CI: [0.35, 0.95], p = 0.03, I2 = 81.95%). Sensitivity analysis led to the exclusion of one cohort study. Consequently, the final meta-analysis comprised 10 studies, encompassing a total of 50,881 participants. The results indicate that the incidence of PND was significantly lower in the neostigmine group compared to the control group (log(OR):-0. 27, 95% CI [-0.47, -0. 08]; OR: 0.76, 95% CI: [0.62, 0.91], p = 0.01, I2 = 2.50%). However, Meta-analysis of RCTs and cohort studies showed no significant difference. Subgroup analysis indicated that neostigmine reduced the incidence of delayed neurocognitive recovery (dNCR), but its impact on POD was unclear, with no significant association to nausea and vomiting. These findings suggest that neostigmine may reduce the risk of PND, but caution is needed in interpretation.

Conclusion

Neostigmine may have a potential positive effect in reducing the incidence of PND. However, no statistical difference was observed when meta-analyses were performed separately for randomized controlled trials (RCTs) and cohort studies. Given the limited number of studies available and the limitations of the current research, further investigation is needed to clarify the impact of neostigmine on PND.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537647, Identifier CRD42024537647.

A dose-response meta-analysis of physical activity and the risk of alzheimer's disease in prospective studies

BACKGROUND

Alzheimer's disease (AD) has become an increasing global health challenge, particularly with the accelerated aging of the population. Therefore, preventive research targeting AD has become especially important. In recent years, physical activity (PA), as a potential non-pharmacological intervention, has garnered increasing attention from researchers. The aim of this study was to evaluate the effect of PA on AD risk through systematic review and meta-analysis and to further explore its potential preventive benefits.

METHODS

The literature search for this study encompassed PubMed, Embase, Web of Science, and the Cochrane Library databases, covering publications from their inception until November 1, 2024. Only English-language publications were included. Stratified analyses were conducted to explore the relationship between PA and AD risk by combining multivariate-adjusted effect estimates using random-effects models, along with subgroup analyses, sensitivity analyses, multifactorial meta-regression, and dose-response analyses to comprehensively assess the association between PA and the risk of AD.

RESULTS

Ultimately, 29 studies were included in the primary analysis, along with 3 additional studies for supplemental analyses, involving 1,453,561 participants, of whom 68,497 were diagnosed with AD. The results indicated that high-intensity PA significantly reduced the risk of AD by 26% (Hazard ratio [HR] = 0.74, 95% CI 0.67-0.83). Additionally, dose-response analyses revealed both linear and nonlinear associations, with linear dose-response results indicating a 15% reduction in AD risk for every 10 MET-h/wk increase in PA. Subgroup analyses indicated that the protective effect of PA was more pronounced in the non-obese population (BMI < 25) (HR = 0.65, 95% CI, 0.52-0.82), in individuals aged 75 years or older (HR = 0.57, 95% CI 0.48-0.67), and in non-APOE ε4 gene carriers (HR = 0.72, 95% CI 0.55-0.93), who exhibited greater protection. To explore the sources of heterogeneity among the included studies, a multifactorial meta-regression analysis was performed, which did not significantly explain the heterogeneity of the primary outcomes. Moreover, the robustness of the pooled results was confirmed through supplemental meta-analysis, subgroup analysis, and sensitivity analysis.

CONCLUSIONS

The results of this study support the potential of PA in reducing the risk of AD, particularly in non-obese populations, older age groups, and non-APOE ε4 gene carriers. PA holds significant potential in public health as a feasible and low-cost non-pharmacological intervention strategy.

Comminuted Mason III/IV Radial Head Fractures: What Is the Best Treatment Between Prosthesis and Radial Head Resection? A Systematic Review and Meta-Analysis

Background/Objectives: Various surgical methods have been proposed for the treatment of comminuted Mason III/IV radial head fractures. In particular, the advantages and disadvantages between prosthesis implantation (RHA) or radial head resection (RHR) are not sufficiently quantified in the current literature. Methods: A systematic literature search was conducted using PubMed Web of Science, Cochrane Library, and Embase in February 2024. Studies conducted on patients with Mason type III or IV radial head fractures and studies relating to surgical methods, including radial head resection or Radial head prosthesis implantation, were included. The two methods were evaluated in terms of clinical and functional results through the DASH score (Disability of the arm, shoulder, and hand), Mayo Elbow Performance Index (MEPI), and flexion-extension range of motion. The onset of osteoarthritis and complications were also assessed. Risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 345 articles were evaluated and, of these, 21 were included in the study for a total of 552 patients. The results of the meta-analysis showed no significant differences in favor of RHA or RHR in terms of Mayo Elbow Performance (p = 0.58), degrees of flexion (p = 0.689), degrees of extension deficit (p = 0.697), and overall incidence of complications (p = 0.389), while it highlighted a statistically significant difference in terms of DASH score (19.2 vs. 16.2, respectively; p = 0.008) and subjects who developed osteoarthritis (13.4% vs. 47.3%, respectively; p = 0.046). Conclusions: The results of this meta-analysis confirm that both surgical methods provide good functional outcomes, with no significant differences in MEPI, DASH, and range of motion. However, a higher incidence of post-traumatic osteoarthritis was observed in patients undergoing RHR. Additionally, RHR patients exhibited slightly worse functional outcomes in the DASH score; however, this difference is not substantial enough to be considered clinically significant. These findings suggest that while both techniques are viable, RHA may be preferable in patients at higher risk of joint degeneration and instability, and the choice of treatment should be tailored to individual patient characteristics.

Colorectal cancer mortality in persons with severe mental illness: a scoping review with meta-analyses of observational studies

BACKGROUND AND PURPOSE

Persons with severe mental illnesses (SMIs) have reduced participation in colorectal cancer (CRC) screening programs, higher odds of advanced stage at diagnosis, and are less likely to receive adequate treatment than the general population. It remains unclear to what extent these factors impact CRC outcomes for persons with SMI. The aim of this scoping review was to describe and quantify CRC mortality for persons with SMI compared with the general population.

PATIENTS/MATERIALS AND METHODS

We followed the JBI Manual for Evidence Synthesis and PRISMA guidelines in a systematic search of four databases from inception until April 29th, 2024. We included studies that provided CRC mortality estimates for adults with preexisting clinical diagnosis of SMI. We synthesized the results descriptively and pooled the data to estimate the magnitude of the associations.

RESULTS

Twenty-four original studies were identified with a total of 16.4 million persons. Most studies reported increased CRC mortality for persons with SMI compared with persons without SMI. The meta-analysis demonstrated a 25% increased CRC mortality for persons with SMI (e.g. pooled hazard ratio 1.25; 95% confidence interval 1.13 to 1.39; n = 13,178,161).

INTERPRETATION

The evidence points consistently to an increased CRC mortality for persons with SMI compared with persons without SMI. Furthermore, this evidence supports the idea that persons with SMI are a heterogenous population, and as such, any future initiatives to improve CRC outcomes for persons with SMI would warrant a tailored approach to potentiate individual resources, to mitigate stigma and structural discrimination.

Interventions for suicidal and self-injurious related behaviors in adolescents with psychiatric disorders: a systematic review and meta-analysis

As a leading cause of adolescent death, suicidal and self-injurious related behaviors (SSIRBs) is a devastating global health problem, particularly among patients with psychiatric disorders (PDs). Previous studies have shown that multiple interventions can alleviate symptoms and reduce risks. This review aimed to provide a systematic summary of interventions (i.e., medication, physical therapy, psychosocial therapy) for the treatment of SSIRBs among Chinese adolescents with PDs. From inception to September 17, 2023, twelve databases (PubMed, CINAHL, ScienceDirect, PsycINFO, EMBASE, Cochrane Library, Clinical Trial, Web of Science, CEPS, SinoMed, Wanfang and CNKI) were searched. We qualitatively and quantitatively synthesized the included studies. Standardized mean differences (SMDs), risk ratios and their 95% confidence intervals (CIs) used the Der Simonian and Laird random-effects model. Fifty-two studies covering 3709 eligible participants were included. Overall, the commonly used interventions targeting SSIRBs and negative feelings in PDs adolescents with SSIRBs included psychosocial therapy (e.g., cognitive behavioral therapy), medication (e.g., antidepressants), and physiotherapy (e.g., repetitive transcranial magnetic stimulation). Importantly, quetiapine fumarate in combination with sodium valproate (SV) had positive effects on reducing self-injury behaviors score [SMD: -2.466 (95% CI: -3.305, -1.628), I2 = 88.36%], depression [SMD: -1.587 (95% CI: -2.505, -0.670), I2 = 90.45%], anxiety [SMD: -1.925 (95% CI: -2.700, -1.150), I2 = 85.23%], impulsivity [SMD: -2.439 (95% CI: -2.748, -2.094), I2 = 0%], as well as its safety in comparison with SV alone. No significant difference of adverse reactions was found by low-dose QF (P > 0.05). This review systematically outlined the primary characteristics, safety and effectiveness of interventions for Chinese PDs adolescents with SSIRBs, which could serve as valuable evidence for guidelines aiming to formulate recommendations.

A Post-Authorisation Safety Study of a Respiratory Syncytial Virus Vaccine in Pregnant Women and Their Offspring in a Real-World Setting: Generic Protocol for a Target Trial Emulation

Background: Assessing the real-world safety of preventive products against respiratory syncytial virus (RSV) in pregnant women holds significant public health implications, especially as vaccination programs become more widespread. This generic protocol describes a post-authorisation safety study (PASS) to evaluate the safety of RSV vaccination in pregnant women using a target trial emulation framework. Methods: This generic protocol, adapted from an ongoing PASS, is designed using the target trial emulation framework to evaluate the safety of an RSV vaccine in pregnant women. Emulating target trial conditions have the ability to minimise confounding and bias. In this pragmatic real-world observational study, RSV-vaccinated pregnant women are matched (1:N) with unexposed women based on gestational age, calendar time, maternal age, immunocompromised status, and high-risk pregnancy. Key adverse outcomes include preterm birth, stillbirth, hypertensive disorders of pregnancy, Guillain-Barré Syndrome (GBS), low birth weight (LBW), and small for gestational age (SGA). Future studies may add additional outcomes per vaccine risk profile and Global Alignment of Immunization safety Assessment (GAIA) recommendations. Distinguishing outcomes measured during pregnancy from those assessed at or after birth is crucial for analysis and interpretation. Conclusions: This protocol offers a structured approach to evaluating the safety of RSV vaccines in pregnant women. It aims to guide researchers in designing studies and should be adapted to specific settings and data availability.

Effectiveness of Neuromuscular Training in Preventing Lower Limb Soccer Injuries: A Systematic Review and Meta-Analysis

Background: Soccer is associated with a high risk of injuries, mainly affecting the lower limbs, leading to significant consequences for player performance and career longevity. Neuromuscular training (NMT) has been proposed as an effective preventive strategy, but its impact varies across different populations and implementation strategies. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, MEDLINE, and SPORTDiscus identified randomized controlled trials, cohort studies, and systematic reviews examining the effects of NMT on lower limb injury prevention in soccer players. Study quality was assessed using the Downs and Black tool, and injury incidence rate ratios were analyzed. Results: Eleven studies, encompassing over 10,000 soccer players, were included. NMT interventions, particularly FIFA 11+, significantly reduced injury rates compared to standard warm-ups. Higher adherence and coach education enhanced program effectiveness. Female players benefited more, particularly in ACL injury prevention. No significant differences were observed between shorter (10 min) and standard (20 min) NMT protocols. Conclusions: NMT effectively reduces lower limb injuries in soccer, with adherence and proper coaching being key determinants of success. Future research should optimize program design and long-term adherence strategies to maximize benefits across all player demographics.

The effects of social media abstinence on affective well-being and life satisfaction: a systematic review and meta-analysis

Abstaining from social media has become a popular digital disconnection strategy of individuals to enhance their well-being. To date, it is unclear whether social media abstinences are truly effective in improving well-being, however, as studies produce inconsistent outcomes. This preregistered systematic review and meta-analysis therefore aims to provide a more precise answer regarding the impact of social media abstinence on well-being. The databases of PubMed, Scopus, Web of Science, Communication Source, Cochrane Library, and Google Scholar were searched for studies examining the effect of social media abstinence on three outcomes, namely positive affect, negative affect, and/or life satisfaction. In total, ten studies (N = 4674) were included, allowing an examination of 38 effect sizes across these three outcomes. The analyses revealed no significant effects of social media abstinence interventions on positive affect, negative affect, or life satisfaction. Relationships between social media abstinence duration and the three outcomes were also non-significant. The findings thus suggest that temporarily stepping away from social media may not be the most optimal approach to enhance individual well-being, emphasizing the need for further research on alternative disconnection strategies. Nevertheless, important methodological differences between studies should be considered when interpreting these results.

Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis

Importance

Depression and anxiety are common among adults with chronic pain, but their prevalence is unclear.

Objectives

To evaluate the prevalence of depression and anxiety among adults with chronic pain and identify factors that moderate prevalence.

Data Sources

A literature search was conducted of MEDLINE, Embase, PsycINFO, and Cochrane Library from January 2013 to October 2023.

Study Selection

Studies reporting the prevalence of depression or anxiety using a validated assessment tool among adults with chronic pain (excluding chronic headache disorders).

Data Extraction and Synthesis

A total of 31 159 initial records were identified, and 5177 full texts were screened. Data were extracted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline using Covidence. Two independent reviewers completed abstract screening, full-text review, and data extraction and rated risk of bias. Random-effects meta-analyses were applied to pool prevalence, assess moderation, and compare prevalence of depression or anxiety among samples with chronic pain vs control samples.

Main Outcomes and Measures

Prevalence of depression and anxiety based on clinically significant symptoms or diagnosis. The moderators of prevalence identified were pain condition, recruitment setting, continent, age, percentage female, and pain duration.

Results

The search identified 376 studies from 50 countries comprising 347 468 individuals (mean [SD] age, 51.3 [9.5] years; 70.0% female) with chronic pain. Among adults with chronic pain, clinical symptoms of depression were present in 39.3% (95% CI, 37.3%-41.1%; I2 = 98.9%), and clinical symptoms of anxiety were present in 40.2% (95% CI, 38.0%-42.4%; I2 = 99.0%). Prevalence differed by pain condition (highest among samples of people with fibromyalgia [depression, 54.0% (95% CI, 48.5%-59.4%); anxiety, 55.5% (95% CI, 50.4%-60.4%)]; lowest among samples of people with arthritis conditions [eg, osteoarthritis: depression, 29.1% (95% CI, 20.3%-39.7%); anxiety, 17.5% (95% CI, 6.6%-38.8%)]) and was highest among younger people (depression, β = -0.02 [95% CI, -0.03 to -0.01]; anxiety, β = -0.02 [95% CI, -0.03 to -0.01]) and women (depression, β = 0.69 [95% CI, 0.31-1.08]; anxiety, β = 0.90 [95% CI, 0.48-1.33]). With regard to diagnoses, 36.7% (95% CI, 29.0%-45.1%) had a major depressive disorder, and 16.7% (95% CI, 11.8%-23.2%) had generalized anxiety disorder. Women, younger people, and people with nociplastic pain (ie, pain arising from altered nociception without tissue damage) were most likely to have depression and anxiety.

Conclusions and Relevance

In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development.

Effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Spouses often assume the role of primary informal caregivers for ageing partners. Spousal caregivers are more likely than other family members to experience negative psychological outcomes due to their unique identities. However, little is known as to whether psychoeducation interventions can support them in the caregiving process.

OBJECTIVES

To systematically identify and synthesise evidence regarding the effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

Eight electronic databases, including Cochrane Library, PubMed, CINAHL, MEDLINE, Embase, PsycINFO, Chinese Journal Net and Wanfang were searched from inception to August 2024. Randomised controlled trials of psychoeducation interventions on psychological outcomes in spousal caregivers of older adults were included. The quality of the evidence was evaluated using The Cochrane Risk of Bias Tool v2. The certainty of the evidence was assessed by the GRADE approach. Data synthesis methods, including meta-analysis and narrative synthesis, were conducted based on data availability. Meta-analysis was performed using a random-effects model given the substantial heterogeneity in the intervention design and outcomes. Sensitivity analyses were used to assess the robustness of the findings.

RESULTS

Among the 18 reviewed studies, the overall risk of bias indicated that four had low risk, eight had some concerns, and six had high risk. The pooled analysis suggested that psychoeducation interventions had significant effects on improving marital satisfaction (SMD = 0.28, 95 % CI: 0.09 to 0.47; low certainty) and positive aspects of caregiving (SMD = 1.30, 95 % CI: 0.44 to 2.16; very low certainty). However, the effects on depressive symptoms, caregiving burden, anxiety, mental health, coping and self-efficacy were negligible. Narrative synthesis of evidence suggested potential beneficial effects on posttraumatic growth, family functioning, family relationship and life satisfaction.

CONCLUSIONS

Psychoeducation interventions have potential to improve marital satisfaction and positive aspects of caregiving among spousal caregivers of older adults. However, the evidence has a low level of certainty with considerable variability in intervention design and outcome measures, indicating the need for further rigorous investigation. The non-significant effects on enhancing caregiving competence or alleviating negative psychological outcomes highlight the importance of exploring the specific needs and expectations of spousal caregivers.

REGISTRATION

PROSPERO (CRD42024498599).