Quantifying heterogeneity in a meta-analysis

Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies

BACKGROUND

Maternal diabetes might alter fetal brain development. However, well-designed systematic analyses are needed to comprehensively assess and quantify the association between maternal diabetes and neurodevelopmental outcomes in children. We aimed to synthesise and evaluate the available evidence on the effects of maternal diabetes on neurodevelopmental outcomes in children.

METHODS

For this systematic review and meta-analysis we searched PubMed, Web of Science, Embase, and EBSCO databases from inception to Dec 1, 2024, for studies exploring neurodevelopmental outcomes of children born to mothers with diabetes. The primary outcome was neurodevelopmental disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases 11th Revision. Data were extracted from published reports. Data were pooled with random-effects models and presented as risk ratios or standard mean differences with 95% CIs. This study was prospectively registered on PROSPERO (CRD42023395464).

FINDINGS

202 studies, involving 56 082 462 mother-child pairs, were included in the meta-analysis. Of these, 110 (54%) examined gestational diabetes, while 80 (40%) investigated pre-gestational diabetes. Among the total studies reviewed, 169 (84%) exclusively focused on children and adolescents aged up to 18 years. In studies adjusting for at least one key confounder, maternal diabetes was associated with increased risks of all types of neurodevelopmental disorders as well as lower intelligence and psychomotor scores. In studies adjusting for multiple confounders (n=98, 49%), children exposed to maternal diabetes had an increased risk of any neurodevelopmental disorder (risk ratio 1·28; 95% CI 1·24-1·31), autism spectrum disorder (1·25; 1·20-1·31), attention-deficit hyperactivity disorder (1·30; 1·24-1·37), intellectual disability (1·32; 1·18-1·47), specific developmental disorders (1·27; 1·17-1·37), communication disorder (1·20; 1·11-1·28), motor disorder (1·17; 1·10-1·26), and learning disorder (1·16; 1·06-1·26), compared with unexposed children. Maternal pre-gestational diabetes was more strongly associated with the risk of most neurodevelopmental disorders in children than gestational diabetes (risk ratio 1·39; [95% CI 1·34-1·44] vs 1·18 [1·14-1·23]; subgroup difference p<0·0001).

INTERPRETATION

Maternal diabetes is associated with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children. Further high-quality research is needed to establish causality and clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders.

FUNDING

The National Natural Science Foundation of China, and the Science and Technology Innovation Program of Hunan Province.

TRANSLATION

For the Mandarin translation of the abstract see Supplementary Materials section.

Quantifying the impact of bladder complications following gynecological cancer treatment: systematic review and meta-regression

Gynecological cancer treatments, including radiotherapy (RT) and chemotherapy, leads to various bladder complications. The anatomical proximity of the treatment site to the urinary bladder primarily explains the complications following RT, while chemotherapy contribute to bladder dysfunction through systemic mechanisms. This study systematically reviews the nature, extent, and prevalence of bladder complications among women treated for these malignancies, underscoring the influence of treatment modalities on bladder function. A comprehensive search of databases including Embase, Scopus, PubMed/MEDLINE, CINAHL, and the Cochrane Library was conducted, focusing on women undergoing RT, chemotherapy, or both for gynecological cancers. Meta-regression was performed to quantify the effects of treatments on bladder function, using random-effect models. From 15,081 citations, 12 studies with a total of 12,469 participants were included. Our analysis revealed a broad spectrum of bladder complications, with urinary incontinence (UI) and overactive bladder symptoms being common, alongside with radiation cystitis and anatomical defects formation. The prevalence of these complications varied, reflecting the complexity of treatment modalities, cancer types, and patient characteristics. Specifically, UI rates ranged from 2.6% to 84%, while the incidence of fistula formation and ureteral stenosis remained relatively low but clinically significant. Urodynamic findings showed reduced bladder capacity and increased detrusor overactivity in up to 44% of evaluated patients, highlighting treatment's impact on bladder function. Bladder complications are prevalent among gynecological cancer survivors, with notable occurrences associated with chemotherapy and RT treatments. Integrated care focusing on both oncological and urological health is essential for enhancing survivors' quality of life.

Comparative Efficacy and Safety of Different Regimens of Current JAK Inhibitors in Psoriatic Arthritis: A Network Meta-analysis

BACKGROUND

Janus kinase (JAK) inhibitors have been approved for treating psoriatic arthritis (PsA); however, the comparative efficacy of different JAK inhibitors remains unclear. This study aimed to investigate the comparative efficacy and safety of different JAK inhibitors in treating PsA.

METHODS

This network meta-analysis was conducted in strict accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Network Meta-Analyses and Cochrane methods.

RESULTS

Five studies involving 2757 patients were included. Pairwise meta-analysis revealed that JAK inhibitors significantly increased the American College of Rheumatology 20 score and Psoriasis Area and Severity Index 75 responses, which were confirmed by the network meta-analysis. The network meta-analysis further suggested that filgotinib 200 mg once daily (OD) (odds ratio [OR] = 3.17, 95% credible interval [CrI] = 1.07-9.88) and upadacitinib 30 mg OD (OR = 2.34, 95% CrI = 1.13-4.78) had higher American College of Rheumatology 20 score responses compared with tofacitinib 5 mg twice a day. However, upadacitinib 30 mg OD was associated with a higher risk of adverse events (placebo: OR = 1.80, 95% CrI = 1.14-2.87) and serious adverse events compared with filgotinib 200 mg OD (OR = 0.05, 95% CrI = 0.00-0.82). Upadacitinib 15 mg OD, the currently recommended therapy, is comparable in both efficacy and safety to other treatment regimens.

CONCLUSIONS

Filgotinib 200 mg OD is the safest and most effective JAK inhibitor for PsA, followed by upadacitinib 30 mg OD. However, upadacitinib 30 mg OD carries the highest risk of adverse events. Upadacitinib 15 mg OD, the currently recommended therapy, is not superior in efficacy and safety compared with other treatment options. More high-quality studies are needed to confirm these findings due to the limited number of included studies.

Prevalence and burden of HBV-HIV co-morbidity: a global systematic review and meta-analysis

Introduction

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). Because of the shared modes of transmission, co-infections of HBV are common among people living with Human Immunodeficiency Virus (HIV) infection. While the use of antiretroviral therapy (ART) has significantly improved the life expectancy of HIV patients, hepatitis viral co-infections have become increasingly important. Particularly, HBV infection remains under-diagnosed and under-reported, despite its highly infectious nature. Therefore, this review was aimed at understanding the burden of hepatitis B disease among adults living with HIV receiving ART.

Methods

Using pertinent search terms, all research found in Google Scholar, HINARI, EMBAS, Scopus, and PubMed was located. Data were extracted following the evaluation of the evidence using the Joanna Briggs Institute's cross-sectional and cohort study methodologies.

Result

A total of 18 groups involving 71,411 adults with HBV-HIV were selected for the study. Of those, 10.21% with 95% CI (5.06, 15.36) and 11.05% with 95% CI (2.78, 19.32) of HBV-HIV adults worldwide had an overall prevalence of HBV, with an I2 value of 0.0% (p-value = 0.729) and an I2 value of 0.0% (p-value = 0.818) from cross-sectional and cohort studies, respectively.

Conclusion

The global prevalence of people living with HBV-HIV is high, which poses a serious risk to public health. The review can clearly show the current pooled prevalence of HIV-HBV in the world, which may be helpful for policymakers because a large number of recent studies were included in it. Thus, it is strongly advised to broaden the current preventive and control program's purview and implement new, sensitive screening, testing, and treatment techniques. To raise community awareness, it would also be preferable to revamp the current prevention and control program and establish target-specific task forces at various health facility levels.

Mind-body therapies and their interplay with the immune system in children and adolescents: a protocol for a systematic review and meta-analysis

BACKGROUND

Chronic inflammation is a critical public health concern that, in children and adolescents, increases the long-term risk of a variety of different health issues. While mind-body therapies like yoga, meditation, and acupuncture have shown promise in modulating immune responses in adults, their safety and effectiveness in pediatric populations remain underexplored. This protocol outlines the methodology for a systematic review and meta-analysis aimed at evaluating the effects of mind-body therapies on immune modulation in children and adolescents.

METHODS

This systematic review and meta-analysis will follow PRISMA 2020 guidelines. We will include randomized controlled trials, non-randomized controlled trials, cohort studies, and case-control studies that examine the relationship between mind-body therapies and immune markers in pediatric populations. Electronic searches will be conducted in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library, supplemented by trial registries. Risk of bias will be assessed using the Cochrane Risk of Bias Tool (RoB 1), the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I), and the Newcastle-Ottawa Scale (NOS). Two independent reviewers will screen studies, extract data, and assess study quality, with a third reviewer resolving any discrepancies. Results will be synthesized both narratively and through meta-analysis using R software.

DISCUSSION

The review will evaluate the effectiveness and safety of mind-body therapies on immune markers in children and adolescents. The synthesized evidence will guide clinical practice and public health policies in integrating mind-body therapies into pediatric care. The findings will also provide a foundation for future research and policymaking in this area.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024546585.

Revisiting traditional Chinese exercise in prediabetes: effects on glycaemic and lipid metabolism - a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Most existing studies have primarily focused on the effects of Traditional Chinese Exercises (TCEs) on glycemic control in individuals with prediabetes, while specific recommendations for managing dyslipidemia in this population remain insufficient. Moreover, there is a lack of systematic research and conclusive evidence regarding the optimal exercise dose required to achieve metabolic improvements in individuals with prediabetes. Therefore, this meta-analysis aims to comprehensively evaluate the efficacy of TCEs in improving glycemic and lipid profiles in individuals with prediabetes and to explore the potential impact of exercise dose on these metabolic parameters.

METHODS

A comprehensive search of six databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, and WanFang Data) followed PRISMA guidelines to identify randomized controlled trials (RCTs) on TCEs (e.g., "Tai Chi," "Yijinjing," "Baduanjin") and prediabetes (e.g., "impaired glucose tolerance," "impaired glucose regulation") published up to November 10, 2024. Three reviewers independently screened studies, extracted data, and assessed bias risk. Meta-analysis and subgroup/meta-regression analyses were conducted using Stata 17 software. The review protocol is registered in PROSPERO (CRD42024615150).

RESULTS

A total of 15 studies involving 1,839 participants were included. The meta-analysis revealed that TCEs significantly improved HbA1c (MD = -0.28%; 95% CI: -0.38% to -0.18%; P = 0.001), FBG (MD = -0.44 mmol/L; 95% CI: -0.53 to -0.34 mmol/L; P < 0.001), 2hPG (MD = -1.16 mmol/L; 95% CI: -1.48 to -0.85 mmol/L; P < 0.001), TC (MD = -0.31 mmol/L; 95% CI: -0.50 to -0.11 mmol/L; P = 0.002), TG (MD = -0.28 mmol/L; 95% CI: -0.50 to -0.06 mmol/L; P = 0.012), and HDL (MD = -0.28 mmol/L; 95% CI: -0.50 to -0.06 mmol/L; P = 0.012) compared to control groups.

CONCLUSIONS

TCEs significantly improve prediabetics' blood glucose and lipid levels. The recommended exercise regimen is 30-50 min per session, 2-3 times per week, for at least three months.

Dietary Glycemic Index, Glycemic Load, Sugar, and Fiber Intake in Association With Breast Cancer Risk: An Updated Meta-analysis

CONTEXT

Several prospective cohort studies have investigated the association between glycemic index (GI), glycemic load (GL), dietary sugar, and total dietary fiber intake, with female breast cancer (BC) risk and reported inconsistent results. In the last decade, several large epidemiological studies have investigated these associations, suggesting the need to revisit the current body of evidence.

OBJECTIVE

The aim of this study was to update a systematic review and meta-analysis conducted by Schlesinger et al in 2017 using recent scientific evidence published since 2015.

DATA SOURCES

Publications indexed in PubMed, Embase, and The Cochrane Library were retrieved from the inception of the database up to January 2024.

DATA EXTRACTION

Two reviewers independently extracted data and assessed each study's quality.

DATA ANALYSIS

A random-effects model was used to estimate summary risk ratios (RRs) and 95% CIs for a meta-analysis that included 33 publications, with 26 prospective cohort studies cumulatively enrolling 2 212 645 women, among whom 79 777 were diagnosed with incident BC.

RESULTS

Dietary GI and GL (highest vs lowest exposure intake) were both associated with 5% higher BC risk-RR (95% CI): 1.05 (1.01-1.09; P = .007) and 1.05 (0.97-1.13; P = .24), respectively. No clear associations were observed for sugar and total dietary fiber intake (highest vs lowest exposure intake)-RR (95% CI): 1.12 (0.95-1.11; P = .16) and 0.93 (0.86-1.00; P = .05), respectively. For the latter, the association was more pronounced among premenopausal women (RR: 0.78; 95% CI: 0.68-0.90; P = .0008).

CONCLUSION

This meta-analysis supports a significant positive association between high dietary GI intake and higher risk of BC and a significant inverse association between high dietary fiber intake and lower risk of BC. Interventions promoting a high-fiber and low-sugar diet may be useful components of BC-prevention strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023463143.

Mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents: a systematic review and meta-analysis

Objective

To examine the mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents.

Design

Systematic review and meta-analysis.

Data sources

Studies from electronic databases from inception to 31 December 2023.

Eligibility criteria for selecting studies

Included were 123 observational studies (cross-sectional and longitudinal) that assessed risk by constructing a continuous score incorporating cardiometabolic parameters. Studies were considered if they evaluated at least one fitness component as an exposure in children and adolescents (5-19 years). Thirty-one were included in the main meta-analyses.

Results

Cross-sectional findings indicate that cardiorespiratory fitness is modestly but beneficially associated with cardiometabolic risk, either indirectly via obesity-related variables (indirect standardized beta coefficient [βIndirect]=-0.17; 95% confidence interval [CI] -0.23; -0.11; inconsistency index [I2]=94.4%) or directly and independently from obesity-related variables (r=-0.11; 95% CI -0.15; -0.07; I2=87.4%), whereas muscular fitness seems to be associated with risk only via obesity-related variables (βIndirect=-0.34; 95% CI -0.47; -0.20; I2=85.1%). There was no cross-sectional difference between biological sexes (p≥0.199). Longitudinal findings indicate no total (r=-0.12; 95% CI -0.24; 0.01; I2=23.1%) and direct (r=-0.03; 95% CI -0.08; 0.03; I2=0%) associations.

Conclusion

The association between fitness and risk appears to take place either indirectly through the reduction of obesity-related levels or directly by influencing risk. The latter underscores that the inverse association extends beyond a mere reduction in obesity-related variables, encompassing specific enhancements linked to exercise training, including increased metabolic efficiency, and cardiovascular capacity.

PROSPERO registration number

CRD42022354628.

Smoking behavior-related genetic variants and lung cancer risk in Japanese: an assessment by mediation analysis

Cigarette smoking is one of the most important risk factors for lung cancer. Genetic studies have shown that smoking behavior-related genetic variants are directly associated with lung cancer, independent of smoking behavior, mainly in European populations. A recent genome-wide association study in Japan identified five loci associated with the number of cigarettes smoked per day. This study aimed to evaluate whether these loci are associated with lung cancer risk directly or indirectly through changing smoking behavior. Here, we conducted a case-control study (1427 cases and 5595 controls) and a prospective cohort study (128 incident cases in 10 520 subjects). Using mediation analysis, we decomposed the total effect of the lead single nucleotide polymorphism (SNP) at each locus on lung cancer risk into direct and indirect effects. The results of the two studies were pooled using a random-effects model to estimate summary relative risks (RRs) and their 95% confidence intervals (CIs). Two studies showed that: (i) rs78277894 (EPHX2-CLU, G > A) had a protective direct effect (RR: 0.84; 95% CI: 0.77-0.93) on lung cancer risk; and (ii) rs56129017 (CYP2A6, C > T) had carcinogenic direct and indirect effects on lung cancer risk (RR: 1.26; 95% CI: 1.15-1.39 and RR: 1.01; 95% CI: 1.00-1.01, respectively). This mediation analysis revealed that two smoking behavior-related SNPs, EPHX2-CLU rs78277894 and CYP2A6 rs56129017, were associated with lung cancer risk through pathways independent of changing smoking behavior. Our findings may contribute to our understanding of lung carcinogenesis pathways that cannot be addressed by changes in smoking behavior.

Dietary phytochemical index and the risk of cancer: A systematic review and meta-analysis

BACKGROUND

Recently, the association between dietary phytochemical index (DPI) and the risk of cancer has been the focus of researchers, however, this possible association has not been fully understood. The current meta-analysis aimed to assess the relationship between DPI and the risk of cancers.

METHODS

A literature search by the main keywords such as "dietary phytochemical index", "DPI", and "cancer" was completed using Scopus, PubMed, and Web of Science up to December 2024 and references of retrieved relevant articles. Observational studies examining the association between the DPI and the risk of cancers were included. The reported odds ratio (OR) with a 95% confidence interval (CI) for each study was converted into log OR, and their standard deviation was calculated. Then to compute the pooled OR, the random-effects model with inverse variance weighting method was performed.

RESULTS

Nine case-control studies were included in the present meta-analysis. The sample size ranged from 120 to 851 with an age range from 18 to 75 years. The pooled results indicate an inverse association between DPI and the risk of all cancers (OR: 0.40; 95% CI: 0.29-0.54, I2 = 0.00%; P-value < 0.001). Also, subgroup analysis indicated that higher a DPI score is related to the decreased risk of breast cancer (OR: 0.38; 95% CI: 0.26-0.55, I2 = 0.00%; P-value < 0.001) and pooled non-breast cancer including glioma, prostate, and colorectal cancers (OR: 0.43; 95% CI: 0.27-0.71, I2 = 0.00%; P-value = 0.001).

CONCLUSIONS

The results of the current meta-analysis revealed that the higher DPI score is associated with a decreased odds of cancers. Large-scale cohort studies are recommended to validate the findings presented in the current study.

Meta-analysis of the prevalence of tuberculosis in cattle and zoonotic tuberculosis in humans in sub-Saharan Africa

BACKGROUND

Tuberculosis (TB) in cattle negatively affects the cattle economy in Africa, with zoonotic TB posing drug-resistance issues in humans. The burden of TB in cattle and zoonotic TB in humans in sub-Saharan Africa (SSA) is not well understood. This study aimed to determine the prevalence of both TB in cattle and zoonotic TB in humans in SSA through meta-analysis.

METHODS

Research on TB prevalence was sourced from multiple databases. A random effects meta-analysis model estimated TB prevalence in SSA and its regions, while meta-regression identified risk factors. The analysis included 114 studies for cattle and 59 for humans.

RESULTS

The estimated TB prevalence in cattle was 5.06% (95% CI: 3.76-6.78), with a higher burden in West Africa. The prevalence was greater on farms than at abattoirs. Among humans, M. bovis prevalence was 0.73% (95% CI: 0.53-1.01), increasing to 1.56% (95% CI: 1.04-2.33) in TB incident cases, especially in the West and East Africa. Higher prevalence was noted among livestock workers, and in drug-resistant cases. Significant factors influencing TB prevalence varied for cattle and humans, including country, diagnostic methods, and study populations.

CONCLUSION

Focusing interventions on farms and livestock workers could help reduce the disease burden.

Behaviour profile characterization of PS19 and rTg4510 tauopathy mouse models: A systematic review and a meta-analysis

The rTg4510 and PS19 mouse models are widely used in tauopathy research. Alzheimer's disease (AD) is the most prevalent among tauopathies. Behavioural tests are frequently used to assess emotional, cognitive, and motor behaviours in mouse models of AD. Cognitive deficits begin to manifest in rTg4510 mice around 3 months of age and in PS19 mice around 6 months. However, it's widely recognized that behavioural outcomes can vary due to environmental factors, health status, and husbandry practices, causing phenotypic differences between facilities. This study aims to consolidate current knowledge of the behavioural phenotypes of these two mouse models. We conducted a comprehensive literature review using keyword searches with Boolean operators across databases up to January 2024. Additional studies were included from manual searches. A total of 23 articles were reviewed for rTg4510 mice and 52 for PS19 mice. We extracted methodological details and key findings from each study. Results for rTg4510 mice show consistent findings regarding locomotion, memory and learning, and neurological dysfunction. However, the limited studies on motor and balance behaviour revealed no significant differences, while anxiety-like behaviour showed some inconsistencies. PS19 mice demonstrate more robust results for anxiety-like behaviour, memory and learning, and locomotion, while findings for balance and coordination are more inconsistent. Although there is overall coherence in certain aspects of the behavioural profiles of these tauopathy mouse models, it is crucial to recognize experimental heterogeneity and profile behavioural baselines to optimize the testing of both genetic and pharmacological interventions.

Epidemiology of arboviruses in humans and livestock in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Arbovirus infections are a global public health threat, accounting for approximately 73% of the total emerging and re-emerging human infections, where the burden is worsened in sub-Saharan Africa, including Ethiopia. However, the surveillance system has been still challenged, and their burden and magnitude are not well estimated due to underestimates of true arbovirus burdens by passive case detections. To support targeted evidence-based public health decision-making, comprehensive evidence of arbovirus prevalence is crucial. Thus, the aim of this study was to assess the prevalence of arboviruses in humans and livestock in Ethiopia.

METHOD

Articles were extensively searched in bibliographic databases and gray literatures using entry terms or phrases. PRISMA 2020 flow diagram was used and data among studies meeting eligibility criteria extracted in MS Excel sheet and exported into STATA-17 software for analysis. A random-effects model was used to compute the pooled magnitude of arboviruses in humans and livestock. The heterogeneity was quantified using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis, subgroup analysis and meta-regression were performed to explore heterogeneity.

RESULT

Of the 1957 studies identified, 39 human and 6 livestock studies were eligible for meta-analysis. The overall pooled sero-epidemiology of arboviruses in humans using anti-IgG and anti-IgM was 15.43% (95% CI: 12.11-18.76) and 10.04% (95% CI: 6.46-13.62), respectively. The molecular prevalence of arboviruses in humans was 38.42% (95% CI: 21.77-55.08). The pooled prevalence of arboviruses in livestock was 15.77% (95% CI: 0.45, 31.08). Dengue virus, Yellow fever virus, Zika virus, Rift valley fever, West Nile virus, and chikungunya virus in humans and Rift valley fever, West Nile virus, and Schmallenberg virus in livestock were reported.

CONCLUSION

The magnitude of arboviruses in humans and livestock in Ethiopia alarms the need for immediate multi-sectoral interventions such as strengthening laboratory diagnostic capacities, undertaking an integrated regular national surveillance, and implementation of one-health initiatives and a planetary health approach.

Aspartate Aminotransferase-to-platelet Ratio Index (APRi) as Biomarker for Liver Damage in Biliary Atresia (BA): A Meta-analysis

BACKGROUND

Biliary atresia (BA) is a severe paediatric liver disease causing cirrhosis without prompt treatment. Aspartate aminotransferase-to-platelet ratio index (APRi), a non-invasive biomarker, shows promise in assessing fibrosis and cirrhosis severity, offering an alternative to liver biopsy. However, standardised criteria and research on APRi accuracy in paediatric BA, especially across diverse populations, remain limited.

OBJECTIVES

To assess the correlation between APRi values, liver fibrosis and cirrhosis severity in children with BA, evaluate APRi's diagnostic accuracy and clinical utility, and identify appropriate cut-off values for significant fibrosis and cirrhosis.

METHODS

This systematic review and meta-analysis, conducted per PRISMA guidelines, evaluated non-invasive biomarkers for liver fibrosis in BA patients. Data were managed using REDCap and analysed with R software. Heterogeneity was assessed with the Cochrane Q test and I2 values.

RESULTS

Fourteen studies (retrospective, prospective, and one cross-sectional) examined APRi and liver fibrosis in BA. APRi cut-off values for diagnosing fibrosis and cirrhosis ranged from 0.7 to 2.26 for advanced fibrosis (F3). The meta-analysis provided pooled means and 95% confidence intervals for APRi, assessing its diagnostic performance. Significant heterogeneity was noted in studies with favourable histology, while none was observed in those with unfavourable histology, highlighting variability in APRi values.

CONCLUSION

Limited patient numbers and significant heterogeneity across studies impeded the establishment of a definitive threshold for identifying unfavourable histology in BA. Consequently, APRi's clinical utility remains unclear. Further research is required to determine its precise role as a biopsy surrogate and in clinical decision-making during BA diagnosis.

TYPE OF ARTICLE

Study of diagnostic test.

LEVEL OF EVIDENCE

IV.

Physical activity and executive functions in children and adolescents with neurodevelopmental disorders: A systematic review and meta-analysis

OBJECTIVE

The current study aimed to examine the effects of physical activity interventions on executive functions in children and adolescents with neurodevelopmental disorders and to identify possible moderators and the interactions among moderators.

METHODS

Six databases (Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC) were searched from inception to January 2024. Randomized controlled trials/quasi-experimental designs applying physical activity interventions and reporting at least one executive function outcome in children and adolescents with neurodevelopmental disorders were included. Random multilevel meta-analyses and moderator analyses were conducted in 2024.

RESULTS

Thirty-nine studies were included, 35 of which were used for meta-analysis. The findings indicated that physical activity interventions elicited significant benefits for overall executive functions (Hedges' g = 0.60) and its subdomains: cognitive flexibility (Hedges' g = 0.60), inhibitory control (Hedges' g = 0.55), working memory (Hedges' g = 0.40), and higher-level functions (Hedges' g = 0.83). Session duration, number of intervention weeks, total session, and total duration were identified as moderators. The interactions among session duration, physical activity type, total duration, frequency, and executive function subdomains were also observed.

CONCLUSIONS

Physical activity interventions could serve as an alternative or adjunctive method to promote multiple aspects of executive functions in children and adolescents with different types of neurodevelopmental disorders. However, physical activity, especially the type, session duration and frequency, should be carefully designed to produce significant effects when targeting different domains of executive functions in this population.

Effects of smokeless tobacco on cancer incidence and mortality: a global systematic review and meta-analysis

INTRODUCTION

The prevalence of smokeless tobacco consumption remains high despite policies on reduction interventions. This study aims to quantify the associations between smokeless tobacco use with cancer incidence and mortality globally.

METHODS

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and PROSPERO protocol (ID: CRD42023390468). A comprehensive literature search was performed using PubMed, Web of Science, and Scopus databases, covering the period from January 1, 2000, to February 28, 2023. We included peer-reviewed observational studies, specifically case-control and cohort studies, where smokeless tobacco use was the primary exposure and cancer incidence, or mortality were the main outcomes. Three independent reviewers screened titles, abstracts, and full texts, and extracted data from the included studies. Risk of bias was assessed by the same three reviewers. Any disagreements were resolved through discussion with a fourth reviewer. We performed random-effects meta-analyses and assessed heterogeneity and publication bias to ensure the robustness of our findings.

RESULTS

Of the 3,611 articles identified, 80 were included in the final analysis. Increased risks were observed for cancer mortality [Risk Ratio (RR) 1.38, 95% Confidence Interval (CI) 1.22-1.56] and incidence [RR 1.17, 95% CI 1.08-1.27]. The specific cancer sites with increased mortality risk included head and neck cancers, as well as stomach cancer. For cancer incidence, associations were observed with head and neck, oral, esophageal, stomach, and pancreatic cancers. Significant heterogeneity (I2 statistic 65% to 90%) was observed among most cancer outcomes.

CONCLUSION

Our study found significant associations between smokeless tobacco use and cancer incidence and mortality. Targeted policy interventions, such as stricter regulations on smokeless tobacco use, are recommended to reduce its consumption and mitigate the associated cancer risks.

Association Between β-Adrenoreceptor Agonists and Antagonists and Parkinson's Disease: Systematic Review and Meta-Analysis

BACKGROUND

β-agonists and β-antagonists are among the most prescribed drugs worldwide. In 2018, studies suggesting a harmful association between propranolol and Parkinson's disease (PD) prompted a signal procedure by the European Medicines Agency's safety committee, which concluded with no update of product information. Several studies have been published since then. We aimed to systematically review, critically appraise, and meta-analyse all studies on the association between the use of β-antagonists (including propranolol) and β-agonists, and the risk of PD.

METHODS

We searched Embase and Medline up to December 2024 for observational and intervention studies that reported relative risk estimates of the association between use of these medicines and PD. Two reviewers screened the records, extracted the data, and assessed the risk of bias. The restricted maximum likelihood method was used to compute pooled effect estimates and 95% confidence intervals (CIs).

RESULTS

Twenty-two studies were eligible. Overall, 20 had a high risk of bias in at least one domain. Twelve studies had medium to high risk of outcome misclassification. Of the 14 studies concerning β-antagonists, eleven had an unclear or high risk of protopathic bias, as propranolol is indicated for the treatment of essential tremor. Control for confounding by socio-economic status, area of residence (urban/rural), and smoking (a protective factor against PD) was deficient or lacking in 9/22, 15/22, and 12/22 studies, respectively. Lag times were applied in 9/22 studies. In meta-analysis, the summary relative risk (RR) of PD was 1.41 (95% CI: 1.18-1.68) for the class of β-antagonists (12 studies) and 0.93 (0.84-1.03) for β2-agonists (11 studies). Among specific β-antagonists, the summary RR of PD was 2.36 (1.66-3.36) for propranolol (7 studies), 0.84 (0.80-0.88) for carvedilol (3 studies) and 1.02 (0.87-1.18) for metoprolol (4 studies). For specific β2-agonists, summary RR was 0.88 (0.77-1.01) for salbutamol (7 studies), 0.91 (0.88-0.95) for short-acting β2-agonists (6 studies), and 0.85 (0.76-0.96) for long-acting β2 agonists (5 studies). Restricting to subgroups based on quality criteria resulted in weaker or non-statistically significant associations.

CONCLUSION

The quality and quantity of the available evidence do not support a causal association between use of β-adrenoreceptor modulators and PD. Significant associations are most likely explained by protopathic bias and confounding.

Improving large language model applications in biomedicine with retrieval-augmented generation: a systematic review, meta-analysis, and clinical development guidelines

OBJECTIVE

The objectives of this study are to synthesize findings from recent research of retrieval-augmented generation (RAG) and large language models (LLMs) in biomedicine and provide clinical development guidelines to improve effectiveness.

MATERIALS AND METHODS

We conducted a systematic literature review and a meta-analysis. The report was created in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 analysis. Searches were performed in 3 databases (PubMed, Embase, PsycINFO) using terms related to "retrieval augmented generation" and "large language model," for articles published in 2023 and 2024. We selected studies that compared baseline LLM performance with RAG performance. We developed a random-effect meta-analysis model, using odds ratio as the effect size.

RESULTS

Among 335 studies, 20 were included in this literature review. The pooled effect size was 1.35, with a 95% confidence interval of 1.19-1.53, indicating a statistically significant effect (P = .001). We reported clinical tasks, baseline LLMs, retrieval sources and strategies, as well as evaluation methods.

DISCUSSION

Building on our literature review, we developed Guidelines for Unified Implementation and Development of Enhanced LLM Applications with RAG in Clinical Settings to inform clinical applications using RAG.

CONCLUSION

Overall, RAG implementation showed a 1.35 odds ratio increase in performance compared to baseline LLMs. Future research should focus on (1) system-level enhancement: the combination of RAG and agent, (2) knowledge-level enhancement: deep integration of knowledge into LLM, and (3) integration-level enhancement: integrating RAG systems within electronic health records.

Prevalence and Types of Strabismus in Cerebral Palsy: A Global and Historical Perspective Based on a Systematic Review and Meta-Analysis

PURPOSE

Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations.

METHODS

We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus.

RESULTS

The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels.

CONCLUSION

Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.

Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis

BACKGROUND

Exercise can improve the symptoms of chemotherapy-induced peripheral neuropathy. Traditional pairwise meta-analyses of exercise interventions can only identify the difference in effect between an exercise intervention and usual care. It is necessary to conduct network meta-analyses to establish evidence on the comparative effectiveness of all relevant exercise intervention strategies.

OBJECTIVE

To evaluate the comparative effectiveness of all known exercise interventions for chemotherapy-induced peripheral neuropathy, rank the best exercise intervention and explore the influencing factors of exercise intervention.

DESIGN

Systematic review and network meta-analysis.

METHODS

A comprehensive search was conducted in 14 databases. Risk of bias assessment, quality of evidence, sensitivity analysis, subgroup analysis and meta-regression were performed on the included studies. A network meta-analysis was used to identify the optimal exercise intervention.

RESULTS

Twenty-four eligible studies were included, and a total of 19 interventions were identified. Regular physical training combined with sensorimotor exercise, sensorimotor exercise, aerobic combined with resistance and balance training, aerobic exercise and resistance training had statistically significant differences in reducing CIPN symptoms with SMD and 95 % CI were - 1.06 (-1.77, -0.36), -0.61 (-1.08, -0.14), -1.88 (-2.81, -0.94), 0.94 (0.39, 1.49) and - 1.31 (-1.87, -0.74). For pain, the most effective interventions included hand-foot exercises, aerobic combined with resistance training, muscular strength combined with balance exercises, SMD and 95 % CI were - 1.99 (-2.85, -1.13), -1.13 (-1.58, -0.67) and - 1.04 (-1.66, -0.41). Endurance combined with strength training, endurance combined with resistance and balance training, regular physical training combined with sensorimotor exercise and balance training were found to be effective in treating balance with SMD and 95 % CI were 1.61 (0.74, 2.48), 1.10 (0.31, 1.88), 0.92 (0.23, 1.61), and 1.40 (0.59, 2.21). Nerve gliding exercises, aerobic combined with resistance and flexibility exercises, endurance combined with strength training, aerobic combined with resistance training and balance training were found to be effective in treating muscular strength with SMD and 95 % CI were 1.09 (0.48, 1.70), 0.94 (0.29, 1.60), 1.13 (0.32, 1.94), 0.75 (0.51, 1.00) and 1.00 (0.23, 1.76). Subgroup analysis showed that frequency of exercise, duration of exercise, exercise time per session, type of exercise supervision, types of cancer, types of chemotherapy drugs and age had a significant effect on CIPN patients.

CONCLUSIONS

This network meta-analysis found that multimodal exercise, consisting of aerobic, balance, resistance and sensorimotor training, was the most effective intervention for CIPN in adults. Healthcare professionals should consider the effects of patient characteristics and different exercise doses on CIPN patients.

REGISTRATION

CRD42024500334.

Simultaneous Increase of Mean Susceptibility and Mean Kurtosis in the Substantia Nigra as an MRI Neuroimaging Biomarker for Early-Stage Parkinson's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Parkinson's disease (PD) is the second most common neurodegenerative disorder. Early detection is crucial for treatment and slowing disease progression.

HYPOTHESIS

Simultaneous alterations in mean susceptibility (MS) from quantitative susceptibility mapping (QSM) and mean kurtosis (MK) from diffusion kurtosis imaging (DKI) can serve as reliable neuroimaging biomarkers for early-stage PD (ESPD) in the basal ganglia nuclei, including the substantia nigra (SN), putamen (PUT), globus pallidus (GP), and caudate nucleus (CN).

STUDY TYPE

Systematic review and meta-analysis.

POPULATION

One hundred eleven patients diagnosed with ESPD and 81 healthy controls (HCs) were included from four studies that utilized both QSM and DKI in both subject groups.

FIELD STRENGTH/SEQUENCE

Three-dimensional multi-echo gradient echo sequence for QSM and spin echo planar imaging sequence for DKI at 3 Tesla.

ASSESSMENT

A systematic review and meta-analysis using PRISMA guidelines searched PubMed, Web of Science, and Scopus.

STATISTICAL TESTS

Random-effects model, standardized mean difference (SMD) to compare MS and MK between ESPD patients and HCs, I2 statistic for heterogeneity, Newcastle-Ottawa Scale (NOS) for risk of bias, and Egger's test for publication bias. A P-value <0.05 was considered significant.

RESULTS

MS values were significantly higher in SN (SMD 0.72, 95% CI 0.31 to 1.12), PUT (SMD 0.68, 95% CI 0.29 to 1.07), and GP (SMD 0.53, 95% CI 0.19 to 0.87) in ESPD patients compared to HCs. CN did not show a significant difference in MS values (P = 0.15). MK values were significantly higher only in SN (SMD = 0.72, 95% CI 0.16 to 1.27). MK values were not significantly different in PUT (P = 1.00), GP (P = 0.97), and CN (P = 0.59). Studies had high quality (NOS 7-8) and no publication bias (P = 0.967).

DATA CONCLUSION

Simultaneous use of MS and MK may be useful as an early neuroimaging biomarker for ESPD detection and its differentiation from HCs, with significant differences observed in the SN.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

Deep Inferior Epigastric Perforator Flap Breast Reconstruction in Patients With or Without Previous Abdominal Surgery: A Systemic Review and Meta-analysis

Background

The deep inferior epigastric perforator (DIEP) flap is now considered the gold standard for autologous breast reconstructions (BRs). Previous abdominal surgery (PAS) is considered to be a potential contraindication to abdominal-based BR. This systematic review and meta-analysis aim to evaluate the impact of PAS following a DIEP flap BR comparing patients with or without PAS.

Methods

A systematic review of the literature and comparative meta-analysis were performed to assess the differences in abdominal donor-site and flap complication rates between patients with or without PAS. Only comparative studies that reported on postoperative complications following DIEP flap BR were included. Odds ratios and 95% confidence intervals were calculated using a random-effects model.

Results

Nine studies were included, representing 2440 patients with or without PAS corresponding to 3082 DIEP flap BR. There were no differences across groups in flap-related complication rates. However, PAS was associated with an increase in the overall rate of abdominal complications (odds ratio = 1.92; 95% confidence interval = 1.41-2.62; P < 0.0001).

Conclusions

PAS is not a contraindication to DIEP flap BR, and no increase in the flap complication rate has been found in association with PAS. However, our study shows that PAS is associated with a higher overall abdominal complication rate at the donor site.

Effects of exercise on sleep quality in women - A systematic review and meta-analysis

OBJECTIVES

Insomnia affects at least one-third of the global population and is more common in women. Exercise has been reported to improve sleep quality and subsequent use of hypnotics. Therefore, we performed a meta-analysis to assess the effect of exercise on sleep quality in adult women.

DESIGN

This meta-analysis systematically assessed the effects of exercise on women's sleep quality using a random-effects model.

METHODS

We searched seven databases for randomised controlled trials examining the effect of exercise on sleep quality in women. Inclusion criteria were women aged 18 or older with insomnia symptoms, exercise used as an intervention, and the Pittsburgh Sleep Quality Index or Insomnia Severity Index as outcome measures. We excluded studies using other treatments, those involving cancer patients or pregnant women, and those with unclear, unanalysable data. A random-effects model was used for meta-analysis, with outcomes expressed as the weighted mean difference and 95 % confidence interval. Risk of bias was assessed using Cochrane Handbook criteria.

RESULTS

The meta-analysis included 16 studies. The results indicated that exercise significantly reduced the Pittsburgh Sleep Quality Index total score. Exercise implemented for <12 weeks was more effective in improving sleep quality and daytime dysfunction, whilst interventions ≥12 weeks reduced the use of sleep medication.

CONCLUSIONS

Exercise training can significantly improve sleep quality in adult women, as measured by the Pittsburgh Sleep Quality Index. Therefore, exercise can be crucial in promoting health, especially as a non-pharmacological treatment. When more studies will be available in the future, it will be possible to further explore the impact of age, type of exercise, and time of exercise.

Circulating VEGF levels and genetic polymorphisms in Behçet's disease: a meta-analysis

Objective

This study aimed to explore the relationship between circulating vascular endothelial growth factor (VEGF) levels and Behçet's disease (BD), as well as to examine the association between VEGF gene polymorphisms and BD.

Methods

We conducted a comprehensive search of the MEDLINE, Embase, and Web of Science databases to identify relevant research articles. A meta-analysis was performed to compare serum or plasma VEGF levels in BD patients with those in control groups. Additionally, we evaluated the potential associations between BD susceptibility and specific VEGF polymorphisms, namely -634 C/G, +936 C/T, and the 18 bp insertion/deletion (I/D) at -2549.

Results

The analysis included 15 studies with a total of 1,020 BD patients and 1,031 controls. BD patients exhibited significantly higher circulating VEGF levels compared to controls (standardized mean difference [SMD]=1.726, 95% confidence interval [CI]=1.030~2.421, p<0.001). Elevated VEGF levels were noted among BD patients from European and Arab populations. Subgroup analysis further confirmed the increase in VEGF levels across different data types and sample sizes. Patients with active BD had higher VEGF levels than those with inactive BD (SMD=0.635, 95% CI=0.092~1.177, p=0.022). However, no significant association was found between BD and the VEGF -634 C allele (odds ratio=1.023, 95% CI=0.707~1.481, p=0.904). Similarly, no association was detected between BD and the VEGF +936 C/T or 18 bp I/D at -2549 polymorphisms.

Conclusion

Our meta-analysis showed a strong association between elevated circulating VEGF levels and BD. However, the VEGF polymorphisms examined in this study do not appear to be associated with susceptibility to BD.

Genetic association of MIR-449B, GCLC, eNOS, SORD, and ENPP1 with diabetic retinopathy

Identifying the genetic risk factors of diabetic retinopathy (DR) is essential for discovering the potential pathogenesis of DR. This study determined the association of DR with five single nucleotide polymorphisms (SNPs) specifically in type 2 diabetes mellitus (T2DM) patients, including rs10061133(MIR-449B), rs17883901(GCLC), rs2070744(eNOS), rs3759890 (SORD) and rs7754561 (ENPP1). A total of 1433 individuals were enrolled in this study, comprising healthy controls (ctrls = 480), individuals with diabetes mellitus without retinopathy (DNR = 480), non-proliferative DR(NPDR = 378), and proliferative DR(PDR = 95). The five SNPs were genotyped utilizing Mass ARRAY MALDI-TOF technology. Odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the risk of genotype and allele. We performed a literature search in PubMed published before July 16, 2023. The Newcastle Ottawa Scale was used to evaluate the overall quality of the case-control studies. Consequently, we found that there were statistically significant differences between PDR cases and healthy controls for rs10061133 (P = 0.007, OR = 1.59, 95% CI = 1.32-2.23) and rs17883901 (P = 0.020, OR = 1.67, 95% CI = 1.08-2.57), rs17883901 was significantly associated with NPDR (P = 0.023, OR = 1.39, 95% CI = 1.05-1.85), there was a significant association between DR cases and healthy controls (P = 0.048, OR = 1.22, 95% CI = 1.00-1.48) for rs3759890 in the allelic model. DR show no relationships with the other two SNPs compared to healthy controls. In multivariate analyses comparing the DR and DNR groups, rs7754561(A), rs10061133(G), and rs17883901(A) were identified as risk loci for DR in individuals with a duration of diabetes of ≥5 years (P = 0.0023, P = 0.0037, and P = 0.0376, respectively). Furthermore, individuals carrying rs10061133(G) exhibited a higher risk of DR in the hyperglycemic group (glucose ≥8 mmol/L). Secondly, we showed that one polymorphism in eNOS (rs2070744, T > C) showed a suggestive association with DR in the meta-analysis (allelic model:P < 0.05, OR = 1.18, 95% CI: 1.07-1.30, Z = 3.46, I2 = 34%). Subsequently, including studies that used either healthy subjects or diabetic subjects without DR as controls, the association of eNOS rs2070744 with DR was consistently significant (P = 0.002) and exhibited intermediate heterogeneity (I2 = 48%). Furthermore, polymorphisms in GCLC (rs17883901) and SORD (rs3759890) were also associated with DR, with P-values of 0.004 (I2 = 93%) and 0.03 (I2 = 3%), respectively, suggesting their potential involvement in the disease. In conclusion, this study documented that rs10061133(G), rs17883901(A), and rs3759890(G) could be the independent risk factors for retinopathy in Chinese patients with T2DM, offering a foundation for genetic risk assessment in clinical practice. Furthermore, our meta-analysis reveals a significant association between rs2070744 and DR, implying the potential involvement of the MIR-449B, GCLC, SORD, and eNOS variants in the development of DR, which could be a promising direction for developing new treatments aimed at mitigating the risk of DR in susceptible populations.

A New Frequentist Implementation of the Daniels and Hughes Bivariate Meta-Analysis Model for Surrogate Endpoint Evaluation

Surrogate endpoints are used when the primary outcome is difficult to measure accurately. Determining if a measure is suitable to use as a surrogate endpoint is a challenging task and a variety of meta-analysis models have been proposed for this purpose. The Daniels and Hughes bivariate model for trial-level surrogate endpoint evaluation is gaining traction but presents difficulties for frequentist estimation and hitherto only Bayesian solutions have been available. This is because the marginal model is not a conventional linear model and the number of unknown parameters increases at the same rate as the number of studies. This second property raises immediate concerns that the maximum likelihood estimator of the model's unknown variance component may be downwardly biased. We derive maximum likelihood estimating equations to motivate a bias adjusted estimator of this parameter. The bias correction terms in our proposed estimating equation are easily computed and have an intuitively appealing algebraic form. A simulation study is performed to illustrate how this estimator overcomes the difficulties associated with maximum likelihood estimation. We illustrate our methods using two contrasting examples from oncology.

Safety of crushed/chewed P2Y12 inhibitors in acute coronary syndromes - a meta-analysis of randomized controlled trials

The administration of crushed or chewed P2Y12 inhibitors (P2Y12i) allows faster platelet inhibition in patients presenting acute coronary syndrome (ACS). Whether this administration approach is safe needs further analysis. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing chewed/crushed to integral P2Y12i administration in patients with ACS. Major bleeding, minor bleeding, and major adverse cardiovascular events (MACE) were analyzed as binary outcomes. Platelet reactivity unit (PRU) was assessed as a continuous outcome to estimate the impact on platelet physiology. A subgroup analysis of P2Y12i administered was performed. Nine studies comprising 1091 patients with ACS were included, 77% were males. Overall, 87% presented with ST-segment elevation acute myocardial infarction. Six studies administered Ticagrelor, while 3 studies used Prasugrel. The absolute risk of bleeding, assessed by TIMI, was low in both intervention and control arms (0.36% vs. 0.95% for major bleedings and 3.3% vs. 4.4% for minor bleedings), and crushed/chewed administration did not increase the relative risk of bleeding events for TIMI major or minor bleedings (RR 0.51, 95% CI 0.09-2.77, p = 0.293; RR 0.76, 95% CI 0.24-2.43, p = 0.542) or MACE (RR 0.94, 95% CI 0.28-3.19, p = 0.902). PRU was significantly reduced within 1 h after administration in the crushed/chewed P2Y12i group (MD: -70.0%, 95% CI, -89.0 to -51.1%, p<0.01) while we did not observe a significant difference after 4 h (MD: -15.1%, 95% CI -34.2 to 4.0%, p = 0.12). The type of drug did not influence the relative risk of crushed/chewed P2Y12i on major or minor bleeding (pinteraction = 0.62 and pinteraction = 0.23, respectively). The crushed/chewed administration of P2Y12i in the setting of ACS was not associated with an increased risk of bleeding, suggesting the safety of this strategy.

Suicide methods and severe mental illness: A systematic review and meta-analysis

INTRODUCTION

People with severe mental illness (SMI) have a higher risk of suicide compared with the general population. However, variations in suicide methods between people with different SMIs have not been examined. The aim of this pre-registered (PROSPERO CRD42022351748) systematic review was to pool the odds of people with SMI who die by suicide versus those with no SMI, stratified by suicide method.

METHODS

Searches were conducted on December 11, 2023 across PubMed, PsycInfo, CINAHL, and Embase. Eligible studies were those that reported suicide deaths stratified by SMI and suicide methods. Studies were pooled in a random-effects meta-analysis, and risk of bias was measured by the Joanna Briggs Institute checklist.

RESULTS

After screening, 12 studies were eligible (n = 380,523). Compared with those with no SMI, people with schizophrenia had 3.38× higher odds of jumping from heights (95% CI: 2.08-5.50), 1.93× higher odds of drowning (95% CI: 1.50-2.48). People with bipolar disorder also had 3.2× higher odds of jumping from heights (95% CI: 2.70-3.78). Finally, people with major depression had 3.11× higher odds of drug overdose (95% CI: 1.53-6.31), 2.11× higher odds of jumping from heights (95% CI: 1.93-2.31), and 2.33× lower odds of dying by firearms (OR = 0.43, 95% CI: 0.33-0.56). No studies were classified as high risk of bias, and no outcomes had high levels of imprecision or indirectness.

CONCLUSION

These findings could inform lethal means counselling practices in this population. Additionally individual, clinical, community and public health interventions for people with SMI should prioritise, where feasible, means restriction including access to heights or drugs to overdose.

Bovine adenovirus prevalence and its role in bovine respiratory disease complex: A systematic review and meta-analysis

Bovine adenoviruses (BAdVs) are major contributors to the bovine respiratory disease complex (BRDC). A systematic review and meta-analysis were carried out to explore the epidemiology of BAdV across diverse cattle populations using different detection methods. The study showed a higher BAdV prevalence of 0.66 in general cattle populations using antibody detection, compared with 0.28 in cattle showing clinical signs. The study identified significant prevalence differences between BAdV-3 (0.87) and BAdV-7 (0.21) in general cattle populations. However, in clinical cattle, BAdV-3 and BAdV-7 showed similar prevalence at 0.27 and 0.32, respectively. Moreover, a high herd-based BAdV seroprevalence of 0.82 was observed. When nucleic acid detection methods were used in general cattle populations, a lower BAdV (0.05) prevalence was observed, in contrast to the higher prevalence (0.32) in cattle exhibiting clinical signs. In contrast, using antigen detection in cattle with clinical signs of disease showed a prevalence of 0.06, compared to 0.32 with nucleic acid methods, indicating detection method-specific sensitivity and specificity. The study also highlighted the role of BAdV in BRDC, particularly BAdV-3 and BAdV-7. Existing empirical evidence on BAdV epidemiology and pathobiology is scarce and requires further investigation; however, the current findings offer insights into the epidemiology of BAdV and its role in the BRDC, which could potentially inform and enhance disease control strategies.

Effects of seal oil supplementation on lipid profile biomarkers: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Seal oil (SO) supplementation has been purported to have cardiovascular health benefits due to its content of omega-3 fatty acids; however, the clinical evidence base for this intervention has yet to be comprehensively assessed.

OBJECTIVE

We aimed to evaluate the effects of oral SO supplementation on lipid profile biomarkers.

METHODS

A systematic search was performed on Pubmed, Embase, Web of Science and Cochrane Library, from inception to August 2024. Only randomized controlled trials (RCTs) assessing the effect of SO on lipid profile biomarkers were included. A random-effects meta-analysis was applied to determine the overall effect estimate. The certainty of evidence (CoE) was evaluated using the GRADE approach.

RESULTS

Nine RCTs were included in the review after the screening of 242 studies, comprising a total of 626 patients. Supplementation of SO resulted in no statistically significant effects on LDL-C (MD -0.07 mmol/L; 95 % CI [-0.19, 0.05]; CoE: Low) and total cholesterol (MD -0.12 mmol/L; 95 % CI [-0.30, 0.06]; CoE: Very low). There were statistically significant results of modest-to-trivial clinical importance on triglycerides (MD -0.19 mmol/L, 95 % CI [-0.30, -0.08]; CoE: Low) and trivial importance on HDL-C (MD 0.07 mmol/L, 95 % CI [0.003, 0.13]; CoE: Very low).

CONCLUSION

There is no sufficiently certain evidence to determine the effects of SO on cardiovascular lipid biomarkers. Our analyses may suggest a modest-to-trivial, clinically uncertain beneficial effect on triglyceride levels; and little to no effect on LDL-C. Effect estimates for HDL-C and total cholesterol levels were highly uncertain. Further evidence is required to conclusively determine the effects of oral SO on lipid biomarkers.

PROTOCOL REGISTRATION NUMBER

CRD42024583739.

Meta-analysis of the acoustic adaptation hypothesis reveals no support for the effect of vegetation structure on acoustic signalling across terrestrial vertebrates

Acoustic communication plays a prominent role in various ecological and evolutionary processes involving social interactions. The properties of acoustic signals are thought to be influenced not only by the interaction between signaller and receiver but also by the acoustic characteristics of the environment through which the signal is transmitted. This conjecture forms the core of the so-called "acoustic adaptation hypothesis" (AAH), which posits that vegetation structure affects frequency and temporal parameters of acoustic signals emitted by a signaller as a function of their acoustic degradation properties. Specifically, animals in densely vegetated "closed habitats" are expected to produce longer acoustic signals with lower repetition rates and lower frequencies (minimum, mean, maximum, and peak) compared to those inhabiting less-vegetated "open habitats". To date, this hypothesis has received mixed results, with the level of support depending on the taxonomic group and the methodology used. We conducted a systematic literature search of empirical studies testing for an effect of vegetation structure on acoustic signalling and assessed the generality of the AAH using a meta-analytic approach based on 371 effect sizes from 75 studies and 57 taxa encompassing birds, mammals and amphibians. Overall, our results do not provide consistent support for the AAH, neither in within-species comparisons (suggesting no overall phenotypically plastic response of acoustic signalling to vegetation structure) nor in among-species comparisons (suggesting no overall evolutionary response). However, when considering birds only, we found weak support for the AAH in within-species comparisons, which was mainly driven by studies that measured frequency bandwidth, suggesting that this variable may exhibit a phenotypically plastic response to vegetation structure. For among-species comparisons in birds, we also found support for the AAH, but this effect was not significant after excluding comparative studies that did not account for phylogenetic non-independence. Collectively, our synthesis does not support a universal role of vegetation structure in the evolution of acoustic communication. We highlight the need for more empirical work on currently under-studied taxa such as amphibians, mammals, and insects. Furthermore, we propose a framework for future research on the AAH. We specifically advocate for a more detailed and quantitative characterisation of habitats to identify frequencies with the highest detection probability and to determine if frequencies with greater detection distances are preferentially used. Finally, we stress that empirical tests of the AAH should focus on signals that are selected for increased transmission distance.

Utility of preoperative ultrasound in assessing the adequacy of autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis

OBJECTIVE

Anterior cruciate ligament (ACL) reconstruction using tendon autograft requires imaging to evaluate graft adequacy. Ultrasound (US) offers an efficient adjunct to MRI; however, the utility of US is variable in prior literature and should be investigated. The primary aim of this study is to provide a statistical appraisal of literature assessing correlation of preoperative US measurements with intraoperative size of autografts during ACL reconstruction.

MATERIALS AND METHODS

PubMed, Embase, and Web of Science databases were queried for studies comparing preoperative US-based measurements to intraoperative measurements of autografts to assess graft adequacy (defined as > 8 mm diameter). Correlation coefficients from studies comparing combined cross-sectional area (CCSA) of autograft tendons on US to intraoperative autograft tendon diameters were collected and pooled. Random-effects models were generated to compare sensitivity, specificity, positive predictive values (PPV), and negative predictive value (NPV) for the identification of adequate graft sizes.

RESULTS

Eleven studies compared preoperative measurements of autograft size to intraoperative measurements. Meta-analysis of studies assessing hamstring tendon CCSA on US in comparison to intraoperative tendon diameters revealed a pooled correlation coefficient of 0.54 (CI 0.41-0.66, I2 = 9.6%). Three studies reported if US correctly identified adequate graft sizes, demonstrating sensitivity of 83% (I2 = 0.0%) and specificity of 78% (I2 = 49.2%). PPV was 91% (I2 = 0.0%), and NPV was 62% (I2 = 11.7%).

CONCLUSION

Hamstring CCSA on US has moderate correlation with intraoperative diameter, high sensitivity (83%), moderate specificity (78%), and very high PPV (91%) for identifying adequately sized autografts for ACL reconstruction.

The effect of exercise-induced muscle fatigue on gait parameters among older adults: a systematic review and meta-analysis

BACKGROUND

Exercise-induced fatigue is a common consequence of physical activities. Particularly in older adults, it can affect gait performance. Due to a wide variety in fatiguing protocols and gait parameters used in experimental settings, pooled effects are not yet clear. Furthermore, specific elements of fatiguing protocols (i.e., intensity, duration, and type of activity) might lead to different changes in gait parameters. We aimed to systematically quantify to what extent exercise-induced fatigue alters gait in community-dwelling older adults, and whether specific elements of fatiguing protocols could be identified.

METHODS

This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. In April 2023, PubMed, Web of Science, Scopus, Cochrane and CINAHL databases were searched. Two independent researchers screened and assessed articles using ASReview, Rayyan, and ROBINS-I. The extracted data related to spatio-temporal, stability, and variability gait parameters of healthy older adults (55 +) before and after a fatiguing protocol or prolonged physical exercise. Random-effects meta-analyses were performed on both absolute and non-absolute effect sizes in RStudio. Moderator analyses were performed on six clusters of gait parameters (Dynamic Balance, Lower Limb Kinematics, Regularity, Spatio-temporal Parameters, Symmetry, Velocity).

RESULTS

We included 573 effect sizes on gait parameters from 31 studies. The included studies reflected a total population of 761 older adults (57% female), with a mean age of 71 (SD 3) years. Meta-analysis indicated that exercise-induced fatigue affected gait with a standardized mean change of 0.31 (p < .001). Further analyses showed no statistical differences between the different clusters, and within clusters, the effects were non-uniform, resulting in an (indistinguishable from) zero overall effect within all clusters. Elements of fatiguing protocols like duration, (perceived) intensity, or type of activity did not moderate effects.

DISCUSSION

Due to the (mainly) low GRADE certainty ratings as a result of the heterogeneity between studies, and possible different strategies to cope with fatigue between participants, the only conclusion that can be drawn is that older adults, therapist, and researchers should be aware of the small to moderate changes in gait parameters as a result of exercise-induced fatigue.

Environmental Protective and Risk Factors for Gastric Cancer: An Umbrella Review and Reanalysis of Meta-Analyses

PURPOSE

Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.

MATERIALS AND METHODS

We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and meta-analyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06-1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21-1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04-1.91).

CONCLUSIONS

The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42020209817.

The prevalence of oral mucositis after radiotherapy in patients with Head and Neck Cancer and its associated factors: a meta-analysis

OBJECTIVES

Although the discussion about oral mucositis in Head and Neck Cancer (HNC) patients has become a prominent issue, its incidence and influencing factors have not been thoroughly synthesized. This meta-analysis aims to integrate the prevalence and associated factors of radiation-induced oral mucositis among HNC patients.

METHODS

This study searched the following electronic databases: PubMed, the Cochrane Database, the Web of Science, EMBASE, CNKI, the Wanfang Database, and the VIP Database. The publication timeframe for the included studies ranged from January 2005 until January 2024. Two investigators used the NOS scale and AHRQ evaluation criteria for quality evaluation. All qualified studies and statistical analyses were conducted using RevMan 5.2 and Stata 17.0.

RESULTS

Thirty eligible studies were included in the analysis. The results show that the prevalence of radiation-induced oral mucositis in HNC patients was 94% [95% CI (89%, 98%)]. Furthermore, the prevalence of severe radiation-induced oral mucositis in HNC patients is 37% [95%CI (29%, 45%)]. Chemotherapy, smoking history, diabetes, oral PH ≤ 7.0, and alcohol consumption are the main risk factors for radioactive oral mucositis. In addition, BMI > 24.0 kg/m2, no use of antibiotics, and no use of oral mucosal protective agents are associated with radioactive oral mucositis.

CONCLUSIONS

This meta-analysis underscores a significantly high prevalence of radiation-induced oral mucositis in HNC patients. Establishing healthy lifestyle habits and maintaining a healthy oral environment are pivotal in preventing radiation-induced oral mucositis.

Effect of long-term treatment with memantine on mortality in patients with major cognitive disorders: A systematic review and meta-analysis

BACKGROUND

Dementia is responsible for a reduction in life expectancy, and the effect of memantine on mortality is still poorly understood. Our aim was to evaluate the effect of long-term treatment with memantine on all-cause mortality.

METHODS

In this systematic review and meta-analysis, we searched five databases from their creation to June 2024.

RESULTS

We found 12 randomized trials (n = 4266) and 7 observational studies (n = 20,216). Treatment with memantine was associated with a reduction in all-cause mortality (risk ratios [RRs] 0.81, 95% CI: 0.72-0.92, p = 0.001). In the sensitivity analysis, the pooled RR was similar for randomized controlled trials (RCT) (RR 0.86) and non-randomized studies (RR 0.81) but pooled results from RCTs did not reach statistical significance (95% confidence interval [CI]: 0.59-1.26, p = 0.45), while they did for observational studies (95% CI: 0.70-0.95, p = 0.008), so we consider the overall evidence as of low certainty.

CONCLUSION

Our results suggest that the use of memantine in patients with dementia may be associated with a reduction in all-cause mortality.

Highlights

Dementia reduces patients' survival and the effect of long-term use of memantine on all-cause mortality is not well known.This systematic review and metanalysis included 19 studies including more than 24000 patients.We found that memantine in patients with dementia may be associated with a reduction in all-cause mortality.

Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

Association between MASLD and increased risk of serious bacterial infections requiring hospital admission: A meta-analysis

BACKGROUND

Previous studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of serious bacterial infections. However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the association between MASLD and serious bacterial infections requiring hospital admission.

METHODS

We systematically searched PubMed, Scopus, Web of Science and Embase from database inception to 1 April 2024, using predefined keywords to identify studies examining the risk of serious bacterial infections among individuals with and without MASLD. MASLD was diagnosed using liver biopsy, imaging or International Classification of Diseases codes. Meta-analysis was performed using random-effects modelling.

RESULTS

We identified six cross-sectional and two prospective cohort studies with aggregate data on ~26.6 million individuals. MASLD was significantly associated with higher odds of serious bacterial infections (pooled random-effects odds ratio 1.93, 95% confidence interval [CI] 1.44-2.58; I2 = 93%). Meta-analysis of prospective cohort studies showed that MAFLD was associated with an increased risk of developing serious bacterial infections (pooled random-effects hazard ratio 1.80, 95% CI 1.62-2.0; I2 = 89%). This risk further increased across the severity of MASLD, especially the severity of fibrosis (pooled random-effects hazard ratio 2.42, 95% CI 1.89-2.29; I2 = 92%). These results remained significant after adjusting for age, sex, obesity, diabetes and other potential confounders. Sensitivity analyses did not modify these findings. The funnel plot did not reveal any significant publication bias.

CONCLUSIONS

This meta-analysis shows a significant association between MASLD and an increased risk of serious bacterial infections requiring hospital admission.

Memory deficits in children and adolescents with a psychotic disorder: a systematic review and meta-analysis

Early-onset psychosis (EOP) is a severe disorder which takes place before 18 years. It entails diverse clinical and functional implications, and it may lead to critical impairments in neurocognitive functions. Although deficits in memory are well described in adult populations and they appear to be clinically related with psychosis, impairments in memory in EOP show inconsistencies between studies. This study aimed to gain insight into the relationship between EOP and memory impairments, studying the potential contribution of moderators (storage source and memory content) on the observed memory deficits. This systematic review and meta-analysis was conducted following the PRISMA-2020 guidelines. Search was conducted in English and Spanish in five databases. Case-control studies which met all requirements were selected. Overall effect size was calculated under the random-effects model and Z-based tests were used. Heterogeneity was analysed by the I2 statistic. Mixed-effects meta-regression analysis was used to study the influence of methodological quality of studies, mean age, proportion of female participants within sample, mean diagnosis, memory storage type, memory content as moderators on individual effect size variability. As a result, 32 articles were finally selected, pooling data from 2636 participants (49.29% EOP participants). Overall effect size was Hedges' g =  - 1.01, CI95 = [ - 1.35,  - 0.67], p < .01, indicating lower memory performance in the EOP group in comparison to healthy controls. Diagnosis and memory storage were found as significant moderators in the memory performance variance: larger deficits were found in children with psychosis and in working memory tasks.

Prevalence and risk factors of frailty in people experiencing homelessness: A systematic review and meta-analysis

BACKGROUND

The experience of homelessness has been associated with premature ageing and an earlier onset of geriatric syndromes. Identification of frailty and appropriate intervention, may help improve health outcomes for people experiencing homelessness (PEH). This review aimed to identify prevalence, use of screening tools and risk factors for frailty in PEH.

METHOD

A systematic review, conducted and reported following the PRISMA checklist, was undertaken investigating the prevalence and risk factors of frailty among PEH. Searches were conducted in Ovid MEDLINE, PsycInfo, Web of Science and CINAHL from inception to July 2024. A meta-analysis examining prevalence of frailty and pre-frailty was completed with a narrative synthesis of related risk factors.

RESULTS

A total of 1672 articles were screened for eligibility and 11 studies were included, containing 1017 participants from seven countries. Six different screening tools were employed to detect frailty in the included studies. The range of frailty prevalence was 16-70 % and pre-frailty prevalence was 18-60 %. The pooled frailty prevalence from studies employing the Fried Criteria was 39 % (95 % CI 15-66); the Clinical Frailty Scale: 37 % (95 % CI 24-51); the Edmonton Frailty Scale: 53 % (95 % CI 44-63); and the Tilburg Fraily Indicator: 31 % (95 % CI 8-60). High heterogeneity was observed between the studies. Identified risk factors for developing frailty in PEH included being female, increased years spent homeless, and drug addiction.

CONCLUSION

This study highlights a high prevalence of frailty and pre-frailty in PEH. The identified risk factors illustrate potential areas to target interventions to reverse frailty. Future research should focus on the role of screening for frailty in PEH and developing appropriate frailty detection tools in this group.

Incomplete reporting of adverse events in duloxetine trials: a meta-research survey of randomized controlled trials vs placebo

BACKGROUND AND OBJECTIVES

Relying on published data alone might be insufficient for meta-analyses to be reliable and trustworthy since selective outcome reporting is common, especially for adverse events (AEs). We investigated the existence of selective reporting and its potential for bias in a case study exploring AEs of duloxetine in adults.

STUDY DESIGN AND SETTING

We systematically searched all previous meta-analyses/pooled analyses on duloxetine published on PubMed for seven indications approved by the American and European health authorities. We included all randomized controlled trials (RCTs) vs placebo. For each RCT, we extracted the number of serious adverse events (SAEs), AEs, drop-outs (DOs) and drop-outs for safety reasons (DOSRs) using four information sources: published articles, clinical study registries, clinical study reports and data available in meta-analyses/pooled analyses. To assess the range of differences resulting from these four extraction strategies, we performed 4 meta-analyses using random effect models as well as a complete meta-analysis combining all sources.

RESULTS

A total of 70 RCTs (including 24,330 patients) were included. Of those, SAEs were identified for 42 studies (61%) in published articles, 58 (84%) in study reports (8 study reports were not retrieved), 24 (34.7%) in registries, and 21 (30.4%) in meta-analyses/pooled analyses. For 2 (2.9%), 2 (2.9%), 2 (2.9%) and 1 (1.4%) studies, we found respectively no data on SAEs, AEs, DOs, and DOSRs in any sources. Discrepant results across sources were found in 24 (34.5%), 20 (28.5%), 13 (18.6%), and 9 (12.8%) studies, respectively for SAEs, AEs, DOs, and DOSRs. Despite variations in point estimates and their 95% confidence intervals, we did not find different results in the conclusions of meta-analyses depending on the different information sources used, except for DOs, for which no effect was found using results published in registries, in contrast to other information sources.

CONCLUSION

None of the four information sources provided complete retrieval of safety results for duloxetine in adults across various indications. However, we did not find strong evidence that this underreporting leads to different conclusions in meta-analyses. Nonetheless, this finding remains uncertain, as we were unable to obtain complete information for all studies despite extensive searches.

Effects of non-pharmacological interventions on anxiety in patients undergoing colonoscopy: A network meta-analysis of randomized controlled trials

BACKGROUND

Anxiety is a common and significant problem in patients who need to undergo colonoscopy. However, the question of which non-pharmacological intervention is the best strategy to reduce anxiety in patients undergoing colonoscopy remains unanswered.

OBJECTIVES

To evaluate and rank the effectiveness of various non-pharmacological interventions for reducing anxiety in patients undergoing colonoscopy in order to identify the most effective strategies.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, and Medline for randomized controlled trials published from the database construction to March 2024. The primary outcome was the difference between pre- and post-intervention anxiety means. A network meta-analysis was conducted utilizing the "gemtc" package based on R4.3.0.

RESULTS

The analysis encompassed 24 randomized controlled trials, incorporating 2525 participants and evaluating 9 non-pharmacological interventions. All non-pharmacological interventions reduced anxiety in patients undergoing colonoscopy compared to standard care, with music intervention (SMD = -0.52, 95 %CI (-0.84,-0.20)), audiovisual distraction (SMD = -0.54, 95 %CI(-0.96,-0.12)), video information (SMD = -1.47, 95 %CI(-2.03,-0.90)), individual education (SMD = -1.72, 95 %CI(-2.76,-0.70)), and electroacupuncture (SMD = -1.12, 95 %CI(-2.10,-0.13)) having statistically significant effects. SUCRA ranking identified the priority of individual education (SUCRA: 92.5 %) and video information (SUCRA: 87.7 %). Meta-regression and sensitivity analysis further demonstrated the stability of the evidence. The certainty of the evidence was mostly rated as medium to low.

CONCLUSION

This review highlights the superior effects of individual education and video information in reducing anxiety in patients undergoing colonoscopy. The findings of our review could provide clinical decision-makers and healthcare practitioners, such as doctors and nurses, with evidence-based practices for selecting interventions to reduce anxiety in patients undergoing colonoscopy.

Whey Protein Intervention and Inflammatory Factors and Oxidative Stress: Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Whey protein (WP), a high-biological-value protein contained in milk, may have anti-inflammatory properties and can reduce proinflammatory cytokines; however, the current evidence is inconclusive.

OBJECTIVE

The aim of this study was to further investigate the effects of whey protein supplementation on inflammatory factors and oxidative stress in adults.

DATA SOURCES

We conducted a comprehensive search up to March 2022 using relevant key words in databases such as PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials, focusing on randomized controlled trials (RCTs).

DATA EXTRACTION

RCTs that examined the impact of WP on C-reactive protein, tumor necrosis factor alpha, interleukin-6, glutathione, malondialdehyde, and total antioxidant capacity were selected independently by 2 authors. Results were pooled using a random-effects model as weighted mean differences and 95% CIs.

DATA ANALYSIS

The results of the present study demonstrated that WP supplementation had no significant effect on the modulation of inflammation and oxidative stress compared with the control. None of the predefined subgroup analyses explained the differences in the effects of WP supplementation on inflammatory factors and oxidative stress.

CONCLUSION

This research suggests that WP supplementation had no significant effect on inflammatory factors and oxidative stress.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022325855.

Endoscopic Ultrasound-Guided Fine Needle Acquisition for Evaluation of Pancreatic Neuroendocrine Tumors: A Meta-Analysis

AIMS

The aim of this meta-analysis was to assess the diagnostic performance of EUS-FNA/B in patients with panNETs.

METHODS

We conducted a computerized search of the MEDLINE and Embase databases to identify relevant articles. The primary outcomes involved grading concordance rate, diagnostic rate, and correlation coefficient (Cohen's κ) for FNA/B samples compared with surgical specimens. Secondary outcomes included sample adequacy, mean number of passes, and adverse events.

RESULTS

Forty-five studies involving 2978 patients were finally included. The pooled concordance rate between EUS-FNA/B and surgical grading was 0.77 (95% CI: 0.73-0.80; I2 =48.2%). A significantly higher level of concordance was observed in G1 subgroup (0.88, 95% CI: 0.84-0.91), whereas the G2 subgroup revealed the lowest level of agreement (0.59, 95% CI: 0.52-0.65; P < 0.001). Pooled diagnostic rate for FNA/B sampling was 0.83 (95% CI: 0.79-0.86; I2 =63.3%). In addition, FNB outperformed FNA in terms of sample adequacy (0.93 for FNB vs. 0.81 for FNA; P =0.007) and number of needle passes required (2.53 for FNB vs. 3.32 for FNA; P =0.013). Moreover, the overall level of agreement for grading was moderate (κ=0.59, 95% CI: 0.49-0.68; I2 =84.5%). There were a limited number of adverse events that had minor influence on patient outcomes (0.03, 95% CI: 0.02-0.05; I2 =19.2%).

CONCLUSIONS

EUS-FNA/B is a reliable approach for the diagnosis and preoperative grading of panNET, with FNB demonstrating superior performance compared with FNA.

Comparison of Analgesic Efficiency between Local Infiltration of a Long-Acting Analgesic and Regional Nerve Block among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: Meta-Analysis of Randomized Controlled Trials

Background

Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction.

Methods

We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots.

Results

The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies.

Conclusions

Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine. In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.

Ex-situ normothermic machine perfusion prevents ischemic cholangiopathy after liver transplantation: A meta-regression analysis

BACKGROUND & AIMS

Liver transplantation (LT) is the gold standard for end-stage liver disease, but ischemic cholangiopathy (IC) remains a significant complication. Ex-situ normothermic machine perfusion (ESNMP) has emerged as a potential strategy to mitigate ischemic injury. However, the effect of ESNMP on reducing post-LT IC remains controversial. This study aimed to perform an updated meta-analysis to evaluate the impact of ESNMP on IC incidence.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. The literature search included studies from 2015 to 2025 comparing LT outcomes using ESNMP vs. static cold storage (SCS). The primary outcome was the incidence of IC. Risk of bias was assessed using the ROBINS-E tool. Statistical analysis, including random-effects meta-analysis, sensitivity analysis, and meta-regression, was performed to evaluate heterogeneity, potential confounders, and the impact of follow-up duration.

RESULTS

Seventeen studies, including 76,045 patients (4843 ESNMP; 71,202 SCS), were analyzed. No statistically significant difference in IC incidence was found between ESNMP and SCS (1.3 % vs. 0.6 %; RR = 0.68, 95 %CI = 0.41-1.13; P = 0.14). Sensitivity analysis excluding one outlier study revealed a reduction in IC risk with ESNMP (RR = 0.62, 95 %CI = 0.38-1.01; P = 0.054). Two sub-analyses of studies with ≥12 months of follow-up (RR = 0.51, 95 %CI = 0.26-0.99; P = 0.049) and DCDs (RR = 0.33, 95 %CI = 0.16-0.67; P = 0.002) showed risk reduction. The meta-regression revealed that the back-to-base perfusion approach was associated with the occurrence of IC, with an OR of 1.03 (95 %CI = 1.00-1.07, P = 0.035).

CONCLUSIONS

a correlation between ESNMP use and IC reduced risk appears to exist, especially with longer follow-up periods and DCDs, though more high-quality studies are needed to confirm this finding.

Robotic versus laparoscopic colorectal surgery for patients with obesity: an updated systematic review and meta-analysis

BACKGROUND

Obesity poses significant challenges in colorectal surgery, affecting operative difficulty and postoperative recovery. The choice of minimally invasive approach for this patient population remains a challenge during preoperative planning. This review aims to provide an updated synthesis of studies comparing laparoscopic and robotic approaches for adult patients with obesity undergoing colorectal surgery.

METHODS

MEDLINE, Embase and CENTRAL were searched up to August 2023. Articles were included if they compared laparoscopic and robotic colorectal surgery outcomes in adults with obesity (BMI ≥30 kg/m2). Outcomes included overall postoperative morbidity, conversion to laparotomy, and operative time. Inverse variance random-effects meta-analyses were used to pool effect estimates.

RESULTS

After screening 2187 citations, 10 observational studies were included with 3281 patients with obesity undergoing robotic surgery (mean age: 58.1 years, female: 43.9%) and 11 369 patients with obesity undergoing laparoscopic surgery (mean age: 58 years, female: 53.2%). Robotic surgery resulted in longer operative times (MD 46.71 min, 95% CI 33.50-59.92, p < 0.01, I2 = 93.79%) with statistically significant reductions in conversions to laparotomy (RR 0.50, 95% CI 0.39-0.65, p < 0.01, I2 = 67.15%). No significant differences were seen in postoperative morbidity (RR 0.94, 95% CI 0.82-1.08, p = 0.40, I2 = 36.08%).

CONCLUSION

These data suggest that robotic colorectal surgery in patients with obesity may reduce the risk for conversion to laparotomy, but at the expense of increased operative times and with no overt benefits in postoperative outcomes. Further high quality randomized controlled trials assessing the utility of robotic surgery in patients with obesity undergoing colorectal surgery are warranted.

A study of the association between Helicobacter pylori infection type and pancreatic cancer risk: A systematic review and meta‑analysis

Pancreatic cancer is a highly invasive malignant tumor with a complex pathogenesis that makes early diagnosis challenging. The potential association between Helicobacter pylori infection and pancreatic cancer risk has been noted; however, the available results are still highly divergent. The aim of the present study was to systematically evaluate the association between different types of H. pylori infection and pancreatic cancer risk as well as to explore the possible causes. A systematic search was conducted using the PubMed, Embase and Cochrane Library databases up to August 2023. The literature quality was evaluated using the Newcastle-Ottawa Scale. All studies that met the criteria were included in the overall meta-analysis to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). In addition, subgroup analyses were performed based on factors such as diagnostic criteria for H. pylori infection, study region, type of study design and CagA status. The effect of publication bias on the quantitative synthesis results was assessed using the trim-and-fill analysis, and sensitivity analyses were used to verify the robustness of the quantitative synthesis results. A total of 17 studies involving 67,910 participants, including 64,372 controls and 3,538 patients with pancreatic cancer, were included in the present study. The overall analysis showed that no significant association was observed between H. pylori infection and pancreatic cancer risk (OR, 1.15; 95% CI, 0.93-1.41). Further subgroup analyses, which did not consider the effects of study quality, diagnostic criteria, geographical distribution and the type of study design, did not produce new findings that contradicted the results of the overall analysis. CagA+ H. pylori infection did not significantly affect the risk of pancreatic cancer (OR, 0.95; 95% CI, 0.78-1.16), whereas CagA- H. pylori infection may be a possible risk factor for pancreatic cancer (OR, 1.24; 95% CI, 1.004-1.541). The H. pylori infection did not significantly increase the risk of pancreatic cancer. However, it is noteworthy that CagA- H. pylori infection could be a potential factor that elevated the risk of pancreatic cancer.

Girls and Boys Typically Have Similar Math Value Beliefs: Replication Evidence Across Historical Time, High School, and Racial/Ethnic Groups

INTRODUCTION

Individuals' math value beliefs are theorized to influence who persists in STEM. However, the existing findings on gender differences in adolescents' math value beliefs are inconsistent. The goal of this study was to use three existing datasets to help clarify when gender differences emerge for high school adolescents and for whom (i.e., adolescents across historical time, grade level, and race/ethnicity). Specifically, we examined the extent to which gender differences in adolescents' math value beliefs (i.e., interest, utility, and attainment) replicated (1) across three datasets spanning the 1990s to 2010s, (2) from 9th-12th grade, and (3) within each of the four largest U.S. racial/ethnic groups (i.e., Asian, Black, Latine, and White adolescents).

METHODS

We tested these aims with three existing longitudinal U.S. datasets: the California Achievement Motivation Project (CAMP) (n = 8855), the Childhood and Beyond Study (CAB) (n = 582), and the High School Longitudinal Study (HSLS) (n = 21,000). Students were in high school (9th-12th grade) and half were girls (49%-53%). All three datasets included measures with the same or similar math value belief items, making conceptual replication possible.

RESULTS AND CONCLUSIONS

Overall, we did not find strong evidence for meaningful gender differences in adolescents' math value beliefs overall. We did find meaningful gender differences in the oldest data set (CAB). When examined within each racial/ethnic group, we found no evidence of gender differences in math value beliefs among Black or Latine adolescents, but some differences among Asian and White adolescents. The findings align with the gender similarities hypothesis, suggesting adolescent girls and boys had similar math value beliefs.

Close Males Sing With Dissimilar Minimum Frequency and Repertoire Size in a Wild Passerine

The position occupied in social networks influences the success of individuals in many animal species. However, the associations between bird song (an important means of communication) and the relative position in social networks remained understudied. Such associations are expected because neighbors can learn song elements from each other or change their songs due to competition, and also because song can be related to other individual traits determining social network positions. We investigated these phenomena in males of the collared flycatcher (Ficedula albicollis), a passerine with complex songs and intense territorial interactions. Relying on 19 years of song recordings, we used multiple traits reflecting the spectral and temporal characteristics and complexity of songs, as well as syllable composition, to investigate if similarity in song is associated with the position in neighbor networks. We also examined whether birds settle down in an age-dependent manner (as age is linked to individual quality) and whether the nonrandom spatial distribution of song is affected by the proportion of immigrants, young birds, or the number of displaying males. We found that the minimum frequency and the repertoire size of neighbors differed, but this pattern was not shaped by the investigated predictors. Therefore, our results highlight the need to study communication traits and social environment together. The fact that neighboring males tend to sing differently with respect to some song traits suggests that songs can be flexibly adjusted based on the performance of conspecifics.