Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Ergonutrition Supplementation and Recovery in Water Polo: A Systematic Review

BACKGROUND

Water polo (WP) is a high-intensity team sport that requires a combination of physical endurance, muscular strength, speed, and specific technical skills. Due to the demanding and prolonged nature of this sport, adequate and balanced nutrition plays a fundamental role in athletes' performance, recovery, and overall health maintenance.

OBJECTIVES

We aimed to compile all available information on the importance of ergonutrition and supplementation in the recovery of WP players. This will help in understanding this sport's specific challenges and requirements, enabling players and coaches to design more effective recovery plans to optimize performance, achieve goals, and successfully cope with intense training and competition.

METHOD

English-language publications were searched in databases such as Web of Science, Scopus, SciELO Citation Index, Medline (PubMed), KCI Korean Journal Database, and Current Contents Connect using a series of keywords such as WP, nutrition, recovery, and ergogenic aids individually or in combination.

RESULTS

In the field of ergonutritional recovery in WP, certain supplements such as whey protein, beta-alanine, L-arginine, spirulina, and copper can be beneficial for improving performance and recovery. In some cases, WP athletes may consider using ergogenic supplements to further improve their performance and recovery process. However, it is important to bear in mind that any supplement should be carefully evaluated under the supervision of a health professional or a sports nutritionist, as some supplements may present side effects or unwanted interactions.

CONCLUSIONS

Adequate ergogenic nutrition adapted to the needs of WP players is essential not only to optimize their athletic performance but also to ensure effective recovery and maintain their long-term health and general well-being. The application of these strategies should be evidence-based and tailored to the individual needs of the players and the specific demands of the sport. Future experimental research that can confirm our results is essential.

Willingness to join community-based health insurance and associated factors among households in Ethiopian: a systematic review and meta-analysis

BACKGROUND

In Ethiopia, out-of-pocket medical expenses make up one-third of all medical expenses, which makes it difficult for households to obtain and utilize healthcare. One of the prepayment mechanisms that shield low-income households from unaffordable medical bills is the community-based health insurance (CBHI) program. This systematic review and meta-analysis aimed to estimate the pooled willingness to join Community-based Health Insurance schemes and its associated factors among households in Ethiopia.

METHODS

Articles were searched from PubMed, Google Scholar, Web of Science, Scopus, Science Direct, and Ethiopian Universities' repositories for grey literature. The study used the modified PRISMA guidelines for rewriting and reviewing the literature. The quality of studies was assessed using Joanna Briggs Institute Critical Appraisal tools. Data was extracted using Microsoft Excel and exported to STATA version 16 software for analysis. Cochran's Q statistic and I2 tests were utilized to determine the heterogeneity between studies. Studies publication bias was determined using a funnel plot and Egger's test. Subgroup analysis was conducted to demonstrate variations of the effect sizes across study regions. Finally, we utilized a random-effect model to compute the overall willingness to join the CBHI scheme and its determinants among households in Ethiopia.

RESULT

We included thirty studies to determine the pooled prevalence of willingness to join the CBHI scheme and its determinants. The pooled magnitude of households' willingness to join the CBHI scheme was 60.42% (95% CI: 51.45%, 69.38%). Old aged (AOR = 2.17, [95% CI: 1.37, 3.44], I2 = 82.33%), formal educational status(AOR = 2.74, [95% CI: 2.10, 3.56], I2 = 59.85%), Rich wealth index (AOR = 2.51, [95% CI: 1.99, 3.18], I2 = 48.25%), good knowledge/awareness of CBHI scheme(AOR = 4.21, [95% CI: 3.01, 5.88], I2 = 66.0%), experienced illness in the last three months (AOR = 3.42, [95% CI: 2.19, 5.35], I2 = 71.15%), and large family size (AOR = 2.36, [95% CI: 1.95, 2.87], I2 = 50.81%) were determinants of willingness to join the CBHI scheme. In addition, affordability of CBHI premium (AOR = 3.12, [95% CI: 2.34, 4.14], I2 = 10.35%), poor health status (AOR = 3.23, [95% CI: 2.57, 4.06], I2 = 35.97%), trust in scheme (AOR = 4.38, [95% CI: 1.91, 10.06], I2 = 88.35%), chronic diseases (AOR = 3.24, [95% CI: 2.40, 4.37], I2 = 67.15%) and good quality of healthcare services (AOR = 2.91, [95%CI:2.08, 4.09], I2 = 65.40%) were also predictors of willingness to join the CBHI program.

CONCLUSION

The pooled prevalence of willingness to join the CBHI scheme was low and below the national target of 80%. Age, family size, educational status, wealth status, illnesses in last three months, presence of chronic illnesses, affordability of the premium for the CBHI scheme, self-reported health status, Knowledge/awareness of the scheme, trust in the scheme and perceived quality of healthcare service were significantly determine the willingness to join the CBHI scheme. Health providers should provide detailed awareness creation through health education on the concepts and principles of the CBHI scheme.

The Utility of a Critical Antibody Titer in Anti-K Alloimmunized Pregnancies: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

Anti-Kell (anti-K) alloimmunization is a known cause of severe hemolytic disease of the fetus and newborn (HDFN), yet the utility of a critical maternal antibody titer in guiding clinical management remains debated. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of a maternal anti-K titer threshold of ≥8 for predicting the need for intrauterine intervention due to severe anti-K-mediated HDFN. In parallel, we characterized all reported cases of severe HDFN occurring in the setting of low maternal anti-K titers (<8). Studies were excluded if they lacked reported titers, did not include K-positive or K-unknown fetuses, failed to report fetal outcomes, or included interventions that could lower maternal alloantibody levels. Studies that assessed all alloimmunized patients meeting inclusion criteria were incorporated into a diagnostic test accuracy (DTA) meta-analysis; all eligible studies were included in a qualitative synthesis. Fifty-four studies, comprising 582 fetuses, met inclusion criteria. Of these, 6 studies (350 fetuses) were included in the DTA analysis, which demonstrated a pooled sensitivity of 97.0% (95% CI, 88.7%-99.2%) and specificity of 33.1% (95% CI, 27.9%-38.8%) for an anti-K titer ≥8. Among fetuses affected by severe HDFN, 98.6% (204/207) were associated with maternal anti-K titers ≥8. These findings suggest that severe disease is uncommon in the setting of low anti-K titers and support the use of a critical titer threshold to inform antenatal surveillance. Reevaluation of current clinical guidelines may be warranted in light of these data.

Comparative Efficacy and Safety of Multiple Wake-Promoting Agents for the Treatment of Residual Sleepiness in Obstructive Sleep Apnea Despite Continuous Positive Airway Pressure: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVES

Residual sleepiness can occur in adult patients with obstructive sleep apnea (OSA) despite adequate treatment with continuous positive airway pressure (CPAP). Various wake-promoting agents (WPAs) have been shown to reduce residual sleepiness in CPAP-treated patients with OSA. This systematic review and network meta-analysis aimed to compare the efficacy and safety of WPAs in this setting.

METHODS

We searched MEDLINE, Scopus, and ClinicalTrials.gov up to 9 January 2025 for randomized controlled trials (RCTs) examining WPAs for treating sleepiness in patients with OSA. Included were all RCTs that explored the efficacy and/or safety of any approved WPAs (i.e., modafinil, armodafinil, solriamfetol, or pitolisant) in patients with OSA (aged ≥ 18 years) treated with CPAP but who are still sleepy [Epworth sleepiness scale (ESS) score ≥10]. Studies that were conducted in patients whose comorbidities cause daytime somnolence [i.e., psychiatric conditions (other than depression), other sleep disorders, medical or surgical conditions], open label extension studies, and studies published in a language other than English were excluded. The primary outcomes included ESS, maintenance of wakefulness test (MWT), and adverse events. Two authors independently assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials 2.0.

RESULTS

In total, 14 RCTs studying four WPAs (total N = 2969) including modafinil (six RCTs; 200-400 mg/day), armodafinil (four RCTs; 150-250mg/day), solriamfetol (two RCTs; 37.5-300 mg/day), and pitolisant (two RCTs; 5-40 mg/day) were included. Solriamfetol, modafinil, and armodafinil were efficacious in reducing subjective sleepiness as measured by ESS [mean difference (95% confidence interval) at ≤ 4 weeks: -3.84 (-5.60, -2.07), -2.44 (-3.38, -1.49), and -2.41 (-3.60, -1.21) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: -4.11 (-6.14, -2.08), -2.88 (-3.85, -1.91), -2.46 (-3.68, -1.24) for solriamfetol, armodafinil, and modafinil, respectively] and clinical global impression of change, as well as the objective MWT [at ≤ 4 weeks: 11.66 min (9.70, 13.61), 3.61 min (2.48, 4.73), and 2.52 min (1.27, 3.76) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: 10.34 min (4.16, 16.52) for solriamfetol]. Pitolisant showed later improvements in ESS [at > 4 weeks: -2.70 (-3.66, -1.73)], with limited data on MWT. Sensitivity analyses restricted to U.S. Food and Drug Administration-approved solriamfetol dosages (37.5-150 mg/day) still showed higher efficacy, but lower anxiety risk.

CONCLUSIONS

Among all WPAs, solriamfetol demonstrated the highest efficacy on ESS and MWT, with the latter being significant. Modafinil demonstrated the best clinician impression, albeit not statistically significant. All four WPAs were associated with a low risk of serious or adverse events.

REGISTRATION

PROSPERO registration number, CRD42022359237.

A systematic review and comparative evaluation to develop and validate a comprehensive framework for cancer surveillance systems

BACKGROUND

The increasing global burden of cancer necessitates robust cancer surveillance systems to generate accurate and comprehensive data for effective public health interventions. Despite advancements, significant gaps remain in data standardization, interoperability, and adaptability to diverse healthcare settings. This study aims to develop and validate a comprehensive framework for cancer surveillance systems that addresses these gaps, ensuring enhanced global applicability and regional relevance.

METHODS

A systematic review was conducted following PRISMA guidelines, analyzing 13 studies selected from an initial pool of 1,085 articles retrieved from five major databases: PubMed, Embase, Scopus, Web of Science, and IEEE. Additionally, a comparative evaluation of 13 international cancer surveillance systems was performed to identify critical data elements and practices. Key indicators were extracted. A researcher-designed checklist consolidating these elements was validated through expert consultation with a response rate of 82% (n = 14), achieving high reliability (Cronbach's alpha = 0.849).

RESULTS

The proposed framework addresses critical gaps in existing cancer surveillance systems by integrating a comprehensive set of epidemiological indicators, including incidence, prevalence, mortality, survival rates, years lived with disability, and years of life lost, calculated using multiple standard populations for age-standardized rates. Furthermore, the framework incorporates key demographic filters such as age, sex, and geographic location to enable stratified analyses. It also includes advanced data elements, such as cancer type classification based on ICD-O standards, ensuring precision, consistency, and enhanced comparability across diverse cancer datasets.

CONCLUSION

The validated framework provides a structured and adaptable approach to cancer data collection and analysis, enhancing public health decision-making and resource allocation. By addressing current limitations, this study offers a significant advancement in cancer surveillance methodologies, with potential applications in diverse healthcare contexts globally.

CLINICAL TRIAL REGISTRATION

Clinical trial number: Not applicable.

Comparative Impact of Integrated Palliative Care vs. Standard Care on the Quality of Life in Cancer Patients: A Global Systematic Review and Meta-Analysis of Randomized Controlled Trials

IntroductionCancer is a leading cause of global morbidity and mortality, significantly impairing patients' quality of life (QoL). Integrated Palliative Care (IPC) has been proposed as a holistic approach to enhance quality of life by addressing patients' physical, emotional, and psychosocial needs. While some studies suggest Integrated Palliative Care improves quality of life more than standard care, the evidence remains inconclusive. This systematic review and meta-analysis aim to evaluate the comparative impact of Integrated Palliative Care versus standard care on the quality of life in cancer patients. MethodsA comprehensive search of databases including PubMed, Cochrane Library, and Embase was conducted. We selected randomized controlled trials (RCTs) comparing Integrated Palliative Care and standard care for cancer patients, focusing on the quality of life as measured by validated tools such as the EORTC QLQ-C30 and FACT-G. Data were pooled using a random-effects model to account for study heterogeneity. Subgroup and sensitivity analyses were also performed. ResultsNine randomized controlled trials involving 1,794 patients met the inclusion criteria. Meta-analysis showed that Integrated Palliative Care significantly improved quality of life compared to standard care (SMD = 3.25; 95% CI: 1.20-5.30; p < 0.001). Studies conducted in Asia showed the highest standardized mean difference (SMD = 6.15; 95% CI: 3.07-9.23; p < 0.001), followed closely by studies from Africa (SMD = 6.0; 95% CI: 5.13-6.87; p < 0.001), compared to those from other regions. Similarly, research focusing on lung cancer patients showed the greatest standardized mean difference of (SMD = 6.15; 95% CI: 3.07-9.23; p < 0.001) relative to other cancer types. Furthermore, studies involving newly diagnosed cancer patients recorded the highest standardized mean difference of (SMD = 5.69; 95% CI: 4.57-6.80; p < 0.001). ConclusionIntegrated Palliative Care significantly enhances the quality of life in cancer patients compared to standard care. These findings support integrating Integrated Palliative Care into oncology practices to provide comprehensive, patient-centered care that addresses both physical and emotional needs. Further research should explore long-term benefits across diverse populations.

Efficacy and safety of astragalus polysaccharides in patients with malignant tumors: A systematic review and meta-analysis

Current evidence suggests that Astragalus membranaceus is one of the most commonly used herbal medicines for cancer treatment, with its primary component, Astragalus polysaccharide (APS), demonstrating immunomodulatory effects. However, the reliability of the available evidence remains elusive. Therefore, this systematic review and meta-analysis of studies intended to evaluate the therapeutic effects and safety of APS supplementation in malignant tumor patients. We searched eight databases for articles published from January 2010 to August 2024. Uilizing the ROB2 tool for bias risk. Meta-analysis of the objective response rate (ORR), immune function, and adverse reactions was performed using Stata 15.1 software. This study is registered with PROSPERO (ID: CRD42021272595). A total of 31 randomized controlled trials (RCTs) involving 2,648 participants were incorporated. The meta-analysis results unraveled that the treatment group outperformed the control group in terms of treatment efficacy [RR = 1.30, 95% CI (1.21, 1.39), P < 0.01], CD3 + T cell count [MD = 8.79, 95% CI (6.15, 11.43), P < 0.01], CD4 + T cell count [MD = 7.94, 95% CI (5.27, 10.61), P < 0.01], and the CD4 + /CD8 + ratio [MD = 0.40, 95% CI (0.28, 0.52), P < 0.01]. No substantial distinctions were noted between the two groups in terms of CD8 + T cell count [MD = -1.74, 95% CI (-4.66, 1.17), P = 0.242]. Regarding adverse reactions, the incidence of symptoms such as hand-foot numbness and weakness was low, indicating a high safety profile. Supplementation with APS can improve treatment outcomes, enhance immune function, and demonstrate a high level of safety in malignant tumor patients, making it a promising option for clinical use. However, given the variety of cancer types included in the studies, future research should focus on specific cancer types.

Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review

Background

Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics.

Objective

In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology.

Methods

Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded.

Results

Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution.

Conclusions

Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics.

A systematic qualitative review of ethical issues in open label placebo in published research

Open-label placebos (OLPs), which are transparently administered inert treatments, have gained increasing attention in the research community. They have the potential to harness placebo effects without deceiving the patient. The purpose of this study was to examine and synthesize prior research discussing ethical issues in OLPs. A systematic qualitative literature review was conducted (last search on January 2023) across multiple databases (e.g., MEDLINE, Embase, PsycInfo) using keywords related to OLPs. Publications were screened and assessed for eligibility. Seventeen articles explicitly addressing OLP ethics were included. Data were extracted and thematically analyzed following established qualitative content analysis procedures. 37 distinct ethical issues were identified, grouped into five overarching themes: (1) Sociocultural and Contextual Factors, (2) Implementation and Logistics, (3) Informed Consent, (4) Patient Health Behavior and Dynamics, and (5) Therapeutic Relationship. Frequently mentioned concerns focused on uncertainty of OLP efficacy, the need for further research, and complexities of dose-extending OLPs. The effective integration of OLPs into healthcare necessitates thoughtful consideration and responsible communication. This analysis shows that demonstrating the efficacy of OLPs becomes pivotal for their widespread adoption, underscoring the necessity for additional research to validate their effectiveness. This review was pre-registered on January 26th, 2023, in the Open Science Framework Registry under the identifier: DOI https://doi.org/10.17605/OSF.IO/R6NKG .

Life experiences after kidney transplantation in adolescents: A qualitative meta-synthesis

PURPOSE

To systematically evaluate the life experience of adolescents after kidney transplantation.

METHODS

We use computer search Web of Science, PubMed, Cochrane Library, Embase, EBSCO, CNKI, Wanfang, VIP database, search database to October 2024, screening after kidney transplant adolescents life experience of qualitative study. We used the Australian Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to quality evaluation, and using the thematic analysis method to integrate the results.

RESULTS

7 articles were included, and 31 research results were integrated into 8 new categories and combined results are 3 integration results: complex emotional experience; eager for multifaceted support; self-adjustment.

CONCLUSION

Nursing staff should pay attention to the psychological experience and needs of adolescents, to eliminate their stigma, to promote positive cognition, and to improve their quality of life.

Systematic review of AI/ML applications in multi-domain robotic rehabilitation: trends, gaps, and future directions

Robotic technology is expected to transform rehabilitation settings, by providing precise, repetitive, and task-specific interventions, thereby potentially improving patients' clinical outcomes. Artificial intelligence (AI) and machine learning (ML) have been widely applied in different areas to support robotic rehabilitation, from controlling robot movements to real-time patient assessment. To provide an overview of the current landscape and the impact of AI/ML use in robotics rehabilitation, we performed a systematic review focusing on the use of AI and robotics in rehabilitation from a broad perspective, encompassing different pathologies and body districts, and considering both motor and neurocognitive rehabilitation. We searched the Scopus and IEEE Xplore databases, focusing on the studies involving human participants. After article retrieval, a tagging phase was carried out to devise a comprehensive and easily-interpretable taxonomy: its categories include the aim of the AI/ML within the rehabilitation system, the type of algorithms used, and the location of robots and sensors. The 201 selected articles span multiple domains and diverse aims, such as movement classification, trajectory prediction, and patient evaluation, demonstrating the potential of ML to revolutionize personalized therapy and improve patient engagement. ML is reported as highly effective in predicting movement intentions, assessing clinical outcomes, and detecting compensatory movements, providing insights into the future of personalized rehabilitation interventions. Our analysis also reveals pitfalls in the current use of AI/ML in this area, such as potential explainability issues and poor generalization ability when these systems are applied in real-world settings.

Hospital Volume as a Determinant of Outcomes After Partial Nephrectomy: A Systematic Review by the European Association of Urology Renal Cell Carcinoma Guidelines Panel

The influence of surgical volume on partial nephrectomy (PN) outcomes is a subject of debate. The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel performed a protocol-driven systematic review of the association between hospital volume (HV) and oncological, functional, and complication outcomes following PN for RCC. The intervention was PN performed in a higher-volume hospital (defined according to the number of procedures per unit time) and the comparator was PN performed in a lower-volume hospital. Ten studies involving a total of 106 569 patients were included in the review. Higher HV was associated with lower complication rates, shorter length of stay, lower positive surgical margin rates, and lower transfusion rates. For six studies, multivariable analyses showed that low HV was an independent risk factor for inpatient complications, PSM presence, longer LOS, and failure to achieve a trifecta of no complications, warm ischemia time <25 min, and negative surgical margins. Most studies were judged to have high risk of bias. The available evidence suggests a potential association between higher HV and better PN outcomes in RCC. The EAU RCC guidelines panel encourages the development and rigorous evaluation of indicators of surgery quality in RCC to better inform the designation of high-quality centers within models of centralized care.

Brachial Plexus Lipoma Causing Neurological Impairment: A Case Series and Systematic Review

BACKGROUND AND OBJECTIVES

Lipomas are benign adipocyte tumors that typically present as painless, firm nodules. In rare cases, lipomas may grow near the brachial plexus (BP) and compress various peripheral nerves. This can manifest as upper extremity motor and/or sensory deficits, numbness, tingling, or burning sensations. Surgical intervention of a brachial plexus lipoma (BPL) may be challenging because of variability in location and size. This study reviews previously reported cases of BPL causing neurological impairment and presents 5 additional cases, focusing on operative details and patient outcomes.

METHODS

A systematic review of PubMed, Scopus, and World of Science was performed to identify all previously reported cases of BP lipomas resulting in neurological deficit. A retrospective review of a neurosurgeon's prospectively collected database was conducted to identify all patients operated on for BPL. Patient demographics, tumor characteristics, presentation, surgical notes, and outcomes were collected for both reviews.

RESULTS

Our literature review yielded 13 articles presenting at least one case meeting the eligibility criteria, resulting in 22 eligible patients. The surgeon's database provided an additional 5 patients meeting the criteria. Of the 27 total cases, 15 were men and 12 were women. The average age was 46.5 with a range of 25 to 70. All patients had upper extremity motor and/or sensory dysfunction preoperatively. Tumors were found in various regions, with the involvement of the supraclavicular fossa reported in 52% of cases. Gross tumor resection was achieved in all but 2 of the 27 operations. Four patients had a nonconventional lipoma type on histology. Sixteen patients experienced complete resolution of neurological symptoms.

CONCLUSION

BP lipomas are rare but can cause a wide range of neurological symptoms depending on their size and location. A thorough patient examination and imaging studies are essential for creating a successful surgical plan for tumor resection.

Off-label use of sodium cantharidinate and vitamin B6 injection in cancer: a protocol for a systematic review and meta-analysis

BACKGROUND

In China, sodium cantharidinate/vitamin B6 (SC/VB6) injection has been approved since 2002 for the treatment of lung cancer and primary liver cancer. In addition to these authorized indications, clinical application of SC/VB6 is also common in various other types of cancer. However, there is a lack of comprehensive understanding on this topic. Thus, this systematic review and meta-analysis aims to consolidate evidence regarding the efficacy and safety of off-label use of SC/VB6 in oncology.

METHODS

International databases including PubMed, Embase, Cochrane Library, Web of Science, and CINAHL Plus, as well as Chinese databases including China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Wanfang, will be searched from the inception to 31 December 2024. Comparative studies that evaluated the add-on effect of SC/VB6 to conventional cancer treatments against the use of conventional treatments alone will be considered in the scope of this review. The primary outcomes are objective response rate and performance status. Secondary outcomes are disease control rate (DCR), progression-free survival (PFS), disease-free survival (DFS), overall survival (OS), and adverse events (AEs). Depending on heterogeneity, data will be synthesized using either the Mantel-Haenszel fixed-effect or the DerSimonian and Laird random-effect model. Subgroup analyses will be conducted for the following variables: type of cancer, study design, SC/VB6 dosage, treatment duration, and combined therapies, provided that each subgroup contains at least two studies. Sensitivity analyses will be performed on efficacy outcomes. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be utilized to appraise the overall quality of evidence.

DISCUSSION

This review will encompass both randomized controlled trials (RCTs) and cohort studies, thereby enabling us to synthesize and assess evidence across experimental and real-world observational settings. Our findings will contribute to a better understanding on the benefit-risk profile regarding the off-label use of SC/VB6 in oncology, guiding the trajectory of future research, and offering a robust scientific foundation to inform clinical and regulatory decision-making process.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024504977.

Caregiver factors influencing family-based treatment for child and adolescent eating disorders: a systematic review and conceptual model

Introduction

The need to assess and manage familial factors influencing family-based treatment (FBT) has been identified in the literature in the context of improving outcomes. While some studies have attempted to address this need, results have not been unified into a framework and to date, no conceptual model exists to bring these factors together for use in clinical practice. A systematic review was conducted to fill this gap and addressed the following question: which caregiver factors influence FBT outcome for child and adolescent eating disorders?

Methodology

The protocol was registered in PROSPERO (CRD42022338843) and utilized the PRISMA framework. A total of 1,994 results were returned from EBSCO Host, Embase, ProQuest, PubMed Central, SCOPUS and Web of Science. Screening returned 164 studies for full-text-review with third-party replication to reduce risk of bias. Thirty-nine articles were included and organized in an evidence hierarchy including both quantitative and qualitative methodologies. Heterogeneity of the data precluded meta-analysis; results were synthesized and grouped using a systematic-narrative approach.

Results

Influential caregiver factors were identified and grouped into eight domains: caregiver capacity, confidence, readiness, internalizing factors, externalizing factors, food-related factors, support network and family function. Factors within each domain and their influence on treatment outcome were reported. A conceptual model, caregiver factors influencing treatment (Care-FIT) was produced as a graphical representation of the identified domains and factors by frequency of appearance.

Conclusion

Caregiver factors can significantly impact FBT outcome, and given the importance of their role in treatment, effective identification and management of caregiver factors is warranted. The conceptual model can be used in clinical case formulation and to support further exploration of the degree to which factors are influential. Identifying caregiver factors likely to influence treatment can facilitate support to enhance treatment and recovery.

Adjuvant immunotherapy improves survival in completely resected stage IB-III NSCLC: a systematic review and meta-analysis

Background

The clinical benefits of postoperative chemotherapy for non-small cell lung cancer (NSCLC) have plateaued, thus highlighting the need for novel strategies. This meta-analysis evaluated the efficacy and safety of adjuvant immunotherapy in patients with completely resected NSCLC and wild-type epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK).

Methods

PubMed, Web of Science, Embase, and the Cochrane Library were searched up to February 12, 2025, for studies assessing adjuvant immunotherapy in NSCLC. Primary endpoints included disease-free survival (DFS), overall survival (OS), correlation between subgroup characteristics and efficacy, and safety outcomes, including treatment-related adverse events (TRAEs), severe adverse events (SAEs), and treatment discontinuation.

Results

Twelve articles involving 4048 patients were included. Adjuvant immunotherapy significantly improved DFS in patients with resected stage IB-III NSCLC than supportive care or placebo (hazard ratio [HR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, p = 0.01; I2 = 0%, p = 0.46). However, the OS benefit was not significant (HR: 0.9, 95% CI: 0.67-1.21, p = 0.34). DFS benefit was observed in EGFR-negative (HR: 0.75, 95% CI: 0.62-0.91, I2 = 0%), EGFR status unknown (HR: 0.78, 95% CI: 0.63-0.96, I2 = 0%), programmed cell death ligand 1 (PD-L1) 1-49% (HR: 0.75, 95% CI: 0.58-0.97, I2 = 7.13%), non-squamous cell carcinoma (HR: 0.72, 95% CI: 0.61-0.84, I2 = 0%), and never-smoking (HR: 0.68, 95% CI: 0.49-0.96, I2 = 0%) subgroups. The pooled incidences of TRAEs, SAEs, and discontinuation of treatment due to toxicity were 70% (95% CI: 62%-77%), 12% (95% CI: 8%-16%), and 17% (95% CI: 15-19%), respectively.

Conclusions

Adjuvant immunotherapy improved DFS in patients with completely resected NSCLC, particularly those who were EGFR-negative, had PD-L1 levels of 1-49%, had non-squamous cell carcinoma, or never smoked.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024547752.

Closure of mesenteric defects for prevention of internal hernia after Roux-en-Y gastric bypass in bariatric surgery

RATIONALE

Internal hernia is one of the most severe complications observed in people undergoing Roux-en-Y gastric bypass (RYGB). There are some who advocate for the closure of defects to prevent internal hernias. However, the closure of these defects might be associated with an increased risk of small bowel obstruction, resulting from a kink in the anastomosis of the small intestines. Currently, there is a lack of robust evidence demonstrating the benefits of defect closure.

OBJECTIVES

To assess the benefits and harms of defect closure for prevention of internal hernia after Roux-en Y gastric bypass in bariatric surgery.

SEARCH METHODS

We searched CENTRAL, MEDLINE, and Embase to August 2024. We reviewed the reference lists of included studies and reached out to the study authors to obtain any missing data. We also searched PubMed, grey literature in the OpenGrey database, Clinical Trials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) that included people with obesity (defined as a body-mass index (BMI) ≥ 35 kg/m²) who underwent laparoscopic or robotic RYGB in bariatric surgery, and compared the closure of defects with the non-closure of defects. We excluded quasi-randomised trials, cluster-RCTs, and cross-over trials.

OUTCOMES

The critical outcomes assessed were the incidence of internal hernia with bowel obstruction within 10 years, the incidence of postoperative overall complications within 30 days, and the incidence of postoperative mortality within 30 days. The important outcomes included the incidence of intraoperative overall complications, length of hospital stay, and the postoperative pain resulting from gastric bypass surgery, assessed using a visual analogue scale (VAS) two years after surgery.

RISK OF BIAS

Two review authors independently evaluated the risk of bias for each included study using the Cochrane RoB 2 tool.

SYNTHESIS METHODS

Two review authors independently assessed the methodological quality and extracted data from the included trials. We performed a random-effects meta-analysis for data synthesis. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CIs for continuous outcomes. We assessed the certainty of evidence based on the GRADE approach.

INCLUDED STUDIES

We identified three RCTs with 3010 participants, which met our inclusion criteria. The closure of mesenteric defects used non-absorbable, interrupt closure in one study, and non-absorbable running sutures in two studies.

SYNTHESIS OF RESULTS

The closure of defects during RYGB may reduce the incidence of internal hernia with bowel obstruction within 10 years compared with non-closure (RR 0.32, 95% CI 0.24 to 0.42; P < 0.00001, I² = 0 %; 3 studies, 3010 participants; low-certainty evidence). The closure of defects may result in little to no difference in the incidence of postoperative overall complications within 30 days compared to non-closure (RR 1.13, 95% CI 0.87 to 1.47; P = 0.35, I² = 0 %; 2 studies, 2609 participants; low-certainty evidence). The closure of defects may result in little to no difference in the incidence of postoperative mortality within 30 days compared to non-closure (RR 2.97, 95% CI 0.12 to 72.93; P = 0.50, I² not applicable; 2 studies, 2908 participants; very low-certainty evidence). The closure of defects may result in little to no difference in the incidence of intraoperative overall complications compared to non-closure (RR 0.87, 95% CI 0.54 to 1.42; P = 0.59, I² not applicable; 1 study, 2507 participants; very low-certainty evidence). Closure defects may lead to the longer length of hospital stay; however, the evidence is very uncertain (MD 0.27 days, 95% CI 0.15 to 0.38; P < 0.00001; I² = 93%; 2 studies, 2609 participants; very low-certainty evidence). Postoperative pain from gastric bypass surgery was not assessed because there was not enough information available for analysis.

AUTHORS' CONCLUSIONS

The closure of defects may be more effective than the non-closure of defects for prevention of internal hernia after RYGB. However, the small number of trials limited our confidence in the evidence. There is little to no difference between the closure and non-closure of defects in the incidence of postoperative overall complications, the incidence of postoperative mortality, and the incidence of intraoperative overall complications. The length of hospital stay may be longer for those undergoing defect closure than for those who did not have the defects closed. The evidence is very uncertain about the incidence of postoperative mortality, the incidence of intraoperative overall complications, and the length of hospital stay. Additional evidence based on trials designed to be at low risk of bias and with an adequate sample size is imperative.

FUNDING

This Cochrane review had no dedicated funding.

REGISTRATION

The protocol was registered in the Cochrane Library on 9 May 2023.

Plaque scores after 1 or 2 minutes of toothbrushing A systematic review and meta-analysis

AIM

To evaluate the difference in plaque score reduction achieved by 1 and 2 min of toothbrushing, based on data from single brushing exercises.

METHODS

MEDLINE-PubMed, Cochrane-CENTRAL databases and the first five pages of Google Scholar were searched for randomised controlled trials. Extracted data were summarised in a descriptive and, if possible, a meta-analysis using standardised mean difference (SMD). Separate analyses were performed for manual (MTB) and powered (PTB) toothbrushes.

RESULTS

Based on the selection criteria, the search identified five unique eligible publications providing 16 comparisons. For both toothbrush types, 2 min of brushing resulted in a significantly higher plaque score reduction. The SMD of 1 versus 2 min of brushing using MTB was 0.69 [95% CI: 0.06, 1.33] (p = 0.03) can be interpreted as a medium size effect and the SMD of using a PTB was 0.47 [95% CI: 0.28, 0.66], (p < 0.00001) interpreted as a small size effect.

CONCLUSION

With respect to plaque scores, based on single brushing exercises, there is moderate certainty for the recommendation to brush for 2 min over 1 min.

Personalizing Care for Informal Heart Failure Caregivers: Challenges and Practical Implications

PURPOSE OF REVIEW

To summarize articles describing how to personalize care for heart failure (HF) informal caregivers on the basis of the literature review results. We also describe informal caregivers' preferences and wishes regarding personalized care.

RECENT FINDINGS

Recent interventions to support informal caregivers were delivered face-to-face or online in group or individual sessions. The sessions embraced various elements, including coaching on setting personalized goals and developing problem-solving strategies. The interventions improved a range of variables, such as caregiver burden, quality of life, depression, stress and anxiety. Informal caregivers described personalized care as being in a partnership, clear communication and coordination of care. Several intervention studies reported positive caregiver effects; however, they were small, and sometimes, the interventions were only briefly described. A deeper and more comprehensive understanding of the experiences and needs of informal caregivers is essential before new tailored interventions can be developed.

The sustainability of health interventions implemented in Africa: an updated systematic review on evidence and future research perspectives

BACKGROUND

Sustaining evidence-based interventions in resource-limited settings is critical to optimizing gains in health outcomes. In 2015, we published a review of the sustainability of health interventions in African countries, highlighting gaps in the measurement and conceptualization of sustainability in the region. This review updates and expands upon the original review to account for developments in the past decade and recommendations for promoting sustainability.

METHODS

First, we searched five databases (PubMed, SCOPUS, Web of Science, Global Health, and Cumulated Index to Nursing and Allied Health Literature (CINAHL)) for studies published between 2015 and 2022. We repeated the search in 2023 and 2024. The review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies were included if they reported on the sustainability of health interventions implemented in African countries. Study findings were summarized using descriptive statistics and narrative synthesis, and sustainability strategies were categorized based on the Expert Recommendations for Implementing Change (ERIC) strategies.

RESULTS

Thirty-four publications with 22 distinct interventions were included in the review. Twelve African countries were represented in this review, with Nigeria (n = 6) having the most representation of available studies examining sustainability. Compared to the 2016 review, a similar proportion of studies clearly defined sustainability (52% in the current review versus 51% in the 2015 review). Eight unique strategies to foster sustainability emerged, namely: a) multi-sectorial partnership and developing stakeholder relationships, b) tailoring strategies to enhance program fit and integration, c) active stakeholder engagement and collaboration, d) capacity building through training, e) accessing new funding, f) adaptation, g) co-creation of intervention and implementation strategies and h) providing infrastructural support. The most prevalent facilitators of sustainability were related to micro-level factors (e.g., intervention fit and community engagement). In contrast, salient barriers were related to structural-level factors (e.g., limited financial resources).

CONCLUSIONS

This review highlights some progress in the published reports on the sustainability of evidence-based intervention in Africa. The review emphasizes the importance of innovation in strategies to foster funding determinants for sustainable interventions. In addition, it underscores the need for developing contextually relevant sustainability frameworks that emphasize these salient determinants of sustainability in the region.

How can nature connectedness and behaviours for learning be deliberately developed in children, adolescents and young adults? A systematic literature review

BACKGROUND

Nature sustains lives, enhances well-being and benefits human populations in many ways. In a world dominated by human technology, the task of effectively reconnecting to and caring for nature is both urgent and vital. Evidence shows that many children and young people (CYP) feel increasingly disconnected from nature Schools and other settings could play a crucial role in promoting time spent in nature, potentially fostering nature connectedness (NC) and improving behaviours for learning (BFL).

METHOD

A systematic literature review was conducted to explore how NC can be developed in CYP through nature-based interventions and investigate their impact on BFL. Studies from settings working with CYP aged 0 to 29 were included, utilising quantitative, qualitative, and mixed-methods approaches.

RESULTS

A total of 22 studies from 2009-2023 were identified from ERIC, PsycINFO, and Web of Science. Most were quantitative studies (n = 13) from the global north (n = 19), involving primary or secondary school-aged CYP. A variety of nature-based interventions were assessed, including hiking, surfing, gardening, and art-in-nature activities.

CONCLUSIONS

The review highlights numerous ways to develop NC in CYP, with many associated benefits for BFL. Areas of impact include social skills, self-regulation, attention, motivation, independence, and problem-solving. Effective activities included walking and reflecting in nature, sensory connections, and creative activities. Many of the interventions reviewed were not carried out by schools, nor did they take place on their grounds, perhaps due to limited access to green space and nature on their school site. This highlights a significant gap in the literature. Given the large range of interventions, ages of participants, and quality of the included studies, it is not possible to draw specific conclusions about the type of activities that may work best for specific age groups or types of setting.

Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis

BACKGROUND

Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear.

OBJECTIVE

This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs.

METHODS

Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis.

RESULTS

A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=-0.30, 95% CI -0.47 to -0.14; I2=57%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=-0.39, 95% CI -0.56 to -0.21; I2=53%; P<.001). There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events, and cardiovascular events showed inconclusive findings.

CONCLUSIONS

Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery.

TRIAL REGISTRATION

PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276.

Exploring balance control mechanisms in people with multiple sclerosis in virtual reality environment: a systematic review

BACKGROUND

Multiple sclerosis (MS) impairs balance control, affecting mobility and quality of life. Virtual reality (VR) offers a novel way to study balance mechanisms and potential rehabilitation. This review examines balance control in MS patients using VR, comparing responses in VR and non-VR settings with those of healthy controls.

METHODS

This systematic review adhered to PRISMA guidelines. Comprehensive searches were conducted across databases including PubMed, Web of Science, Scopus, CINAHL, and ScienceDirect. Studies involving individuals with MS were analyzed to explore population characteristics and types of VR environments employed. Data extraction focused on participant demographics, clinical profiles, VR configurations, and reported outcomes.

RESULTS

The potential value of VR training in this population was explored via systematic review. 23 studies highlighted the potential of VR environments to explore balance mechanisms in MS. Diverse VR types, ranging from immersive to semi-immersive systems, were used to assess postural control, functional balance outcomes, gait, and mobility. Despite variability in methodologies and reported outcomes, changes in functional measures such as gait and balance were frequently observed. This variability underscores the need for standardized protocols to enhance the comparability and application of VR in MS rehabilitation.

CONCLUSION

This systematic review highlights the variability in assessed balance response outcomes in PwMS.

The Impact of Music Therapy on Preoperative Anxiety in Pediatric Patients Undergoing Anesthesia: A Systematic Review and Meta-analysis

PURPOSE

Preoperative anxiety remains a critical concern in pediatric anesthesia, often worsening surgical outcomes and complicating postoperative recovery. This systematic review and meta-analysis aimed to evaluate whether music therapy, as a nonpharmacological intervention, effectively reduces preoperative anxiety in children undergoing anesthesia.

DESIGN

Systematic review and meta-analysis.

METHODS

Studies examining the impact of music therapy on preoperative anxiety in pediatric patients were systematically identified, screened, and selected for inclusion. Data from eligible studies were synthesized using a random-effects model to assess the pooled effect size, with sensitivity analyses performed to verify result stability. Publication bias across the included studies was also investigated to ensure reliability of the findings.

FINDINGS

The analysis included 7 studies comprising a total of 440 pediatric participants. Findings indicated that music therapy led to a statistically significant reduction in anxiety levels, yielding a moderate effect size (standardized mean difference = -0.48; 95% confidence interval, -0.81 to -0.15; I2 = 65.6%). Sensitivity analyses demonstrated consistent results, as the removal of individual studies did not significantly alter the overall effect estimate. Additionally, no substantial publication bias was detected, supporting the validity of the meta-analysis.

CONCLUSIONS

The findings strongly endorse music therapy as an effective nonpharmacological strategy for managing preoperative anxiety in pediatric patients undergoing anesthesia. With a statistically significant moderate reduction in anxiety observed, music therapy emerges as a valuable tool for improving the perioperative experience and potentially enhancing recovery outcomes in pediatric surgical care.

Indications, Functional Outcomes, Return to Sport and Complications of Anterior and Lateral Approaches for Total Ankle Arthroplasty: A Comprehensive Review

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were "total ankle arthroplasty", "total ankle replacement", "ankle anterior approach", "ankle lateral approach", "outcomes", "return to sport", and "complications", and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize outcomes.

Effectiveness of nurse-initiated smoking cessation intervention: a systematic review and meta-analysis

BACKGROUND

Smoking is a major preventable cause of death, associated with cancers and chronic diseases. Nurse-initiated smoking cessation programs have proven effective, providing counseling, education, and mental health support. These interventions increase quit rates by tackling nicotine addiction, emphasizing the important role of nurses and the need for targeted training. Systematic reviews and meta-analyses are essential for gaining a deeper understanding of the effectiveness of various cessation strategies.

METHODS

A literature search was conducted using eight electronic databases (CINAHL, EMbase, MEDLINE, Cochrane, RISS, KMbase, KISS, and NDSL). The literature search was conducted from March, 27, 2024, to August 1, 2024. All included studies were randomized controlled trials (RCTs). Quality assessment was conducted using the Risk of Bias (ROB) tool. RevMan 5.4 was used for qualitative analysis, with effect sizes measured as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Thirteen studies, all published after 2005, were included in the evidence assessment of nurse-initiated smoking cessation programs. The interventions examined comprised 11 intensive or personalized counseling programs and 3 telephone-based approaches. The OR for self-reported quit success 7-day smoking cessation rate at 6-month follow-up was 1.43 (95% CI [1.08, 1.90]), indicating a significant difference in quit effectiveness (Z = 2.27, p =.01), with moderate heterogeneity observed across studies (I2 = 67.0%, p =.001). A meta-analysis of 7-day point abstinence rate at 12-month follow-up revealed a pooled OR of 1.18 (95% CI [0.96, 1.44]), showing no significant difference in quit effectiveness (Z = 1.58, p =.11) and moderate heterogeneity among the studies (I2 = 55.0%, p =.02).

CONCLUSIONS

A comprehensive approach by trained nursing professionals is essential in addressing the complexities of smoking cessation. Further clinical trials are needed to assess intervention methods and follow-up strategies. Future research should emphasize long-term outcomes and ongoing support to sustain behavior change, contributing to more effective, tailored cessation programs and improved public health outcomes.

A Systematic Review and Meta-Analysis of Implicit Stigma Toward People with Mental Illness Among Different Groups: Measurement, Extent, and Correlates

Introduction

Implicit association tests have been extensively applied to reveal socially unacceptable and concealed stigma. Studies have explored the implicit stigma toward mental illness in specific groups, with limited comparisons across different groups. To investigate the implicit stigma toward mental illness among different groups, along with the interaction between implicit and explicit measurements.

Methods

Based on PRISMA guidelines, Web of Science, Embase, PubMed/MEDLINE, Cochrane Library, and PsycINFO were searched from 1998 to April 18, 2024. Searches were updated through February 12, 2025. The Medical Education Research Quality Instrument (MERSQI) served as the quality evaluation framework, and Stata 12.0 facilitated the conduct of a meta-analysis.

Results

The analysis included fifty studies in the systematic review and thirty in the meta-analysis. Most studies used "mental illness" or related physical illness terms as concept words, paired with emotionally contrasting attribute words. Twenty-eight studies calculated the implicit effect using an improved algorithm, while thirty-eight examined the correlations between implicit and explicit measures. The pooled standardized mean differences (SMDs) revealed that the lowest D scores were observed in the general population (SMD = 0.79, P < 0.001), followed by healthcare providers (SMD = 1.09, P = 0.054), students (SMD = 1.17, P < 0.001) and people with mental illness (SMD = 1.20, P < 0.001).

Conclusion

The findings indicated that the selection of concept and attribute words, as well as the processing of data measuring implicit stigma, was not standardized. No reliable correlation was found between implicit and explicit measures. Despite the heterogeneity of included studies, the general public demonstrated the most positive attitudes, while individuals with mental illness exhibited negative attitudes. Further research is required to develop personalized anti-stigma interventions for different groups and regions based on these results, particularly from the perspective of implicit stigma.

Panic Disorder in Patients With Vestibular Dysfunction: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the prevalence of panic disorder (PD) among patients with vestibular dysfunction.

DATABASES REVIEWED

CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS.

METHODS

Databases were searched from inception through August 2024. Observational studies on PD in adults with vestibular dysfunction were included. Studies of patients without a vestibular disorder diagnosis or vertigo arising from trauma or tumors were excluded. Primary outcome measures included continuous measures (mean), proportions (%), and relative risk (RR) with 95% confidence intervals (CI). Two authors extracted data and discrepancies were resolved with a third party. Level of evidence was evaluated using Oxford Centre for Evidence-Based Medicine criteria. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies-of Exposure for cohort studies and Joanna Briggs Institute criteria for case-control and cross-sectional studies.

RESULTS

Ten studies (n = 874) on PD and vestibular disorders were included. The mean age was 49.7 years for the vestibular group and 46.0 years for the control group. Although there were no significant differences in the prevalence of anxiety and depression, there was a significantly higher prevalence of PD (7.4% vs. 2.5%) in patients with vestibular dysfunction than the control population (p = 0.02). However, the risk of developing PD among patients with vestibular disorders was not significantly higher (RR = 1.9, 95% CI: 0.4-8.1) than the controls.

CONCLUSION

The prevalence of PD in patients with vestibular dysfunction is nearly three times higher than in people without vestibular dysfunction. This evidence suggests otolaryngologists treating this condition should consider screening for PD.

Global trends in antimicrobial resistance of Enterococcus faecium: a systematic review and meta-analysis of clinical isolates

Background

Multidrug-resistant bacteria are associated with a high number of deaths and pose a significant global concern. In recent decades, among these resistant bacteria, Enterococcus faecium, a hospital-acquired pathogen, has attracted more attention.

Objective

The present study aims to document the current state of resistance in E. faecium globally by considering several variables, including geographical locations, temporal trends, and sources of infection.

Methods

We searched studies in PubMed, Scopus, and Web of Science (30 November 2022). All statistical analyses were carried out using the statistical package R.

Results

Our meta-analysis of antibiotic resistance across various clinical isolates revealed substantial heterogeneity and variability. The average resistance proportions ranged from 2% for linezolid to 62.8% for erythromycin, with significant differences observed across different time periods, countries, and World Health Organization regional offices.

Conclusion

Our findings confirm the high antibacterial activity of linezolid against E. faecium isolates. Additionally, our investigation reveals a gradual increase and a concerning upward trend in resistance rates for nearly all agents in recent years. However, the significant reduction in resistance rates for certain antibiotics suggests that these drugs could potentially regain their effectiveness in the future.

Prognostic value of neutrophil-lymphocyte ratio in gastroenteropancreatic neuroendocrine neoplasm: a systematic review and meta-analysis

Purpose

A high neutrophil-to-lymphocyte ratio (NLR) might be connected with an unfavorable tumor prognosis. We sought to conduct a meta-analysis of published studies exploring the prognostic value of NLR in patients with gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).

Methods

We have referred to the PRISMA 2020 for the Abstracts checklist and have registered our review at the International Prospective Register of Systematic Reviews (registration number CRD42020187679). The PubMed, Embase, and Web of Science databases were screened using words like 'neutrophil to lymphocyte ratio', 'neuroendocrine tumors', and others up to July 2024. In our study, we evaluated the significance of NLR on overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) of patients with GEP-NEN. Subgroup analysis were conducted to identify the origins of heterogeneity and examine the impact of factor grouping.

Results

We gathered 18 cohorts with 2,995 cases. All included studies were high quality, with Newcastle Ottawa Scale (NOS) scores ranging from 6 to 8. The pooled analysis revealed that a higher NLR related to worse OS (hazard ratio (HR): 4.59, 95% confidence interval (CI) [3.35-6.29], p < 0.00001) and poor RFS (HR: 4.05, 95% CI [2.78-5.90], p < 0.00001) in patients with GEP-NEN. Subgroup analysis of race, tumor sites, and therapy showed good predictive significance, however, NLR is not effective in predicting the overall survival time of non-operative patients.

Conclusion

This meta-analysis showed that a high NLR predicted poor OS, RFS, and PFS in patients with GEP-NEN and can be used as a promising predictor.

Hepatocellular Carcinoma and Health-Related Quality of Life: A Systematic Review of Outcomes From Systemic Therapies

Aim: Poor outcomes in advanced hepatocellular carcinoma (HCC) coupled with potential significant treatment side effects underpin a strong rationale to assess health-related quality of life (HRQOL) in those treated with systemic therapies. This study is aimed at quantifying the effect of systemic therapies on HRQOL outcomes in HCC patients when compared to baseline or placebo, other systemic therapies, and transarterial radioembolisation (TARE). Methods: In May 2024, two independent reviewers searched PubMed, EMBASE, and Google Scholar for studies comparing postsystemic therapy HRQOL scores in adult patients with HCC to baseline or placebo, other systemic therapies, or to TARE. Narrative synthesis was used to synthesise results. Risk of bias was assessed using RoB 2 and ROBINS-I. This review was structured according to PRISMA guidelines and was prospectively registered in the PROSPERO register (CRD42024521699). Results: Twenty-nine studies with 10,472 patients using eight HRQOL instruments were included. Compared to baseline, patients on atezolizumab/bevacizumab and sorafenib both experienced significant declines in HRQOL, and lenvatinib nonsignificantly decreased HRQOL. HRQOL remained unchanged in patients on pembrolizumab or nivolumab. Atezolizumab/bevacizumab and lenvatinib both significantly delayed HRQOL deterioration compared to sorafenib. Compared to TARE, atezolizumab/bevacizumab delayed time-to-deterioration in HRQOL, whereas sorafenib had significantly worse HRQOL. Conclusion: Despite worsening HRQOL outcomes compared to baseline, the first-line agents atezolizumab/bevacizumab and lenvatinib had superior HRQOL outcomes in comparison to sorafenib. Sorafenib significantly worsened HRQOL compared to TARE. As the majority of included studies included sorafenib, which has been largely superseded by newer therapies, further trials evaluating HRQOL with these newer therapies are required.

The associations and effects of mindfulness on anger and aggression: A meta-analytic review

Dispositional mindfulness and mindfulness-based interventions have been linked to emotion regulation and may reduce anger and aggression. The present set of four meta-analyses examined and quantified correlational relationships between trait mindfulness, trait anger, and trait aggression, as well as the effects of experimental mindfulness-based interventions on anger and aggression. These meta-analyses contained data from 118 correlational (dispositional mindfulness) and experimental (mindfulness-based intervention) studies. For the subset of self-report correlational studies (kanger = 243, kaggression = 286), we found small-to-medium inverse relationships between dispositional mindfulness and both anger (r = -0.23, p < .001) and aggression (r = -0.19, p < .001). For experimental studies (kanger = 95, kaggression = 38), we found medium effects. Specifically, mindfulness-based interventions produced lower anger (d = -0.48, p < .001) and aggression (d = -0.61, p < .001) relative to the control groups. In sum, results suggest that mindfulness can curb angry and aggressive responses. Effect sizes for the interventions were largest in Asia. Studies with passive versus active control groups showed larger effect sizes. Effect sizes were largely equivalent for all populations studied (e.g., clinical, forensic, healthy adults, medical, students). Our meta-analytic findings suggest that mindfulness training may aid the effective regulation of anger and aggression for diverse populations. They also highlight the need for more rigorous control groups in future research.

Evaluation of intervention systematic reviews on chronic non-communicable diseases and lifestyle risk factors in low-middle income countries: meta-research

BACKGROUND

Systematic Reviews (SRs) rigorously synthesize findings on a theme, but some articles with this design are redundant due to errors and conflicts. Meta-research aims to rigorously analyze research, assessing SRs' methodological quality and result reliability. This study evaluates SRs' overall quality in low- and middle-income countries (LMICs) on chronic non-communicable Diseases (NCDs) and key modifiable risk factors, using assessment tools.

METHODS

A search strategy was conducted in the following databases: MEDLINE (via PubMed), Embase, (via Elsevier), Cochrane Library, and Grey Literature for published studies from January 1, 2014 - April 5, 2024. SRs addressing the association between at least one of the four most important modifiable behavioral risk factors (tobacco use, inadequate diet, alcohol consumption, and physical inactivity) and chronic NCDs in populations classified as LMICs according to the 'World Bank list of countries' were included. The selected studies were imported into the EndNote 20 software and analyzed using a form for the extraction of their main data and four tools were chosen to assess each of the most important domains of scientific evidence: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) for article writing; Template for Intervention Description and Replication (TIDieR) for intervention description; A Measurement Tool for Evaluating Systematic Reviews (AMSTAR-2) for methodological assessment; and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for certainty of evidence.

RESULTS

Nine studies were included in this analysis. The average Overall Score on the PRISMA 2020 checklist was 13.5 for articles published before 2020 and 25.67 for those published after 2020. TIDieR analysis revealed complete correspondence (100%) for item 'Brief Name', while other items, like 'Why' (89%), and 'What', 'Who Provided', and 'How' (78%), were partially met but significantly so. Regarding AMSTAR-2 criteria, only one study fulfilled all critical items, meeting item 7 by providing a detailed list of excluded studies and justifying each exclusion motive. Additionally, among critical items applicable to multiple articles, only item 11 was consistently fulfilled by all studies. In the final classification, one article achieved a moderate quality rating, three were critically low quality, and five had low quality among the nine evaluated articles. In the GRADE tool evaluation, limitations resulted in estimations for only 19 outcomes and 8 intervention-exposure sets.

CONCLUSION

The results demonstrated that the writing of recent scientific articles meets most of the PRISMA 2020 criteria, with a checklist being the most used tool. Interventions and exposure were also very well reported, with the TIDieR checklist not being cited in any study as a guiding tool. AMSTAR-2 revealed a methodological approach of varied quality, mainly low and critically low. The GRADE approach classified the certainty of the evidence as generally very low. Therefore, it is necessary to encourage adherence to these approaches to improve the methodological quality in SR studies on chronic NCDs and behavioral factors in LMICs.

The design and implementation of culturally-safe dementia risk reduction strategies for immigrant women: a theoretical review

BACKGROUND

Raising awareness about dementia risk reduction is particularly important for ethno-culturally diverse or immigrant women, who have greater risk of dementia compared with men due to multiple interacting factors. We aimed to synthesize prior research on culturally-safe strategies to raise diverse women's awareness of dementia risk reduction.

METHODS

We conducted a theoretical review. We searched for studies published up to April 2023 included in a prior review and multiple databases. We screened studies and extracted data in triplicate, informed by existing and compiled theoretical frameworks (WIDER, RE-AIM, cultural safety approaches) and used summary statistics, tables and text to report study characteristics, and strategy design, cultural tailoring, implementation and impact.

RESULTS

We included 17 studies published from 2006 to 2021. Most were conducted in the United States (15, 88%), before-after cohorts (7, 41%), and included African, Caribbean or Latin Americans (82%). No studies focused solely on women (median women 72%, range 50% to 95%). All strategies consisted of in-person didactic lectures, supplemented with interactive discussion, role-playing, videos and/or reinforcing material. Strategies varied widely in terms of format, delivery, personnel, and length, frequency and duration. Details about tailoring for cultural safety were brief and varied across studies. Ten approaches were used to tailor strategies, most often, use of target participants' first language. Assessment of implementation was limited to reach and effectiveness, offering little insight on how to promote adoption, fidelity of implementation and longer-term maintenance of strategies. Strategies increased knowledge of dementia and decreased misconceptions, but did not prompt participants to seek dementia screening in the single study that assessed behaviour.

CONCLUSIONS

While this review revealed a paucity of research, it offers insight on how to design culturally-safe dementia risk reduction strategies that may be suitable for ethno-culturally diverse or immigrant women. Healthcare professionals can use these findings to inform policy, clinical guidelines and public health programs. Future research is needed to establish the ideal number, length and duration of sessions, and confirm strategy effectiveness for diverse women.

The augmentative efficacy of second-generation anti-psychotics (SGA) to anti-depressants in treating treatment-resistant depression: a network meta-regression analysis

BACKGROUND

To compare the augmentative efficacy of second-generation anti-psychotics (SGA) to anti-depressants in adult patients with treatment-resistant depression (TRD) adjusting follow-up period and explore the underlying"time window"effects of the regimens.

METHODS

Databases included Embase, PubMed, Scopus, Cochrane Library and Google Scholars as well as Clinicaltrials.gov from inception to May 15, 2024, for relevant randomized controlled studies (RCTs) were retrieved. The primary endpoint was Montgomery Asberg Depression Rating Scale (MADRS). The secondary endpoint was MADRS response rate. The tertiary endpoints were Clinical Global Impression-severity (CGI-S) and MADRS remission rate. Standard mean difference (SMD) and hazard ratio (HR) were generated by Bayesian network meta-regression (NMR) for pairwise comparisons on dichotomous and consecutive variants, respectively.

RESULTS

A total of 23 studies (N = 10679) with 24 augmentation agents were included in the NMR. For the primary endpoint, compared with ADT, aripiprazole 3 - 12 mg/d, brexpiprazole 1 - 3 mg/d, cariprazine 1.5 - 3 mg/d, olanzapine 6 - 12 mg/d and fluoxetine 25 - 50 mg/d combination, and quetiapine XR were significantly effective (SMD ranged from - 0.28 to - 0.114) and their effect sizes were comparable, after adjusting follow-up period, the results resembled the former except for quetiapine XR (SMD = - 0.10, 95%CI: - 0.212 to 0.014). Brexpiprazole 3 mg/d (7.22 weeks), cariprazine 1 - 2 mg/d (2.97 weeks), cariprazine 2-4.5 mg/d (2.81 weeks), cariprazine 3 mg/d (7.16 weeks), olanzapine 6 - 12 mg/d (4.11 weeks) and quetiapine 150 - 300 mg/d (3.89 weeks) showed"time window". For the secondary endpoint, brexpiprazole 3 mg/d and rispridone 0.5 - 3 mg/d was evidently superior to all others (HR ranged from 1.748 to 2.301). For the tertiary endpoints, as for CGI-S, aripiprazole 2 - 20 mg/d, brexpiprazole 2 - 3 mg/d, cariprazine 3 mg/d, olanzapine 6 - 12 mg/d and fluoxetine 25 - 50 mg/d combination, and rispridone 0.5 - 3 mg/d were conspicuously effective compared with ADT (SMD ranged from - 0.438 to - 0.126) and for MADRS remission rate, aripiprazole 2 - 20 mg/d, brexpiprazole 3 mg/d, cariprazine 3 mg/d, rispridone 0.5 - 3 mg/d were conspicuously effective compared with ADT (HR ranged from 0.477 to 3.326).

CONCLUSION

Holistically considering each endpoint and corresponding "time window", certain SGAs appeared to be efficient augmentation to anti-depressants for TRD, but aripiprazole was relatively more effective and better tolerated.

Augmented intelligence in oral and maxillofacial radiology: a systematic review

BACKGROUND

Artificial intelligence (AI) is transforming diagnostic imaging in dentistry. This systematic review evaluates existing literature on augmented intelligence in dentomaxillofacial radiology, focusing on its influence on human collaboration in interpreting dental imaging.

STUDY DESIGN

A literature search across seven databases and gray literature was conducted. Studies evaluating clinician performance with AI-assistance were included, while reviews, surveys, and case reports were excluded. The QUADAS-2 tool assessed the risk of bias.

RESULTS

Sixteen studies assessed the influence of AI on radiographic interpretation. AI-assisted caries detection consistently improved accuracy, sensitivity, and specificity. Detection of apical pathoses and jaw lesion segmentation improved accuracy, reducing diagnostic time. Cephalometric landmark identification showed increased accuracy, particularly for students. Soft tissue calcification detection improved accuracy, but sensitivity decreased. Overall, augmented intelligence enhanced interobserver agreement and reduced diagnostic variability, with general dentists and students showing the greatest gains.

CONCLUSIONS

Augmented intelligence enhances dental radiographic interpretation by improving tasks, particularly for less experienced clinicians, and positively influences clinical decision-making. However, AI performance remains inconsistent in challenging cases involving complex pathoses or varied imaging conditions. While it complements rather than replaces clinicians, further validation of AI's generalizability and reliability using larger, diverse datasets is necessary.

The effect of game-based interventions on children and adolescents with autism spectrum disorder: A systematic review and meta-analysis

Purpose

The purpose of this meta-analysis was to conduct a comprehensive evaluation of randomized controlled trials (RCTs) of game-based interventions (GBI) for children and adolescents with autism spectrum disorder (ASD) to identify the clinical efficacy of GBI on core symptoms and other concomitant symptoms of ASD.

Methods

PubMed, Web of Science, Embase and the Cochrane Library were systematically searched for articles published until July 2023.

Results

Twenty-four studies with 1,801 patients met the inclusion criteria. The results showed that GBI had a significant positive effect on social skills (g = -0.59, p = 0.004), social behaviors (g = 0.45, p < 0.001), and cognition (g = 0.57, p < 0.001) in children and adolescents with ASD, while the effects of language expression (g = 0.15), anxiety (g = -0.13), and parenting stress (g = -0.51) were small and nonsignificant.

Conclusions

The results of the current meta-analysis showed that GBI was effective in improving social skills, social behaviors and cognition in children and adolescents with ASD in the existing studies and was not significant in improving language skills, anxiety and parental stress, but due to the limited number and low quality of the included studies, the above conclusions need to be validated by conducting more large-sample, high-quality RCTs.

Systematic Review Registration

www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023390793, identifier: CRD42023390793.

Two decades of vagus nerve stimulation for stroke: a bibliometric analysis

Background

Stroke is a major global health concern, imposing significant medical and social burdens. Vagus nerve stimulation (VNS), an emerging neuromodulation technology, has shown potential in the treatment of stroke. This bibliometric analysis aims to explore the knowledge structure and research trends in the field of VNS for stroke from 2004 to 2024.

Methods

Publications were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to conduct bibliometric analyses, including author productivity, institutional contributions, and emerging research themes etc.

Results

A total of 191 eligible publications were analysed. Kilgard, M. P., and Hays, S. A. were the most prolific authors, each contributing 26 publications. The USA (96 publications), China (69 publications), and Scotland (17 publications) were the most prolific countries. The University of Texas at Dallas (33 publications) was the most prolific institution, followed by Chongqing Medical University (19 publications) and the University of Glasgow (15 publications). Future research is expected to focus on: (1) neurophysiological mechanisms of VNS in stroke recovery; (2) synergistic effects of VNS with other rehabilitation therapies; (3) comparative efficacy of non-invasive transauricular VNS versus invasive VNS; (4) safety and effectiveness of VNS for post-stroke functional impairments beyond motor rehabilitation; and (5) optimisation of VNS parameters for stroke treatment.

Conclusion

The field of VNS for stroke has experienced steady growth over the past two decades. This bibliometric analysis provides valuable insights to guide future research, clinical applications, and policy developments.

The prognostic impact of tumor mutations and tumor-infiltrating lymphocytes in patients with localized pMMR colorectal cancer - A systematic review and meta-analysis

BACKGROUND

Tumor mutations and the composition of the tumor microenvironment have prognostic and therapeutic significance in colorectal cancer (CRC). However, immunotherapy remains a challenge for patients with proficient mismatch repair (pMMR) CRC. In this paper, the association between tumor-infiltrating lymphocytes (TILs) and tumor mutations on survival outcomes in patients with localized pMMR CRC was examined.

METHODS

A systematic review of the literature and a meta-analysis were conducted in accordance with the PRISMA guidelines. The literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The outcomes of interest were overall survival, disease-free survival, and cancer-specific survival. The risk of bias was assessed through the Newcastle-Ottawa Scale and the quality of the cumulative evidence was evaluated through the modified GRADE approach.

FINDINGS

In total, 8498 articles were screened for eligibility and 44 articles were included in the meta-analysis with 33,704 patients in total. Patients with high infiltration of any TILs showed significantly improved overall survival (HR = 0.57, 95 % CI: 0.49-0.67, I2: 0 %), especially for the subgroup of CD3 + (HR = 0.52, 95 % CI: 0.38-0.71, I2: 0 %) and CD8 + (HR = 0.60, 95 % CI: 0.37-0.99, I2: 10 %) TILs. Patients with BRAF mutation (HR = 2.68, 95 % CI: 1.47-4.89, I2: 83 %) and KRAS mutation (HR = 1.25, 95 % CI: 1.18-1.33, I2: 0 %) showed decreased overall survival.

INTERPRETATION

High infiltration of TILs, especially CD3 + and CD8 + , was associated with significantly improved survival, while BRAF and KRAS mutations were correlated with worse survival outcomes for patients with non-metastatic pMMR CRC.

Genetic and neural mechanisms shared by schizophrenia and depression

Schizophrenia (SCZ) and depression are two prevalent mental disorders characterized by comorbidity and overlapping symptoms, yet the underlying genetic and neural mechanisms remain largely elusive. Here, we investigated the genetic variants and neuroimaging changes shared by SCZ and depression in Europeans and then extended our investigation to cross-ancestry (Europeans and East Asians) populations. Using conditional and conjunctional analyses, we found 213 genetic variants shared by SCZ and depression in Europeans, of which 82.6% were replicated in the cross-ancestry population. The shared risk variants exhibited a higher degree of deleteriousness than random and were enriched for synapse-related functions, among which fewer than 3% of shared variants showed horizontal pleiotropy between the two disorders. Mendelian randomization analyses indicated reciprocal causal effects between SCZ and depression. Using multiple trait genetic colocalization analyses, we pinpointed 13 volume phenotypes shared by SCZ and depression. Particularly noteworthy were the shared volume reductions in the left insula and planum polare, which were validated through large-scale meta-analyses of previous studies and independent neuroimaging datasets of first-episode drug-naïve patients. These findings suggest that the shared genetic risk variants, synapse dysfunction, and brain structural changes may underlie the comorbidity and symptom overlap between SCZ and depression.

A Systematic Review on Immediate Implant Placement in Intact Versus Non-Intact Alveolar Sockets

Objectives: The primary objective of this systematic review was to compare IIP in intact versus non-intact sockets in terms of buccal bone thickness. Methods: Two independent reviewers carried out an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2024. Randomized controlled trials (RCTs), cohort studies, and case series on intact and/or non-intact sockets were included for analysis. The primary outcome was buccal bone thickness (BBT). Secondary outcomes were vertical midfacial soft tissue level change, pink esthetic score (PES), implant survival and complications. This systematic review was conducted in accordance with the PRISMA guidelines. Results: After screening 1001 unique titles and conducting manual searches, 20 articles reporting on 525 implants (intact: 265; non-intact: 260) in the anterior maxilla with a follow-up of up to 120 months were selected. The overall study quality was low, especially for non-intact sockets since only two RCTs could be found, and none demonstrated a low risk of bias. Meta-analyses were not feasible due to a lack of direct comparisons, and heterogeneity in terms of surgical approach, soft tissue handling, and restorative approach. BBT ranged between 1.10 and 3.18 mm (intact) and 1.18 and 3 mm (non-intact). Vertical midfacial soft tissue level change ranged between -0.13 and -0.58 mm (intact) and -0.03 and -0.59 mm (non-intact). Pink esthetic scores ranged between 10.48 and 12.80 (intact) and 9.25 and 12.43 (non-intact). Implant survival exceeded 90% in all studies and was 100% in the vast majority of the studies. Conclusions: This systematic review suggests a similar outcome of IIP in intact and non-intact sockets. However, the overall low study quality, a lack of direct comparisons, and heterogeneity rendered the comparison highly biased. Future studies should be conducted to establish an evidence-based treatment approach for IIP in non-intact sockets.

COVID-19 infection in inborn errors of immunity and their phenocopies: a systematic review and meta-analysis

BACKGROUND

Inborn errors of immunity (IEI) are congenital disorders of the immune system. Due to impaired immune system, they are at a higher risk to develop a more severe COVID-19 course compared to general population.

OBJECTIVES

Herein, we aimed to systematically review various aspects of IEI patients infected with SARS-CoV-2. Moreover, we performed a meta-analysis to determine the frequency of COVID-19 in patients with different IEI.

METHODS

Embase, Web of Science, PubMed, and Scopus were searched introducing terms related to IEI and COVID-19.

RESULTS

3646 IEI cases with a history of COVID-19 infection were enrolled. The majority of patients had critical infections (1013 cases, 27.8%). The highest frequency of critical and severe cases was observed in phenocopies of IEI (95.2%), defects in intrinsic and innate immunity (69.4%) and immune dysregulation (23.9%). 446 cases (12.2%) succumbed to the disease and the highest mortality was observed in IEI phenocopies (34.6%). COVID-19 frequency in immunodeficient patients was 11.9% (95% CI: 8.3 to 15.5%) with innate immunodeficiency having the highest COVID-19 frequency [34.1% (12.1 to 56.0%)]. COVID-19 case fatality rate among IEI patients was estimated as 5.4% (95% CI: 3.5-8.3%, n = 8 studies, I2 = 17.5%).

CONCLUSION

IEI with underlying defects in specific branches of the immune system responding to RNA virus infection experience a higher frequency and mortality of COVID-19 infection. Increasing awareness about these entities and underlying genetic defects, adherence to prophylactic strategies and allocating more clinical attention to these patients could lead to a decrease in COVID-19 frequency and mortality in these patients.

The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol

Background

Polyetheretherketone (PEEK) is widely used in the biomedical field due to its outstanding biological and mechanical properties. Originally employed as a temporary abutment in implantology, recent research has expanded its indications for more definitive applications, such as frameworks and dental post and core. However, PEEK's inert nature and low surface energy pose challenges for adhesion, necessitating surface modifications. Various physical and chemical modification techniques, including acid etching (e.g., 98% sulfuric acid), sandblasting with alumina oxide (Al₂O₃), plasma treatment, laser irradiation, silanization, and air abrasion with silica-coated particles, have been proposed to enhance PEEK's bonding performance. Despite numerous clinical investigations, standardized protocols for surface treatment remain lacking. This systematic review aims to assess the impact of surface treatments on the bonding performance of PEEK posts.

Methods

A detailed search of the literature will be conducted across several databases including PubMed, Scopus and clinical trial registries. Additional databases such as Cochrane Central, EMBASE, Web of Science and EBSCO will also be included. The search strategy will target controlled randomized studies and non-randomized clinical trials evaluating the impact of surface treatments on PEEK post adhesion strength. The Newcastle-Ottawa Scale (NOS) will be used to assess bias in non-randomized studies, while the Cochrane Risk of Bias (ROB II) tool will be employed for evaluating randomized controlled trials. Data extraction will focus on study design, treatment methods, outcomes and results.This systematic review protocol will adhere to the guidelines for systematic reviews outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Discussion

The discussion will explore the implications of findings on clinical practice, highlighting the importance of enhancing PEEK's bioactivity and surface energy to improve bonding efficacy in dental procedures. Moreover, it will suggest areas for future research to advance dental materials science, aiming to optimize the utilization of PEEK in dental applications.

Systematic review registration

PROSPERO: CRD42024529783 (Registered on 08/04/2024).

Transversus abdominis plane (TAP) blocks for prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery

RATIONALE

Pain control following laparoscopic gynaecologic surgery is key to successful recovery. The efficacy of the transversus abdominis plane (TAP) block compared to no block or a local anaesthetic injection has not been well established in this population.

OBJECTIVES

To evaluate the benefits and harms of single-shot transversus abdominis plane blocks for the prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery compared to no block, sham block, or injection of local anaesthetic.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, two trials registers, and handsearched abstracts to 6 December 2024.

ELIGIBILITY CRITERIA

We included prospective randomised controlled trials (RCTs) of adult women undergoing minimally invasive gynaecologic surgery that compared single-shot TAP block to no block, sham block, or injection of local anaesthetic. We excluded studies that were non-randomised or of non-gynaecologic surgery.

OUTCOMES

Critical and important outcomes: participant-reported pain intensity 24 hours following surgery (combined, at rest, and with movement), adverse events (serious adverse events, nausea and vomiting, postoperative sedation), opioid consumption 24 and 48 hours after surgery. Other outcomes: pain intensity 2, 6, 12, and 48 hours after surgery, opioid consumption intraoperatively, time from surgery to first participant requirement for postoperative opioid, time from surgery until discharge.

RISK OF BIAS

We assessed the risk of bias with RoB 1.

SYNTHESIS METHODS

We conducted meta-analyses using random-effects models. We calculated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes. We reported serious adverse events as described by the study authors. We summarised the certainty of evidence using GRADE methods.

INCLUDED STUDIES

We included 21 RCTs with a total of 1645 participants. Studies were conducted in 10 countries, and published between 2011 and 2023. Six studies compared TAP block to no block, eight compared TAP block to an injection of local anaesthetic, and seven studies compared TAP block to sham block. Studies reported pain outcomes in various ways, so we made assumptions to allow us to combine data.

SYNTHESIS OF RESULTS

1. TAP block compared to no block TAP blocks may result in little or no difference in pain 24 hours after surgery for women undergoing laparoscopic or robotic gynaecologic procedures (MD -4.66, 95% confidence interval (CI) -11.06 to 1.74; 4 RCTs, 242 women; I2 = 88%; very low-certainty evidence). TAP blocks may result in little or no difference in pain at rest (MD -0.16, 95% CI -1.60 to 1.28; 2 RCTs, 146 women; I2 = 0%, low-certainty evidence), or pain with movement (MD -1.59, 95% CI -4.44 to 1.25; 2 RCTs, 146 women; I2 = 0%, low-certainty evidence) 24 hours after surgery. Two studies reported serious adverse events. None reported an event related to the TAP block (out of 50 women). TAP blocks may result in little or no difference in postoperative nausea and vomiting (RR 0.60, 95% CI 0.24 to 1.54; 2 RCTs, 111 women; I2 = 0%, low-certainty evidence). TAP blocks may have little or no effect on 0- to 24-hour postoperative morphine consumption (MD 3.08, 95% CI -3.71 to 9.88; 3 RCTs, 140 women; I2 = 70%; very low-certainty evidence). None of the studies reported 48-hour morphine consumption. 2. TAP block compared to local anaesthetic Women who received TAP blocks may experience a small reduction in 24-hour postoperative pain compared to local anaesthetic (MD -11.58, 95% CI -20.52 to -2.64; 6 RCTs, 393 women; I2 = 89%; low-certainty evidence). None of the studies reported pain at rest or with movement. Four studies reported serious adverse events. None reported an event related to the TAP block (out of 168 women). TAP block may result in little or no difference in postoperative nausea and vomiting compared to local anaesthetic (RR 0.63, 95% CI 0.34 to 1.15; 1 RCT, 62 women; low-certainty evidence). There may be little or no difference in opioid consumption 0 to 24 hours after surgery for women who received a TAP block compared to local anaesthetic (MD -8.21, 95% CI -19.69 to 3.27; 2 RCTs, 177 women; I2 = 81%; very low-certainty evidence). TAP block compared to local anaesthetic may result in little or no difference in opioid consumption 0 to 48 hours after surgery (MD -15.80, 95% CI -32.11 to 0.51; 1 RCT, 40 women; low-certainty evidence). 3. TAP block compared to sham block TAP block probably results in a small decrease in 24-hour postoperative pain compared to sham block (MD -14.26, 95% CI -27.03 to -1.48; 4 RCTs, 371 women; I2 = 98%; moderate-certainty evidence). None of the studies reported pain at rest. TAP block probably results in a small reduction in pain with movement 24 hours following surgery (MD -3.60, 95% CI -6.72 to -0.48; 1 RCT, 60 women; moderate-certainty evidence). Six studies reported serious adverse events. None reported an event related to the TAP block (out of 307 women). There may be little or no difference in postoperative nausea and vomiting between TAP and sham blocks (RR 0.68, 95% CI 0.45 to 1.03; 3 RCTs, 244 women; I2 = 0; low-certainty evidence). There may be little or no difference in 24-hour postoperative morphine consumption between TAP and sham blocks (MD -13.08, 95% CI -30.78 to 4.63; 5 RCTs, 310 women; I2 = 99%; low-certainty evidence). None of the studies reported 48-hour postoperative opioid consumption.

AUTHORS' CONCLUSIONS

Amongst women undergoing minimally invasive gynaecologic surgery, we did not find a clinically meaningful effect of TAP block on postoperative pain or opioid consumption. However, there may be a small reduction of pain using TAP blocks compared to local anaesthetic or sham blocks. The TAP block is probably safe, since no adverse events were noted amongst the 525 women who received a block, and for whom safety data were available. The evidence is limited by heterogeneity in the results, risk of bias in the studies, and assumptions made for synthesis when combining data.

FUNDING

The review had no dedicated funding.

REGISTRATION

Protocol (2022): DOI: 10.1002/14651858.CD015145.

Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

Background

Shoulder-hand syndrome (SHS) is one of the common sequelae after stroke, which not only hinders the recovery of patients, but also increases the economic burden of the family. In the absence of effective treatment measures, acupuncture treatment has been widely used in China to treat post-stroke shoulder-hand syndrome, but the details are unclear. Therefore, this review aims to evaluate the true efficacy of acupuncture in patients with SHS.

Methods

We searched eight databases [PubMed, Embase, Web of Science, Cochrane library, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from its inception to March 2025, randomized controlled trials (RCTs) of SHS acupuncture treatment combined with rehabilitation (Rehab). Two investigators independently used pre-designed forms to extract valid data from eligible randomized controlled trials. Meta-analysis was implemented through the Rev. Man software (version 5.4). The strength of the evidence obtained was implemented using the GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.

Results

Forty-seven studies, involving 4,129 participants, met the eligibility criteria, and were included in the review. Overall meta-analysis showed that combined acupuncture rehabilitation significantly improved motor function (upper-limb Fugl-Meyer Assessment (FMA): 41 studies, mean difference (MD) 9.50, 95% confidence interval (CI) [8.47, 10.53]) and pain reduction (visual analog score (VAS): 37 studies, MD: -1.49, 95% CI [-1.66, -1.33]). It also improved activities of daily living (ADL) compared to rehabilitation alone (ADL: 17 studies, MD: 11.94, 95% CI [8.26, 13.63]). There was no significant difference in the occurrence of adverse events (AEs) between acupuncture treatment combined with Rehab and Rehab alone (p > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.

Conclusion

This review found that acupuncture treatment combined with Rehab treatment may have a positive promoting effect on improving motor function, reducing pain, and improving daily living ability in SHS patients. However, due to the existing methodological quality issues, our findings should be treated with caution. Future high-quality studies are urgently needed to validate our findings.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024536169.

Diagnostic Value of PET Tracers in Differentiating Glioma Tumor Recurrence from Treatment-Related Changes: A Systematic Review and Meta-Analysis

BACKGROUND

It is often difficult to identify treatment-related changes (TRC) from tumor progression (TP) in patients with glioma, and the current application of PET scanning is expected to improve the diagnosis.

PURPOSE

We used a systematic review and meta-analysis to reveal diagnostically more promising tracers by comparing the diagnostic accuracy of different PET tracers in identifying TRC and TP in patients with glioma.

DATA SOURCES

We searched PubMed, Web of Science, and EMBASE databases, and we selected studies that used PET scans to identify TP and TRC in patients with glioma.

STUDY SELECTION

Twenty-eight studies were identified based on the set criteria. The studies involved a total of 10 different tracers and 1405 patients. TP occurred in 67.4% (947) of patients, while TRC occurred in 32.6% (458) of patients.

DATA ANALYSIS

The sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of various PET tracers were calculated and summarized. Moreover, the diagnostic value of various tracers was compared.

DATA SYNTHESIS

This systematic review included 28 studies comparing 10 different PET tracers, including 18F-fluoro-deoxy-glucose FDG (18F-FDG), 11C methionine (11C -MET), 18F-fuoroethyl-L-tyrosine (18F-FET), 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (18F-FDOPA), 18F-fluorothymidine (18F-FLT), 18F-PSMA-1007, 68Ga-PSMA-11, 18F-choline (18F-CHO), 18F-fluciclovine, and [11]C-Alpha-Methyl-Tryptophan(11C-AMT). The results revealed that 11C-MET exhibited the highest diagnostic value, with an overall sensitivity and specificity of 0.89 [0.85, 0.93] and 0.91 [0.84, 0.99], respectively. Although the number of 18F-FDOPA studies is limited, it exhibited high diagnostic value, with an overall sensitivity and specificity of 1.00 [0.91, 1.00] and 0.92 [0.75, 0.99], respectively.

LIMITATIONS

Most studies consisted of small sample sizes; however, the included studies differed to some extent regarding the reference standard for the final diagnosis and the standard of care. Additionally, most selected studies were retrospective.

CONCLUSIONS

Amino acid-based tracers exhibited the highest diagnostic value in identifying TRC and TP in gliomas, with 11C-MET and 18F-FDOPA having the most notable advantages. Research on other new tracers is limited, therefore, further studies are needed to prove their diagnostic value.

Meta-analysis of altered gray matter volume in acute lymphoblastic leukemia patients' postchemotherapy via the AES-SDM

BACKGROUND

Voxel-based morphometry (VBM) reveals diverse alterations in gray matter volume in acute lymphoblastic leukemia (ALL) patients after chemotherapy. However, the reported results are inconsistent. Therefore, our objective was to conduct a meta-analysis to synthesize findings from existing VBM studies and identify consistent patterns of altered gray matter volume in ALL patients post-chemotherapy.

MATERIALS AND METHODS

A systematic search was conducted across PubMed, Web of Knowledge, Embase, Google Scholar, and CNKI for VBM studies that compared ALL patients post-chemotherapy with healthy controls (HCs) up to April 1, 2024. Significant cluster coordinates were extracted for comprehensive analysis.

RESULTS

We included 7 studies involving 143 ALL patients post-chemotherapy and 140 HCs. ALL patients who underwent chemotherapy presented decreased gray matter volume in the left caudate nucleus, left calcarine fissure/surrounding cortex, left precentral gyrus and right anterior thalamic projections. Jackknife sensitivity analysis validated the robustness of these findings.

CONCLUSIONS

This meta-analysis revealed consistent gray matter volume alterations in ALL patients post-chemotherapy, emphasizing the need to explore their underlying mechanisms and long-term effects on cognitive and neurological health.

Palliative care with negative pressure wound therapy application in malignant wounds: a systematic review

OBJECTIVE

To synthesise and appraise the evidence for and benefits of palliative application of negative pressure wound therapy (NPWT) in malignant wounds.

METHOD

We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). MEDLINE, Embase, Cochrane Library and trial registers (www.clinicaltrials.gov) from inception to 1 June 2021 were searched. Quality was assessed using the tool of methodological quality and synthesis from the 2018 BMJ Evidence-Based Medicine article on case series and case report synthesis.

RESULTS

Of 765 articles screened, 14 eligible studies were included in the review. All were case reports and included a total of 22 patients. The mean age of the patients was 60.7 (range: 33-77) years. The location of the hard-to-heal wounds was widely distributed: five wounds on the scalp; three wounds over the anogenital area; and the remaining wounds on the trunk and extremities. The reported outcomes included: improvement of wound healing; decreased exudation and malodour of the wound; decreased pain sensation; eligibility for further treatment; and a shift to the homecare system.

CONCLUSION

The findings of this study suggested NPWT could be a choice in palliative care for patients with malignant wounds. However, more studies are needed to evaluate the efficacy of NPWT in these wounds.

Reporting and Methodological Qualities of Systematic Reviews in Rehabilitation Journals After 2020: A Cross-Sectional Meta-Epidemiological Study

OBJECTIVES

The aim of this study was to investigate the reporting and methodological qualities in systematic reviews (SRs) of rehabilitation journals following updating to the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.

METHODS

SRs with pairwise meta-analyses on the effects of health interventions were selected, which were published in rehabilitation journals in 2020, 2021, and 2022 using MEDLINE (PubMed). Exposure was defined as reporting use of the PRISMA 2020 statement. A comparison group consisted of SRs that did not use the PRISMA 2020 statement. The adherence of the PRISMA 2020 items, PRISMA 2020 for abstracts, and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 items were evaluated.

RESULTS

Thirteen thousand, three hundred eighty-one articles were identified after conducting a search on April 2, 2023. The study included 100 articles each that used and those that did not use the PRISMA 2020 statement. Of 41 items in the PRISMA 2020 statement, 48.8% (20/41) adhered to ≥80% of each item for those that used the PRISMA 2020 statement and 41.5% (17/41) in those that did not use the PRISMA 2020 statement. The PRISMA 2020 statement did not lead to any major improvement, and only a slight improvement of 9.8% (4/41) was observed when compared with those that did not use the PRISMA 2020 statement. Similarly, no item improved in the PRISMA 2020 for abstracts, and only 5.6% (1/18) improved in the AMSTAR 2 items.

CONCLUSION

This study showed that reporting use of the PRISMA 2020 statement did not result in any major improvements; however, only a slight improvement was observed in the reporting and methodological qualities of SRs in rehabilitation journals. Researchers should adhere to each item in the PRISMA 2020 statement in SRs published in rehabilitation journals.

IMPACT

The reporting and methodological quality of systematic reviews in rehabilitation journals is insufficient. It is important to improve the reporting and methodological quality of systematic reviews in rehabilitation journals. It is recommended that researchers not only declare their reporting use of the PRISMA 2020 statement, but also adhere to each item correctly.

Efficacy and safety of oral anticoagulants in patients with atrial fibrillation and acute myocardial infarction: a systematic review and meta-analysis

BACKGROUND

The optimal antithrombotic therapy strategies for patients with atrial fibrillation (AF) and acute myocardial infarction (AMI) remain uncertain. We aimed to evaluate the efficacy and safety of oral anticoagulants (OAC) among patients with AF and AMI.

METHODS

PubMed, Embase, and Web of Science were searched from inception till 5 February 2025. The primary outcome was any stroke.

RESULTS

Eleven studies with 83 549 patients were included. OAC therapy was associated with lower risks of any stroke (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.60-0.77; P < .001), ischemic stroke (OR: 0.64; 95% CI: 0.57-0.73; P < .001), and all-cause mortality (OR: 0.81; 95% CI: 0.74-0.89; P < .001). Additionally, OAC therapy was associated with a higher risk of any bleeding (OR: 1.24; 95% CI: 1.06-1.46; P = .009), but not for major bleeding (OR: 1.28; 95% CI: 0.87-1.90; P = .21).

CONCLUSIONS

OAC therapy is effective for patients with AF and AMI, but should be administered cautiously in those at high bleeding risk.