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

Faecal intestinal permeability and intestinal inflammatory markers in older adults with age-related disorders: A systematic review and meta-analysis

This systematic review and meta-analysis appraised previous findings to uncover potential faecal intestinal permeability and intestinal inflammatory markers in older adults. A comprehensive literature search led to the identification of ten eligible studies with findings of potential faecal intestinal permeability (zonulin and alpha-1-antitrypsin) and intestinal inflammatory markers [calprotectin, lactoferrin and neutrophil gelatinase-associated lipocalin (NGAL)]. Most of the cases (n > 2) [Parkinson's disease (PD) and Alzheimer's disease (AD)] exhibited higher faecal alpha-1-antitrypsin, zonulin and calprotectin levels. The present meta-analysis confirmed significantly higher faecal alpha-1-antitrypsin in older persons with PD compared to non-PD [MD = 22.92 mg/dL; 95 % CI = 14.02-31.81, p < 0.00001; I2 = 0 % (p = 0.73)]. There was, however, no significant difference in faecal zonulin between PD and non-PD individuals [MD = 26.88 ng/mL; 95 % CI = -29.26-83.01, p = 0.35; I2 = 94 % (p < 0.0001)]. Meanwhile, faecal calprotectin was higher in older adults with GI symptoms, multiple system atrophy (MSA) or PD than the healthy controls [MD = 9.51 μg/g; 95 % CI = 0.07-18.95, p = 0.05; I2 = 84 % (p < 0.00001)]. Altogether, faecal calprotectin appears to be a potential intestinal inflammatory marker whereas previous findings on faecal alpha-1-antitrypsin as an intestinal permeability marker remain limited and require further validation.

Open vs robotic-assisted pancreaticoduodenectomy, cost-effectiveness and long-term oncologic outcomes: a systematic review and meta-analysis

BACKGROUND

Whipple pancreaticoduodenectomy (PD) is a complex gastrointestinal surgery that is performed increasingly via minimally invasive approach through robotic platforms. We sought to provide a comparative review of available data regarding robot-assisted vs open PD in terms of cost-effectiveness, overall survival, and other perioperative and long-term oncologic outcomes.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, PubMed, Scopus, and Web of Science databases were searched from 1980 to April 2024 using designated keywords. English-language studies comparing costs and oncologic outcomes of robotic vs open PDs were considered for inclusion. Reviews, abstracts, case reports, letters to the editor, and non-English articles were excluded.

RESULTS

A total of 1733 studies were initially identified throughout the literature search. After the removal of duplicates, title and abstract screening identified 16 studies that were included in the review. No statistically significant differences were detected in terms of short-term complications (95% CI, 0.805-1.096; P = .42), mortality (95% CI, 0.599-1.123; P = .21), and readmission (95% CI, 0.959-1.211; P = .20) among patients undergoing open vs robotic PD. Robotic PDs was associated with a slightly better overall survival (95% CI, 1.020-1.233) and higher costs (95% CI, 0.134-1.139; P = .013). Mean length of stay (LOS) was higher in the open PD group (95% CI, -0.353 to 0.189; P < .001).

CONCLUSION

Robotic-assisted PD had a slightly shorter LOS and improved overall survival. There were no differences in short-term complications, mortality, or readmission. The use of cohort studies and residual potential selection bias necessitate randomized controlled trials to define the benefit of robotic PD.

Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis of cohort studies

STUDY OBJECTIVE

The association between early childhood exposure to general anesthesia and subsequent risk of developing attention-deficit/hyperactivity disorder remains unknown.

DESIGN

A systematic review and meta-analysis of cohort studies.

PATIENTS

Children undergoing general anesthesia.

INTERVENTIONS

A comparison of any type of general anesthesia exposure, including total intravenous anesthesia, inhalation general anesthesia, and combined intravenous and inhaled anesthesia, with non-anesthetic exposures, which did not receive any exposure to anesthetic drugs, including general anesthetics as well as local anesthetics.

MEASUREMENTS

The primary outcome measure was the risk of developing attention-deficit/hyperactivity disorder after general anesthesia exposure.

MAIN RESULTS

The results of the overall meta-analysis showed an increased risk of subsequent attention-deficit/hyperactivity disorder in children exposed to general anesthesia (RR = 1.26, 95% CI, 1.16-1.38; P < 0.001; I2 = 44.6%). Subgroup analysis found that a single exposure to general anesthesia in childhood was associated with an increased risk of developing attention-deficit/hyperactivity disorder (RR = 1.29, 95% CI, 1.19-1.40, P < 0.001; I2 = 2.6%), and the risk of attention-deficit/hyperactivity disorder was further increased after multiple general anesthesia exposures (RR = 1.61, 95% CI, 1.32-1.97, P < 0.001; I2 = 57.6%). Exposure to general anesthesia lasting 1-60 min during childhood is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (RR: 1.38, 95% CI: 1.26-1.51, P < 0.001; I2 = 0.0%). Moreover, with longer durations of exposure (61-120 min), the risk further rises (RR: 1.55, 95% CI: 1.21-1.99, P = 0.001; I2 = 37.8%). However, no additional increase in ADHD risk was observed with exposures exceeding 120 min (RR: 1.55, 95% CI: 1.35-1.79, P < 0.001; I2 = 0.0%).

CONCLUSIONS

Exposure to general anesthesia during early childhood increases the risk of developing attention-deficit/hyperactivity disorder. In particular, multiple general anesthesia exposures and exposures longer than 60 min significantly increase the risk of developing ADHD.

A Systematic Review and Meta-analysis of the Impact of the COVID-19 Pandemic on Access to HIV Pre-exposure Prophylaxis: Lessons for Future Public Health Crises

BACKGROUND

The World Health Organization is committed to strengthening access to pre-exposure prophylaxis (PrEP) for HIV prevention and its integration into primary care services. Unfortunately, the COVID-19 pandemic has disrupted the delivery of primary care, including HIV-related services. To determine the extent of this disruption, we conducted a systematic review and meta-analysis of the changes in access to PrEP services during the pandemic and the reasons for these changes.

METHODS

A search was conducted using PubMed, Scopus, Embase, PsycINFO, and Cinahl for studies published between January 2020 and January 2023. Selected articles described self-reported disruptions to PrEP service access associated with the COVID-19 pandemic or its responses. Pooled effect sizes were computed using a random-effects model.

RESULTS

Thirteen studies involving 12,652 PrEP users were included in our analysis. The proportion of participants reporting a disruption in access to PrEP services during the COVID-19 pandemic ranged from 3% to 56%, with a pooled proportion of 21% (95% confidence intervals: 8% to 38%). Social restrictions, financial constraints, and limited health insurance coverage were key factors affecting access to PrEP services during the pandemic.

CONCLUSIONS

To our knowledge, this is the first meta-analysis to quantify the extent of disruptions to accessing PrEP services because of the COVID-19 pandemic. To increase the ability of primary care services to maintain PrEP services during public health crises, a mixture of strategies is worth considering. These include multi-month PrEP prescriptions, telehealth services, deployment of peer support groups to provide a community-based service or home delivery, and provision of financial support interventions.

The effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference.

RESULTS

Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO2, mean difference [MD] (2.66 mL/kg/min; 95% confidence interval [CI] 1.48, 3.83; p < 0.00001); the 6-min walk (MD 58.83 m; 95% CI 35.26, 82.41; p < 0.00001), timed up and go (standardised mean difference - 0.35; 95% CI - 0.54, - 0.15; p = 0.0006), 2-min step (MD 57.48 steps; 95% CI 27.80, 87.16; p = 0.0001), and sit to stand tests (MD 4.55 repetitions; 95% CI 1.49, 7.60; p = 0.004); short form [SF]-36 general health (MD 4.26; 95% CI 0.04, 8.47; p = 0.05); SF-36 mental component summary (MD 1.84; 95% CI 0.18, 3.51; p = 0.03); estimated glomerular filtration rate (MD 2.19 mL/min/1.73 m2; 95% CI 0.97, 3.50; p = 0.001); serum cystatin-C (MD - 0.06 mg/L; 95% CI - 0.11, - 0.02; p = 0.004); resting heart rate (MD - 1.97 bpm; 95% CI - 3.84, - 0.11; p = 0.04); triglycerides (MD - 12.97mg/dL; 95% CI - 17.30, - 8.63; p < 0.00001); glycosylated haemoglobin (MD - 0.25%; 95% CI - 0.50, - 0.01; p = 0.04); waist circumference (MD - 3.12 cm; 95% CI - 4.37, - 1.86; p < 0.00001); and interleukin-6 (MD - 2.24 pg/mL; 95% CI - 3.87. - 0.61; p = 0.007).

CONCLUSIONS

Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.

Risk and protective factors of youth crime: An umbrella review of systematic reviews and meta-analyses

INTRODUCTION

Several systematic reviews and meta-analyses have been conducted on the risk and protective factors of youth crime. This study aims to consolidate this evidence using an umbrella review methodology.

METHODS

A systematic electronic search was conducted using multiple electronic databases. Strength of associations was evaluated using quantitative umbrella review criteria, and AMSTAR was used to assess the quality of the studies.

RESULTS

Among the 58 factors identified, 11 factors were supported by highly suggestive or suggestive evidence. Evidence of association was highly suggestive (class II) for substance use (odds ratio [OR] = 2·29, 95%CI 1·58-3.01), previous history of crime (OR = 2·03, 95%CI 1·62-2·45), moral development (OR = 3·98, 95%CI 3·57-4·39), psychopathology (OR = 2·22, 95%CI 1.40-2.69), adverse childhood experiences (OR = 1·37, 95%CI = 1·36-1·38), poor parental supervision (OR = 1·85, 95%CI 1·83-1·87), maltreatment or neglect (OR = 1·34, 95%CI 1·08-1·65), attachment (OR = 1·94; 95%CI 1.93-1·95), and school bullying (OR = 2·50; 95%CI 2·03-3·08); and suggestive (class III) for peer pressure (OR = 2·11, 95%CI 2·06-2·16) and supportive school environments (OR = 0·56; 95%CI 0·55-0·57).

CONCLUSION

The evidence-based atlas of key risk and protective factors identified in this umbrella review could be used as a benchmark for advancing research, prevention, and early intervention strategies for youth crime.

Long-term survival following adrenalectomy for secondary adrenal tumors: A systematic review and meta-analysis

BACKGROUND

Secondary adrenal tumors (SATs) are uncommon, and the benefits of adrenalectomy for SATs have not been well-established. A systematic review and meta-analysis were conducted to assess the survival benefits of adrenalectomy for SATs.

METHOD

ology: A systematic literature search was performed (1990-2022). The inclusion criteria included a known primary tumor with confirmed adrenal metastasis in patients who underwent adrenalectomy. The primary outcome was the overall survival (OS).

RESULTS

A total of 26 studies were included, with 2279 patients. The average age at the time of diagnosis was 61.1 years. Lung cancer was the most common primary tumor. The average time from primary tumor diagnosis to identification of adrenal metastasis was 17 months. The median OS was 35.2 months. One, three, and five-year OS were 79.7 ​%, 49.1 ​%, and 37.9 ​%, respectively.

CONCLUSION

The results of this review provide insight into the long-term survival of patients with SATs who underwent adrenalectomy. The study highlights the need for further research to identify the risk factors that play a role in the outcome of adrenalectomy in patients with SATs.

Living systematic review and comprehensive network meta-analysis of ALS clinical trials: study protocol

INTRODUCTION

Amyotrophic lateral sclerosis (ALS) is a fatal neurogenerative disease with no effective treatment to date. Despite numerous clinical trials, the majority of studies have been futile in their effort to significantly alter the course of the disease. However, these studies may still provide valuable information for identifying patient subgroups and generating new hypotheses for future research. Additionally, synthesising evidence from these studies may help overcome the limitations of individual studies. Network meta-analysis may refine the assessment of efficacy in specific patient subgroups, evaluate intervention characteristics such as mode of administration or biological mechanisms of action, and rank order promising therapeutic areas of interest. Therefore, we aim to synthesise the available evidence from ALS clinical trials.

METHODS AND ANALYSIS

We will conduct a systematic review to identify all clinical trials that assessed disease-modifying pharmaceutical therapies, cell therapies, or supplements in patients with ALS. Outcomes of interest are clinical disease progression outcomes and survival. We will conduct this search in the period Q4 2024 in three databases: PubMed, Embase and ClinicalTrials.gov for studies from 1999 to 2023. Individual patient data and aggregate data will be collected and subsequentially synthesised in meta-analytical models. The final model will be presented as an open-source web application with biannual updates of the underlying data, thereby providing a 'living' overview of the ALS clinical trial landscape.

ETHICS AND DISSEMINATION

No ethics approvals are required. Findings will be presented at relevant conferences and submitted to peer-reviewed journals. Data will be stored anonymously in secure repositories.

Intima media thickness of the carotid artery in primary antiphospholipid syndrome: A systematic review and meta-analysis

BACKGROUND

Primary antiphospholipid syndrome (PAPS) has been associated with an increase in clinical events associated with atherosclerotic vascular disease. Intima media thickness (IMT) of carotid arteries is a surrogate marker of atherosclerotic vascular disease.

OBJECTIVES

To conduct a systematic review and meta-analysis of studies evaluating IMT and their clinical correlates in PAPS.

METHODS

Systematic search of EMBASE and PubMed databases from January 2000 to December 2023; we employed random effect meta-analyses for continuous outcomes and Peto's odds ratio for rare events.

RESULTS

The meta-analysis included 21 studies (20 case control and 1 cohort) showing that PAPS patients (n = 1103) had thicker IM than controls (n = 832) (p < 0.0001) with wide heterogeneity (I2 = 86.9 %); PAPS patients (n = 782) also had a greater pooled prevalence of carotid plaques than controls (n = 537) (13.1 % vs 2.97 %, p < 0.0001). A sensitivity analysis by meta-regression indicated that mean age, gender, disease duration, lipid profile, blood pressures, smoking and statin use all explained the heterogeneity variance; a sensitivity analysis by subgroups confirmed smoking status and statin use as explanatory variables with the addition of ethnicity.

CONCLUSION

Atherosclerosis of the carotid artery represents a clinical feature of PAPS in relation to the traditional risk factors and to statin use. Minimising the atherogenic risk with statins could reduce the late arterial atherothrombotic risks of PAPS.

Effectiveness of interventions to increase physical activity in adults with SCI: a systematic review and meta-analysis

PURPOSE

To determine the effectiveness of interventions to increase physical activity (PA) in people with spinal cord injury (SCI).

METHOD

Online databases PubMed, Medline, AMED and CINAHL were searched from the earliest date available to July 2022. Randomised controlled trials (RCT) exploring the effect of interventions on physical activity in people with SCI were eligible. The search identified 1191 studies, after screening 16 reports of 15 RCT's were included. Data were extracted on participant characteristics, intervention characteristics and physical activity outcomes. Methodological quality was assessed using the PEDro Scale and certainty of evidence assessed using GRADE. Post intervention means and standard deviations were pooled in meta-analyses to calculate standardised mean differences or mean differences and 95% confidence intervals.

RESULTS

Fifteen trials with 693 participants (mean age 41-52) were included. There was moderate certainty evidence that exercise interventions had no effect on subjectively or objectively measured PA. There was moderate to high certainty evidence that behavioural interventions and combined behavioural and exercise interventions increased subjectively, but not objectively measured physical activity.

CONCLUSION

Behaviour change techniques are an important intervention component for increasing PA in people with SCI.

From the Individual to the Group: Using Idiographic Analyses and Two-Stage Random Effects Meta-Analysis to Obtain Population Level Inferences for within-Person Processes

In psychology, the use of portable technology and wearable devices to ease participant burden in data collection is on the rise. This creates increased interest in collecting real-time or near real-time data from individuals within their natural environments. As a result, vast amounts of observational time series data are generated. Often, motivation for collecting this data hinges on understanding within-person processes that underlie psychological phenomena. Motivated by the body of Dr. Peter Molenaar's life work calling for analytical approaches that consider potential heterogeneity and non-ergodicity, the focus of this paper is on using idiographic analyses to generate population inferences for within-person processes. Meta-analysis techniques using one-stage and two-stage random effects meta-analysis as implemented in single-case experimental designs are presented. The case for preferring a two-stage approach for meta-analysis of single-subject observational time series data is made and demonstrated using an empirical example. This provides a novel implementation of the methodology as prior implementations focus on applications to short time series with experimental designs. Inspired by Dr. Molenaar's work, we describe how an approach, two-stage random effects meta-analysis (2SRE-MA), aligns with recent calls to consider idiographic approaches when making population-level inferences regarding within-person processes.

The effect of tobacco tax increase on price-minimizing tobacco purchasing behaviours: A systematic review and meta-analysis

BACKGROUND AND AIMS

Tobacco product excise taxes are a cost-effective method for reducing tobacco consumption, but industry pricing and marketing strategies encourage consumers to engage in price-minimizing behaviours (PMBs). We investigated the relationship between tobacco tax increases and PMBs, measuring whether PMBs intensify following tax increases, whether low-income consumers with higher nicotine dependence are more likely to engage in PMBs and whether PMBs are negatively related to smoking cessation.

METHOD

This was a systematic review with meta-analysis of cross-sectional and longitudinal studies from seven databases up to March 2023, using studies that reported any product- and purchasing-related smoking behaviours post-tobacco tax increase in a general representative population. Sixty-eight studies were quality-assessed using the Newcastle-Ottawa scale. All studies were narratively synthesized, with five studies involving 13 068-26 575 participants providing data for pooled analyses on PMBs [purchasing lower-priced brands, roll-your-own (RYO) tobacco and cartons] pre- and post-tax increases using a random effects meta-analytical model.

RESULTS

Fifty-seven studies reported on legal PMBs, and 17 studies reported illicit cigarette purchasing. Meta-analysis showed that consecutive tax increases were positively associated with purchasing RYO [odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.04-2.46], especially in higher tobacco taxing environments, with substantial heterogeneity (I2 = 96%). Lower income and higher nicotine dependence were associated with purchasing lower-priced brands and RYO, whereas higher income and nicotine dependence were associated with purchasing cartons, large-sized packs and cross-border sales. Less evidence associated illicit tobacco purchases with tax increases or PMBs with smoking cessation.

CONCLUSIONS

Tobacco purchasers' PMBs vary widely by state, country and time-period within countries. Both legal and illegal PMBs, potentially influenced by industry pricing tactics, may exacerbate health inequalities and dilute the public health benefits of tobacco tax increases.

Association analysis of mitochondrial DNA heteroplasmic variants: Methods and application

We rigorously assessed a comprehensive association testing framework for heteroplasmy, employing both simulated and real-world data. This framework employed a variant allele fraction (VAF) threshold and harnessed multiple gene-based tests for robust identification and association testing of heteroplasmy. Our simulation studies demonstrated that gene-based tests maintained an appropriate type I error rate at α = 0.001. Notably, when 5 % or more heteroplasmic variants within a target region were linked to an outcome, burden-extension tests (including the adaptive burden test, variable threshold burden test, and z-score weighting burden test) outperformed the sequence kernel association test (SKAT) and the original burden test. Applying this framework, we conducted association analyses on whole-blood derived heteroplasmy in 17,507 individuals of African and European ancestries (31 % of African Ancestry, mean age of 62, with 58 % women) with whole genome sequencing data. We performed both cohort- and ancestry-specific association analyses, followed by meta-analysis on both pooled samples and within each ancestry group. Our results suggest that mtDNA-encoded genes/regions are likely to exhibit varying rates in somatic aging, with the notably strong associations observed between heteroplasmy in the RNR1 and RNR2 genes (p < 0.001) and advance aging by the Original Burden test. In contrast, SKAT identified significant associations (p < 0.001) between diabetes and the aggregated effects of heteroplasmy in several protein-coding genes. Further research is warranted to validate these findings. In summary, our proposed statistical framework represents a valuable tool for facilitating association testing of heteroplasmy with disease traits in large human populations.

Treatment outcome and its predictors among children with epilepsy on chronic follow-up in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Seventy percent of epileptic patients may not experience seizures if they receive proper treatment with antiepileptic drugs (AEDs). However, many children and adolescents face poor seizure control (PSC). Therefore, the purpose of this review is to systematically and quantitatively summarize the pooled prevalence of PSC and its predictors among children with epilepsy in Ethiopia.

METHODS

The following databases were used to conduct a thorough literature search: Africa Journal of the Online Library, Hinari, Google Scholar, PubMed, Science Direct, EMBASE, Cochrane Database, Sci-Hub, and Scopus. To evaluate the quality of the studies, Newcastle‒Ottawa Scale (NOS) checklists were utilized. The data on study characteristics and prevalence estimates were then combined via random effects meta-analysis, followed by subgroup and sensitivity analyses. Both visual and statistical analyses were employed to assess for any potential publication bias.

RESULTS

This review analyzed a total of 12 main studies and reported that the overall prevalence of PSC was 42.42% (95% CI: 33.42-51.42). However, there was significant heterogeneity in the results based on the study region, design, and seizure-free period. The subgroup analysis revealed that the highest prevalence of PSC was found in Southern Nations, Nationalities, and Peoples' (SNNPs) studies (61.88%; 95% CI: 35.91-87.85), studies with a cross-sectional design (46.73%; 95% CI: 36.83-56.62), and studies with a seizure-free period < 6 months (44.69%; 95% CI: 34.51-54.86). However, the lowest prevalence was observed in the Amhara region (35.54%; 95% CI: 27.40-43.67), cohort studies (29.53%; 95% CI: 21.26-38.21), and studies with a seizure-free duration of six months or more (41.64%; 95% CI: 29.94-53.35). The results also revealed a significant correlation between PSC and medication nonadherence (4.64, 95% CI: 2.84-7.58), comorbidities (2.08, 95% CI: 1.01-4.26), and seizure type (3.59, 95% CI: 1.18-10.8).

CONCLUSION

Based on this review, the findings suggest a notable prevalence of poorly controlled seizures (PSC) among children with epilepsy who are receiving antiepileptic drugs (AEDs) in Ethiopian outpatient epilepsy clinics. Seizures of tonic‒clonic status, comorbidities, and medication nonadherence were associated with poor seizure control.

First-line therapy for high-risk people with chronic lymphocytic leukemia: a network meta-analysis

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective: to assess the benefits and harms of currently recommended regimens as the first-line therapy in high-risk people with chronic lymphocytic leukemia, using network meta-analysis Secondary objectives: to assess whether the benefits and harms of the recommended regimens differ according to sex, Rai stage, or genetic mutation status to estimate the ranking of treatments for overall survival, progression-free survival, objective response rate, complete response rate, minimal residual disease, and serious adverse events to estimate the overall rate of adverse events and serious adverse events.

Effectiveness and acceptability of different lifestyle interventions for women with polycystic ovary syndrome: protocol for a systematic review and network meta-analysis

INTRODUCTION

Women with polycystic ovary syndrome (PCOS) experience various metabolic, endocrine, reproductive and psychosocial manifestations. Lifestyle modification is crucial for the management of PCOS to reduce long-term complications. Nonetheless, the efficacy and acceptability of lifestyle interventions differs, and there are no uniform methods of clinical application. Hence, a systematic review and network meta-analysis (NMA) are needed to explore the efficacy and acceptability of lifestyle interventions to inform clinical practice.

METHODS AND ANALYSIS

Ten databases (Cochrane Gynaecology and Fertility Specialised Register, Cochrane Register of Studies Online, PubMed, EMBASE (Excerpta Medica Database), PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Chinese National Knowledge Infrastructure, WanFang, VIP, and Sinomed) and four clinical trial registry platforms will be searched to identify literature published in English or Chinese reporting results of randomised clinical trials conducted to evaluate the effects of lifestyle interventions for women with PCOS. The reference lists of the included studies will be manually searched. Primary outcomes will include biochemical and clinical hyperandrogenism, recruitment and retention rates. Secondary outcomes will encompass menstrual regularity, ovulation, anthropometry and quality of life. Literature selection and extraction of data will be performed independently by at least two researchers. An NMA random-effects model will be implemented for amalgamating evidence. All treatments will be ranked based on the value of p. OpenBUGS will be used for Bayesian modelling, with output verifications generated in Stata and R. The quality of evidence supporting network estimates of major outcomes will also be appraised using the Grading of Recommendations Assessment, Development, and Evaluation framework.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review as no data will be collected from human participants. Results will be presented in a peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42024499819.

Estimating reference intervals from an IPD meta-analysis using quantile regression

BACKGROUND

Reference intervals, which define an interval in which a specific proportion of measurements from a healthy population are expected to fall, are commonly used in medical practice. Synthesizing information from multiple studies through meta-analysis can provide a more precise and representative reference interval than one derived from a single study. However, the current approaches for estimating the reference interval from a meta-analysis mainly rely on aggregate data and require parametric distributional assumptions that cannot always be checked.

METHODS

With the availability of individual participant data (IPD), non-parametric methods can be used to estimate reference intervals without any distributional assumptions. Furthermore, patient-level covariates can be introduced to estimate personalized reference intervals that may be more applicable to specific patients. This paper introduces quantile regression as a method to estimate the reference interval from an IPD meta-analysis under the fixed effects model.

RESULTS

We compared several non-parametric bootstrap methods through simulation studies to account for within-study correlation. Under fixed effects model, we recommend keeping the studies fixed and only randomly sampling subjects with replacement within each study.

CONCLUSION

We proposed to use the quantile regression in the IPD meta-analysis to estimate the reference interval. Based on the simulation results, we identify an optimal bootstrap strategy for estimating the uncertainty of the estimated reference interval. An example of liver stiffness measurements, a clinically important diagnostic test without explicitly established reference range in children, is provided to demonstrate the use of quantile regression in estimating both overall and subject-specific reference intervals.

Association between gout and cancers: A systematic review and meta-analysis

BACKGROUND

This study aimed to investigate the association between gout and cancer risk.

METHODS

This study was registered with the Prospective Registry for International Systematic Reviews (ID: CRD42023465587). We searched PubMed, Embase, Scopus, Cochrane, and Web of Science databases for studies related to gout and cancer risk, with a timeframe from the date the database was created to September 2023. We assessed the methodological quality of the included studies using the Newcastle-Ottawa scale and assessed heterogeneity between studies using the I2 statistic. Depending on the heterogeneity, we calculated pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using fixed-effects or random-effects models. In addition, we performed sensitivity analyses and publication bias tests.

RESULTS

In this study, we conducted a meta-analysis of 6 studies encompassing a total of 1279,804 participants. Our analysis revealed that individuals with gout are at a heightened risk of developing cancer in general (HR = 1.18, 95% CI = 1.04-1.34, P < .001). Moreover, specific types of cancer displayed a significant correlation with gout, including gastric cancer (HR = 1.31, 95% CI = 1.07-1.62, P = .012), liver cancer (HR = 1.24, 95% CI = 1.01-1.52, P < .001), lung cancer (HR = 1.26, 95% CI = 1.03-1.53, P = .001), and bladder cancer (HR = 1.57, 95% CI = 1.02-2.41, P < .001). Furthermore, gout exhibited a marginally increased risk for other cancer types, such as head and neck cancer and esophageal cancer, although these associations did not attain statistical significance.

CONCLUSION

Our study suggests that gout is a risk factor for cancer, especially for stomach, liver, lung, and bladder cancers. Patients with gout have an increased risk of developing overall cancers, lung cancer, liver cancer, stomach cancer, and bladder cancer. However, more high-quality epidemiologic studies are needed to explore the association between gout and individual cancers more accurately.

Prevalence and determinants of prehospital delay among stroke patients in mainland China: A systematic review and meta-analysis of the study protocol

BACKGROUND

Prehospital delay is one of the most serious problems in the treatment of stroke patients. In China, although hospitals at all levels have promoted the construction of stroke centers, pre-hospital delays are still very common. As the primary cause of death and disability, stroke not only brings great harm to patients themselves, but also brings a heavy burden on social progress and economic development, it is important to understand the prevalence and determinants of prehospital delay among stroke patients. Therefore, this review aims to determine the pooled prevalence and determinants of prehospital delay in mainland China.

METHODS

A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive literature search will be conducted in PubMed, Embase, Cochrane, web of science, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu (VIP) and Chinese Biomedicine Iiterature databas (CBM) databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS). The pooled prevalence of prehospital delay, and odds ratio and their 95% confidence intervals for relevant influencing factors, will be calculated using RevMan 5.3 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins's I2 test statistics and Cochran's Q-statistics. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be evaluated by funnel chart and by Egger's regression test. This review protocol has been registered PROSPERO (CRD42023484580).

DISCUSSION

By collecting and summarizing information on prehospital delay among stroke patients can be a step towards a better understanding of the prevalence of prehospital delay among stroke patients in mainland China and how the associated factors influence the prevalence of prehospital delay. Therefore, a rapid, accurate diagnosis Stroke, timely pre-hospital first aid, the treatment process forward, for the patient It has great significance. This summarized finding at the national level will provide new clues for intervention to reduce the rate of pre-hospital delay of stroke patients, and is expected to further improve the treatment effect of stroke patients.

Prevalence of caregiver hesitancy for vaccinations in children and its associated factors: A systematic review and meta-analysis

This review aimed to systematically compare and pool the prevalence of all the known evidence on caregiver hesitancy and to describe the factors influencing vaccine hesitancy among caregiver worldwide such as COVID-19, MMR, Influenza, HPV and others. We searched article from few electronic databases (PubMed, CENTRAL, ProQuest, and Web of Science) from inception to August 2023 using specific keywords for example caregiver, parents, prevalence, factor, hesitancy, and others. We included population-based studies that reported the prevalence of caregiver hesitancy. We used random-effects meta-analyses for pool prevalence estimates of caregiver hesitancy. A total of 765 studies met our inclusion criteria, containing data on 38,210,589 caregivers from seven regions across the globe. Overall or pool prevalence of vaccine hesitancy among caregiver is 25.0% (95% CI: 0.22-0.27, I2 = 99.91%, p = 0.001). Based on the evidence gathered, vaccine hesitancy was found to be religious sentiments, personal beliefs, perceived safety concerns, and a desire for more information from healthcare providers, along with factors related to availability, accessibility, affordability, and acceptability of vaccinations. Vaccine safety and efficiency have been identified as the main factor for caregiver vaccine hesitancy globally with a prevalence of 91.4%. Trial registration PROSPERO registration number: CRD42022331629. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022331629.

Dupuytren's disease and occupational mechanical exposures: a systematic review and meta-analysis

The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I2=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I2=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I2=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.

Inappropriate ceftriaxone utilization and predictor factors in Ethiopia: a systematic review and meta-analysis

Ceftriaxone stands as a cornerstone in global antibiotic therapy owing to its potent antibacterial activity, broad spectrum coverage, and low toxicity. Nevertheless, its efficacy is impeded by widespread inappropriate prescribing and utilization practices, significantly contributing to bacterial resistance. The aim of this study is to determine the overall national pooled prevalence of inappropriate ceftriaxone utilization and its predictor factors in Ethiopia. A systematic search was conducted across multiple databases including, PubMed, Science Direct, Hinari, Global Index Medicus, Scopus, Embase, and a search engine, Google Scholar, to identify relevant literatures that meet the research question, from March 20 to 30, 2024. This meta-analysis, which was conducted in Ethiopia by incorporating 17 full-text articles, unveiled a national pooled inappropriate ceftriaxone utilization of 55.24% (95% CI, 42.17%, 68.30%) with a substantial heterogeneity index (I2 = 99.24%, p value < 0.001). The review has also identified predictive factors for the inappropriate use of ceftriaxone: empiric therapy (AOR 21.43, 95% CI; 9.26-49.59); multiple medication co-prescription (AOR: 4.12, 95% CI; 1.62-8.05). Emergency ward (AOR: 4.22, 95% CI; 1.8-12.24), surgery ward (AOR: 2.6, 95% CI; 1.44-7.82) compared to medical ward, prophylactic use (AOR: 500, 95% CI; 41.7-1000), longer hospital stay-8-14 Days; (AOR: 0.167, 95% CI; 0.09-0.29), > 14 days; (AOR: 0.18, 95% CI; 0.1-0.32). The study reveals a high national pooled prevalence of inappropriate ceftriaxone utilization, standing at 55.24%, highlighting a significant hazard in the use of this antibiotic. This could be attributed to instances of overuse, misuse or prescription practices that deviates from established guidelines. This eminent challenge can lead to the development of antibiotic resistance, increased healthcare costs, adverse drug reactions, and treatment failures, necessitating multifaceted approach such as improved antibiotic stewardship, better adherence to guidelines, and enhanced clinician education on appropriate antibiotic use.

Vitamin D association with systemic sclerosis and its clinical features: A systematic review, meta-analysis, and meta-regression

Objectives

The aim of this review was to summarize existing data on the contribution of Vitamin D level and/or deficiency/insufficiency to systemic sclerosis susceptibility and its clinical features.

Methods

An electronic literature search for eligible studies among all papers published prior to 30 June 2024 was conducted through PubMed, EMBASE, Web of science, and Scopus databases. Meta-analyses estimating pooled raw mean differences, odds ratios, and Pearson r together with subgroup analyses and meta-regressions were performed for the association of Vitamin D with susceptibility to systemic sclerosis and disease presentation.

Results

Combined analysis revealed a significant decrease in Vitamin D level in systemic sclerosis patients comparatively to healthy controls, with raw mean differences 95% CI = -11.68 [-15.43 to -7.92] ng/mL, p < 1 E-10. Likewise, Vitamin D insufficiency (Vitamin D < 30 ng/mL) and deficiency (<10 ng/mL) were significantly associated with systemic sclerosis; odds ratios 95% CI = 3.58 [2.59-4.95], p < 1 E-10 and odds ratios 95% CI = 7.67 [3.97-14.83], p < 1 E-10, respectively. Moreover, decreased Vitamin D level was significantly associated with interstitial lung disease occurrence (raw mean differences 95% CI = -3.61 [-6.93 to -0.3], p = 0.003), while Vitamin D deficiency was associated with increased systolic pulmonary arterial pressure, raw mean differences (95% CI = 4.17 [1.44-6.89], p = 0.003). Besides, Vitamin D level was negatively correlated with the modified Rodnan skin score, r (95% CI = -0.26 [-0.44 to -0.08], p = 0.004). Conversely, Vitamin D level was significantly increased in systemic sclerosis patients with cutaneous calcinosis, raw mean differences (95% CI = 4.18 [1.07-7.28], p = 0.008).

Conclusion

This meta-analysis showed that decreased Vitamin D level was associated with susceptibility to systemic sclerosis, interstitial lung disease occurrence, increased systolic pulmonary arterial pressure, and higher modified Rodnan skin score. Conversely, calcinosis was found to be associated with increased Vitamin D level.

Registration

This review has been registered on PROSPERO: CRD42024565045, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024565045.

Interventions to reduce opioid use for patients with chronic non-cancer pain in primary care settings: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings.

METHODS

In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from inception to December 28th 2021, and updated on Dec 14th 2023 for randomized controlled trials (RCTs) and cohort studies with no restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs and Newcastle Ottawa Scale for cohort studies. Primary outcomes included mean reduction in morphine equivalent daily dose (reported as mean differences [MDs] mg/day; 95% confidence intervals [95%CIs]) and/or opioid cessation proportion. Secondary outcomes were mean changes in pain severity (reported as standardized mean difference [SMDs]; 95%CIs) and (serious) adverse events. Meta-analyses were performed using random-effects models.

RESULTS

We identified 3,826 records, of which five RCTs (953 participants) and five cohort studies (901 participants) were included. Overall, opioid dosage was significantly reduced in intervention groups compared to controls (MD: -28.63 mg/day, 95%CI: -39.77 to -17.49; I2 = 31.25%; eight studies). Subgroup analyses revealed significant opioid dose reductions with mindfulness (MD: -29.36 mg/day 95%CI: -40.55 to -18.17; I2 = 0.00%; two trials) and CBT-based multimodalities (MD: -41.68 mg/day; 95%CI: -58.47 to -24.89; I2 = 0.00%; two cohort studies), respectively, compared to usual care. No significant differences were observed in opioid cessation (Odds ratio: 1.10, 95%CI: -0.48 to 2.67, I2 = 58.59%; two trials) or pain severity (SMD: -0.13, 95%CI: -0.37 to 0.11; I2 = 33.51%; three trials). Adverse events were infrequently examined, with withdrawal symptoms commonly reported.

CONCLUSIONS

The studied interventions were effective in reducing opioid dosage for people with CNCP in primary care. They highlighted the importance of multidisciplinary collaboration. Large-scale RCTs measuring the long-term effects and cost of these interventions are needed before their implementation.

Systematic review and meta-analysis of the association between ABCA7 common variants and Alzheimer's disease in non-Hispanic White and Asian cohorts

Background and aims

The relationship between the ABCA7 gene and Alzheimer's disease (AD) has been widely studied across various populations. However, the results have been inconsistent. This meta-analysis aimed to evaluate the association of ABCA7 polymorphisms with AD risk, including specific subtypes such as late-onset Alzheimer's disease (LOAD).

Methods

Relevant studies were identified through comprehensive database searches, and the quality of each study was assessed using the Newcastle-Ottawa Scale (NOS). Allele and genotype frequencies were extracted from the included studies. The pooled odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated using random-effects or fixed-effects models. Multiple testing corrections were conducted using the false discovery rate (FDR) method. The Cochran Q statistic and I2 metric were used to evaluate heterogeneity between studies, while Egger's test and funnel plots were employed to assess publication bias.

Results

A total of 36 studies, covering 21 polymorphisms and involving 31,809 AD cases and 44,994 controls, were included in this meta-analysis. NOS scores ranged from 7 to 9, indicating high-quality studies. A total of 11 SNPs (rs3764650, rs3752246, rs4147929, rs3752232, rs3752243, rs3764645, rs4147934, rs200538373, rs4147914, rs4147915, and rs115550680) in ABCA7 were significantly associated with AD risk. Among these SNPs, two (rs3764650 and rs3752246) were also found to be related to the late-onset AD (LOAD) subtype. In addition, two SNPs (rs4147929 and rs4147934) were associated with the susceptibility to AD only in non-Hispanic White populations. A total of 10 SNPs (rs3764647, rs3752229, rs3752237, rs4147932, rs113809142, rs3745842, rs3752239, rs4147918, rs74176364, and rs117187003) showed no significant relationship with AD risk. Sensitivity analyses confirmed the reliability of the original results, and heterogeneity was largely attributed to deviations from Hardy-Weinberg equilibrium, ethnicity, and variations between individual studies.

Conclusion

The available evidence suggests that specific ABCA7 SNPs may be associated with AD risk. Future studies with larger sample sizes will be necessary to confirm these results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42024540539.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BACKGROUND

Preventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.

METHODS

A systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.

RESULTS

A total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.

CONCLUSIONS

Pooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

The Risk of SARS-CoV-2 Transmission in Community Indoor Settings: A Systematic Review and Meta-analysis

BACKGROUND

Quantifying the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in indoor settings is crucial for developing effective non-vaccine prevention strategies and policies. However, summary evidence on the transmission risks in settings other than households, schools, elderly care, and health care facilities is limited. We conducted a systematic review to estimate the secondary attack rates (SARs) of SARS-CoV-2 and the factors modifying transmission risk in community indoor settings.

METHODS

We searched Medline, Scopus, Web of Science, WHO COVID-19 Research Database, MedrXiv, and BiorXiv from 1 January 2020 to 20 February 2023. We included articles with original data for estimating SARS-CoV-2 SARs. We estimated the overall and setting-specific SARs using the inverse variance method for random-effects meta-analyses.

RESULTS

We included 34 studies with data on 577 index cases, 898 secondary cases, and 9173 contacts. The pooled SAR for community indoor settings was 20.4% (95% confidence interval [CI], 12.0%-32.5%). The setting-specific SARs were highest for singing events (SAR, 44.9%; 95% CI, 14.5%-79.7%), indoor meetings and entertainment venues (SAR, 31.9%; 95% CI, 10.4%-65.3%), and fitness centers (SAR, 28.9%; 95% CI, 9.9%-60.1%). We found no difference in SARs by index case, viral, and setting-specific characteristics.

CONCLUSIONS

The risk of SARS-CoV-2 transmission was highest in indoor settings where singing and exercising occurred. Effective mitigation measures such as assessing and improving ventilation should be considered to reduce the risk of transmission in high-risk settings. Future studies should systematically assess and report the host, viral, and setting-specific characteristics that may modify the transmission risks of SARS-CoV-2 and other respiratory viruses in indoor environments.

Effectiveness of artificial reefs in enhancing phytoplankton community dynamics: A meta-analysis

Artificial reefs (ARs) are widespread globally and play a positive role in enhancing fish communities and restoring habitat. However, the effect of ARs on phytoplankton, which are fundamental to the marine food chain, remains inconclusive. Conducting a literature review and meta-analysis, this study investigates how ARs influence phytoplankton community dynamics by comparing the biomass, density, and diversity of phytoplankton between ARs and natural water bodies across varying deployment durations, constituent materials, and climatic zones. The study findings suggest that, overall, ARs enhance the biomass, density, and diversity of phytoplankton communities, with no significant differences observed compared to natural water bodies. The enhancement effect of ARs on phytoplankton communities becomes progressively more pronounced with increasing deployment time, with the overall status of phytoplankton communities being optimal when artificial reefs are deployed for 5 years or longer. Concrete and stone ARs can significantly enhance the biomass and diversity of phytoplankton, respectively. The effect of ARs on phytoplankton diversity is unrelated to climatic zones. However, deploying ARs in temperate waters significantly enhances phytoplankton biomass, while in tropical waters, it significantly reduces phytoplankton density. The research findings provide practical implications for the formulation of artificial reef construction strategies tailored to the characteristics of different aquatic ecosystems, emphasizing the need for long-term deployment and appropriate material selection. This study offers a theoretical basis for optimizing AR design and deployment to achieve maximum ecological benefits.

Comparison of proximal gastrectomy and total gastrectomy in proximal gastric cancer: a meta-analysis of postoperative health condition using the PGSAS-45

PURPOSE

Proximal gastrectomy (PG) offers advantages over total gastrectomy (TG) in enhancing the postoperative nutritional status of patients with proximal gastric cancer (PGC), yet its effect on long-term quality of life is still debated. This study aims to thoroughly compare postoperative health condition outcomes between PG and TG.

METHODS

We conducted a systematic search of English-language articles from the PubMed, Web of Science, and Cochrane Library databases, covering studies published up to February 2023. Key evaluation endpoints included surgical outcomes and postoperative health condition, assessed using the Post-Gastrectomy Syndrome Assessment Scale-45 (PGSAS-45).

RESULTS

Six retrospective cohort studies were included in the analysis. The PG group demonstrated no significant negative impact on surgical outcomes compared to the TG group. Notably, patients who underwent PG experienced a superior postoperative health condition, characterized by fewer gastroesophageal reflux symptoms (WMD = -0.106, 95% CI -0.183 to -0.029, P < 0.01), less weight loss (WMD = 4.440, 95% CI 3.900 to 4.979, P < 0.01), and reduced dietary dissatisfaction (WMD = -0.205, 95% CI -0.385 to -0.025, P = 0.03).

CONCLUSION

This study provides compelling evidence that PG is superior to TG in enhancing postoperative health condition for patients with proximal gastric cancer, without compromising surgical outcomes. However, further rigorous randomized controlled trials are necessary to inform surgical decision-making more effectively.

Comprehensive Assessment of Labiaplasty Techniques and Tools, Satisfaction Rates, and Risk Factors: A Systematic Review and Meta-analysis

BACKGROUND

Various surgical techniques have been devised for the surgical cosmetic enhancement of female outer genitalia. The selection of an optimal method should be based on satisfaction rates and safety; however, comprehensive, contemporary systematic assessment of these factors has been limited in the literature.

OBJECTIVES

Our aim was to conduct a comprehensive systematic review and meta-analysis to evaluate the overall satisfaction rates and risk factors associated with various labiaplasty techniques and tools.

METHODS

The authors performed a systematic literature search in 3 medical databases: PubMed, Elsevier, and Cochrane (Central) with the closing date of October 2023. Original articles with quantitative satisfaction rates and frequencies of the most common complications (hematoma, dehiscence, swelling, bleeding, and infection) were included.

RESULTS

Systematic search provided a total of 3954 records. After selection and review of the articles, 86 eligible, peer-reviewed studies were identified, of which 53 provided quantitative data. High overall satisfaction rate was found for all methods (proportion [prop] 94%; confidence interval [CI] 93%-95%), with highest satisfaction for deepithelialization (prop 97%; CI, 85%-99%). Complications were generally rare, with elevated incidences for some techniques (wedge resection: dehiscence, prop, 8%, CI 5%-13%; and composite reduction: swelling, prop 13%, CI 2%-54%). Scalpel technique had significantly higher incidence of complications than laser, namely for bleeding, swelling, and hematoma.

CONCLUSIONS

Labiaplasty can be considered a generally effective approach to outer female genitalia beautification, with low associated risks. Surgeons must tailor their approach to the patients' needs and anatomy to achieve maximal satisfaction, given the differences in the frequency of complications for each method.

LEVEL OF EVIDENCE: 3

Causal association between gastrointestinal diseases and coronary artery disease: a bidirectional Mendelian randomization study

BACKGROUND

Coronary artery disease (CAD) has been a dominating reason of mortality globally due to its complexity of etiology. A variety of gastrointestinal disorders (GDs) have been accounted to be related to CAD. Thus, this study aims to determine their causal relationship by two-sample Mendelian randomization (MR) analysis.

METHODS

Single-nucleotide polymorphisms (SNPs) relevant to 22 GDs were employed as instrumental variables from the genome-wide association summary (GWAS) datasets. Genetic associations with CAD and HF were acquired from UK Biobank, FinnGen, and other GWAS studies. We conducted a univariable MR (UVMR) analysis followed by a meta-analysis. A multivariable MR (MVMR) analysis was then performed with smoking and body mass index (BMI) as justifications. Also, a bi-directional MR analysis was leveraged to verify the reverse causal correlations.

RESULTS

Generally, UVMR analyses separately observed the causal effects of GDs on CAD and HF. Genetic liability to gastroesophageal reflux disease displayed a positive association with both CAD (OR=1.19; 95%CI: 1.01-1.41) and HF (OR=1.22; 95%CI: 1.00-1.49) risk; genetic liability to celiac disease separately attributed to CAD (OR=1.02; 95%CI: 1.01-1.03) and HF (OR=1.01; 95%CI: 1.00-1.02), which also maintained after MVMR analysis. Besides, we observed mutually causal associations between CAD and celiac disease.

CONCLUSION

Our work suggested that genetic susceptibility to some GDs might causally increase the risk of CAD and HF, emphasizing the importance of preventing CAD in patients with GDs.

Verbal and Spatial Working Memory Capacity in Blind Adults and the Possible Influence of Age at Blindness Onset: A Systematic Review and Meta-analysis

The loss of a sense, such as vision, forces individuals to adapt to their environment and its demands in a variety of ways. In the case of blindness, significant neurofunctional and cognitive changes have been documented. However, there is no clear consensus on the differences in performance between adult blind participants and sighted controls in cognitive processes such as working memory (WM). Two variables are important, including the cognitive task used to measure working memory and the age at which vision loss occurs. This review is aimed at exploring potential disparities in verbal and spatial WM performance between blind and sighted adults, as well as understanding how these differences may be influenced by the age of vision loss. A systematic search across PsycArticles, PsycInfo, Medline, and Web of Science databases identified 21 pertinent studies. The studies were categorized, and effect sizes were calculated through meta-analysis, distinguishing between verbal (auditory simple forward and backward span, complex span, and n-back) and visuospatial WM tasks (adapted Corsi-block and simple storage tasks, imagery tasks, and complex storage tasks). Visual sensory loss induces adaptations affecting WM function in blind participants. In the verbal domain, improved phonological processing and/or serial item position encoding might facilitate WM retrieval. In contrast, in spatial WM, an over-reliance on serial processing may hinder strategic grouping in blind individuals. This review highlights the need to further explore the role of age at the time of vision loss. Although evidence suggests that adaptations to serial processing may be more pronounced in early development, particularly in comparison to those who become blind in adulthood, the available data are limited. The study calls for further research to deepen our understanding of cognitive adaptations and their temporal dynamics in response to vision loss.

Determinants of Fertility Intentions among South Koreans: Systematic Review and Meta-Analysis

(1) Background/objectives: This study aims to systematically review and conduct a meta-analysis of factors influencing fertility intentions among South Koreans. This research is crucial given South Korea's lowest-in-the-world fertility rate of 0.72 in 2023, necessitating rapid and effective policies to address this demographic challenge; (2) Methods: Articles published from database inception through April 2024 were collected from five Korean databases using keywords based on the PEO (Population, Exposure, Outcome) framework. Following PRISMA guidelines, 35 articles were selected. The effect sizes and network of predictors related to fertility intention were analyzed using the R statistical package; (3) Results: A meta-analysis of the effect sizes of factors influencing fertility intentions revealed that the husband's involvement in parenting (ESr = 0.131), women's education level (ESr = 0.127), socioeconomic status (ESr = 0.116), and the expected gender of the child (ESr = 0.068) showed statistically significant positive effects. Conversely, women's age (ESr = -0.175), parental stress (ESr = -0.146), and household labor ratio (ESr = -0.117) showed statistically significant negative effects. The network analysis further elucidated the complex interrelationships among these factors; (4) Conclusions: This study suggests the need for multifaceted policy approaches to address Korea's low fertility, emphasizing promoting men's participation in parenting, supporting women's education and career development, reducing parenting stress, supporting work-family balance, and ensuring economic stability. These findings provide important insights for policymakers and researchers addressing the complex issue of low fertility in South Korea and may inform more effective interventions to boost fertility rates.

The global burden of erectile dysfunction and its associated risk factors in diabetic patients: an umbrella reviews

BACKGROUND

Erectile dysfunction is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of erectile dysfunction and associated risk factors among diabetic patients in the global context.

METHODS

Following PRISMA guidelines, we searched for relevant studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. These studies reported the prevalence of erectile dysfunction and associated risk factors in diabetic patients. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of erectile dysfunction, we employed a weighted inverse variance random-effects model. We further conducted subgroup analyses, assessed heterogeneity and publication bias, and performed sensitivity analyses to strengthen the robustness of our findings. Prediction intervals were also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance was declared at P- value < 0.05.

RESULTS

In this umbrella review, a total of 108 030 male diabetic patients were included to estimate the global prevalence of erectile dysfunction. The pooled global prevalence of erectile dysfunction in diabetic patients was 65.8% (95CI: 58.3 - 73.3%), while In Africa it was 62.9% (95CI: 46.1-79.7). Age (> 40 years) (AOR = 1.95, 95CI: 1.03-3.24), DM duration (> 10years) (AOR = 1.90,95CI: 1.16-2.65), peripheral vascular disease (AOR = 2.74, 95CI: 1.42-4.06) and BMI (> 30 kg/m2) (AOR = 1.07,95CI: 1.01-1.20) were identified as associated risk factors of erectile dysfunction in diabetic patient.

CONCLUSION

The high global prevalence of erectile dysfunction (ED) in diabetic patients is alarming, with an estimated two-thirds experiencing the condition. These findings underscore the significant burden of ED faced by diabetic men and emphasize the urgent need for global attention to the issue. This includes promoting early screening for erectile dysfunction in this population and ensuring access to appropriate treatment and support.

Outcomes Associated with Arrest for Domestic Violence: A Systematic Review and Meta-Analysis

This systematic review evaluated outcomes associated with arrest for domestic violence (DV), for both victims and perpetrators, considering both classic and modern research. A systematic search of 5 databases for quantitative reports resulted in 1,379 potentially relevant entries, of which 34 met the inclusion criteria. Studies were screened using prespecified criteria for the population (adults), outcomes (individual-level outcomes), study design (quantitative, including arrest for DV as a focal independent variable and a non-arrest comparator), publication type (peer-reviewed academic journal), study location (United States), language (English), and publication year (in or after 1984). Part I employs narrative synthesis to explore the impact of arrests by race/ethnicity, revealing gaps in reporting and a scarcity of analyses that consider race/ethnicity or its intersections with gender. Part II, a meta-analysis, indicates that arrest does not consistently reduce repeat violence and suggests variability based on the type of comparator used and the proportion of Black victims in a sample. The review finds that much of the research on the impacts of arrest is outdated and lacks diversity in data sources and outcomes, with few studies examining outcomes other than repeat violence. Future research should prioritize an intersectional approach and the perspectives and needs of survivors. Policymakers should consider the potential for disparate impacts and evaluate alternatives to mandatory arrest policies, with funding available for new data sources and related projects. Ultimately, policymakers must consider the context when evaluating the effectiveness and ethics of arrest policies.

A Systematic Review and Meta-Analysis of the Association between Childhood Exposure to Intimate Partner Violence and Intimate Partner Violence Victimization/Perpetration in Adulthood in Africa

Intimate partner violence (IPV) is widespread in many African countries. Evidence, mainly from Western countries, shows that exposure to IPV in childhood is an important risk factor for experiences of IPV in adulthood. However, to date, no systematic review has synthesized the evidence on this association for individuals living in Africa, which is the goal of the current study. We used three search strategies: database searches (e.g., MEDLINE and PsycINFO), manual searches, and machine learning tools (e.g., Connected Papers). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included peer-reviewed studies (in French or English) that reported quantitative or qualitative associations between childhood exposure to IPV and later IPV victimization/perpetration. A total of 48 studies from 29 African countries were included (N = 520,000 participants). Pooled effects indicated an association between childhood exposure to IPV and IPV victimization for females (odds ratio [OR] = 2.46, 95% CI [2.09, 2.91], p < .001) and males (OR = 1.76, 95% CI [1.57, 1.97], p < .001). Similarly, males (OR = 1.92, 95% CI [1.60, 2.29], p < .001) and females (OR = 3.04, 95% CI [2.51, 3.69], p < .001) who were exposed to IPV in childhood were more likely to perpetrate IPV compared to those with no childhood exposure. Effect sizes varied substantially across studies (0.89-5.66), suggesting that other risk factors should be considered in future studies. This review provides unique insights on cycles of IPV in Africa that may usefully inform practice and research.

Systematic review and meta-analysis of standalone digital interventions for cognitive symptoms in people without dementia

Cognitive symptoms are prevalent across neuropsychiatric disorders, increase distress and impair quality of life. Self-guided digital interventions offer accessibility, scalability, and may overcome the research-to-practice treatment gap. Seventy-six trials with 5214 participants were identified. A random-effects meta-analysis investigated the effects of all digital self-guided interventions, compared to controls, at post-treatment. We found a small-to-moderate positive pooled effect on cognition (k = 71; g = -0.51, 95%CI -0.64 to -0.37; p < 0.00001) and mental health (k = 30; g = -0.41, 95%CI -0.60 to -0.22; p < 0.0001). Positive treatment effects on fatigue (k = 8; g = -0.27, 95%CI -0.53 to -0.02; p = 0.03) and quality of life (k = 22; g = -0.17, 95%CI -0.34 to -0.00; p = 0.04) were only marginally significant. No significant benefit was found for performance on activities of daily living. Results were independent of control groups, treatment duration, risk of bias and delivery format. Self-guided digital transdiagnostic interventions may benefit at least a subset of patients in the short run, yet their impact on non-cognitive outcomes remains uncertain.

Cardiac Implantable Electronic Device Infections in Patients with Renal Insufficiency: A Systematic Review and Meta-Analysis

(1) Background: Renal insufficiency is a risk factor for cardiac implantable electronic device (CIED) infection. (2) Methods: A comprehensive search was conducted from multiple electronic databases to identify studies. Using the random effects model, we calculated the pooled rates of CIED infection and their 95% confidence intervals. We also calculated the pooled odds ratios to determine the risk of CIED infections due to chronic kidney disease (CKD) and end-stage renal disease (ESRD). We utilized the Cochran Q and I2 statistics to detect and quantify heterogeneity. (3) Results: A total of 17 studies comprising 359,784 patients with renal insufficiency were added to the meta-analysis. Out of these, 263,819 were CKD patients and 89,617 were ESRD patients. The pooled rate of CIED infection in patients with CKD was 4.3% (95% CI: 2-8.8; I2: 95.7), and in patients with ESRD, it was 4.8% (95% CI: 2.6-8.7; I2: 99.4). The pooled risk of CIED infection in the CKD population was OR 2.5 (95% CI: 1.9-3.3; p < 0.001; I2: 21.1), and in the ESRD population, it was OR 2.4 (95% CI: 1.01-5.7; p = 0.046; I2: 88.8). ESRD was associated with higher mortality, OR 2.5 (95% CI: 1.4-4.4.8; p = 0.001; I2: 95). (4) Conclusions: The presence of renal insufficiency increases the number of CIED infections. In particular, patients with ESRD have an increased risk of mortality.

Agreement Between Heart Rate Variability - Derived vs. Ventilatory and Lactate Thresholds: A Systematic Review with Meta-Analyses

BACKGROUND

Determining thresholds by measuring blood lactate levels (lactate thresholds) or gas exchange (ventilatory thresholds) that delineate the different exercise intensity domains is crucial for training prescription. This systematic review with meta-analyses aims to assess the overall validity of the first and second heart rate variability - derived threshold (HRVT1 and HRVT2, respectively) by computing global effect sizes for agreement and correlation between HRVTs and reference - lactate and ventilatory (LT-VTs) - thresholds. Furthermore, this review aims to assess the impact of subjects' characteristics, HRV methods, and study protocols on the agreement and correlation between LT-VTs and HRVTs.

METHODS

Systematic computerised searches for studies determining HRVTs during incremental exercise in humans were conducted. The agreements and correlations meta-analyses were conducted using a random-effect model. Causes of heterogeneity were explored by subgroup analysis and meta-regression with subjects' characteristics, incremental exercise protocols, and HRV methods variables. The methodological quality was assessed using QUADAS-2 and STARDHRV tools. The risk of bias was assessed by funnel plots, fail-safe N test, Egger's test of the intercept, and the Begg and Mazumdar rank correlation test.

RESULTS

Fifty included studies (1160 subjects) assessed 314 agreements (95 for HRVT1, 219 for HRVT2) and 246 correlations (82 for HRVT1, 164 for HRVT2) between LT-VTs and HRVTs. The standardized mean differences were trivial between HRVT1 and LT1-VT1 (SMD = 0.08, 95% CI -0.04-0.19, n = 22) and between HRVT2 and LT2-VT2 (SMD = -0.06, 95% CI -0.15-0.03, n = 42). The correlations were very strong between HRVT1 and LT1-VT1 (r = 0.85, 95% CI 0.75-0.91, n = 22), and between HRVT2 and LT2-VT2 (r = 0.85, 95% CI 0.80-0.89, n = 41). Moreover, subjects' characteristics, type of ergometer, or initial and incremental workload had no impact on HRVTs determination.

CONCLUSION

HRVTs showed trivial differences and very strong correlations with LT-VTs and might thus serve as surrogates. These results emphasize the usefulness of HRVTs as promising, accessible, and cost-effective means for exercise and clinical prescription purposes.

Resilience after adversity: an umbrella review of adversity protective factors and resilience-promoting interventions

Introduction

Resilience is the dynamic adaptive process of maintaining or recovering mental health from stressors, such as trauma, challenging life circumstances, critical transitions, or physical illnesses. Resilience after adversity can be fostered through protective factors and the implementation of interventions that promote resilience. Hence, it is essential to investigate both protective and vulnerable factors to reduce the negative effects of unfavorable life events and increase resilience through positive risk-response interventions.

Objective

To assess the effect of previous adversity, protecting factors, and resilience-promoting interventions to possess resilience after adversity in a global context.

Methods

The study included English language articles sourced from PubMed, Embase, Scopus, Web of Sciences, the Cochrane Database of Systematic Reviews, Scopus, and Google Scholar published before 15 April 2024. These articles reported the effect of adversity, protecting factors, and/or resilience-promoting interventions to possess resilience after adversity in a global context without a population age limitation. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse-variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

Results

A total of 44 articles (n = 556,920 participants) were included in this umbrella review. From the random-effects model analysis, the pooled effect of adversity on the development of resilience was 0.25 (p < 0.001). The pooled effects of adversity-protective factors and resilience-promoting interventions after adversity were 0.31 (p < 0.001) and 0.42 (p < 0.001), respectively. The pooled effects of specific adversity protective factors were 0.26, 0.09, 0.05, 0.34, 0.23, and 0.43 for the availability of support, cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, respectively. The pooled effects of specific resilience-promoting interventions were 0.30, 0.21, 0.51, and 0.52 for cognitive behavior therapy (CBT) interventions, mindfulness-based interventions, mixed interventions, and resilience-promoting interventions, respectively.

Conclusion

The findings of this umbrella review revealed that people who experienced early adversity can develop resilience later in life. The study highlights the need to consider adversity protective factors, such as availability of support (family, friends, and school), cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, and resilience-promoting interventions, including CBT interventions, mindfulness-based interventions, and mixed interventions, to enhance resilience promotion programs.

Safety and efficacy of PCSK9 inhibitors and effect on coronary plaque phenotype in statin-treated patients following acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Acute coronary syndrome continues to be a significant cardiovascular issue. Statins are commonly acknowledged as medications that reduce LDL-C levels and stabilize plaques. Nevertheless, their efficacy is limited. Presently, PCSK9 inhibitors are suggested to be advantageous in patients who are already receiving statin treatment. The study seeks to assess the safety and effectiveness of PCSK9 inhibitors in individuals who have been treated with statins after experiencing acute coronary syndrome (ACS), as well as investigate the impact on the characteristics of coronary plaque.

METHODS

Articles were identified from PubMed, Cochrane Central Register of Controlled Trials, and ProQuest. Our analysis comprised trials and observational studies that compared the plaque phenotype, lipid profile, and safety outcomes between PCSK9 inhibitors and a control group in patients with acute coronary syndrome who were already being treated with statins. The random-effect model was used to measure the pooled effect, which was presented in terms of mean difference, standardized mean difference, and risk ratio.

RESULTS

Acquired 12 studies that fulfilled our criteria. The addition of PCSK9 inhibitors ameliorates the plaque phenotype significantly in terms of percent atheroma volume (P = 0.02), total atheroma volume (P < 0.010), fibrous cap thickness (P < 0.00001), lipid arc (P < 0.00001), quantitative flow ratio (P = 0.003), and diameter of stenosis (P = 0.0003) but not in lipid/lesion length (P = 0.17). The administration of PCSK9 inhibitors led to a considerable improvement in all lipid profiles (P < 0.00001). Regarding safety analysis, there is no substantial disparity in the likelihood of non-serious side events (RR 1.21; P = 0.2), however, a significant reduction in the risk of serious adverse effects (RR 0.77; P = 0.04) in the PCSK9 inhibitor group.

CONCLUSIONS

The addition of PCSK9 inhibitors compared to statin-only treatment led to a majority of patients experiencing significant benefits in terms of safety and efficacy following ACS.

The Effects of Social Interaction Intervention on Cognitive Functions Among Older Adults Without Dementia: A Systematic Review and Meta-Analysis

Background and Objectives

Previous systemic reviews, predominantly including observational studies, have shown that participation in social activities is a protective factor against cognitive decline. However, this association is subject to potential reverse causality, creating a knowledge gap in our understanding of the effect of social interaction interventions on cognitive function. Therefore, this study aims to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effects of social interaction interventions on cognitive decline among older adults without dementia.

Research Design and Methods

This systematic review, registered in PROSPERO (CRD42022367828), systematically searched 6 databases from inception to May 6, 2022, to identify relevant articles on the effects of activities with social interaction components on cognitive function in community-dwelling older adults without dementia aged above 60. Two independent reviewers conducted study selection, data extraction, and bias assessment, with RevMan5.3 used for meta-analysis. Subgroup analysis was conducted to assess variation in intervention effects among subgroups.

Results

We included 11 studies for qualitative analysis and 8 studies for the meta-analysis. The results showed that social interaction intervention had a significant effect on executive function (standardized mean difference [SMD] = 1.60; 95% CI, 0.50 to 2.70; p = .004), but not attention and memory. The subgroup analysis showed a greater cognitive benefit for healthy older adults, but not those with mild cognitive impairment. Moreover, in-person social interaction positively affected global cognition, whereas online interaction did not.

Discussion and Implications

Social interaction interventions have a limited impact on cognitive function in older adults without dementia but showed potential effects on executive function. This finding offers insights for implementing social intervention in the community.

Reverse Allograft Prosthetic-Composite Versus Endoprosthesis Reconstruction for Massive Proximal Humerus Bone Loss: A Systematic Review and Meta-analysis of Outcomes and Complications

Background

This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.

Methods

Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.

Results

Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (P = .231), external rotation (P = .634), ASES score (P = .420), Constant score (P = .414), MSTS (P = .815), SST (P = .367), or VAS (P = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.

Discussion

Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients' healing capacity and surgeon experience.

Level of Evidence

Level IV; Systematic Review.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43465-024-01248-7.

Diagnostic Performance of 18-Fluorodeoxyglucose Positron-Emission Tomography-Computed Tomography (18F-FDG PET-CT) in the Detection of Autosomal Dominant Polycystic Kidney Disease Cyst Infections: A Meta-Analysis

Diagnosing suspected renal or hepatic infections in autosomal dominant polycystic kidney disease (ADPKD) is difficult. Although 18-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET-CT) is recommended to aid in the diagnosis, there is no consensus about its diagnostic accuracy. We aimed to investigate its diagnostic performance. To further assess this, we performed a meta-analysis. A comprehensive literature search screening of PubMed/MEDLINE, Embase, and Cochrane library databases through February 2024 was performed. Pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and C-reactive protein (CRP) were estimated using the random effects model. Heterogeneity between studies was estimated using Cochran Q and I2 statistics. A total of seven studies were included in the final analysis. The pooled sensitivity of 18F-FDG PET-CT in diagnosing kidney and hepatic cyst infection was 82.6% (95% CI: 73.8-88.9; I2 16.9%), specificity was 77.6% (95% CI: 66.7-85.7; I2 15.6%), PPV was 79.4% (95% CI: 62.4-89.9; I2 62.6%), and NPV was 81.3% (95% CI: 72.7-87.7; I2 0%). The mean CRP was 244.2 mg/L (95% CI: 209.1-279.1; I2 66%). The results showed that 18F-FDG PET-CT demonstrated excellent pooled diagnostic performance in diagnosing renal and hepatic cyst infections in ADPKD.

Epidemiology of Methicillin-resistant Staphylococcus aureus Colonization in Neonates within Neonatal Intensive Care Units: A Systematic Review and Meta-analysis

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) colonization in neonatal intensive care units (NICUs) is a significant global health concern, leading to severe infections, extended hospital stays, and substantial economic burdens on health-care systems. To develop effective infection control strategies, we need to fill existing gaps in our understanding of MRSA epidemiology in neonates. The aim of this systematic review is to provide an extensive analysis of the proportion of MRSA colonizations in NICUs.

Methods

We used a comprehensive search strategy across databases such as Medline, Embase, Global Health, Web of Science, and Global Index Medicus, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were independently reviewed and selected based on a variety of criteria, including the inclusion of neonates tested for MRSA colonization during NICU stay, and the reporting of community-acquired and hospital-acquired MRSA (CA-MRSA and HA-MRSA) incidence levels. Exclusion criteria included studies outside NICUs, those focused on specific MRSA outbreaks or clinical infections, review studies, and those lacking abstracts or full texts. Five authors independently extracted data, which was summarized and checked for quality. Statistical analysis included a random-effects model to compute pooled proportions, stratification by geographical location, evaluation of heterogeneity, and examination of publication bias.

Results

Our systematic review evaluated 62 studies out of an initial 536 records identified. The majority of the selected studies were conducted in high-income countries, primarily in the United States. From these studies, we estimated a cumulative incidence rate of 7.2% for MRSA colonization in NICUs. When the source of MRSA was considered, CA-MRSA incidence was 2.7%, while HA-MRSA incidence was notably higher at 11%. A subgroup analysis showed geographical differences in the cumulative incidence of MRSA colonization in NICUs, with Brazil having the lowest incidence and Taiwan the highest. The proportion of HA-MRSA colonization also varied significantly by country, with South Korea reporting higher incidence rates than the United States. However, the differences in CA-MRSA colonization rates between countries and WHO regions were not statistically significant.

Conclusions

Our systematic review found a cumulative incidence of 7.2% for MRSA colonization in NICUs, with HA-MRSA (11%) being more prevalent than CA-MRSA (2.7%). Regional variations were detected, with Taiwan exhibiting the highest cumulative incidence and South Korea having both the highest CA-MRSA and HA-MRSA. These findings underline the substantial public health impact of MRSA, especially in NICUs, necessitating context-specific prevention and control strategies. Future research should strive to address these regional disparities and aspire to attain a more globally representative understanding of MRSA colonization rates.

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Objective

This study aims to systematically assess physical exercise-related symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC or long COVID) in coronavirus disease 2019 (COVID-19) survivors.

Methods

Eight databases were systematically searched on March 03, 2024. Original studies that compared physical exercise-related parameters measured by exercise testing between COVID-19 survivors who recovered from SARS-CoV-2 infection over 3 months and non-COVID-19 controls were included. A random-effects model was utilized to determine the mean differences (MDs) or standardized MDs in the meta-analysis.

Results

A total of 40 studies with 6241 COVID-19 survivors were included. The 6-min walk test, maximal oxygen consumption (VO2max), and anaerobic threshold were impaired in COVID-19 survivors 3 months post-infection compared with non-COVID-19 controls in exercise testing, while VO2 were comparable between the two groups at rest. In contrast, no differences were observed in SpO2, heart rate, blood pressure, fatigue, and dyspnea between COVID-19 survivors and non-COVID-19 controls in exercise testing.

Conclusion

The findings suggest an underestimation of the manifestations of PASC. COVID-19 survivors also harbor physical exercise-related symptoms of PASC that can be determined by the exercise testing and are distinct from those observed at rest. Exercise testing should be included while evaluating the symptoms of PASC in COVID-19 survivors.

Treatment failure among Sub-Sahara African children living with HIV: a systematic review and meta-analysis

BACKGROUND

Antiretroviral treatment failure is a global issue, particularly in developing countries such as Sub-Saharan Africa. Prior research findings were highly variable and inconsistent across areas. As a result, the goal of this systematic review and meta-analysis was to determine the pooled prevalence of treatment failure among children receiving antiretroviral medication in Sub-Saharan Africa.

METHODS

To find qualifying papers, we searched databases (such as PubMed, Google Scholar, African Journals Online, Scopus, and the Cochrane Library). The data were retrieved using Microsoft Excel and exported to STATA Version 14 for analysis. To check for publication bias, we employed Egger and Begg's regression tests. A random-effects model was used to assess the pooled prevalence of treatment failure due to high levels of variability.

RESULTS

Following the removal of duplicated articles and quality screening, a total of 33 primary articles were determined to be appropriate for inclusion in the final analysis for this study. Overall, the pooled prevalence of treatment failure among HIV-infected children was 25.86% (95% CI: 21.46, 30.26). There is great variety across the included studies, with the majority of them being conducted in Ethiopia. Cameroon had the greatest pooled prevalence of treatment failure among HIV-infected children, at 39.41% (95% CI: 21.54, 57.28), while Ethiopia had the lowest, at 13.77% (95% CI: 10.08, 17.47).

CONCLUSIONS

The pooled estimate prevalence of treatment failure among HIV-infected children in Sub-Saharan Africa was high. The implementation of national and international policies and strategies on ART clinic care services should be given special focus in order to reduce treatment failure in children living with HIV/AIDS.

TRIAL REGISTRATION

The protocol has been registered in the PROSPERO database under the registration number CRD-429011.

"Textbook outcome(s)" in colorectal surgery: a systematic review and meta-analysis

BACKGROUND

Textbook outcome (TO) is a composite measure used in surgery to evaluate post operative outcomes. No review has synthesised the evidence in relation to TO regarding the elements surgeons are utilising to inform their TO composite measure and the rates of TO achieved.

METHODS

Our systematic review and meta analysis was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. PubMed, EMBASE, and Cochrane central registry of controlled trials were searched up to 8th November 2023. Pooled proportions of TO, clinical factors considered and risk factors in relation to TO are reported.

RESULTS

Fifteen studies with 301,502 patients were included in our systematic review while fourteen studies comprising of 247,843 patients were included in our meta-analysis. Pooled rates of TO achieved were 55% with a 95% confidence interval (95% CI) of 54-55%. When stratified by elective versus mixed case load, rates were 56% (95% CI 49-62) and 54% (95% CI 50-58), respectively. Studies reported differing definitions of TO. Reported predictors of achieving TO include age, left sided surgery and elective nature.

CONCLUSIONS

TO is achieved, on average in 55% of reported cases and it may predict short and long term post operative patient outcomes. This study did not detect a difference in rates between elective versus mixed case load TO proportions. There is no standardised definition in use of TO. Standardisation of the composite is likely required to enable meaning comparison using TO in the future and a Delphi consensus is warranted.

Efficacy of TIL therapy in advanced cutaneous melanoma in the current immuno-oncology era: updated systematic review and meta-analysis

BACKGROUND

Adoptive cell therapy with tumor-infiltrating lymphocytes (TIL-ACT) has consistently shown efficacy in advanced melanoma. New results in the field provide now the opportunity to assess overall survival (OS) after TIL-ACT and to examine the effect of prior anti-programmed cell death protein 1/programmed death-ligand 1 [anti-PD-(L)1] therapy on its efficacy.

METHODS

A comprehensive search was conducted in PubMed up to 29 February 2024. Ιn this meta-analysis we focused on studies including high-dose interleukin 2, doubling the patient numbers from our previous meta-analysis conducted up to December 2018 and using OS as the primary endpoint. Objective response rate (ORR), complete response rate (CRR), and duration of response were secondary endpoints. Findings are synthesized using tables, Kaplan-Meier plots, and forest plots. Pooled estimates for ORR and CRR were derived from fixed or random effects models.

RESULTS

A total of 13 high-dose interleukin 2 studies were included in this updated meta-analysis, with OS information available for 617 patients. No difference was found in median OS between studies with prior anti-PD-(L)1 treatment {n = 238; 17.5 months [95% confidence interval (CI) 13.8-20.5 months]} and without [n = 379; 16.3 months (95% CI 14.2-20.6 months)] (log-rank P = 0.53). ORR was estimated to be 34% (95% CI 16%-52%) and 44% (95% CI 37%-51%), for the studies with and without prior anti-PD-(L)1, respectively. The pooled estimate for CRR was 10% for both groups. No statistically significant difference was observed between the two groups, either for ORR (P = 0.15) or CRR (P = 0.45).

CONCLUSIONS

Prior anti-PD-(L)1 treatment has no effect on the clinical response or survival benefit from TIL-ACT in advanced cutaneous melanoma. The benefit of TIL therapy in the second-line setting is also present after anti-PD-(L)1 treatment. Our data reinforce the evidence that TIL-ACT should be considered as a treatment of choice in second line for metastatic melanoma patients failing anti-PD-(L)1 therapy.

Intimate Partner Violence Against Women Before, During, and After Pregnancy: A Meta-Analysis

Intimate partner violence (IPV) against pregnant women negatively impacts women's and infants' health. Yet inconsistent results have been found regarding whether pregnancy increases or decreases the risk of IPV. To answer this question, we systematically searched for studies that provided data on IPV against women before pregnancy, during pregnancy, and after childbirth. Nineteen studies met our selection criteria. We meta-analyzed the nineteen studies for the pooled prevalence of IPV across the three periods and examined study characteristics that moderate the prevalence. Results showed the pooled prevalence estimates of IPV were 21.2% before pregnancy, 12.8% during pregnancy and 14.7% after childbirth. Although these findings suggest a reduction in IPV during pregnancy, our closer evaluation of the prevalence of IPV after childbirth revealed that the reduction does not appear to persist. The prevalence of IPV increased from 12.8% within the first year after childbirth to 24.0% beyond the first year. Taken together, we should not assume pregnancy protects women from IPV, as IPV tends to persist across a longer-term period. Future studies are needed to investigate if IPV transits into other less obvious types of violence during pregnancy. Moderator analyses showed the prevalence estimates significantly varied across countries by income levels and regions.