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

Prevalence of acute kidney injury in Mexico; a systematic review and meta-analysis of pre-pandemic reports

BACKGROUND

Acute Kidney Injury (AKI) is a health problem worldwide, accounting for high hospital morbidity and mortality. There is little available information regarding the characteristics and incidence of AKI in Latin America (LA), especially in Mexico.

OBJECTIVES

Systematically search the literature and perform a meta-analysis of the epidemiology of AKI in Mexico, to provide data on AKI and kidney replacement therapy (KRT) that would contribute to general knowledge in this matter.

METHODS

We performed a systematic search for articles in pediatric and adult patients admitted to the general ward, Emergency Room or Intensive Care Unit published between January 1, 2000, and September 30, 2024. MEDLINE LILIACS, EMBASE and SciELO were searched, as additional reports from supplements, abstracts, and conference sessions. We performed a random-effects meta-analysis for clinically and methodologically comparable studies to estimate the frequency of AKI and KRT. We calculated pooled estimates stratified by age group, year of publication, and setting.

RESULTS

83 full-text articles were included. The percentage of AKI was calculated at 35% (95% CI, 28-42). Mortality for AKI adult patients was 36% (95% CI, 28-45). An overall KRT rate was 7% (95% CI, 6-9), all-cause mortality for AKI requiring KRT was 49% (95% CI, 42-56), with a global Ι2 estimated in 99.87% (p < 0.01).

CONCLUSION

AKI is common in Mexico and remains a main public health problem that needs to be addressed at every level of care. Efforts should be made to reinitiate AKI research and control in Mexico and LA.

Prognostic and clinicopathological value of C-reactive protein in patients with bladder cancer: a meta-analysis

BACKGROUND

The prognostic value of C-reactive protein (CRP) in patients with bladder cancer (BCa) has been widely analysed; however, the results remain conflicting. Therefore, we performed this meta-analysis to identify the precise role of CRP level in predicting BCa prognosis.

METHODS

PubMed, Web of Science, Embase and Cochrane Library databases were comprehensively searched until 19 April 2024. The impact of CRP level on predicting the prognosis of patients with BCa was examined using combined hazard ratios (HRs) and 95% confidence intervals (CIs). The relationship between CRP level and BCa clinicopathological characteristics was investigated by combining the odds ratios (ORs) with 95%CIs.

RESULTS

Twenty studies with 7276 patients were enrolled in this study. As revealed by pooled data, elevated CRP levels were markedly related to poor overall survival (OS) (HR = 2.02, 95%CI = 1.41-2.90, p < .001), inferior cancer-specific survival (CSS) (HR = 1.46, 95%CI = 1.29-1.66, p < .001), shortened recurrence-free survival (RFS) (HR = 1.25, 95%CI = 1.17-1.33, p < .001) and dismal progression-free survival (PFS) (HR = 2.28, 95%CI = 1.80-2.90, p < .001) in BCa patients. Nevertheless, there was no significant relationship between CRP level and sex, tumour size, tumour grade or lymph node metastasis (LNM) in BCa.

CONCLUSIONS

Elevated CRP levels were significantly related to poor OS, CSS, RFS and PFS of BCa patients with BCa. CRP could act as a reliable biomarker for predicting the short- and long-term survival of patients with BCa in clinical practice.

Particulate matter 2.5 (PM2.5) - associated cognitive impairment and morbidity in humans and animal models: a systematic review

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one of the criteria air pollutants that (1) serve as an essential carrier of airborne toxicants arising from combustion-related events including emissions from industries, automobiles, and wildfires and (2) play an important role in transient to long-lasting cognitive dysfunction as well as several other neurological disorders. A systematic review was conducted to address differences in study design and various biochemical and molecular markers employed to elucidate neurological disorders in PM2.5 -exposed humans and animal models. Out of 340,068 scientific publications screened from 7 databases, 312 studies were identified that targeted the relationship between exposure to PM2.5 and cognitive dysfunction. Equivocal evidence was identified from pre-clinical (animal model) and human studies that PM2.5 exposure contributes to dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity disorder, and neurodevelopment. In addition, there was substantial evidence from human studies that PM2.5 also was associated with Alzheimer's disease, anxiety, neuropathy, and brain tumors. The role of exposome in characterizing neurobehavioral anomalies and opportunities available to leverage the neuroexposome initiative for conducting longitudinal studies is discussed. Our review also provided some areas that warrant consideration, one of which is unraveling the role of microbiome, and the other role of climate change in PM2.5 exposure-induced neurological disorders.

Patient Safety Culture Among Nurses in Hospital Settings Worldwide: A Systematic Review and Meta-Analysis

BACKGROUND

Assessment of patient safety culture (PSC) is critical for health care organizations worldwide to recognize areas that require urgent attention, promote patient safety, and improve quality of care. The aim of this systematic review was to determine the overall PSC score among nurses worldwide and identify the dimensions of PSC that score the highest and the lowest, as well as any geographical differentiations.

METHODS

Literature research was conducted in PubMed and Scopus search engines and the Agency for Healthcare Research and Quality (AHRQ) Research Reference List to identify studies published in English between January 2004 and May 2023 that used the Hospital Survey on Patient Safety Culture, version 1, to measure hospital nurses' assessment of PSC. This review followed the PRISMA 2020 guidelines and was registered in PROSPERO.

RESULTS

From 1,507 records, 21 studies were included with 10,951 participants. The overall PSC score was 3.341 (95% confidence interval [CI] 3.221-3.460). The dimension scored highest was Teamwork Within Units, with a mean score of 3.719 (95% CI 3.594-3.844). Staffing, with a mean score of 3.096 (95% CI 2.980-3.212) was scored lowest. Statistically significant differences related to geographical distribution were found for overall PSC score and five of the PSC dimensions.

CONCLUSION

Nurses throughout the world rated the PSC at their organizations moderate to good. Certain dimensions of PSC were reported to need reinforcement to create a strong overall safety culture in health care. Participants rated European hospitals as having a stronger PSC than South American or Middle Eastern hospitals. Differentiations need to be further studied and analyzed for effective and targeted global interventions.

Reasons for Crown Failures in Primary Teeth: Systematic Review and Meta-Analysis

Background

Understanding long-term retention rates and complications associated with different materials for fabricating pediatric crowns for primary teeth is crucial for material selection and optimizing clinical outcomes.

objectives

This systematic review aimed to descriptively analyze the crown-retention rates and complications associated with crown retention, as well as the biological and technical complications of pediatric crowns, for primary teeth. The meta-analysis reported herein was performed to estimate long-term (3-year and 5-year) retention rates of these pediatric crowns fabricated using various materials.

Methods

Using the PICOS (Population, Intervention, Comparison, Outcomes, and Study design) paradigm, a systematic search was conducted between July and August 2023 in the Cochrane, Embase, and PubMed databases to identify randomized controlled trials (RCTs) and clinical (prospective and retrospective) studies reporting retention rates, complications of crown retention, and biological and technical complications. After selecting studies with a predefined set of selection criteria, data from included studies were used for a systematic review aimed at a descriptive analysis of factors associated with the failure of crowns for primary teeth. Data from the included RCTs were used for meta-analysis, wherein 3-year and 5-year crown-retention rates were estimated using Poisson regression models.

Results

This systematic review included 13 RCTs and 5 clinical studies on dental crowns for primary teeth, involving 454 children (1172 crowns) in RCTs and 810 children (2667 crowns) in clinical studies. The median follow-up durations were 12 months for RCTs and 20.8 months for clinical studies, with a 10.6% (124/1172) dropout rate in RCTs. Meta-analysis of pooled 5-year retention rates for different crown materials revealed the following retention rates: 88.90% for compomer crowns, 92.18% for composite resin crowns, 90.30% for resin-modified glass ionomer cement (RMGIC) crowns, and 97.88% for stainless steel crowns. Additionally, strip crowns exhibited a retention rate of 83.48%, while zirconia crowns had a retention rate of 97.09%. Poisson regression estimated 3-year and 5-year crown-retention rates, indicating good outcomes across materials. Complications included secondary caries (up to 21.8% in zirconia crowns) and marginal adaptation issues (up to 22.2% in compomer crowns). These findings highlight material-specific considerations necessary for optimizing outcomes in pediatric dental crown treatments.

Conclusions

While retentive complications such as chipping, material loss, and fractures do occur across materials, compomer, composite resin, stainless steel, strip, and zirconia crowns all have clinically acceptable retention rates. However, the differences in biological and technical complications between materials may provide insights for selecting appropriate materials for pediatric crowns based on clinical considerations.

The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

The purpose of this study was to assess the efficacy of aspirin versus low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty.

METHODS

PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6-69.0) years and 66.8 (57.9-68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48-1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11-2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40-1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40-1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21-1.98; p < 0.001).

CONCLUSION

This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures.

LEVEL OF EVIDENCE

Level I.

Feeding Behaviors in Infants and Toddlers Later Diagnosed with Autism Spectrum Disorder: A Systematic Review

Children with autism spectrum disorder (ASD) are five times more likely to have feeding difficulties than neurotypical peers, although the majority of evidence describes feeding difficulty in children age 2 years and older. The purpose of this study is to systematically review the literature on feeding characteristics of children age 0-24 months who were later diagnosed with ASD with an emphasis on the measurement tools used to assess these feeding behaviors. We conducted a systematic review of the literature using PRISMA guidelines. Using selected keywords, a search was conducted using PubMed, PsycINFO, and CINAHL databases for relevant articles to identify feeding characteristics in infants and toddlers (age 0-24 months) later diagnosed with ASD. Sixteen studies were selected for this review by two independent reviewers. Among the selected studies, feeding difficulties were reported in all infant oral feeding modalities (breastfeeding, bottle feeding, and complementary feeding) by infants later diagnosed with ASD. However, the evidence was conflicting among studies regarding feeding characteristics, such as sucking differences while breastfeeding, use of the spoon with feedings, and preference of solid food texture, that presented in infants later diagnosed with ASD. A lack of consistent measurement of feeding behaviors in infants later diagnosed with ASD contributes to the difficulty in comparison across studies. Future research should focus on developing targeted, validated instruments for measuring feeding difficulty in this population with emphasis on breastfeeding and bottle feeding difficulty.

Circulating tumor DNA in human papillomavirus-associated oropharyngeal cancer management: A systematic review

OBJECTIVE

Circulating tumor DNA (ctDNA) has emerged as a promising tool in the treatment of HPV-associated oropharyngeal squamous cell cancer (OPSCC). This systematic review sought to answer the question: what is the current role of ctDNA in the diagnosis, treatment, and surveillance of HPV-associated OPSCC?

DATA SOURCES

Medline (Ovid), Embase (Ovid), Scopus.

REVIEW METHODS

Original articles studying the role of ctDNA in the diagnosis or surveillance of HPV-associated OPSCC were eligible for inclusion. Two authors independently reviewed studies for inclusion and abstracted data, including study design, characterization of liquid biopsy technology, and diagnostic outcomes.

RESULTS

After a preliminary screening of 441 studies, 23 were selected for inclusion. Ten studies were conducted retrospectively, and 13 were conducted prospectively. In these studies, diagnostic testing included plasma-based droplet digital polymerase chain reaction (ddPCR, n = 13), quantitative PCR (qPCR, n = 4), digital PCR (dPCR, n = 3), next-generation sequencing (NGS) (n = 3), or a ctDNA detection kit (n = 1). Diagnostic outcomes were reported for pre-diagnosis (n = 1), pre-treatment (n = 17), during treatment (n = 6), and surveillance/recurrence (n = 11) timepoints. Test sensitivities ranged from 20.6 %-100 % pre-treatment and 72 %-100 % during surveillance, while test specificities ranged from 95 %-100 % pre-treatment and 87.2 %-100 % during surveillance.

CONCLUSION

The majority of studied ctDNA technologies allow for detection of HPV-associated OPSCC with high diagnostic accuracy. However, heterogeneity is introduced by test type and assay used. These findings highlight the utility, as well as limitations, of ctDNA in the diagnosis, treatment monitoring, and surveillance of HPV-associated OPSCC. Future studies and clinical consensus will need to address acceptable diagnostic accuracy thresholds for clinical use.

How do surgically treated multiligamentous knee injuries affect overall complication rate and especially stiffness? A systematic review

BACKGROUND

Multiligamentous knee injuries (MLKIs), defined as injuries involving at least two of the four primary knee ligaments, are rare but severe, with potentially limb- or life-threatening complications. Despite numerous publications, the low incidence and heterogeneity of injury patterns limit high-level evidence for optimal surgical timing, technique, and management of complications. This systematic review aims to consolidate the available evidence on MLKI surgery complications, with a particular focus on arthrofibrosis as the underlying cause of stiffness, infection, and graft failure.

METHODS

This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (no. CRD42024618025). A comprehensive search of PubMed, EMBASE, and MEDLINE from January 2013 to November 2024 identified studies reporting complications in surgically treated MLKIs with at least a 12-month follow-up. The studies were screened independently by two reviewers. Data on demographics, injury mechanisms, surgical techniques, and complication outcomes were extracted. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

A total of 33 studies with 2863 patients met the inclusion criteria. The mean age was 32.4 years (standard deviation, SD ± 5.37), with males constituting 69.4% of the sample. Arthrofibrosis was the most common complication, requiring surgical management in 8.4% of cases. Graft failure was reported in 5%, while infection, the third most common complication, occurred in 2.86% of cases. Management of lack of range of motion varied, with manipulation under anesthesia and arthroscopic arthrolysis utilized. Surgical timing also influenced outcomes; 54.2% of patients underwent acute surgery (< 21 days), which seems to be associated with increased stiffness rates.

CONCLUSIONS

This systematic review highlights the complexity of managing MLKIs, with a 19.2% overall complication rate. Stiffness demanding reoperation remains a rare but a significant challenge, underscoring the need for standardized treatment protocols. However, the included studies demonstrate heterogeneity and lack high methodological rigor, highlighting the need to account for these limitations.

Hypothermia and Adverse Outcomes in Very Preterm Infants: A Systematic Review

CONTEXT

Hypothermia after very preterm birth, typically defined as a temperature less than 36 °C, is variably linked to neonatal mortality and morbidities.

OBJECTIVE

To examine the association between admission hypothermia and adverse outcomes in very preterm infants with a gestational age (GA) of less than 32 weeks.

DATA SOURCES

CENTRAL, MEDLINE, and Embase from inception to February 18, 2024.

STUDY SELECTION

Observational or randomized designs reporting on the association between admission temperature and adverse outcomes in very preterm infants.

DATA EXTRACTION

Two reviewers screened abstracts and full texts, extracted the data, and assessed the risk of bias, following Meta-analysis Of Observational Studies in Epidemiology /Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We planned to perform random-effects meta-analyses, subgroup (GA, birthweight [BW], and income), sensitivity analysis (NOS, study type), and meta-regression (GA, BW). Outcomes included mortality and neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), and sepsis.

RESULTS

This review included 32 studies with >300 000 infants. The mean hypothermia rate was 42% (range 14%-88%). Hypothermia was associated with increased mortality (crude odds ratio [cOR] [95% CI] 2.02[1.84;2.21]; adjusted OR 1.55[1.29;1.87]). Subgroup and sensitivity analyses upheld these results. Meta-regression analysis showed an inversed relationship between effect size and BW. Hypothermia was associated with higher risks of BPD (cOR 1.13[1.01;1.27]), IVH (cOR 1.37[1.17;1.61]), ROP (cOR 1.55[1.41;1.69]), and sepsis (cOR 1.32[1.16;1.51]).

LIMITATIONS

Only observational studies were included.

CONCLUSIONS

Hypothermia is associated with increased mortality and morbidity in very preterm infants. The strength of this association may be influenced by BW, definitions of hypothermia and outcomes, and exclusion criteria. Given the robustness of our results and our sample size, identical cohort studies might not provide different insights.

Lutein and zeaxanthin for reducing morbidity and mortality in preterm infants

BACKGROUND

Lutein and zeaxanthin are nutrients with antioxidant properties found in the macula of the eye and brain tissue. They have been reported to play a role in reducing oxidative damage, especially in the eyes and possibly in other organ systems. Oxygen free radicals are one of the agents postulated to cause tissue damage in preterm infants, which leads to morbidities such as retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), and necrotising enterocolitis (NEC). Supplementation with lutein and zeaxanthin may reduce oxidative damage, hence reducing morbidity and mortality in preterm infants.

OBJECTIVES

To assess the effectiveness of lutein and zeaxanthin supplementation in reducing morbidity and mortality in preterm infants.

SEARCH METHODS

We conducted searches up to 17 December 2024 in CENTRAL, MEDLINE, Embase, and two trial registries. We also searched the reference lists of included studies, and related reviews and studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-RCT, cross-over trials, and quasi-RCTs that compared lutein and zeaxanthin supplementation against placebo or no supplementation for preterm infants less than 37 completed weeks' postmenstrual age.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were the incidence of any stage of ROP, incidence of ROP stage 3 and above, incidence of visual impairment, and mortality assessed throughout the neonatal intensive care unit (NICU) stay. Secondary outcomes included the incidence of IVH, incidence of NEC, and any reported adverse effects. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included five studies (666 preterm infants) that compared lutein and zeaxanthin supplementation versus control (placebo or no supplementation). All five studies were conducted in high-income countries (Italy and the USA). We did not find any studies comparing lutein or zeaxanthin separately versus placebo or no supplementation. Most of the studies had a low risk of bias in most key domains, such as allocation concealment and blinding. The evidence suggests that lutein and zeaxanthin supplementation probably has little or no effect on ROP (any stage) when comparing infants who received lutein and zeaxanthin supplementation with those who did not (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.66 to 1.24; P = 0.53; I2 = 0%; 4 studies, 532 infants; moderate-certainty evidence). Lutein and zeaxanthin supplementation probably reduces the incidence of ROP stage 3 and above (RR 0.49, 95% CI 0.29 to 0.81; P = 0.005; I2 = 0%; 4 studies, 532 infants; moderate-certainty evidence). No studies assessed the incidence of visual impairment. Lutein and zeaxanthin supplementation may have little or no effect on mortality assessed throughout the NICU stay (RR 0.95, 95% CI 0.42 to 2.17; P = 0.91; I2 = 0%; 4 studies, 470 infants; low-certainty evidence), incidence of IVH (all grades) (RR 0.87, 95% CI 0.44 to 1.75; P = 0.70; I2 = 0%; 4 studies, 483 infants; low-certainty evidence), and incidence of NEC: Bell's stage II or greater (RR 0.87, 95% CI 0.43 to 1.76; P = 0.71; I2 = 0%; 5 studies, 666 infants; low-certainty evidence). No adverse effects were reported in either group.

AUTHORS' CONCLUSIONS

While supplementation with lutein and zeaxanthin from day one of life in preterm infants until discharge probably reduces the incidence of ROP stage 3 and above, it may have little or no effect on the incidence of ROP at any stage, IVH or NEC, or mortality assessed throughout the NICU stay. However, the pooled estimates for these outcomes may change with further rigorously conducted trials. There were no adverse effects reported.

Mediastinal lymphangioma and intestinal lymphangiomatosis presenting with chylothorax: a systematic review of therapeutic modalities

INTRODUCTION

Chylothorax is defined by the accumulation of chyle in the pleural space, characterized by triglyceride levels exceeding 110 milligrams per deciliter. The clinical presentation of chylothorax varies depending on its acuity and underlying etiology. Mediastinal lymphangiomas are extremely rare and benign lesions that can affect both infants and adults. They may occur independently or in association with other lymphatic disorders and can lead to complications such as chylothorax.

CASE REPORT

A 60-year-old male patient presented with shortness of breath and was diagnosed with left-sided chylothorax secondary to mediastinal lymphangioma, accompanied by intestinal lymphangiomatosis. Conservative approach was unsuccessful, and surgical therapy was needed.

MATERIALS AND METHODS

We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. The search parameters we used included the following Boolean terms: [("lymphangioma" OR "mediastinal lymphangioma" OR "cavernous lymphangiomas" OR "cystic hygromas" OR "capillary lymphangioma" OR "lymphangioma simplex") AND ("chylothorax" OR "chylous pleural effusion" OR "chylous effusion" OR "chylous lung")]. Our search yielded 166 articles in total, out of which we selected 17 articles for inclusion. We included patients who presented to the hospital with chylothorax secondary to mediastinal lymphangioma and those who developed chylothorax after the removal of mediastinal lymphangioma. The primary outcome was the total number of reported cases of chylothorax secondary to mediastinal lymphangioma. The secondary outcomes included patient characteristics, fluid characteristics, clinical manifestations, and therapeutic modalities.

RESULTS

The systematic review encompassed seventeen case reports. Most patients were male, spanning ages from six weeks to 82 years, with an average age of 28.35 years. Most pleural effusions were on the left side. Few cases were asymptomatic, while the most reported symptom was shortness of breath. The mean pleural triglyceride level was 708 mg/dl, with cystic hygroma being the most common subtype. The anterior mediastinum was the most frequent location. The primary treatment involved surgical removal of the lymphangioma along with thoracic duct ligation.

CONCLUSION

Mediastinal lymphangioma is an infrequent etiology of chylothorax and is scarcely documented in the literature. It may be present in isolation or may be associated with extra mediastinal lymphatic anomalies. The management of chylothorax in such cases is challenging with conservative measures often being ineffective, necessitating surgical intervention. The rarity of these conditions complicates the study of potential risk factors and genetic predispositions. Furthermore, there is no established consensus on the therapeutic modalities for patients with similar diagnoses which vary based on patient characteristics.

Epidemiology of sleep disturbances among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Background

Sleep disturbances and their associated health issues are common among medical students. Despite this, the epidemiology of sleep disturbances among medical students in the Middle East and North Africa (MENA) region remains inadequately understood. Our objective was to synthesise the prevalence of sleep disturbances, including poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness (EDS), and their variation in relation to academic performance and stress levels.

Methods

We performed a systematic review and meta-analysis. Two independent reviewers searched PubMed, Web of Science, Google Scholar, and the reference lists of relevant studies and reviews up to May 2024. We assessed the quality of the included studies using a risk of bias tool. We performed meta-analyses using random-effects models and used Cochran's Q between-subgroups statistic to test for differences across subgroups. We used the I2 statistic to assess the statistical heterogeneity. Further, we assessed the publication bias using Doi plots.

Results

We included 150 studies conducted in 16 MENA countries. We found that 59.1% of medical students suffer from poor sleep quality (Pittsburgh Sleep Quality Index mean (x̄) = 8.5; 95% confidence interval (CI) = 7.0-10.1), 59.8% have insufficient sleep duration (<7 hours per night) averaging 6.1 hours per night (95% CI = 5.4-6.9), and 38.4% experience EDS (Epworth Sleepiness Scale x̄ = 8.6; 95% CI = 8.0-9.1). Our results indicate a significantly higher prevalence of poor sleep quality among students with moderate or high stress levels during the preclinical training period and in low-income MENA countries. A significantly higher prevalence of insufficient sleep duration was found among students during preclinical academic years. A significantly higher prevalence of EDS was found among students in public medical schools and those in low-income MENA countries. We observed no differences in poor sleep quality and EDS between students with poor and good academic performance.

Conclusions

Our findings highlight the substantial prevalence of sleep disturbances among MENA medical students. Medical schools must address this critical issue with targeted, locally informed, and culturally appropriate interventions. Further research is needed to assess the association between sleep disturbances and identify factors for tailored interventions that mitigate the adverse consequences on medical students' health and well-being.

Registration

Open Science Framework BF2A6.

Blood transfusion strategies for major bleeding in trauma

BACKGROUND

Trauma is a leading cause of morbidity and mortality worldwide. Research shows that haemorrhage and trauma-induced coagulopathy are reversible components of traumatic injury, if identified and treated early. Lack of consensus on definitions and transfusion strategies hinders the translation of this evidence into clinical practice.

OBJECTIVES

To assess the beneficial and harmful effects of transfusion strategies started within 24 hours of traumatic injury in adults (aged 16 years and over) with major bleeding.

SEARCH METHODS

CENTRAL, MEDLINE, Embase, five other databases, and three trial registers were searched on 20 November 2023. We also checked reference lists of included studies to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of adults (aged 16 years and over) receiving blood products for the management of bleeding within 24 hours of traumatic injury.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology to perform the review and assessed the certainty of the evidence using GRADE.

MAIN RESULTS

We included 18 RCTs with 5041 participants. Comparison 1: Prehospital transfusion strategies Five studies compared use of plasma (fresh frozen plasma (FFP) or lyophilised plasma) versus 'standard of care'. We are uncertain of the effect of plasma on all-cause mortality at 24 hours (risk ratio (RR) 1.05, 95% confidence interval (CI), 0.48 to 2.30; 3 studies, 279 participants; very low certainty evidence). There is probably no difference between plasma and standard of care in all-cause mortality at 30 days (RR 0.95, 95% CI 0.78 to 1.17; 3 studies, 664 participants; moderate-certainty evidence). However, the results of one cluster-RCT that could not be included in our meta-analysis suggested that plasma may be associated with a lower risk of death at 30 days (RR 0.54, 95% CI 0.42 to 0.70; 1 study, 481 participants; low-certainty evidence). There may be no difference between plasma and standard of care in the total number of thromboembolic events in 30 days (RR 1.23, 95% CI 0.67 to.2.27; 4 studies, 586 participants; low-certainty evidence). Comparison 2: In-hospital transfusion strategies Ten studies evaluated this comparison, seven providing usable data. The studies evaluated cryoprecitate (three studies); fixed-ratio blood component transfusion (three studies); fresh frozen plasma (FFP) (one study); lyophilised plasma (one study); leucoreduced red blood cells (one study); and a restrictive transfusion strategy (one study). All-cause mortality at 24 hours For all-cause mortality at 24 hours, there is probably no difference between: • cryoprecipitate plus a major haemorrhage protocol (MHP) versus MHP alone (RR 0.92, 95% CI 0.70 to 1.21; 1 study, 1577 participants; moderate-certainty evidence); and • blood products (plasma:platelets:red blood cells (RBCs)) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 0.75, 95% CI 0.52 to 1.08; 1 study, 680 participants; moderate-certainty evidence). We are uncertain of the effect on all-cause mortality at 24 hours for: • blood products (RBCs:FFP) transfused in 1:1 ratio versus transfusion according to coagulation and full blood count results (Peto odds ratio (POR) 0.45, 0.17 to 1.22; 1 study, 434 participants; very low certainty evidence); and • lyophilised (FlyP) plasma versus FFP (POR 1.04, 95% CI 0.06 to 17.23; 1 study, 47 participants; very low certainty evidence); All-cause mortality at 30 days For all-cause mortality at 30 days, there is probably no difference between blood products (plasma:platelets:RBCs) transfused in a 1:1:1 ratio versus a 1:1:2 ratio (RR 0.85, 95% CI 0.65 to 1.11; 1 study, 680 participants; moderate-certainty evidence). There may be little to no difference between the following interventions in all-cause mortality at 30 days: • cryoprecipitate plus MHP versus MHP alone (RR 0.77, 95% CI 0.33 to 1.78; 2 studies, 1572 participants; low-certainty evidence); and •leucoreduced RBCs versus standard RBCs (RR 1.20, 95% CI 0.74 to 1.95; 1 study,55 participants; low certainty evidence). We are uncertain of the effect on all-cause mortality at 30 days for: •lyophilised plasma versus FFP (RR 0.75, 95% CI 0.28 to 2.02; 1 study, 47 participants; very low certainty evidence); and • blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (RR 2.25, 95% CI 0.90 to 5.62; 1 study, 69 participants; very low certainty evidence). Total number of thromboembolic events at 30 days There may be little to no difference between the following interventions for total thromboembolic events at 30 days: • cryoprecipitate plus MHP versus MHP alone (RR 0.55, 95% CI 0.08 to 3.72; 2 studies, 1645 participants; low-certainty evidence); and • blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 1.03, 95% CI 0.75 to 1.42; 1 study, 680 participants; low-certainty evidence). We are uncertain of the effect on the total number of thromboembolic events at 30 days for: •blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (POR 6.83, 95% CI 0.68 to 68.35; 1 study, 69 participants; very low certainty evidence). Comparison 3: Whole blood versus individual blood products We are uncertain of the effect of modified (leucoreduced) whole blood versus blood products (RBCs:plasma) transfused in a 1:1 ratio on all-cause mortality at 24 hours (RR 1.13, 95% CI 0.37 to 3.49) or 30 days (RR 1.62, 95% CI 0.69 to 3.80) (1 study, 107 participants; very low certainty evidence). Comparison 4: Goal-directed blood transfusion strategy of viscoelastic haemostatic assay (VHA) versus conventional laboratory coagulation tests (CCT) to guide haemostatic therapy There may be little or no difference in all-cause mortality at 24 hours between VHA and CCT (RR 0.85, 95% CI 0.54 to 1.35; 1 study, 396 participants; low-certainty evidence). We are uncertain of the effects on all-cause mortality at 30 days (RR 0.75, 95% CI 0.48 to 1.17; 2 studies, 506 participants; very low certainty evidence). There is probably no difference between VHA and CCT in total thromboembolic events at 30 days (RR 0.65, 95% CI 0.35 to 1.18; 1 study 396 participants; moderate-certainty evidence).

AUTHORS' CONCLUSIONS

Overall, there was little to no evidence of a difference between blood transfusion strategies for mortality or thromboembolic events. The studies covered a wide range of interventions, and the comparators and standard of care practice varied between trials, thereby limiting the pooling of data. Further research is needed.

Rate of Spinal Osteochondromas Diagnosed in Pediatric Patients With Hereditary Multiple Osteochondromas: A Systematic Review and Meta-Analysis

BACKGROUND

Hereditary multiple osteochondromas (HMO) is a common pediatric condition defined by multiple cartilage-capped bony lesions. Spinal osteochondromas affect up to 68% of HMO patients. Although most are asymptomatic, intraspinal osteochondromas can cause significant neurological symptoms and morbidity. Limited guidelines exist regarding the use of advanced imaging to screen for spinal osteochondromas. This study evaluates the incidence of spinal osteochondromas detected through advanced imaging in pediatric HMO patients.

METHODS

A systematic review and meta-analysis were conducted following the Cochrane Handbook for Systematic Reviews of Interventions. Included studies reported on the use of computed tomography (CT) or magnetic resonance imaging (MRI) in HMO patients under the age of 21. The primary outcome was spinal osteochondroma incidence. Secondary outcomes included imaging indication, symptoms, intraspinal lesion incidence, surgical intervention incidence, and postoperative outcomes. A meta-analysis of single proportions determined the pooled incidence of spinal osteochondromas, intraspinal lesions, and spinal surgery in HMO patients.

RESULTS

Of 415 eligible articles, seven met inclusion criteria, including 198 HMO patients with a weighted mean age of 12 ± 1.0 years. MRI was the primary imaging modality in 175 patients (99%) with 136 (69%) imaged only per institutional screening protocols. Neurological symptoms were present in 41 subjects (21%) at the time of imaging. The pooled spinal osteochondroma incidence was 36% (95% CI, 24%-51%, event rate 72/183). Of these, 109 lesions (43%) were in the cervical spine, 41 lesions (38%) in the thoracic spine, and 21 lesions (19%) in the lumbar spine. Among those with spinal osteochondromas, 49% (95% CI, 37%-61%, event rate 41/85) had intraspinal lesions, and 21% (95% CI, 13%-33%, event rate 15/70) underwent surgery. Postoperatively, 17 patients (55%) experienced symptom resolution with no long-term complications reported.

CONCLUSIONS

Although spinal osteochondromas are prevalent among HMO patients, standardized screening protocols remain limited. Nonetheless, initial and serial screening is needed to prevent irreversible neurological damage. As global guidelines evolve, large multicentre prospective studies are needed to identify and standardize optimal timing for spinal osteochondroma screening in HMO patients.

LEVEL OF EVIDENCE

Level III.

The Diagnostic Role of miRNAs in Identifying Placenta Accreta: A Systematic Review

OBJECTIVE

This systematic review evaluates the diagnostic accuracy of circulating microRNAs (miRNAs) as potential biomarkers for detecting placenta accreta spectrum (PAS) disorders, a condition characterized by abnormal placental adherence with significant maternal health risks.

DATA SOURCES

A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases up to October 30, 2024, using predefined keywords such as "miRNA" and "placenta accreta."

STUDY ELIGIBILITY

Studies investigating miRNA expression in PAS cases compared to controls, using either blood or placental tissue, were included. Articles were screened independently by two reviewers, with discrepancies resolved by consensus.

STUDY APPRAISAL AND SYNTHESIS METHODS

The methodological quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Extracted data were synthesized to identify miRNAs with diagnostic potential for PAS disorders. Due to significant variations in the comparisons conducted across studies and the diverse outcome measures reported, a meta-analysis of the included studies was not feasible.

RESULTS

Out of 82 articles identified, 14 met the inclusion criteria after duplicate removal and screening. The studies reported distinct differential expression patterns of miRNAs in PAS cases. Notably, a combination of miR-26a-5p and miR-17-5p demonstrated 100% sensitivity and 82% specificity for predicting PAS in the first-trimester of pregnancy.

CONCLUSIONS

PAS disorders are typically diagnosed during the third trimester through imaging techniques like ultrasonography. However, miRNAs exhibit promise as non-invasive, early biomarkers, potentially enabling earlier diagnosis and improved clinical management. These findings support the incorporation of miRNA analysis into diagnostic guidelines for PAS.

Effect of physical activity on sleep in women experiencing vasomotor symptoms during menopause: a systematic review and meta-analysis

Hot flashes and night sweats, common vasomotor symptoms (VMS) during menopause, are strongly associated with poor sleep quality and disorders. Physical activity is proposed as a strategy to improve menopausal health and sleep outcomes. This systematic review and meta-analysis synthesizes and evaluates evidence on the relationship between physical activity and sleep parameters in women experiencing VMS. Comprehensive searches were conducted in October 2024 across multiple databases, including MEDLINE/PubMed, Cochrane Library, and EMBASE, alongside manual backward and forward searches. Randomized controlled trials (RCTs) investigating physical activity or exercise interventions and their effects on subjective and objective sleep outcomes in women with VMS were included. The risk of bias was assessed using the revised Cochrane RoB 2 tool, and data were pooled for meta-analysis. Nine studies with a total of 1579 participants were analyzed. Physical activity interventions did not significantly improve sleep quality (-0.03 [-1.23, 1.18]; P = 0.96; I2 = 78 %) or insomnia (-1.65 [-3.52, 0.21]; P = 0.08; I2 = 0 %) but produced minor improvements in sleep problems (-0.08 [-0.16, -0.00]; P = 0.04; I2 = 0 %). Despite concerns regarding bias, none of the studies were classified as high-risk, supporting result reliability. The findings suggest heterogeneity in the effects of physical activity on sleep, influenced by intervention-specific factors like type, frequency, intensity, timing, and duration. Environmental variables may also moderate these outcomes, highlighting the complexity of sleep regulation and the need for tailored approaches to improve sleep in menopausal women. Review protocol is registered in PROSPERO: CRD42024599593.

Percutaneous Coronary Intervention or Minimally Invasive Coronary Bypass for Isolated Left Anterior Descending Artery Disease

The optimal revascularization strategy for isolated left anterior descending (LAD) artery disease, minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI), remains a subject of debate. This updated meta-analysis aimed to compare the long- term outcomes of MIDCAB versus PCI for patients with isolated LAD artery disease. Three databases were systematically searched to identify randomized controlled trials (RCTs) and adjusted studies. Primary outcomes included long-term survival and repeat target vessel revascularization (TVR). The secondary endpoint was long-term major adverse cardiovascular events (MACEs). Hazards ratios (HR) and Confidence Intervals (CI) were calculated for long-term outcomes and a random effects model was used. Sensitivity analyses included subgroups analysis of stent-type. Nine articles, comprising four RCTs, totaling 2,168 patients (MIDCAB=1,086 and PCI=1,080) were included. The weighted mean follow-up was 4.35±4.9 years. Long-term survival was comparable between MIDCAB and PCI (HR=0.76; 95% CI, 0.58-1.00; p=0.05). MIDCAB was associated with a significantly lower rate of repeat TVR (HR=0.35; 95% CI, 0.25-0.49; p<0.0001) and a reduced risk of MACEs (HR=0.59; 95% CI, 0.43-0.81; p<0.0001), although the difference was not evident in subgroup analysis comparing MIDCAB and PCI with drug-eluting stent (HR=0.66; 95% CI, 0.46-1.06; p=0.09). In conclusion, this meta-analysis of RCTs and adjusted studies shows that in patients with isolated LAD lesion, MIDCAB and PCI exhibit comparable long-term survival. However, MIDCAB is associated with a significantly reduced risk of long-term repeat TVR and MACEs compared to PCI.

Evaluating the effectiveness of psilocybin in alleviating distress among cancer patients: A systematic review

OBJECTIVES

Psychological and existential distress is prevalent among patients with life-threatening cancer, significantly impacting their quality of life. Psilocybin-assisted therapy has shown promise in alleviating these symptoms. This systematic review aims to synthesize the evidence on the efficacy and safety of psilocybin in reducing cancer-related distress.

METHODS

We searched MEDLINE, APA PsycINFO, Cochrane database, Embase, and Scopus from inception to February 8, 2024, for randomized controlled trials (RCTs), open-label trials, qualitative studies, and single case reports that evaluated psilocybin for cancer-related distress. Data were extracted on study characteristics, participant demographics, psilocybin and psychotherapy intervention, outcome measures, and results. Two authors independently screened, selected, and extracted data from the studies. Cochrane Risk of Bias for RCTs and Methodological Index for Non-Randomized Studies criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42024511692).

RESULTS

Fourteen studies met the inclusion criteria, comprising three RCTs, five open-label trials, five qualitative studies, and one single case report. Psilocybin therapy consistently showed significant reductions in depression, anxiety, and existential distress, with improvements sustained over several months. Adverse effects were generally mild and transient.

SIGNIFICANCE OF RESULTS

This systematic review highlights the potential of psilocybin-assisted therapy as an effective treatment for reducing psychological and existential distress in cancer patients. Despite promising findings, further large-scale, well-designed RCTs are needed to confirm these results and address existing research gaps.

Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review

PURPOSE

Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.

SOURCE

We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.

PRINCIPAL FINDINGS

Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I2 = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I2 = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I2 = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.

CONCLUSIONS

Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.

STUDY REGISTRATION

PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.

Incidence and risk factors of sarcopenia in gastric cancer patients: a meta-analysis and systematic review

BACKGROUND

This meta-analysis was to assess the incidence and risk factors of sarcopenia in gastric cancer (GC) patients and to provide clinical implications for the prevention and improvement of sarcopenia in GC patients.

METHODS

PubMed, Embase, Cochrane, Web of Science, CNKI, Wanfang, and VIP databases (language was limited to Chinese and English) were searched for observational studies. The random-effects model was used to analyze the incidence of GC combined with sarcopenia and the odd ratio (OR) and 95% confidence interval (CI) of risk factors.

RESULTS

1244 studies were retrieved and 20 eligible studies were included. The meta-analysis revealed that the incidence of sarcopenia in GC patients was 26.6% (95% CI: 21%~32%). Age (OR = 1.128, 95% CI: 1.056 ~ 1.204, P < 0.001), male (OR = 1.054, 95% CI: 0.620 ~ 1.791, P < 0.005), body mass index (OR = 1.117, 95% CI: 0.881 ~ 1.414, P < 0.001), nutritional risk screening 2002 (OR = 3.953, 95% CI: 2.038 ~ 7.668, P < 0.05), and tumor diameter > 3 cm (OR = 1.515, 95% CI: 1.021 ~ 2.248, P < 0.05) may be risk factors for sarcopenia in GC patients. In contrast, tumor stage (OR = 1.907, 95% CI: 0.967 ~ 3.763, P > 0.05), gastrectomy approach (OR = 1.837, 95% CI: 1.237 ~ 2.727, P > 0.05), differentiation type (OR = 0.586, 95%CI: 0.325 ~ 1.059, P > 0.05), and severe adverse reactions (NLR, HB, ALB) after chemotherapy (OR = 0.926, 95%CI: 0.793 ~ 1.082, P > 0.05) had no significant correlation with sarcopenia in GC patients.

CONCLUSIONS

This meta-analysis shows an increased prevalence of sarcopenia in GC patients. This analysis, which focused on Asian populations, suggested that high nutritional risk was a risk factor for sarcopenia in GC patients. Age over 65 years and tumor diameter over 3 cm may be risk factors for sarcopenia. Men may be prone to sarcopenia. Targeting these risk factors may be beneficial in the prevention of sarcopenia in GC patients.

Is legislation effective in reducing risks of all-terrain vehicle-related injuries? A systematic review

BACKGROUND

Over decades, governments have enacted policies and legislation mandating strategies to reduce the incidence and severity of all-terrain vehicle (ATV)-related injuries. We performed a systematic review to determine the efficacy of laws and policies in reducing these injuries.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 articles from the peer-reviewed literature were systematically selected. Associations between legislation/policy and changes or differences in injury numbers, rates or severity were queried.

RESULTS

Data were available to examine age restrictions or child/youth-directed safety measures, use of helmets and vehicle-specific/engineering policies. Legislating age restrictions was associated with limited paediatric injury reduction in five of nine studies; sustained efficacy may require concurrent socialisation through media or regulated riding environments. Mandated helmet use was associated with reduced ATV-related mortality in five of six studies. However, the concurrent presence of other safety legislation precludes concluding the efficacy of helmet laws, alone. Legislation targeting vehicle design/engineering is limited, as are studies of their efficacy. A US federal decree for large-scale vehicle-related and industry-related changes was associated with a brief but dramatic decrease in ATV-related deaths; this reversed once the decree was lifted.

CONCLUSIONS

With the possible exception of helmet legislation, many laws aimed at reducing ATV-related injuries demonstrate little association with actual injury reduction. Most target changing individual behaviours and may be unsuccessful due to personal perceptions of low risk of injury. Enacting policies directed to industry, to address design and engineering interventions that can reduce risk during operation of these products, is more likely to result in substantive and sustained change.

Acupuncture for the Management of Chronic Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIM

Diabetic peripheral neuropathy (DPN) affects up to half of all patients with diabetes mellitus. Acupuncture is often used to manage chronic pain, but its' effects on DPN are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess the effectiveness of acupuncture for DPN.

METHODS

We searched databases from inception to September 30, 2024. Paired reviewers independently extracted data and assessed risk of bias. We used random effects models for all meta-analyses and the GRADE approach to assess the certainty of evidence.

RESULTS

We included 14 RCTs (1,169 participants, 45% female). Low certainty evidence suggests that, compared to sham, acupuncture may reduce pain (weighted mean difference [WMD] -1.44 cm on a 10 cm VAS, 95%CI -1.72 to -1.15; modelled risk difference [RD] for achieving the minimally important difference [MID] of 1.5 cm: 45%, 95%CI 35-54%). Comparted to sham or usual care, low certainty evidence suggests that acupuncture may reduce overall neurological symptom severity (WMD - 1.22 [95%CI -1.85, -0.59] on the 19-point Toronto Clinical Scoring System [TCSS]), and provide little to no difference in physical functioning, mental functioning, or adverse events. Low certainty evidence suggests that, compared to amitriptyline or pregabalin, acupuncture may reduce pain associated with DPN.

CONCLUSIONS

Acupuncture for DPN may reduce pain when compared to sham acupuncture and may reduce neurologic symptom severity and result in little to no difference in physical functioning, mental functioning or adverse events, when compared with sham acupuncture or usual care.

Effect of Connective Tissue Grafts in the Regenerative Treatment of Intrabony Defects: A Systematic Review and Meta-Regression Analysis

AIM

To assess the effect of connective tissue graft (CTG) in the treatment of periodontal intrabony defects (IDs), focusing on changes in postoperative gingival recession (GR) depth and regenerative outcomes.

METHODS

A systematic search was conducted across MEDLINE-PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for articles published through December 31, 2024. Randomized controlled trials (RCTs) comparing treatment outcomes in IDs treated with or without CTG were included in a meta-regression analysis. A mixed-effect linear regression model was employed to estimate the effect of CTG on postoperative GR depth, probing depth (PPD) reduction, clinical attachment level (CAL) gain, and bone fill (BF).

RESULTS

Twenty-three studies were selected, with five RCTs (176 IDs) included in the meta-regression. Of these, two RCTs compared bone graft (BG) + CTG to BG + resorbable membrane (MB), one compared periosteal vs. nonperiosteal CTG combined with BG, one compared open flap debridement (OFD) + CTG to OFD alone, and one compared BG + CTG to either OFD or MB. The use of CTG was significantly associated with a reduction in GR (mean effect size of 0.981 mm, 95% CI: 0.573 to 1.389, p = 0.001), PPD (mean effect size of 1.160 mm, 95% CI: 0.318 to 2.002, p = 0.010), as well as improvements in CAL (mean effect size of 1.105 mm, 95% CI: 0.420 to 1.790, p = 0.004) and BF (mean effect size of 1.382 mm, 95% CI: 0.595 to 2.169, p = 0.002).

CONCLUSION

Within the limitations of the study, the use of CTG in periodontal regenerative therapy for IDs appears beneficial in reducing postoperative GR and might further enhance regenerative outcomes compared to treatments without CTG.

Genetic Biomarkers for Periodontal Diseases: A Systematic Review

AIMS

To identify genetic biomarkers that may be used in the diagnosis, prevention or management of different forms of periodontal disease.

MATERIALS AND METHODS

Following protocol registration and PICOTS (patient, intervention, comparison, outcome, time, studies) questions, a systematic search of the literature was conducted (PudMed, Ovid), resulting in 1592 papers screened by two reviewers. Diagnostic data were extracted or calculated from included papers and compared with clinically determined diagnoses, disease progression and/or response to treatment.

RESULTS

A total of 607 articles met the inclusion criteria, including 10 reporting data on gingivitis and 597 on periodontitis. Only two papers reported diagnostic performance data, while for 41 articles on large candidate gene studies, diagnostic performance could be calculated from the reported data. No study using chair-side tests was identified. Low to moderate values for sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were found.

CONCLUSION

No genetic diagnostic test of clinical value emerged for periodontal diagnosis, prevention or prediction of disease resolution. Thus, potential future applications of polygenic risk scores that encode susceptibility, as well as single-marker testing for monogenic or oligogenic forms of periodontal diseases, are discussed.

Diagnostic and Prognostic Value of Hematological Parameters in Necrotizing Enterocolitis: A Systematic Review

Background/Objectives: Necrotizing enterocolitis (NEC) is a severe, potentially fatal gastrointestinal disease that primarily affects preterm neonates, especially those with very low birth weight (<1500 g). Despite extensive research, its pathophysiology remains unclear, with NEC considered a spectrum of disorders driven by systemic inflammation, microbiota dysregulation, and intestinal hypoxic injury. Diagnosis is challenging due to its subtle presentation and reliance on clinical and radiographic findings, underscoring the urgent need for reliable early biomarkers. Complete blood count (CBC) is one of the most frequently performed laboratory tests in neonatal care, providing valuable insights associated with hematologic alterations associated with NEC. Given its cost-effectiveness, accessibility, and rapid turnaround time, CBC parameters have been increasingly investigated for their diagnostic and prognostic potential in NEC. This systematic review consolidates existing evidence on the diagnostic and prognostic utility of CBC parameters in NEC, examining their association with disease onset, progression, and outcomes. Methods: A systematic review of the literature in PubMed and Scopus databases was conducted, between February 25 and December 2024. Results: Following a PRISMA-compliant search strategy, 77 eligible studies were included, analyzing data from 295,195 neonates, of whom 14,570 had NEC. Among the 77 studies, 17 examined NEC-associated mortality as a primary outcome, while 13 studies focused on the development of predictive models incorporating CBC parameters alongside other clinical and laboratory data to assess NEC severity and prognosis in neonates. The findings highlight the potential of CBC-derived markers to facilitate early NEC detection and risk stratification. However, variations in study design and diagnostic criteria highlight the need for prospective studies to validate their clinical use. Conclusions: Despite advancements in understanding NEC, its diagnosis remains challenging due to the absence of fully reliable biomarkers. CBC parameters show promise in offering early diagnostic and prognostic insights. However, further validation is needed for their routine integration into NICU practice. Given the persistent challenges in NEC diagnosis and management, our findings highlight the necessity for integrated scoring systems that combine hematologic, clinical, and radiologic data to enhance early detection and optimize neonatal care. Further research is essential to refine these predictive models, enabling timely interventions and improving survival rates in NEC-affected neonates.

Real-World Evidence Evaluating Teclistamab in Patients with Relapsed/Refractory Multiple Myeloma: A Systematic Literature Review

Background: Teclistamab (TEC) is the first B-cell maturation antigen-directed bispecific antibody approved in 2022 by the European Medicines Agency and Food and Drug Administration for triple-class exposed relapsed/refractory multiple myeloma (RRMM). Objectives: As TEC is increasingly used in real-world (RW) settings, this study seeks to gather existing RW evidence on effectiveness, safety, healthcare resource utilization, and clinical practices associated with TEC. Methods: A systematic literature review was performed to identify RW observational studies of TEC-treated adults with RRMM from 2023 to June 2024. Results: Sixty-one records representing 41 unique studies were included; sample sizes ranged from 8 to 572 patients. Where reported, median follow-up ranged from 2.3 to 33.6 months, and >65% of the patients would have been ineligible for the pivotal trial of TEC (MajesTEC-1) in all but one study. In eight studies with ≥50 patients and ≥3 months follow-up, overall response rates were 59-66% and cytokine release syndrome (CRS) rates were 18-64%. Tocilizumab use for CRS management was reported in 14 studies, with two indicating CRS rates of 13% and 26% when used prophylactically. Survival and infection outcomes showed wide variability due to short follow-up in most studies. Conclusions: Overall, early RW effectiveness and safety outcomes of TEC were comparable to findings from MajesTEC-1.

Long-term effects on blood pressure of soft tissue surgery for obstructive sleep apnea treatment in adults: a systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate long term effect of soft tissue surgery on blood pressure (BP) in adults with obstructive sleep apnea (OSA).

SEARCH METHODS

PubMed, Scopus, the Cochrane library, and Ovid Medline databases were searched through January 2024. Manual searches were also obtained. This review included studies assessing impact of soft tissue surgery for the treatment of OSA in adults on long-term BP.

RESULT

A total of five studies (299 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant long-term postoperative reduction of BP, with average systolic BP reduction of 14.04 mmHg [95%CI (-21.97, -6.11); P = 0.0005]. Pooled random effects analysis of data from four studies (277 patients) also demonstrated statistically significant long-term postoperative reduction of diastolic BP by 6.88 mmHg compared with preoperative baseline [95%CI (-13.31, -0.45); P = 0.04].

CONCLUSION

Soft tissue surgery for OSA treatment in adults significantly resulted in long-term blood pressure reduction.

Prognostic significance of circulating tumor DNA detection and quantification in cervical cancer: a systematic review and meta-analysis

Background

Circulating tumor DNA (ctDNA) is an emerging biomarker in cervical cancer, with elevated levels typically indicating a higher tumor burden. However, its prognostic value in cervical cancer patients remains debated. This meta-analysis aims to clarify the prognostic significance of ctDNA in this patient population.

Methods

We searched the PubMed, Cochrane Library, CNKI, and EMBASE databases for studies published up to September 30, 2024, to investigate the prognostic significance of ctDNA in cervical cancer patients. The outcome measures included overall survival (OS) and progression-free survival (PFS)/disease-free survival (DFS).

Results

This analysis included 10 studies encompassing a total of 706 cervical cancer patients. Findings revealed that patients with detectable baseline ctDNA had significantly poorer OS(HR = 1.64, 95% CI = 1.45-1.86, P < 0.001) as well as worse PFS or DFS (HR = 1.42, 95% CI = 1.07-1.89, P = 0.015). Additionally, ctDNA detectability during treatment was strongly associated with poorer OS (HR = 17.22, 95% CI = 4.43-66.89, P < 0.001) and PFS/DFS (HR = 4.16, 95% CI = 2.57-6.73, P < 0.001).

Conclusions

This meta-analysis demonstrates that elevated ctDNA levels are significantly associated with poorer PFS, DFS, and OS in patients with cervical cancer. However, data regarding the association between ctDNA levels and OS are relatively limited, and the number of included studies remains small, with a potential risk of publication bias. Based on the current evidence, ctDNA shows promise as a valuable tool for pre-treatment assessment and an effective biomarker for monitoring therapeutic response and disease progression. Further large-scale, prospective studies are warranted to validate these findings and establish their reliability and clinical applicability.

Systematic Review Registration

inplasy.com, identifier INPLASY2024120083.

The Washout Resistance of Bioactive Root-End Filling Materials-A Systematic Review

When performing an apicoectomy avoiding the microleakage is desired. That is why materials used for this procedure should be resistant to washout. Washout refers to the tendency of freshly prepared materials to disintegrate upon contact with fluids. Background/Objectives: The aim of this paper is to provide a literature review on the washout resistance of bioactive root-end filling materials. Methods: This systematic review was conducted following the PRISMA 2020 guidelines. International databases (PubMed, Google Scholar, ScienceDirect, and Wiley Online Library) were searched, and articles published in the last 20 years were selected for analysis. The following keywords were used "antiwashout", "washout resistance", "washout in dentistry", "root-end filling materials", "calcium silicate-based cements", "bioceramic materials". A total of 6 in vitro studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was low in all six studies. Results: Most tested bioceramic materials are Endocem, Capasio, and Ceramicrete-D. Generex-A, MTA-Plus, MTA-AW, Bioaggregate, and MTA HP usually demonstrate very good washout resistance. ProRoot and MTA Angelus performed differently depending on the test; however, generally they showed good washout resistance. The Biodentine material showed significant washout, and requires further research. There is still a lack of a unified method for washout evaluation in dentistry, which makes it difficult to compare different studies. Conclusions: The study the confirmed excellent washout resistance of EndoCem, Capasio, Ceramicrete-D, Generex-A, Bioaggregate, MTA-Plus, and MTA HP. ProRoot, MTA-Angelus, and MTA Angelus White exhibited lower washout resistance. Biodentine shows poor washout resistance, and requires further research. A unified method for assessing washout would be beneficial for comparing different studies.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Comparative effectiveness and acceptability of internet-based psychological interventions on depression in young people: a systematic review and network meta-analysis

BACKGROUND

Depression represents a major global public health challenge, particularly among young individuals aged between 10 and 25. This age bracket is notably critical, as the onset of depression during these years tends to be more severe and consequential. In response to the growing demand for mental health services, internet-based psychological interventions have gained traction as a flexible and convenient alternative to traditional face-to-face treatment. This systematic review and network meta-analysis aims to rigorously assess the comparative efficacy and acceptability of internet-based psychological interventions in addressing depression within the young population over the past three decades.

METHODS

We conducted a comprehensive search of seven electronic databases for eligible randomized controlled trials published from January 1995 to July 2024. The literature screening process adhered to the principles of population, intervention, comparator, outcome, and study design. The quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool. To evaluate the ranking probability of each intervention, we calculated the surface under the cumulative ranking curve values. Network meta-analysis (NMA) was conducted using RStudio and Stata software.

RESULTS

The NMA incorporated a total of 27 studies involving 3,451 participants. Among these studies, 18 assessed internet-based cognitive behavioral therapy (iCBT) interventions, whereas 12 employed a waitlist as a control group. At the end of the interventions, internet-based acceptance and commitment therapy (iACT), iCBT, internet-based dialectical behavior therapy (iDBT), and internet-based psychodynamic therapy (iPDT) all demonstrated statistically significant reductions in depression scores. Notably, no intervention measure was found to be statistically more acceptable than the others.

CONCLUSIONS

Our NMA indicated that iDBT appeared to be more effective, whereas internet-based mindfulness-based therapy (iMBT) may be more acceptable. These findings offered preliminary evidence regarding the comparative effectiveness and acceptability of internet-based psychological interventions in treating depression among young people. However, the limited number of eligible studies underscored the importance and necessity of further research to evaluate novel intervention measures.

TRIAL REGISTRATION

The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), with the registration number CRD42024580958.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPACT

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

Institutional Sexism Against Women Subjected to Gender-Based Violence and their Children. An International Systematic Review

Institutional sexism emerges as a globally pervasive phenomenon, adversely affecting women subjected to gender-based violence. This societal harm demands scrupulous investigation to curtail its occurrence. To this end, a meticulous synthesis and scrutiny of international literature was undertaken via a systematic review, in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis declaration and standards, employing an inductive content analysis methodology. This exhaustive enquiry spanned esteemed databases, namely Web of Science, Scopus, PubMed, and PsycINFO, culminating in a total of 478 references, from which 27 select articles were rigorously examined. The Rayyan utility was instrumental in streamlining data organization and extraction, while textual coding and data analysis were accomplished through Atlas.ti. The review protocol was preregistered with PROSPERO, the International prospective register of systematic reviews (ID CRD42023436945). The outcomes highlight the critical need for states to give precedence to the development of policies that champion gender equality. Furthermore, the analysis reveals a pronounced deficiency in understanding the dynamics of gender-based violence, as well as a conspicuous neglect of feminist and intersectional perspectives by professionals within the legal and social realms.

Safety of Anti-osteoarthritis Medications: A Systematic Literature Review of Post-marketing Surveillance Studies

BACKGROUND

Several meta-analyses of phase 3 randomized controlled trials (RCTs) were published in 2019, reassessing the safety of most anti-osteoarthritis (OA) medications, mainly on the basis of data from full safety reports. The current systematic review (SR) intends to provide complementary insights into the safety of anti-OA medications, using evidence from post-marketing safety surveillance studies.

METHODS

The review protocol was registered with PROSPERO database (registration no. CRD42021227872). We followed the Cochrane methodology for SRs of interventions and comprehensively searched the Medline, CENTRAL, Scopus and TOXLINE databases from inception to November 2023, to include all post-marketing safety surveillance studies on any anti-OA medications. The outcomes of this SR were any adverse events (AEs) reported in the included studies.

RESULTS

The literature search yielded 16,990 studies, of which 59 articles were ultimately included in the review. Most studies investigated non-steroidal anti-inflammatory drugs (NSAIDs, 27 studies, 28 reports) and intra-articular hyaluronic acid (IAHA, 16 studies). Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) were assessed in seven studies (one of which also assessed NSAIDs), and corticosteroid injections in four studies, while opioids and "herbal mixtures and other compounds" each were investigated respectively in three and two studies. Most of the studies were cohort studies (n = 44), others were case reports or case series (n = 12), RCTs (n = 2 reports of the same trial), or a case-control study (n = 1). The most commonly reported AEs with NSAIDs from cohort (sample sizes varied between 129 and 22,938 patients), RCT (21,645 patients with OA), and case-control (174 cases and 926 control patients with OA) studies were gastrointestinal (GI) and/or cardiovascular (CV) AEs, with specific AEs varying with individual NSAIDs. Where comparisons between NSAIDs were made, the overall literature shows a better or similar safety profile for celecoxib (at a daily dose of 200 mg, where dosage was reported) compared with other NSAIDs in regards to GI, CV and renal events. Other anti-OA medications with most common AEs reported from cohort studies were: IAHA (injection site pain); diacerein (GI AEs and reddish urine); avocado-soybean unsaponifiables (GI AEs); non-pharmaceutical-grade glucosamine and chondroitin (allergic reactions, GI disorders); opioids (hip fracture associated with long-term tramadol use among older adults; GI and nervous system disorders with hydrocodone); corticosteroid injections (increased risk of OA progression); herbal mixtures and other compounds (GI AEs). There were case reports or case series of specific AEs with various anti-OA medications that require further investigations in well-designed cohort studies before any definitive conclusions can be reached.

CONCLUSIONS

This SR confirms previous evidence on the safety of anti-OA medications from meta-analyses of phase 3 RCTs. Beyond the evidence here reported, the limitations of this research highlight the urgent need of a reporting guideline for post-marketing safety surveillance studies. Importantly, real-life safety surveillance of anti-OA medications should be strengthened with large cohort studies with control groups, and results should be disaggregated by disease populations for drugs common to several conditions.

The effects of extracorporeal shock wave therapy in children with cerebral palsy: a systematic review

INTRODUCTION

Spastic cerebral palsy (CP) is a major cause of movement disorders in pediatric rehabilitation. Current treatments are often invasive and may lead to substantial discomfort. Extracorporeal shockwave therapy (ESWT) presents a potential alternative, offering a less invasive approach with a reduced side effect profile. However, the impact of ESWT on children with CP remains unclear. This systematic review aims to summarize the current evidence on ESWT's impact in children with spastic CP across various domains of the International Classification of Functioning, Disability, and Health for Children and Youth.

METHOD

To answer the main question, a systematic literature study is used. The studies, collected from four databases, were screened, and data on outcome measures and methodological quality were extracted. Effect sizes were calculated to facilitate study comparison.

RESULTS

In total, twelve randomized controlled trials met inclusion criteria, with PEDro scores ranging from three to eight. The combined study population included 421 children. Positive effects were observed on resistance to passive movements, passive range of motion, and gross motor skills, with effect sizes ranging from moderate (0.65) to very large (14.62).

CONCLUSION

ESWT demonstrated positive effects across multiple domains in children with spastic CP.

Environmental and Clinical Factors Concerning Gastrointestinal Bleeding: An Umbrella Review of Meta-Analyses

OBJECTIVES

Gastrointestinal bleeding, an emergency and critical disease, is affected by multiple factors. This study aims to systematically summarize and appraise various factors associated with gastrointestinal bleeding.

DESIGN

Umbrella review.

SETTING AND PARTICIPANTS

Meta-analyses that evaluated environmental and clinical factors concerning gastrointestinal bleeding.

METHODS

We conducted a systematic search to identify eligible meta-analyses. For each included study, the risk estimates, heterogeneity estimates, small-study effects, excess significance tests, and publication biases were recalculated and appraised. Furthermore, we considered the methodologic quality and classified the evidence.

RESULTS

In this study, 51 beneficial and 44 harmful associations were found. This study found that preemptive transjugular intrahepatic portosystemic shunt was the most reliable treatment to reduce gastroesophageal variceal bleeding and mortality risk, followed by antibiotics. For gastroduodenal ulcer bleeding, Yunnan Baiyao and proton pump inhibitors (PPIs) were relatively dependable treatment drugs, and the comparatively reliable prophylactic drugs comprised PPIs and H2-receptor antagonists. Patients with hemodynamic instability and larger ulcers had a higher risk of rebleeding. Both weekend admissions and the combination of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs were high-risk factors for upper gastrointestinal bleeding and mortality. We also found that tranexamic acid was a credible drug for overall gastrointestinal bleeding. Meanwhile, aspirin, warfarin, diabetes, and renal failure were all high-risk factors.

CONCLUSIONS AND IMPLICATIONS

Altogether, many factors can substantially influence gastrointestinal bleeding. Therefore, in daily life and clinical practice, we should not only remain cautious in prescribing and taking some drugs but also pay attention to the management of lifestyle and underlying diseases. If necessary, protective drugs should be properly supplemented.

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

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

The Association of Cyberspace and Attention-Deficit Hyperactivity Disorder Symptoms in Children During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

The negative impact of the COVID-19 pandemic on the mental health of children has been considered. Children with attention-deficit and hyperactivity disorder (ADHD) are likely to be more vulnerable too. This study aimed to provide a systematic review of evidence regarding the association between screen usage and symptoms of ADHD during the COVID-19 pandemic.

METHODS

This review adhered to PRISMA guidelines. Systematic searches were conducted in PubMed, Scopus, Web of Sciences and Cochrane Library.

RESULTS

Of 130 identified reports, 8 papers covering 1587 subjects were included. The spent time on different types of screen time from TV to video games among children and adolescents with ADHD increased. The majority of studies showed that a surge in screen time was associated with the worsening of ADHD symptoms such as irritation, inattention, hyperactivity and oppositional defiant disorders (ODDs). The finding confirmed the severity of ADHD symptoms in individuals with a history of addictive or problematic usage of media was higher in comparison with others. One study found that educational screen time was not associated with disturbances in ADHD symptoms. In addition, ADHD symptoms during the COVID-19 pandemic were influenced by prior mental health situations.

CONCLUSIONS

The current findings suggest considering the negative association of excess screen time with ADHD symptoms, monitoring of screen time particularly for recreational purposes should be monitored to prevent negative consequences in children and adolescents with ADHD. On the other hand, designing educational and treatment interventions based on digital technology could not be ignored.

Effects of long-term treatment with recombinant growth hormone on growth outcome in children born small for gestational age: a systematic review

Children born small for gestational age (SGA) are defined as those having birth weight and/or length below -2 SD for gestational age. In approximately 90% of cases, SGA children experience catch-up growth in the first two years of life and a subsequent regular growth rate, reaching normal adult height. However, in the remaining 10% of cases, SGA children fail to have catch-up growth, showing persistent short stature and a constantly impaired growth rate, leading to decreased adult height compared with both general population and their mid-parental height. Therefore, in these children GH treatment may be indicated to improve growth outcome. As it can be started in most countries from the age of 4 years and is usually recommended until the completion of puberty, long-term GH treatment in SGA children (namely, longer than three years) showed a persistent improvement in height and an initial improvement in growth rate in the first year of treatment, followed by a stable, regular growth rate over time. In the present article, we systematically reviewed the currently available reports about efficacy of long-term GH treatment in SGA children, with a particular focus on growth rate over time and adult height.

It's Time to Put the Nap in Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC): A Systematic Review Demonstrating the Impact of Child Care on Sleep Outcomes in Early Childhood

Background: Child care-based interventions have largely neglected sleep as an important health behavior for obesity prevention. Child care sleep environments and caregiver practices likely differ from home sleep environments and parent practices. Methods: We summarize findings of past research examining how child care arrangement, dose, and attendance impact young children's sleep using steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology. Keywords related to sleep and child care were entered into PubMed, PsycINFO, and CINAHL, yielding a total of 3535 articles. Results: Twenty-three studies were included in the data extraction process. There was evidence indicating that child care arrangement type, dose, and attendance impact various sleep outcomes among children 0-5 years old. Considerable variation across studies with regard to child care comparison groups and sleep outcomes assessed made making comparisons across studies difficult. However, child care outside the home and increased time spent in child care were commonly positively associated with daytime sleep and negatively associated with nighttime sleep. Child care outside the home was also associated with 24-hour sleep, with decreased sleep observed among infants and toddlers but increased sleep observed among preschool-age children receiving outside care, especially in settings with mandatory naptime. Conclusion: The findings of this review demonstrate that child care impacts children's sleep. More research is needed to understand best practices for promoting sleep across child care settings and inform intervention efforts. Integrating sleep into evidence-based child care obesity prevention interventions, such as Nutrition and Physical Activity Self-Assessment for Child Care, would assist in efforts to reduce obesity risk among young children.

The prognostic value of p53 and Ki-67 expression status in penile cancer: a systematic review and meta-analysis

This meta-analysis aimed to explore penile cancer survival based on p53 and Ki-67 status. A systematic literature search identified studies assessing overall and cancer-specific survival after penile cancer with p53 or Ki-67 expression. Pooled hazard ratios (HRs) and restricted mean survival time (RMST) differences were calculated using a random-effects model. The analysis included 930 and 391 men for p53 expression in overall survival (OS) and cancer-specific survival (CSS), respectively. Those with the p53 mutant pattern exhibited significantly worse OS and CSS compared to the p53 wild-type pattern (HROS=2.42, 95% CI 1.75-3.34; HRCSS=4.18, 95% CI 1.87-9.35). The 5-year RMST difference for OS, according to p53 status, was -10.62 months (95% CI -16.20 to -5.03). We included 202 men with penile cancer tested for Ki-67 expression and found an HR of CSS of 1.96 (95% CI 1.15-3.32). In conclusion, men with the p53 mutant pattern penile cancer have worse OS and CSS than men with p53 wild-type pattern penile cancer. Evidence regarding Ki-67 status was sparse, but the pooled estimate indicated that penile cancers with high Ki-67 expression may have a slightly worse CSS than those with low Ki-67 expression. These findings may inform clinicians when planning the best management and follow-up strategy for penile cancer patients.

Costs and economic impact of student-led clinics-A systematic review

PURPOSE

Student-led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student-led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student-led clinics and report the methods that have been used to measure these costs and benefits.

METHOD

We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student-led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student-led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies.

RESULTS

Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description-monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits.

CONCLUSIONS

Student-led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student-led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student-led clinics in comparison to alternatives. Without the full picture, decision-makers may make decisions that are ill-informed and lead to a loss of benefit for society.

Circulating Chromogranin A Is Associated With Disease Extent, Progression, and Recurrence in Patients With Nonfunctioning Pancreatic Neuroendocrine Tumor

OBJECTIVES

Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with heterogeneous biology. Radiology and serum biomarkers are used for postresection surveillance; however, no universally established protocol exists. Serum chromogranin A (CgA) concentration is elevated in NF-PNET and generally correlates with burden of disease; many CgA studies include mixed gastrointestinal and pancreatic populations. We sought to review the NF-PNET literature with focus on postresection surveillance and hypothesized that CgA is useful for surveillance after NF-PNET resection.

MATERIALS AND METHODS

Comprehensive English literature review by PICO criteria (P, human NF-PNET patients; I, pancreatectomy; C, none; O, CgA correlation with disease recurrence).

RESULTS

Four studies yielded granular data for resected NF-PNET patients. From 333 patients, 113 recurred and 110 (97%) had elevated CgA. Additional 7 studies with mixed gastro-entero-pancreatic NET included 269 NF-PNET patients. In these patients, CgA uniformly predicted disease extent.

CONCLUSIONS

Serum CgA correlates with disease extent in NF-PNET and is useful for surveillance after resection of NF-PNET.

Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis

Background

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.

Patients and methods

A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A p-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on I 2 using the standard χ2 test. When I 2 > 50 %, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.

Results

Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86-4.01), 2.74 % (95 % CI: 1.11-4.37), 2.92 % (95 % CI: 1.63-4.20), 2.19 % (95 % CI: 0.95-3.42), and 3.11 % (95 % CI: 0.10-6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95-91.70).

Discussion

Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable. Level of evidence: Ⅳ (systematic review and meta-analysis).

Efficacy of Apheresis in the Remission of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

PURPOSE

Sudden sensorineural hearing loss (SSHL) is an abrupt hearing loss, often of unknown cause. Apheresis is a treatment option aimed at improving blood hemorheology by removing pathogenic blood components. There are currently no previous meta-analyses on its efficacy. Therefore, the aim of this study was to evaluate the efficacy of apheresis in achieving total, complete, and partial remission of SSHL, as well as remission outcomes based on the type of apheresis used.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, and the Cochrane Library until March 2024. Random-effects models were used to calculate pooled estimates of treatment success rates (TSR) and their respective 95% CI to analyze the efficacy of apheresis in the remission of SSHL. Subgroup analyses were performed by type of apheresis (HELP-apheresis and rheopheresis).

FINDINGS

The systematic review included 12 studies (10 in the meta-analysis) involving 786 adults with SSHL. The effect of apheresis showed significant total remission (TSR: 0.55; 95% CI: 0.47, 0.64), complete remission (TSR: 0.21; 95% CI: 0.11, 0.30), and partial remission (TSR: 0.43; 95% CI: 0.37, 0.48). Subgroup analysis revealed significant remission rates for HELP-apheresis (TSR: 0.58; 95% CI: 0.52, 0.64) and rheopheresis (TSR: 0.51; 95% CI: 0.30, 0.72).

IMPLICATIONS

These findings support apheresis as an equally or more effective treatment for SSHL, particularly in cases where corticosteroid therapy fails. However, due to the unknown etiology of SSHL, further clinical trials with larger, diverse populations are essential to confirm these results.

A systematic review of the methodological considerations in Campylobacter burden of disease studies

BACKGROUND

Campylobacteriosis is a major zoonotic and foodborne disease (FBD), posing a substantial social and health economic burden on human health. Burden of disease (BoD) studies, which increasingly use the disability-adjusted life years (DALYs) metric, provide comprehensive insights into disease effects. However, the complexity of DALY calculations, combined with diverse causative agents and research gaps, complicates cross-regional comparisons. This review evaluates existing Campylobacter BoD studies and interrogates their methodological approaches and assumptions in quantifying DALYs.

METHODS/PRINCIPAL FINDINGS

A systematic search of PubMed, EMBASE, Web of Science, and selected grey literature databases was conducted to identify existing Campylobacter BoD studies. Studies assessing the BoD methodology and calculation using the DALY framework were considered. In total, 23 studies met the predefined inclusion criteria. Of these, 19 were single-country studies, while 4 were multi-country analyses. A significant data gap exists, with limited or no studies from low- and middle-income countries (LMICs), exemplified by just one study obtained from Rwanda. Most studies used an incidence- and pathogen-based approach to estimate DALYs, excluding social weighting, in line with the Global Burden of Disease (GBD) study. Methodological discrepancies were noted, especially in disability weight (DW) assignment, health state classification, and life expectancy table usage. Most single-country studies (n=8) used national life tables rather than universal ones, challenging cross-country comparisons due to a lack of standardisation.

CONCLUSION

Significant variations in the methodological approaches and assumptions for Campylobacter BoD studies exist. Addressing these disparities is essential for harmonising methodological design choices using the DALYs metric to inform evidence-based public health policies and interventions.

PROSPERO REGISTRATION NUMBER

The protocol for this study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), which can be accessed under the registration number CRD42023414973.

Exercise as a transdiagnostic intervention for improving mental health: An umbrella review

Exercise is beneficial for mental health in general, but no review has systematically assessed its potential transdiagnostic nature, i.e. whether it is beneficial across specific disorders. We performed a systematic umbrella review of meta-analyses of randomized controlled trials (RCTs) of exercise in participants with mental disorders defined according to the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM), assessing exercise's transdiagnostic nature with TRANSD criteria, including eight meta-analyses (six included in the TRANSD meta-analysis), encompassing 99 RCTs (n = 5,656) across 11 disorders. Moderate/vigorous aerobic exercise was an effective transdiagnostic intervention for disease-specific primary symptoms across 11 disorders (recurrent depressive disorder, social phobia, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, brief psychotic disorder, schizophrenia, schizoaffective disorder, delusional disorder, schizophreniform disorder, attention-deficit/hyperactivity disorder) and four spectra (depressive disorders, anxiety disorders, schizophrenia-spectrum disorders, neurodevelopmental disorders) with a medium effect size (SMD = -0.67, 95%CI = -0.84, -0.50). Moderate/vigorous aerobic exercise also improved cognition across two disorders (schizophrenia, attention-deficit/hyperactivity disorder) and two spectra (schizophrenia-spectrum disorders, neurodevelopmental disorders), with a large effect size (SMD = 0.92, 95%CI = 0.52, 1.33). According to TRANSD criteria, moderate/vigorous aerobic exercise is a transdiagnostic intervention to improve disease-specific primary symptoms of 11 mental disorders, and cognition in two mental disorders.

Regional abnormalities of white and gray matter in youths with conduct problems

Conduct problems (CP) encompass a wide array of behavioral difficulties in youths, including aggression, defiance, and rule-breaking, resulting in interpersonal conflicts. CP comprises various psychiatric conditions, constituting a significant public health burden. This study performed a whole-brain coordinate-based meta-analysis (CBMA) that synthesized findings from diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and surface-based morphometry (SBM) studies to investigate consistent structural brain abnormalities in children and adolescents with CP. A total of 35 studies were eventually included. Altered white matter integrity in the right lenticular nucleus and the right inferior longitudinal fasciculus (ILF) were observed. Gray matter volume (GMV) alterations included increased volume in the right superior frontal gyrus, as well as reduced volume in the right supramarginal gyrus and left amygdala. Cortical thickness reductions were detected in the left precentral gyrus and right superior frontal gyrus. These findings underscored the intricate neurobiological basis of CP, and the meta-regression analysis revealed age-related variations in structural brain alterations, further highlighting the need for early and personalized interventions. This comprehensive study advanced our understanding of the neural underpinnings of CP, and future research and interdisciplinary collaboration to translate our findings into meaningful interventions for individuals with CP should be further explored.

Currently Available Radiology-Specific Reporting Guidelines

The aim of this paper is to contextualize and review reporting guidelines available at the EQUATOR Network that are most relevant to radiology-specific investigations. Eight EQUATOR Network reporting guidelines for the clinical area of radiology, not including the subspecialized areas of imaging of the cardiovascular, neurologic, and oncologic diseases are reviewed and discussed. The reporting guidelines are for diagnostic and therapeutic clinical research. Why the reporting guideline was development, by whom, their aims and what they hope to achieve are discussed. A table summarizes what the reporting guideline is provided for; an acronym if present is given; a full bibliographic reference with PMID number; the reporting guideline website URL or link; the study design and section of the report that the guideline applies to; and the date that the reporting guideline was last updated.