A multifaceted graphical display, including treatment ranking, was developed to aid interpretation of network meta-analysis

Comparison of Luteal Support Protocols in Frozen IVF/ICSI Cycles: A Network Meta-Analysis

BACKGROUND

Luteal support is a core success factor of frozen embryo transfers (FET). However, inconsistency across recommended protocols generates notable heterogeneity across reproductive outcomes.

OBJECTIVE

To determine the most effective luteal support strategy (LPS) based on five key factors related to the effectiveness of FET cycles.

SEARCH STRATEGY

Twelve databases and two prospective registers were searched from inception to 1st January 2024. The study was prospectively registered under the PROSPERO database (CRD42024513549).

SELECTION CRITERIA

Randomised Controlled Trials (RCTs) and observational studies of women undergoing frozen embryo transfers were included.

DATA COLLECTION AND ANALYSIS

Bayesian network meta-analysis (NMA) model presenting random effects, risk ratios (RRs) with 95% credibility intervals (CrIs) was employed. Primary outcomes included clinical pregnancy, live birth, and miscarriage. Secondary outcomes included biochemical pregnancy and multiple pregnancy events.

MAIN RESULTS

Fourteen studies, of which eight RCTs, comparing 12 interventions upon 4688 participants, were included. Overall, CiNeMa risk of bias was moderate, and network inconsistency per outcome was low. Thirteen studies reported on clinical pregnancy events with vaginal progesterone (VP) and a single or double dose of subcutaneous GnRH agonist (GnRHa), significantly improving clinical pregnancy, RR 1.86 [95% CrI 1.18, 2.93].

CONCLUSIONS

The addition of 0.1 mg subcutaneous GnRH agonist in a single (Day 3 post ET) or double (Day 3 and Day 6 post ET) schema upon a vaginal progesterone regimen till Week 12 appears to improve clinical pregnancy events in FET cycles.

The efficacy of manual therapy and therapeutic exercise for reducing chronic non-specific neck pain: A systematic review and meta-analysis

BackgroundChronic non-specific neck pain (CNSNP) is a highly prevalent musculoskeletal disorder associated with significant disability, resulting in growing recourse to healthcare providers, huge cost for society and a great number of workdays lost.ObjectiveBy this systematic review and metanalysis we aimed to assess the effects of different physical therapy techniques in patients with CNSNP.MethodsPubMed, Scopus, and Web of Science databases were regularly used to search for articles published from 1st January 2010 until 31st January 2024. All RCTs were assessed for eligibility, including studies on: patients with diagnosis of CNSNP; physical therapy approaches such as manual therapy (MT) and therapeutic exercise (TE); waiting list, sham treatments, as comparison; Visual Analogue Scale, Numerical Rating Scale, Numerical Pain Rating Scale, and Numerical Pain Scale, as outcomes.ResultsAt the end of the search, 14025 studies were identified. After the removal of duplicates, 10,852 were considered eligible according to title and abstract screening, while 10,557 papers were excluded after this process. Therefore; a total of 11 RCTs were included in this systematic review. A decrease of pain intensity was observed in all groups, albeit in patients being treated with TE and MT. Besides this, the combination of TE and MT demonstrated a 91% of probability to be the best choice in patients with CNSNP at the first visit. Only the combination of TE plus MT/cognitive behavioral therapy and MT as a single treatment showed a reduction in pain score. Overall, 3 studies (27.2%) showed a low risk of bias, 6 (54.5%) showed some concerns in bias assessment, and 2 (19%) a high risk of bias.ConclusionCollectively, the findings of this systematic review showed that MT and TE might be considered as effective rehabilitation approaches for treatment of pain in patients with CNSNP.

The pharmacodynamics-based prophylactic benefits of GLP-1 receptor agonists and SGLT2 inhibitors on neurodegenerative diseases: evidence from a network meta-analysis

BACKGROUND

Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a new generation of antihyperglycemic agents that operate through mechanisms distinct from conventional diabetes treatments. Beyond their metabolic effects, these medications have demonstrated neuroprotective properties in preclinical studies. While clinical trials have explored their therapeutic potential in established neurodegenerative conditions, their role in disease prevention remains unclear. We conducted a network meta-analysis (NMA) to comprehensively evaluate the prophylactic benefits of these agents across multiple neurodegenerative diseases and identify the most promising preventive strategies.

METHODS

We systematically searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov through October 24th, 2024, for randomized controlled trials (RCTs) of GLP-1 receptor agonists or SGLT2 inhibitors. Our primary outcome was the incidence of seven major neurodegenerative diseases: Parkinson's disease, Alzheimer's disease, Lewy body dementia, multiple sclerosis, amyotrophic lateral sclerosis, frontotemporal dementia, and Huntington's disease. Secondary outcomes included safety profiles assessed through dropout rates. We performed a frequentist-based NMA and evaluated risk of bias with Risk of Bias tool. The main result of the primary outcome in the current study would be re-affirmed via sensitivity test with Bayesian-based NMA.

RESULTS

Our analysis encompassed 22 RCTs involving 138,282 participants (mean age 64.8 years, 36.4% female). Among all investigated medications, only dapagliflozin demonstrated significant prophylactic benefits, specifically in preventing Parkinson's disease (odds ratio = 0.28, 95% confidence intervals = 0.09 to 0.93) compared to controls. Neither GLP-1 receptor agonists nor other SGLT2 inhibitors showed significant preventive effects for any of the investigated neurodegenerative conditions. Drop-out rates were comparable across all treatments.

CONCLUSIONS

This comprehensive NMA reveals a novel and specific prophylactic effect of dapagliflozin against Parkinson's disease, representing a potential breakthrough in preventive neurology. The specificity of dapagliflozin's protective effect to Parkinson's disease might rely on its highly selective inhibition to SGLT2. These findings provide important direction for future research and could inform preventive strategies for populations at risk of Parkinson's disease.

TRIAL REGISTRATION

PROSPERO CRD42021252381.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Methodologies for network meta-analysis of randomised controlled trials in pain, anaesthesia, and perioperative medicine: a narrative review

Network meta-analysis has emerged as a method for analysing clinical trials, with a large increase in the number of publications over the past decade. Network meta-analysis offers advantages over traditional pairwise meta-analysis, including increased power, the ability to compare treatments not compared in the original trials, and the ability to rank treatments. However, network meta-analyses are inherently more complex than pairwise meta-analyses, requiring additional statistical expertise and assumptions. Many factors can affect the certainty of evidence from pairwise meta-analysis and can often lead to unreliable results. Network meta-analysis is prone to all these issues, although it has the additional assumption of transitivity. Here we review network meta-analyses, problems with their conduct and reporting, and methodological strategies that can be used by those conducting reviews to help improve the reliability of their findings. We provide evidence that violation of the assumption of transitivity is relatively common and inadequately considered in published network meta-analyses. We explain key concepts with clinically relevant examples for those unfamiliar with network meta-analysis to facilitate their appraisal and application of their results to clinical practice.

Evaluating exercise therapies in adolescent idiopathic scoliosis: a systematic review with Bayesian network meta-analysis

Background

Exercise therapy represents a financially prudent and readily applicable intervention that has gained considerable traction in the treatment of adolescent idiopathic scoliosis (AIS) in recent years. Nevertheless, a definitive agreement on the superiority of one method over another remains elusive.

Methods

A comprehensive search was performed across the PubMed, Cochrane Library, Embase, and Web of Science databases for randomized controlled trials pertaining to exercise and AIS, concluding on August 20, 2024. Four independent researchers conducted a thorough review of the literature, engaged in meticulous data extraction, and assessed the risk of bias. A Bayesian network meta-analysis was performed utilizing the R programming language (version 4.3.4) and MetaInsight tool (version V6.0.1).

Results

A total of 23 studies were incorporated into the analysis, encompassing 1,289 participants with AIS. Compared to the control group, the primary meta-analysis showed that both SchrothCo and physiotherapeutic scoliosis-specific exercises (PSSE) modalities significantly improved Cobb angle (MD = -4.79, 95% CI [-8.56 to -1.11] MD = -3.11, 95% CI [-5.27 to -0.9]), axial trunk rotation (ATR) (MD = -3.03, 95% CI [-4.68 to -1.46]; MD = -2.37, 95% CI [-3.59 to -1.14]), and SRS-22 scores (MD = 0.66, 95% CI [0.39-0.94]; MD = 0.44, 95% CI [0.22-0.66]). The secondary meta-analysis showed that within the PSSE modality, Schroth therapy significantly reduced Cobb angle (MD = -2.3, 95% CI [-5.45 to -0.66]), while in the SchrothCo modality, both Schroth + Core and Schroth + Hippotherapy significantly improved Cobb angle (MD = -5.27, 95% CI [-14.15 to -3.5]). For ATR, Schroth therapy within PSSE (MD = -2.79, 95% CI [-6.4 to -0.1]), and Schroth + Core (MD = -4.03, 95% CI [-9.37 to -0.98]), Schroth + Sling (MD = -3.12, 95% CI [-10.05 to -2.94]), and Schroth + Hippotherapy (MD = -3.39, 95% CI [-10.29 to -2.84]) within the SchrothCo modality all showed significant reductions. Significant differences in SRS-22 scores were found only in the PSSE modality with Schroth therapy (MD = 0.48, 95% CI [0.02-0.9]) and in the SchrothCo modality with Schroth + Core (MD = 0.79, 95% CI [0.13-1.43]).

Conclusions

According to the latest findings, the integration of the Schroth method with core stabilization training (Schroth + Core) is regarded as the optimal strategy for addressing AIS. The integration of core stabilization training with the Schroth method reveals a markedly enhanced effectiveness. Future inquiries should encompass more rigorous studies to establish a more robust evidence foundation and facilitate progress in this domain.

Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics.

OBJECTIVES

To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain.

DESIGN

Systematic review with network meta-analysis.

DATA SOURCES

PubMed, Cochrane Library for Clinical Trials, and Embase.

ELIGIBILITY CRITERIA

We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms.

RESULTS

We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate.

CONCLUSIONS

While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence.

PROSPERO REGISTRATION NUMBER

CRD42024479424.

Long-term effectiveness of intra-articular injectables in patients with knee osteoarthritis: a systematic review and Bayesian network meta-analysis

BACKGROUND

Intra-articular injectables are proposed as a solution for pain relief and functional improvement in knee osteoarthritis (OA), however most studies involving intra-articular knee injectables are focused on short-term relief, leaving the recommendations regarding long-term management unclear. This network meta-analysis aimed to evaluate the mid- to long-term effectiveness of intra-articular knee injection of platelet-rich plasma (PRP), hyaluronic acid (HA), corticosteroids (CS), and their combinations for management of knee OA.

METHODS

Relevant studies were searched through PubMed, EMBASE, Scopus, and Cochrane Register of Trials databases from inception to 20th October, 2024 for randomized controlled trials (RCTs) of knee OA patients who had taken intra-articular injectable treatment with a follow-up duration of at least one year. The study included 37 RCTs involving 5089 patients. The outcomes assessed were pain relief and functional improvement of knee joint. The random effects Bayesian model was carried out for network meta-analysis. The surface under the cumulative ranking (SUCRA) curve demonstrated the rank probability of each injectable therapy for different outcomes.

RESULTS

Analysis revealed that, in terms of both knee pain relief and improvement of functional outcomes, the combined intra-articular injection of PRP and HA was ranked ahead of the isolated administration of PRP, followed by combination of HA with CS, HA alone, placebo, and CS at the end of one year.

CONCLUSION

These findings emphasize the sustained efficacy of PRP, particularly when combined with HA, in providing superior long-term pain relief and functional improvement in knee OA compared to other intra-articular injectables, highlighting its potential as a preferred treatment modality.

Single-round performance of colorectal cancer screening programs: a network meta-analysis of randomized clinical trials

BACKGROUND

Demonstrating mortality reduction in new colorectal cancer (CRC) screening programs through randomized clinical trials (RCTs) is challenging. We systematically reviewed single-round program performance outcomes using a stepwise approach proposed by the World Endoscopy Organization CRC Screening Committee framework.

METHODS

The MEDLINE, EMBASE, Central, and Ichushi Web databases were searched until October 28, 2024, to find RCTs comparing guaiac-based and immunochemical fecal occult blood testing (gFOBT and FIT), flexible sigmoidoscopy (FS), computed tomographic colonography (CTC), and total colonoscopy (TCS). Paired reviewers screened studies, extracted data, and assessed bias risk. A Bayesian random-effects network meta-analysis was conducted, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The primary outcome was advanced neoplasia (AN) detection, and the secondary outcomes were participation and colorectal cancer (CRC) detection, all during the first screening round.

RESULTS

Eighteen RCTs (437,072 invitees) were included. The risk of bias was low or raised some concerns for screening participation, but it was high for detection outcomes. In the network meta-analysis of 15 RCTs not allowing crossover, the FIT-based program had a higher AN detection rate than the gFOBT-based program (relative risk [RR] 2.48; 95% credible interval [CrI] 1.52-4.21; moderate certainty). AN detection rates were not different in the CTC- (RR 1.01; CrI 0.43-2.23; very low certainty) and TCS-based (RR 1.03; CrI 0.54-1.78; low certainty) programs compared with the FS-based program. All the visualization modality programs had higher AN detection rates than the FIT-based program (FS: RR 2.13 [CrI 1.38-3.77]; CTC 2.16 [1.11-4.51]; and TCS 2.19 [1.43-3.48]; all with low certainty). Low event rates precluded definitive conclusions regarding CRC detection (very low to low certainty). The TCS-based program had the worst participation rate (very low to low certainty). Comparative data allowing crossover were limited.

CONCLUSIONS

This is the first network meta-analysis that evaluates program-level initial performance indicators. FIT-based programs likely detect more AN cases than gFOBT-based programs, while FS-, CTC-, and TCS-based programs may outperform FIT. Due to limitations in first-round results, long-term outcomes should be assessed after 10-15 years.

White diet is not necessary during dental bleaching treatment: A systematic review and network meta-analysis of clinical studies

OBJECTIVES

This systematic review with network meta-analysis (NMA) answered whether a white diet is necessary during dental bleaching and if there was any coloring food impacting more significantly the bleaching potential.

DATA SOURCES

The review followed the PRISMA Extension Statement for NMA. Six electronic databases and gray literature were searched until April 2024.

STUDY SELECTION

The eligibility criteria considered clinical trials comparing the bleaching efficacy in participants that followed a white diet (control) and those who had either a supplemented intake of pigments or an unrestricted diet. Risk of bias was assessed using RoB2 (randomized clinical trials/RCT) and ROBINS-I (non-randomized clinical trials/NRCT), and the quality of evidence was checked using GRADE. Color change data were compared using both standard pairwise meta-analysis (SPMA) and Bayesian NMA.

RESULTS

From 1051 records, seven studies were included in the review (four RCT, three NRCT). All studies were classified as having low risk of bias. Regarding NMA, the control group achieved similar color change than the other groups that received pigment supplementation with grape juice, coffee, tea, wine, cola, or an unrestricted diet (p>0.05). The GRADE analysis revealed a moderate quality of evidence.

CONCLUSIONS

The consumption of soft cola, coffee, black tea, grape juice, and red wine, as well as the consumption of a totally unrestricted diet, do not have a significant influence on the effectiveness of bleaching as compared to a white diet regimen.

CLINICAL SIGNIFICANCE

The accumulated evidence suggests that restricting the intake of dietary pigments during dental bleaching is not essential.

A case study in statistical software development for advanced evidence synthesis: the combined value of analysts and research software engineers

BACKGROUND

Since 2015, the Complex Reviews Synthesis Unit (CRSU) has developed a suite of web-based applications (apps) that conduct complex evidence synthesis meta-analyses through point-and-click interfaces. This has been achieved in the R programming language by combining existing R packages that conduct meta-analysis with the shiny web-application package. The CRSU apps have evolved from two short-term student projects into a suite of eight apps that are used for more than 3,000 h per month.

AIM

Here, we present our experience of developing production grade web-apps from the point-of-view of individuals trained primarily as statisticians rather than software developers in the hopes of encouraging and inspiring other groups to develop valuable open-source statistical software whilst also learning from our experiences.

KEY CHALLENGES

We discuss how we have addressed challenges to research software development such as responding to feedback from our real-world users to improve the CRSU apps, the implementation of software engineering principles into our app development process and gaining recognition for non-traditional research work within the academic environment.

FUTURE DEVELOPMENTS

The CRSU continues to seek funding opportunities both to maintain and further develop our shiny apps. We aim to increase our user base by implementing new features within the apps and building links with other groups developing complementary evidence synthesis tools.

Assessment of Fluid Responsiveness via Central Venous Ultrasound Measurement: A Network Meta-Analysis

Background: Ultrasonographic assessment of the diameters of various veins and their indices are among the most applied diagnostic tools for evaluating fluid responsiveness in clinical practice. Despite their widespread use, there is no definitive answer on which is preferable. Our study aimed to investigate the diagnostic accuracy of different venous diameters and their indices to assess fluid responsiveness. Methods: We conducted a systematic review and network meta-analysis, analyzing prospective studies evaluating the diagnostic accuracy of venous diameters (inferior vena cava [IVC], internal jugular vein [IJV], superior vena cava, and subclavian vena) and their indices for fluid responsiveness. Electronic databases were searched from inception until March 2024; this search was supplemented by snowballing methods. The risk of bias was evaluated with QUADAS-2, and evidence certainty was assessed using the GRADE approach. Nine prospective cohort studies (560 patients) were included. Results: The network meta-analysis revealed that the ΔCaval index exhibited a significant performance advantage over other "venous" test parameters. The caval index significantly outperformed IJV min/max and IVCmax. IJV index and IVCmin significantly outperformed IJVmin/max. The caval index was comparable to the IJV index. The caval index was comparable during mechanical ventilation and spontaneous breathing. Conclusions: In this meta-analysis, the ΔCaval index test showed higher diagnostic accuracy for fluid responsiveness compared with other venous tests. Caval and jugular indices displayed similar accuracy, and caval indices were consistent under mechanical ventilation and spontaneous breathing. Indices generally outperformed absolute values, except for IVCmin, which equaled the caval index in efficacy. This study was registered on the International Platform for Registered Protocols for Systematic Reviews and Meta-Analyses: INPLASY202430104.

Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation: a systematic review and network meta-analysis

BACKGROUND

Emergence agitation is a common complication after nasal surgeries, marked by increased agitation and a heightened risk of injuries. Factors like urinary catheter, endotracheal tube, postoperative pain, and younger age contribute to its occurrence. Due to the variety of preventive approaches reported in the literature, a network meta-analysis is essential.

METHODS

This systematic review employs a network meta-analysis design, following Cochrane Handbook and PRISMA-NMA criteria. Inclusion criteria involve randomized controlled studies on pharmacological and non-pharmacological interventions for preventing emergence agitation in nasal surgeries. Electronic searches, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, without language or date restrictions, were conducted. Two independent reviewers selected studies, and data extraction was performed using standardized tables. Bayesian NMA, MetaInsight web app, and Cochrane Foundation Risk of Bias Assessment Tool were applied for data analysis and bias assessment.

RESULTS

After a rigorous selection process, 17 Randomized Controlled Trials (RCTs) encompassing 2,122 patients and 14 interventions were included. The best ranked treatments identified were intraoperative dexmedetomidine (1 μg.kg-1 for 10 minutes as a bolus, followed by 0.4 μg.kg-1.h-1), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg-1 administered 20 minutes before the end of surgery), nasal compression for 40 minutes before anesthesia induction, and suction above the cuff of the endotracheal tube.

CONCLUSIONS

Both pharmacological and non-pharmacological interventions emerged as effective strategies in mitigating emergence agitation after nasal surgeries, offering clinicians valuable options for improving postoperative outcomes in this patient population.

Mechanical performance of endocrown restorations in anterior teeth: A systematic review and network meta-analysis

OBJECTIVES

To conduct a systematic review and network meta-analysis (NMA) to answer whether endocrown restorations have similar mechanical behavior than other traditional core-crown systems with or without intracanal posts for the rehabilitation of anterior endodontically treated teeth.

METHODS

The review followed the PRISMA Extension Statement for NMA. Studies were identified by a systematic search to select reports on endocrown restorations in anterior teeth. A search was performed in PubMed (MEDLINE), Scopus, Web of Science, Embase, SciELO, and LILACS databases. Articles evaluating mechanical performance through in vitro and finite element analysis (FEA) studies were selected and the risk of bias was assessed using the RoBDEMAT and ROBFEAD tools, respectively. The data were analyzed qualitatively and quantitatively through NMA using the MetaInsight tool.

RESULTS

Eleven articles were included (eight in vitro and three with FEA design). Six in vitro studies were evaluated using NMA. Composite resin endocrowns showed greater load-to-fracture and lower occurrence of catastrophic failures than traditional restorations. Combining glass fiber post with composite restoration also showed good strength behavior. Regarding FEA studies, two out of three studies showed a more homogeneous distribution of stress for the endocrown group.

SIGNIFICANCE

Endocrowns performed similarly to or better than conventional restorative strategies, with composite resin being the most recommended material of choice. The rehabilitation of endodontically treated anterior teeth with extensive coronal destruction is typically challenging for the dentist, and there is still no consensus in the literature that provides conclusive answers for choosing the appropriate material and restorative strategy. Exploring new techniques and materials that make this procedure easier for the dentist and guarantee good results is paramount.

18 F-FDG PET Metabolic Parameters for the Prediction of Histological Response to Induction Chemotherapy in Osteosarcoma and Ewing Sarcoma : A Systematic Review and Network Meta-analysis

PURPOSE

This study aimed to evaluate the ability of 18 F-FDG PET/CT metabolic parameters to predict the histological response to neoadjuvant chemotherapy in patients with osteosarcoma and Ewing sarcoma.

PATIENTS AND METHODS

This systematic review and network meta-analysis adhered to the PRISMA-NMA and Cochrane guidelines. Electronic databases were searched from January 2008 to January 2024; this search was supplemented by snowballing methods. The risk of bias was evaluated with QUADAS-2, and evidence certainty was assessed using the GRADE approach. The prognostic value of 18 F-FDG PET/CT parameters, including pretreatment and posttreatment SUVs (SUV1, SUV2 and the SUV2/SUV1 ratio), metabolic tumor volume (MTV1, MTV2, ΔMTV), and total lesion glycolysis (TLG1, TLG2, ΔTLG), was examined.

RESULTS

The meta-analysis of 18 studies (714 patients) identified the ΔTLG, ΔMTV, and SUV ratio as superior predictors of histological response. The changes in metabolic activity, as indicated by these parameters, provided a robust indication of treatment effectiveness. Baseline parameters showed limited predictive value compared with posttreatment assessments. The study's robustness was confirmed through meta-regression, which revealed that the predictive value of the SUV2 and SUV ratio was consistent across various cutoff thresholds.

CONCLUSIONS

18 F-FDG PET/CT metabolic parameters, particularly those measuring changes posttherapy, are effective in predicting the histological response in patients with osteosarcoma and Ewing sarcoma. These findings underscore the potential of 18 F-FDG PET/CT in guiding early treatment decisions, thereby enhancing personalized therapeutic approaches.

Different surface treatments and adhesive monomers for zirconia-resin bonds: A systematic review and network meta-analysis

This review examined the efficacy of surface treatments and adhesive monomers for enhancing zirconia-resin bond strength. A comprehensive literature search in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library yielded relevant in vitro studies. Employing pairwise and Bayesian network meta-analyses, 77 articles meeting inclusion criteria were analyzed. Gas plasma was found to be ineffective, while treatments including air abrasion, silica coating, laser, selective infiltration etching, hot etching showed varied effectiveness. Air abrasion with finer particles (25-53 µm) showed higher immediate bond strength than larger particles (110-150 µm), with no significant difference post-aging. The Rocatec silica coating system outperformed the CoJet system in both immediate and long-term bond strength. Adhesives containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) were superior to other acidic monomers. The application of 2-hydroxyethyl methacrylate and silane did not improve bonding performance. Notably, 91.2 % of bonds weakened after aging, but this effect was less pronounced with air abrasion or silica coating. The findings highlight the effectiveness of air abrasion, silica coating, selective infiltration etching, hot etching, and laser treatment in improving bond strength, with 10-MDP in bonding agents enhancing zirconia bonding efficacy.

Beading plot: a novel graphics for ranking interventions in network evidence

BACKGROUND

Network meta-analysis is developed to compare all available treatments; therefore it enriches evidence for clinical decision-making, offering insights into treatment effectiveness and safety when faced with multiple options. However, the complexity and numerous treatment comparisons in network meta-analysis can challenge healthcare providers and patients. The purpose of this study aimed to introduce a graphic design to present complex rankings of multiple interventions comprehensively.

METHODS

Our team members developed a "beading plot" to summary probability of achieving the best treatment (P-best) and global metrics including surface under the cumulative ranking curve (SUCRA) and P-score. Implemented via the "rankinma" R package, this tool summarizes rankings across diverse outcomes in network meta-analyses, and the package received an official release on the Comprehensive R Archive Network (CRAN). It includes the `PlotBead()` function for generating beading plots, which represent treatment rankings among various outcomes.

RESULTS

Beading plot has been designed based on number line plot, which effectively displays collective metrics for each treatment across various outcomes. Order on the -axis is derived from ranking metrics like P-best, SUCRA, and P-score. Continuous lines represent outcomes, and color-coded beads signify treatments.

CONCLUSION

The beading plot is a valuable graphic that intuitively displays treatment rankings across diverse outcomes, enhancing reader-friendliness and aiding decision-making in complex network evidence scenarios. While empowering clinicians and patients to identify optimal treatments, it should be used cautiously, alongside an assessment of the overall evidence certainty.

Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials

The aim of this study is to compare the efficacy of different exercise interventions for adult flexible flatfoot. Nine databases (PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PRDro, Google Scholar, China National Knowledge Infrastructure(CNKI) and Wanfang data) were systematically searched from their inception until February 2024. The search resulted in 2112 records, with 11 studies included. All networks revealed low heterogeneity and non-significant inconsistency (I2 ≤ 25.0%). Three network plots were formed for navicular drop. Firstly, compared with the control group, strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE (MD: 3.32, 95% CI: 1.78, 4.89), PNF (MD: 1.81, 95%CI: -0.05, 3.70), SFE (MD: 1.23, 95%CI: 1.02, 1.44) all showed better effects. And strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE exercise is considered to be the most effective intervention, with SUCRA of 0.97. Secondly, compared with the control group, hip-focused neuromuscular exercise (MD: 6.22, 95% CI: -1.69, 14.12), SFE with EMG biofeedback (MD: -0.81, 95%CI: -1.59, 3.21) all showed better effects. And hip-focused neuromuscular exercise is considered to be the most effective intervention, with SUCRA of 0.92. Thirdly, the internal foot muscle training combined with gluteus muscle strengthening is significantly better than the other two groups, with SUCRA of 0.99. For the foot posture index, comprehensive reinforcement (MD: 1.95, 95% CI - 0.19, 4.03) showed better effects compared with the control group. In the probability ranking table, comprehensive reinforcement is significantly better than the other two groups, with SUCRA of 0.98. For the foot function index, orthoses wear + stretching + eccentric progressive resistive exercise of tibialis posterior is significantly better than the other two groups, with SUCRA of 0.92. In conclusion, various exercise therapies improve the arch shape and function of patients with flexible flatfoot, particularly hip muscle and lower limb overall muscle training.

Is Cention-N comparable to other direct dental restorative materials? A systematic review with network meta-analysis of in vitro studies

OBJECTIVES

To compare the performance of Cention-N® with direct restorative materials used at the daily practice (e.g., resin-based composites/RBC, glass ionomer cements/GIC, bioactive resins, silver amalgam) via a systematic review study.

METHODS

The review followed the PRISMA-NMA recommendations, and the protocol of the review was published at osf.io/ybde8. The search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, Lilacs, and SciELO databases, as well as in the grey literature (Open Grey, Proquest, and Periódicos CAPES). Studies with an in vitro experimental design evaluating the characteristics and properties of Cention-N in comparison to other restorative materials were included. The risk of bias of included studies was assessed using the RoBDEMAT tool, and meta-analyses were conducted using Review Manager 5.4 and MetaInsight V3 tools.

RESULTS

A total of 85 studies were included in the review, from which 79 were meta-analyzed. Several characteristics of direct restorative materials were analyzed, including physical (color change, degree of conversion, hardness, microleakage, polymerization rate, roughness, water solubility, water sorption), mechanical (bond strength to dentin, compressive strength, diametral tensile strength, flexural modulus, flexural strength, load-to-fracture, wear), and biological (alkalinizing effect, antibacterial activity, calcium and fluoride release) properties.

SIGNIFICANCE

Cention-N presented similar physico-mechanical properties compared to RBCs, but a stronger behavior than GICs. Despite the Alkasite nature of Cention-N, GICs may still demonstrate the greatest fluoride releasing ability from all direct restorative materials. This review confirmed the adequate behavior of Cention-N when compared to several other more traditionally used materials, confirming its applicability for the permanent restoration of decayed or fractured teeth.

IL-17 and IL-23 Inhibitors Have the Fastest Time to Meaningful Clinical Response for Plaque Psoriasis: A Network Meta-Analysis

Background/Objectives: Several treatment options with differing mechanisms exist for plaque psoriasis. The objective of this analysis was to compare the time to onset of action among the available systemic therapies for plaque psoriasis. Methods: Randomized controlled trials that investigated two or more therapeutics for the management of moderate to severe plaque psoriasis were included. A weighted average time for 50% of patients to reach PASI75 and PAI90 with each of the therapeutics was calculated. A network meta-analysis was performed to determine which therapeutics were significantly faster in time to meaningful clinical response than others. Results: IL-17 inhibitors had the shortest time to achieve PASI75 and PASI90 followed by risankizumab in the weighted mean analysis. In the meta-analysis, the fastest time to PASI75 was seen with bimekizumab, brodalumab and ixekizumab. No significant (p < 0.05) difference was seen in the time to meaningful clinical response between these drugs; however, bimekizumab was significantly faster in time to PASI75 among the remaining therapeutics. In the meta-analysis for PASI90, the fastest time was seen with ixekizumab, bimekizumab, risankizumab, secukinumab and guselkumab with no significant differences in between these therapeutics. However, bimekizumab was significantly faster than the remaining therapeutics for PASI90. Conclusions: IL-17 and IL-23 inhibitors may be considered as requiring the shortest time for meaningful clinical response in plaque psoriasis. In addition to the time to onset, the safety profile of each drug needs to be considered when deciding on a therapeutic to initiate.

Motivational Barriers and Facilitators for Older Adults' Engagement in Exercise during Depressive Episodes: A Network Meta-Analysis of Randomized Controlled Trials

This study aims to assess the motivational factors influencing the participation of older adults in various exercise interventions during depressive episodes and to identify which types of exercise are most effective in alleviating depressive symptoms in this population. Therefore, randomized controlled trials (RCTs) focusing on exercise interventions and their impact on depression in older adult patients, identified by the terms "exercise" AND "depression" AND "elderly" OR "geriatric", were selected from primary electronic databases to conduct this network meta-analysis (NMA). The primary outcome was the effect on depressive symptoms, while the secondary outcome was the comparison of dropout rates between the intervention groups and the usual care control groups, as a measure of sustained motivation and engagement. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed for effect evaluation. This study protocol has been registered in IPLASY (INPLASY 202460035). The results of 31 RCTs with 3238 participants indicated that qigong (SMD -1.17, -2.28 to -0.06), Otago Exercise (SMD -1.15, -2.29 to -0.01), and yoga (SMD -0.88, -1.55 to -0.21) significantly alleviate depressive symptoms in older adults. Walking (SMD -0.82, -1.34 to -0.31) and strength training (SMD -0.67, -1.05 to -0.30) also showed significant effects. Aerobic, physical training, and tai chi had moderate effects, while multisport showed a weaker impact with no significant improvement. In summary, our research findings demonstrate that exercise can effectively alleviate depressive symptoms in older adults, with low dropout rates likely due to interconnected physiological, psychological, and social mechanisms. This is crucial for enhancing treatment strategies for older adults' depression.

Comparison of different agents and doses of anti-vascular endothelial growth factors (aflibercept, bevacizumab, conbercept, ranibizumab) versus laser for retinopathy of prematurity: A network meta-analysis

Laser photocoagulation (LPC) and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections constitute the current standard treatment for retinopathy of prematurity (ROP). This network meta-analysis focus on whether a ranking of interventions may be established for different dose levels of intravitreal injection of anti-VEGF agents (aflibercept, bevacizumab, conbercept, ranibizumab) as primary treatments for ROP versus laser in terms of retreatment rate as primary outcome, and time to retreatment and refractive error as secondary endpoints, since best anti-VEGF dosage remains under debate. Sixty-eight studies (15 randomized control trials and 53 nonrandomized studies) of 12,356 eyes of 6445 infants were retrieved from databases (2005 Jan. - 2023 June). Studies were evaluated for model fit, risk of bias and confidence of evidence in Network Meta-Analysis (CINeMA). Bayesian NMA showed that anti-VEGF drugs were not inferior to laser in terms of retreatment rate. For intravitreal bevacizumab (IVB), doses half of the conventional infant dose showed a low risk of retreatment rate (risk ratio (RR) of 1.43; 95% credible interval (CrI): 0.508, 4.03). On probability ranking as surface under the cumulative ranking curve (SUCRA) plot, half dose of bevacizumab had a better position than conventional and augmented (1.2-2 times the regular dose) doses. A similar probability trend was observed for half vs. conventional doses of aflibercept and ranibizumab. Conventional infant dose of conbercept showed the lowest risk for retreatment (RR 0.846; 95% CrI: 0.245, 2.91). For secondary endpoints, lower doses of anti-VEGF agents were associated with shorter times to retreatment. The largest changes were noted for the augmented doses of bevacizumab and ranibizumab (0.3 mg) with means of 14.1 weeks (95% CrI: 6.65, 21.6) and 12.8 weeks (95% CrI: 3.19, 20.9), respectively. Finally, NMA demonstrated better refractive profile for anti-VEGF than laser therapy, especially for the conventional infant doses of bevacizumab and ranibizumab which exhibited a significantly better refractive profile than LPC, with mean differences of 1.67 (spherical equivalent - diopters) (95% CrI: 0.705, 2.67) and 2.19 (95% CrI: 0.782, 3.59), respectively. In the SUCRA plots, LPC had a markedly different position with a higher probability for myopia. Further clinical trials comparing different intravitreal doses of anti-VEGF agents are needed, but our findings suggest that low doses of these drugs retain efficacy and may reduce ocular and systemic undesired events.

Comparison of luteal support protocols in fresh IVF/ICSI cycles: a network meta-analysis

Despite the proven superiority of various luteal phase support protocols (LPS) over placebo in view of improved pregnancy rates in fresh cycles of IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) cycles, there is ongoing controversy over specific LPS protocol selection, dosage, and duration. The aim of the present study was to identify the optimal LPS under six core aspects of ART success, clinical pregnancy, live birth as primary outcomes and biochemical pregnancy, miscarriage, multiple pregnancy, ovarian hyperstimulation syndrome (OHSS) events as secondary outcomes. Twelve databases, namely Embase (OVID), MEDLINE (R) (OVID), GlobalHealth (Archive), GlobalHealth, Health and Psychosocial Instruments, Maternity & Infant Care Database (MIDIRS), APA PsycTests, ClinicalTrials.gov, HMIC Health Management Information Consortium, CENTRAL, Web of Science, Scopus and two prospective registers, MedRxiv, Research Square were searched from inception to Aug.1st, 2023, (PROSPERO Registration: CRD42022358986). Only Randomised Controlled Trials (RCTs) were included. Bayesian network meta-analysis (NMA) model was employed for outcome analysis, presenting fixed effects, odds ratios (ORs) with 95% credibility intervals (CrIs). Vaginal Progesterone (VP) was considered the reference LPS given its' clinical relevance. Seventy-six RCTs, comparing 22 interventions, and including 26,536 participants were included in the present NMA. Overall CiNeMa risk of bias was deemed moderate, and network inconsistency per outcome was deemed low (Multiple pregnancy χ2: 0.11, OHSS χ2: 0.26), moderate (Clinical Pregnancy: χ2: 7.02, Live birth χ2: 10.95, Biochemical pregnancy: χ2: 6.60, Miscarriage: χ2: 11.305). Combinatorial regimens, with subcutaneous GnRH-a (SCGnRH-a) on a vaginal progesterone base and oral oestrogen (OE) appeared to overall improve clinical pregnancy events; VP + OE + SCGnRH-a [OR 1.57 (95% CrI 1.11 to 2.22)], VP + SCGnRH-a [OR 1.28 (95% CrI 1.05 to 1.55)] as well as live pregnancy events, VP + OE + SCGnRH-a [OR 8.81 (95% CrI 2.35 to 39.1)], VP + SCGnRH-a [OR 1.76 (95% CrI 1.45 to 2.15)]. Equally, the progesterone free LPS, intramuscular human chorionic gonadotrophin, [OR 9.67 (95% CrI 2.34, 73.2)] was also found to increase live birth events, however was also associated with an increased probability of ovarian hyperstimulation, [OR 1.64 (95% CrI 0.75, 3.71)]. The combination of intramuscular and vaginal progesterone was associated with higher multiple pregnancy events, [OR 7.09 (95% CrI 2.49, 31.)]. Of all LPS protocols, VP + SC GnRH-a was found to significantly reduce miscarriage events, OR 0.54 (95% CrI 0.37 to 0.80). Subgroup analysis according to ovarian stimulation (OS) protocol revealed that the optimal LPS across both long and short OS, taking into account increase in live birth and reduction in miscarriage as well as OHSS events, was VP + SCGnRH-a, with an OR 2.89 [95% CrI 1.08, 2.96] and OR 2.84 [95% CrI 1.35, 6.26] respectively. Overall, NMA data suggest that combinatorial treatments, with the addition of SCGnRH-a on a VP base result in improved clinical pregnancy and live birth events in both GnRH-agonist and antagonist ovarian stimulation protocols.

The role of tolvaptan add-on therapy in patients with acute heart failure: a systematic review and network meta-analysis

Background

Several conflicting reviews have concluded that the use of loop diuretics is associated with poorer clinical and safety outcomes. Therefore, this study aimed to investigate the efficacy and safety of tolvaptan as an adjunct to conventional diuretic therapy in patients with acute heart failure (AHF).

Methods

A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan.

Result

A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea [24 h: RR 1.16 (1.04, 1.29), 48 h: RR 1.18 (1.04, 1.33)], reduced body weight within 48 h [Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65)], reduced edema [RR 1.08 (1.02, 1.15)], increased serum sodium [non-Asian group, MD 3.40 (3.02, 3.78)], and resulted in a change in serum creatinine [MD -0.10 (-0.18, -0.01)]. No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF).

Conclusion

In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42023420288).

Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review

OBJECTIVES

To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR).

MATERIAL AND METHODS

Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis.

RESULTS

For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%).

CONCLUSION

Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities.

CLINICAL RELEVANCE

Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.

Pulmonary Vasodilator and Inodilator Drugs in Cardiac Surgery: A Systematic Review With Bayesian Network Meta-Analysis

OBJECTIVE

The authors performed a systematic review to evaluate the effect of pharmacologic therapy on pulmonary hypertension in the perioperative setting of elective cardiac surgery (PROSPERO CRD42023321041).

DESIGN

Systematic review of randomized controlled trials with a Bayesian network meta-analysis.

SETTING

The authors searched biomedical databases for randomized controlled trials on the perioperative use of inodilators and pulmonary vasodilators in adult cardiac surgery, with in-hospital mortality as the primary outcome and duration of ventilation, length of stay in the intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, and change in mean pulmonary artery pressure as secondary outcomes.

PARTICIPANTS

Twenty-eight studies randomizing 1,879 patients were included.

INTERVENTIONS

Catecholamines and noncatecholamine inodilators, arterial pulmonary vasodilators, vasodilators, or their combination were considered eligible interventions compared with placebo or standard care.

MEASUREMENTS AND MAIN RESULTS

Ten studies reported in-hospital mortality and assigned 855 patients to 12 interventions. Only inhaled prostacyclin use was supported by a statistically discernible improvement in mortality, with a number-needed-to-treat estimate of at least 3.3, but a wide credible interval (relative risk 1.26 × 10-17 - 0.7). Inhaled prostacyclin and nitric oxide were associated with a reduction in intensive care unit stay, and none of the included interventions reached a statistically evident difference compared to usual care or placebo in the other secondary clinical outcomes.

CONCLUSIONS

Inhaled prostacyclin was the only pharmacologic intervention whose use is supported by a statistically discernible improvement in mortality in the perioperative cardiac surgery setting as treatment of pulmonary hypertension. However, available evidence has significant limitations, mainly the low number of events and imprecision.

Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials

OBJECTIVE

To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices.

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

PubMed (Medline), the Cochrane library and Web of Science were systematically searched.

ELIGIBILITY CRITERIA

Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included.

RESULTS

270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively.

CONCLUSION

Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.