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

A systematic review and thematic synthesis exploring how gay, bisexual and other men who have sex with men (GBMSM) experience HPV and HPV vaccination

There are suboptimal levels of HPV vaccine uptake among gay, bisexual and men who have sex with men (GBMSM), despite the prevalence and incidence rates of HPV infection among GBMSM being higher than heterosexual males. This systematic review provides a thematic synthesis of qualitative research which examined the perceptions and experiences of GBMSM to HPV vaccine acceptability and explored the barriers and facilitators to participating in HPV vaccination. This review offers new insights about GBMSM understandings of HPV and how they are shaped by a complex relationship between limited knowledge and information of HPV, feminization of HPV with the focus on cervical cancer and women, and the socio-political governmentality of health services in meeting their health needs. Public health communication is required that focuses on the risks of HPV for anal, penile and oropharyngeal cancers and is culturally congruent to tailor and work with GBMSM more effectively for HPV vaccination. Healthcare providers need training around sexual health stigma and should proactively offer the HPV vaccination outside sexual health clinics for this vulnerable group.

Willingness to pay for vaccines in China: A systematic review and single-arm Bayesian meta-analysis

The effective implementation of vaccination heavily depends on the society's willingness to pay (WTP). There is currently a dearth of comprehensive evidence about WTP for vaccines in China. This systematic review aims to review studies on the WTP for vaccines, to summarize factors affect WTP in China. Base-case analysis and Sensitivity analysis of WTP for every vaccine were estimated via single-arm Bayesian meta-analysis. A total of 28 studies were included for systematic review. The point estimates and 95% Credible Interval of pooled WTP for influenza and HPV (9-valent) vaccine were $27.409 (23.230, 31.486), $464.707 (441.355, 489.456). Influencing factors to WTP were age, income, peer influence, health condition and etc. Future research should give focus to improving sample representativeness and survey tool, conducting intervention trials, identifying effective methods to promote WTP.

Prognostic and clinicopathological value of soluble programmed cell death ligand-1 (sPD-L1) in patients with peripheral T-cell lymphoma: a meta-analysis

BACKGROUND

Previous studies have explored whether soluble programmed cell death ligand-1 (sPD-L1) can be used to predict the prognosis of patients with peripheral T-cell lymphoma (PTCL); however, no consistent results have been obtained. Consequently, we conducted the present meta-analysis to identify the precise significance of sPD-L1 in predicting the prognosis of PTCL.

METHODS

We searched PubMed, Embase, Web of Science, and the Cochrane Library until July 31, 2024. The value of sPD-L1 in predicting PTCL prognosis was examined by combining the hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

Seven articles involving 445 patients were included in this study. Based on our pooled findings, increased sPD-L1 was associated with dismal overall survival (OS) (HR = 4.22, 95%CI = 1.89-9.43, p < 0.001) and worse progression-free survival (PFS) (HR = 2.57, 95%CI = 1.35-4.90, p = 0.004) in PTCL. Furthermore, higher sPD-L1 levels were correlated with male sex (OR = 1.80, 95%CI = 1.06-3.03, p = 0.029), International Prognostic Index (IPI) score ≥2 (OR = 4.32, 95%CI = 2.10-8.89, p < 0.001), elevated lactate dehydrogenase (LDH) level (OR = 5.15, 95%CI = 1.94-13.71, p = 0.001), presence of B symptoms (OR = 2.56, 95%CI = 1.45-4.52, p = 0.001), and ECOG PS ≥2 (OR = 7.41, 95%CI = 1.49-36.92, p = 0.015) in PTCL.

CONCLUSION

According to the present meta-analysis, higher sPD-L1 levels were significantly correlated with poor OS and inferior PFS in patients with PTCL. Additionally, high sPD-L1 levels were also associated with clinical features representing the development of PTCL.

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis of efficacy and safety

Background

Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.

Methods

On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.

Results

The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.

Conclusion

The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.

Comprehensive systematic-review and meta-analysis: Treatment outcomes of unipedicular vs bipedicular approaches in vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures

Background

Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.

Methods

Multiple databases were screened using the keywords: "kyphoplasty", "vertebroplasty", "unipedicular", "bipedicular", "osteoporotic fracture", and "compression fracture", and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.

Results

We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.

Conclusion

Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.

Effects of patient safety education programs on nursing students' knowledge, attitude, and competency with patient safety: A systematic review, meta-analysis, and meta-regression

AIMS

Patient safety is a global concern, and nurses, as the largest group of healthcare professionals, play a critical role in ensuring patient safety. This study aimed to systematically review and analyze the effects of patient safety education programs on nursing students' knowledge, attitudes, and competencies by synthesizing existing research and identifying key factors contributing to program effectiveness.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Ovid-EMBASE, MEDLINE, CINAHL, and PubMed were selected for their comprehensive coverage of healthcare and nursing literature. Articles published between January 2000 and July 2024 were included, as the year 2000 marked the beginning of global efforts to prioritize patient safety in healthcare systems.

REVIEW METHODS

This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of Ovid-EMBASE, MEDLINE, CINAHL, and PubMed (2000-2024) identified interventional studies on patient safety education for nursing students. Eligible studies underwent quality appraisal using the weight of evidence framework.

RESULTS

The meta-analysis showed significant improvements in nursing students' knowledge (Z = 5.315, p < .001), attitudes (Z = 2.727, p = .006), and competencies (Z = 4.870, p < .001). Effect sizes ranged from medium to very large (g = 0.684-2.461). Meta-regression analysis indicated that participants' grades (β = -3.29, p < .001) influenced attitudes, while both grades (β = -2.04, p = .007) and education methods (β = 0.85, p = .042) affected competency.

CONCLUSION

Patient safety education programs significantly enhance nursing students' knowledge, attitudes, and competencies. Structured, long-term education and interactive methods, such as simulation and virtual reality, enhance competency development. Integrating these approaches into nursing curricula can help bridge the gap between theory and practice, ultimately improving patient safety.

Intravascular Imaging Improves Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions: A Meta-Analysis of Randomized Controlled Trials

Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.

Ambient air pollution and the risk of cancer: Evidence from global cohort studies and epigenetic-related causal inference

The correlation between air pollution and cancer incidence has been a longstanding concern, understanding the need to elucidate the specifics of this relationship. Thus, this study aimed to assess the association between exposure to air pollution and cancer incidence, and to identify the possible biological links between the two. We examined global cohort studies investigating the association between air pollution and cancer and performed a univariate Mendelian randomization (MR) analysis. Our analysis revealed that the presence of particulate matter (PM)2.5, PM10, NO2, and NOx substantially impacted the risk of developing cancer. MR analysis identified 130 CpGs sites associated with three ambient air pollutants that have significant casual effects on the risk of 14 cancer sites (false discovery rate<0.05). Gene annotation was conducted using g-Profiler by screening for single nucleotide polymorphisms significantly associated with outcome, followed by analysis of the gene interaction network using GeneMANIA, and visualization using igraph. In conclusion, this study demonstrates that air pollution has a significant impact on cancer incidence, provides strong evidence for an epigenetic causal link between the two, and provides new insights into the molecular mechanisms by which air pollution affects cancer development.

Meta-analysis and systematic review of the prevalence and risk factors of animal fascioliasis in Eastern and Southern Africa between 2000 and 2023

Fascioliasis is a zoonotic disease of public health and economic importance. It is caused by trematodes species Fasciola hepatica, and Fasciola gigantica. The parasites infest the liver particularly the bile ducts, and cause harm to the host. The economic loss to both dairy and meat industry is attributed to emaciation, reduction in milk production, death, infertility, and losses to liver condemnation. However, fascioliasis remains poorly studied and limited data is available to guide appropriate interventions especially in low- and middle-income countries. This paper aimed to review the prevalence and risk factors of animal fascioliasis in Eastern and Southern Africa between 2000 and 2023. Globally recognized databases including Science Direct, PubMed and Google scholar were used to search the related studies on fascioliasis conducted between 2000 and 2023 in accordance with PRISMA guidelines. A review of papers was done for risk factors of fascioliasis, and data was extracted. A total of 106 articles met the inclusion criteria, data was extracted, analyzed using meta package in R software (version 4.21), and presented both quantitatively and qualitatively. Forest plots at a 95 % confidence interval were generated to show the prevalence estimate of different subgroups and Cochran's Q statistic was used to measure the level of heterogeneity between studies. The prevalence estimates for different animal species in Eastern and Southern Africa were 47.5 % (95 % CI: 38.0-57.2 %) in mules, 23.3 % (95 % CI: 17.0-31.1 %) in sheep, 23.4 % (95 % CI: 19.2-28.2 %) in cattle, 23.2 % (95 % CI: 19.3-27.6 %) in donkeys, 12.2 % (95 % CI: 9.9-14.8 %) in horses, and 7.9 % (95 % CI: 5.4-11.5 %) in goats. These findings clearly demonstrate the high prevalence of fascioliasis in animals in Eastern and Southern Africa. We therefore recommend enhanced awareness and promotion of effective prevention measures for the Fasciola infection control to maximize benefits from livestock production.

Understanding the role of immune-mediated inflammatory disease related cytokines interleukin 17 and 23 in pregnancy: A systematic review

Background

Pregnancy requires a careful immune balance between tolerance for the semi-allogenic fetus and protection against pathogens. Women with immune-mediated inflammatory diseases (IMIDs), where the interleukin (IL)-23/IL-17 axis plays an important role, often experience changes in disease severity during pregnancy. These changes and the association between disease flares and pregnancy complications, suggests a role for IL-17 and IL-23 in pregnancy.

Methods

We systemically searched PubMed, EMBASE, and Web of Science (March 2024), to assess the role of IL-17 and IL-23 in pregnancy-related in vitro assays, animal or human studies.

Results

Eighty articles (8 in vitro, 11 animal and 61 human studies) were included. Seventy-one studies reported on IL-17 and 16 studies on IL-23. In vitro trophoblast proliferation, migration and invasion was increased in the presence of IL-17, but impaired with IL-23. IL-17 levels were increased in animal models for pregnancy complications. In humans, IL-17 levels seemed to be increased in pregnant women versus non-pregnant women. Additionally, elevated IL-17 levels were associated with pregnancy complications. Although similar trends were found for IL-23, data were limited.

Conclusions

We identified a large, but heterogenic, body of evidence for a significant role of IL-17 in all stages of pregnancy: while an excessive increase seemed to be associated with complications. The limited number of studies prevents firm conclusions on the role of IL-23. Future research is needed to find biomarkers for patients with IMIDs to predict the effect of possible disease flares on pregnancy, and the effect of therapeutic inhibition of IL-17 or IL-23.

A Meta-Analysis Study to Define Variations in Murine Long Bone Biomechanical Testing

A systematic literature search and meta-analysis were performed to evaluate the variability in biomechanical testing of murine long bones, specifically focused on point-bending tests of mice femora. Due to the lack of standardized protocols for these tests, the assessment quantifies the heterogeneity in reported mechanical properties across existing literature. This study followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) and strengthening the reporting of observational studies in epidemiology (STROBE) guidelines to search publicly available databases for relevant studies. After title and abstract screening, full-text reviews identified 73 articles meeting the inclusion criteria. Data was extracted from these studies, including stiffness, maximum load, modulus, and ultimate stress values for both three-point and four-point bending tests. The data were analyzed through ANOVA and metaregression to assess variability caused by age, sex, and genetic strain. The reviewers also assessed the quality of the included studies. The meta-analysis revealed significant heterogeneity in reported mechanical properties, with I2 values ranging from 72% to 100% in the three point-bend tests of pooled genetic strains. This heterogeneity persisted even after accounting for age, sex, and genetic strain differences. The review concludes that nonstandardized testing setups are the likely major source of the observed variability in reported data more than the population characteristics of the mice, highlighting the need for more consistent testing methodologies in future studies.

Comprehensive analysis of West Nile Virus transmission: Environmental, ecological, and individual factors. An umbrella review

Background

West Nile Virus (WNV) exemplifies the complexities of managing vector-borne diseases, expanding globally due to human activities and ecological changes. Originating from Africa and transmitted by Culex mosquitoes, WNV is now reported across multiple continents. The aim of this study was to identify the environmental, ecological, and individual factors influencing WNV transmission.

Methods

An umbrella review was conducted. Comprehensive searches were performed in PubMed, Scopus, Web of Science, Embase, and LILACS. Inclusion criteria were reviews involving WNV transmission agents (reservoirs, vectors, hosts) and associative analyses between environmental, ecological, or individual factors and WNV transmission. Data extraction and quality appraisal were performed using templates and the AMSTAR 2 tool.

Results

From 404 retrieved studies, 23 systematic reviews and meta-analyses were included. Almost 70 % were low or critically low quality. The co-occurrence network highlighted emerging research on climate change and environmental factors. Temperature, precipitation, and land use significantly influence WNV transmission. Warmer temperatures enhance mosquito populations and viral replication, while extreme weather events like droughts increase mosquito-human contact. Climate change significantly contributes to WNV dynamics by altering temperature and precipitation patterns, enhancing vector proliferation, and extending transmission seasons. Ecological factors such as higher avian diversity, vegetation indexes, and distribution of mosquito species can impact WNV transmission significantly. Education and income levels influence preventive behaviors and infection risk, with lower socioeconomic status linked to higher WNV risk. Certain occupational groups are also at elevated risk of WNV infection.

Conclusion

Environmental factors like temperature and precipitation critically affect WNV transmission by influencing mosquito behavior and avian reservoir dynamics. Socio-economic status and education levels significantly impact individual preventive behaviors and infection risk. Multifactorial influences on infection risk make necessary integrated surveillance systems and public health strategies. Longitudinal studies with One Health approaches are necessary to better understand WNV dynamics and reduce WNV transmission.

Sewer-associated rodents in countries with lower human development, a time-bomb for zoonoses?

Sewer-associated rodents inhabiting urban and peri-urban areas constitute a potential infection source for many zoonotic pathogens at a global scale. However, there is a lack of scientific information about the implications of these micromammals in regions with fragile sanitary services, low economic resources and weak educational systems. Consequently, this study aimed to review the scientific knowledge about rodent-borne zoonoses in sewer-related environments from countries with lower Human Development Index (HDI). Our results revealed a low number of publications (n = 13) evaluating the epidemiology of sewer-associated rodents in countries with lower HDI, which were distributed across Central/South America (69.2 %; 9/13), Africa (23.1 %; 3/13) and Asia (7.7 %; 1/13). The most evaluated rodents were Rattus norvegicus -brown rat- (present in 10/13 articles), followed by Rattus rattus -black rat- (6/13) and Mus musculus -house mouse- (5/13). Fourteen zoonotic pathogens were assessed, specifically bacteria (n = 6 publications) and parasites (n = 7), with the highest prevalence described for Bartonella spp. (85.0 %), Calodium hepaticum (83.8 %), Rickettsia spp. (75.0 %), Leptospira spp. (68.0 %) and Hymenolepis nana (60.0 %). Most reviewed publications described the use of molecular methods and direct examination of samples to identify the pathogens studied (46.2 %; 6/13 each), followed by the MALDI-TOF technique (15.4 %; 2/13). The four clusters building the semantic network reinforced the pivotal role of sewer-associated rodents as reservoirs of both vector-borne pathogens and directly transmitted zoonoses. Our findings evidence a severe gap of knowledge in lower-resource areas about the role of sewer-associated rodents in the epidemiology of zoonotic diseases, which could impact on the sanitary system of not only the evaluated countries, but also in other developed and non-developed regions worldwide.

Sevoflurane and its metabolic byproduct compound A induce nephrotoxicity: a systematic review and meta-analysis of animal studies

Animal models investigating sevoflurane or compound A and renal function serve as the initial basis for concerns regarding renal injury following sevoflurane anesthesia and subsequent recommendations of minimum fresh gas flow, but this evidence basis has not been critically appraised. Primary literature searches were performed in MEDLINE OVID, PubMed, EMBASE, the Cochrane Library), the Cochrane Central Register of Controlled Trials, the International HTA Database, CINAHL, and Web of Science to identify randomized controlled trials and quasi-experimental studies in animals utilizing sevoflurane or compound A. The primary outcomes included renal function as determined by blood urea nitrogen, serum creatinine, creatinine clearance, and urine volume. The secondary outcomes included the serum fluoride concentration and histopathological findings. A total of 2537 records were screened, and 21 randomized controlled trials and 9 quasi-experimental animal studies were identified. No associations between sevoflurane exposure and subsequent changes in renal function (blood urea nitrogen, serum creatinine or changes in urine volume) were noted. A similar effect on renal function was observed following compound A exposure, but urine volume was elevated following compound A exposure. In addition, the histopathological damage following compound A exposure was observed only at concentrations that are unachievable in clinical practice. Our review of evidence from animal models revealed that sevoflurane usage was not associated with changes in renal function tests or urine volume. Histopathologic changes after sevoflurane exposure were either nonexistent or minor. Studies on compound A did not reveal an alteration in renal function, although histopathological evidence of injury was present when compound A was administered at very high, unphysiologic concentrations. In light of the existing evidence, the initial concerns of sevoflurane-related nephrotoxicity based on animal studies that leads to minimum fresh gas flow recommendations are called into question.

The diagnostic efficacy of metagenomic next-generation sequencing (mNGS) in pathogen identification of pediatric pneumonia using bronchoalveolar lavage fluid (BALF): A systematic review and meta-analysis

OBJECTIVE

This meta-analysis evaluates and compares the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) with conventional microbiological tests (CMTs) in diagnosing pediatric pneumonia using bronchoalveolar lavage fluid (BALF).

METHODS

Data were sourced from Embase, PubMed, Web of Science, and the Cochrane Library. The pooled positive detection rate (PDR) of pathogens was estimated using fixed-effects or random-effects models. Subgroup analyses explored factors influencing mNGS diagnostic performance. Data analysis was conducted using Review Manager (RevMan) 5.4 and Stata version 16.0.

RESULTS

The pooled PDR of mNGS was 85.83 %, which is higher than the pooled PDR of 49.97 % for CMTs. A random-effects model indicated that, compared to CMTs, mNGS has a significantly higher PDR in pediatric pneumonia (OR = 3.99, 95 %CI: 2.12-7.50, P < 0.0001, I2 = 81 %). Subgroup analysis indicated that mNGS exhibited greater advantages in the group using the QIAamp kit (OR = 5.55, 95 % CI: 3.03-10.16, P < 0.00001), the group using the Illumina Nextseq platform (OR = 4.87, 95 % CI: 2.97-7.99, P < 0.00001), the DNA-only mNGS group (OR = 4.54, 95 % CI: 2.73-7.54, P < 0.00001), and the non-severe pneumonia group (OR = 4.76, 95 % CI: 3.51-6.46, P < 0.00001). However, when the subgroups were categorized as mixed infections or single-pathogen infections, no statistically significant differences were observed (Mixed: OR = 1.77, 95 % CI: 0.30-10.56, P = 0.53; Single: OR = 3.97, 95 % CI: 0.42-37.87, P = 0.23) CONCLUSION: mNGS demonstrates high diagnostic efficacy in detecting pathogens in BALF from pediatric patients with pneumonia. The diagnostic stability of mNGS is influenced by sample extraction, sequencing platforms, positive interpretation criteria, and disease status. Standardized procedures and technologies can enhance mNGS diagnostic performance.

Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis

OBJECTIVE

Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries.

MATERIALS AND METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model.

RESULTS

The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1% (95% CI, 78.0-93.9%) and a specificity of 82.0% (95% CI, 62.0-92.7%) for diagnosing ACL ruptures, with an AUC of 0.92 (95% CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2% (95% CI, 68.2-92.0%), and specificity was 94.9% (95% CI, 92.2-96.7%), with an AUC of 0.96 (95% CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4% (95% CI, 76.8-95.6%), and specificity was 82.1% (95% CI, 56.2-94.2%), with an AUC of 0.93 (95% CI, 0.71-0.97).

CONCLUSION

Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.

Effect of laxative use and laxative type on colorectal cancer risk: A pooling up analysis and evidence synthesis

Colorectal cancer (CRC) is the third most common cancer worldwide and there is a controversy regarding the influence of laxative use on the incidence of CRC. Therefore, the present study aimed to investigate the effects of laxative use and different subtypes of laxatives on the incidence of CRC. To this aim, a comprehensive search of three databases (PubMed, Embase and the Cochrane Library) was conducted on April 12, 2022, using key words that included 'laxative' and 'CRC', which initially retrieved 305 records. Ultimately, 12 studies involving 415,313 patients met all eligibility criteria and were included in a meta-analysis. Subsequently, patients were categorized into the laxative use and non-laxative use groups. Stata 16.0 software was used for all data analyses. The results indicated that laxative use was not significantly associated with CRC risk [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.75-1.20; P=0.65; I2=94.63%]. In the subgroup analyses, the effects of different laxative types were further examined. Notably, all types of laxatives except for fiber laxatives showed no significant influence on CRC risk (P>0.1). By contrast, fiber laxatives were associated with a reduced risk of CRC (OR, 0.74; 95% CI, 0.59-0.93; P=0.01; I2=32.15%), suggesting a potential protective effect of this medication. In conclusion, the findings of the present study suggest that the use of laxatives does not increase the risk of CRC. Moreover, the use of fiber laxatives may have a protective effect by reducing CRC incidence.

Rehabilitation after surgical release of the stiff elbow: A literature review

Background

Elbow stiffness poses a significant challenge for surgeons as well as physiotherapists during and after surgery. To date, there is no consensus regarding the subsequent rehabilitation after surgical release of the stiff elbow.

Objective

The aim is to evaluate the most important therapeutic strategies following open or arthroscopic release of the stiff elbow based on a comprehensive literature review, and to develop a consensus for or against specific therapeutic methods with the help of a survey among elbow experts of the D-A-CH Association for Shoulder and Elbow Surgery (DVSE).

Methods

Literature search was performed based on guidelines, the "health technology assessments", systematic reviews and clinical studies that examined rehabilitation after osteocapsular release of the stiff elbow. The databases of the "Guidelines International Network", various national guidelines, PubMed, the "Cochrane Central Register of Controlled Trials", the "Cochrane Database of Systematic Reviews", and the "Physiotherapy Evidence Database" were scanned, each for the period from January 1989 to December 2019. As part of an online survey, all active members of the DVSE were asked about their strategies in immediate aftercare and rehabilitation after elbow arthrolysis.

Results

A total of 5 reviews and 55 articles could be identified from 107 articles since 1989, which served as the basis for the preparation of an evidence-based aftercare recommendation. By reviewing all the mentioned paper and evaluation of the survery of DVSE members, a basic concept could be finalized.

Effect of physical activity interventions on executive functions in school-age children with ADHD: A meta-analysis of randomized controlled trials

BACKGROUND

Physical activity interventions positively influence executive functions in both the general population and individuals with ADHD. However, there is limited research focusing on school-aged children, who have the highest ADHD diagnosis rates. This study aims to provide targeted intervention strategies for improving executive function in this population, offering a practical reference for selecting specific exercise types when designing interventions for children with ADHD.

METHODS

A systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant RCTs up to September 2023. Two independent reviewers handled literature screening, data extraction, and quality assessment. Stata 15.1 software was used for the meta-analysis.

RESULTS

The meta-analysis included 19 studies, revealing that physical activity interventions significantly improved executive functions in school-aged children with ADHD. Cognitive flexibility (SMD = 0.70, 95 % CI: 0.09, 1.31) and working memory (SMD = 0.74, 95 % CI: 0.20, 1.28) showed moderate to large effects, while inhibition switching had a small to medium effect (SMD = -0.35, 95 % CI: -0.74, 0.03). Subgroup analysis indicated that cognitively engaging exercises were more effective, with intervention outcomes moderated by duration, frequency, and length.

LIMITATIONS

Inconsistent measurement tools among the included studies may introduce biases.

CONCLUSIONS

Physical activity interventions are effective in enhancing executive functions in school-aged children with ADHD. Cognitively engaging exercises show the most promise, especially when tailored by intervention duration, frequency, and length.

A systematic review and meta-analysis of the hemodynamics and outcomes of the Myval balloon-expandable valve in patients with severe aortic stenosis and with aortic regurgitation

Introduction

Transcatheter aortic valve implantation (TAVI) has been growing rapidly. We aim to evaluate the performance and outcomes of the Myval transcatheter heart valve (THV) in patients with severe aortic stenosis and its use in quantitative videodensimetry, transcatheter valve-in-valve (ViV), and non-calcified aortic regurgitation (NCAR).

Methods

A systematic search was done in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to October 2024. We used the relevant keywords to include studies that reported the outcomes of patients with severe aortic stenosis who underwent TAVI using the Myval THV and off-label usage in transcatheter ViV and NCAR. Data analysis was done using R software.

Results

A total of 29 studies were included in this study. The results of the mean aortic gradient at discharge, 30-day, one-year, and 2-year were 9.25 mmHg (95 % CI [8.20, 10.29]), 8.46 (95 % CI [7.57, 9.34]). 10.63 (95 % CI [9.12, 12.14]), and 7.2 (95 % CI [6.78, 7.63]), respectively. Additionally, the pooled percentages of patients with ≥ moderate aortic regurgitation were found in 1 % (95 % CI [1,2]) at discharge, 3 % (95 % CI [2,4]) at 30-day, 4 % (95 % CI [2,7]) at one-year follow-up and 5 % (95 % CI [3,8]) at 2-year. Furthermore, usage of the Myval THV in transcatheter ViV and NCAR led to a reduction in mean aortic gradient and incidence of aortic regurgitation, respectively.

Conclusion

The Myval THV showed good safety and efficacy outcomes in short- and long-term follow-ups following the TAVI. Also, it showed promising results during transcatheter ViV and NCAR.

A comprehensive transcriptome based meta-analysis to unveil the aggression nexus of oral squamous cell carcinoma

Lymph node metastasis in oral cancer (OC) complicates management due to its aggressive nature and high risk of recurrence, underscoring the need for biomarkers for early detection and targeted therapies. However, the drivers of this aggressive phenotype remain unclear due to the variability in gene expression patterns. To address this, an integrative meta-analysis of six publicly available transcriptomic profiles, categorized by lymph nodal status, is conducted. Key determinants of disease progression are identified through functional characterization and the TopConfects ranking approach of nodal associated differentially expressed genes (DEGs). To explore the critical nexus between lymph node metastasis and OC recurrence, significant metastatic genes were cross-analysed with literature-derived genes exhibiting aberrant methylation patterns in OC recurrence. Their clinical relevance and expression patterns were then validated in an external dataset from the TCGA head and neck cancer cohort. The analysis identified elevated expression of genes involved in extracellular matrix remodelling and immune response, while the expression of genes related to cellular differentiation and barrier functions was reduced, driving the transition to nodal positivity. The highest-ranked gene, MMP1, showed a log-fold change (LFC) of 4.946 (95 % CI: 3.71, 6.18) in nodal-negative samples, which increased to 5.899 (95 % CI: 4.80, 6.99) in nodal-positive samples, indicating consistent elevation across disease stages. In contrast, TMPRSS11B was significantly downregulated, with an LFC of -5.512 (95 % CI: -6.63, -4.38) in nodal-negative samples and -5.898 (95 % CI: -7.15, -4.64) in nodal-positive samples. Furthermore, MEIS1, down-regulated in nodal-positive status, was found to exhibit hypermethylation at CpG sites associated with OC recurrence. This study represents the first transcriptomic meta-analysis to explore the intersection of lymph node metastasis and OC recurrence, identifying MEIS1 as a potential key contributor. These comprehensive insights into disease trajectories offer potential biomarkers and therapeutic targets for future treatment strategies.

Examining the effect of Kuntai capsule combined with HRT in the treatment of premature ovarian insufficiency: A systematic review and meta?analysis

While Chinese herbal medicines have been used to treat premature ovarian insufficiency (POI), their efficacy is currently unclear. The present study aimed to review and evaluate the efficacy of the Kuntai capsule combined with hormone replacement therapy (HRT) in treating POI. The China National Knowledge Infrastructure, WanFang, Chinese Biomedical Literature, PubMed, Embase and Cochrane Library databases were searched from the inception of the database to 25th October 2020, for studies comparing the therapeutic effect of Kuntai capsule combined with HRT vs. HRT alone in women with POI. The Cochrane Risk of Bias assessment tool was used to assess the quality of the studies, and the results were reported as weighted mean differences (MD) with 95% confidence intervals (CI). The present study included 10 trials involving 742 women with POI. When compared with HRT alone, HRT combined with Kuntai capsule significantly increased the number of antral follicles (AFC) (MD=0.88; 95% CI, 0.48-1.29; P<0.00001), anti-Müllerian hormone (AMH) levels (MD=0.24, 95% CI, 0.13 to 0.35, P<0.00001) and significantly improved peri-menopausal symptoms [MD=-2.26; 95% CI, -3.77-(-0.75); P=0.003]. The combined treatment regimen significantly decreased the levels of follicle-stimulating hormone [MD=-5.60; 95% CI, -7.98-(-3.22); P<0.00001] and luteinizing hormone [MD=-2.42; 95% CI, -3.40-(-1.44), P<0.00001] and significantly increased the level of estradiol (MD=13.94; 95% CI, 4.16-23.71; P<0.00001). Therefore, the Kuntai capsule combined with HRT could potentially be used as a supplementary therapy to alleviate menstrual disorders and peri-menopausal symptoms and improve serum sex hormone levels in women with POI. The observed increase in the number of AFC in patients with POI treated with the combined therapy was indicative of improved ovarian reserve function. Therefore, combining the Kuntai capsule and HRT had am improved curative effect for POI treatment compared with HRT alone. However, as the present study was limited by the quality of the included reports, additional high-quality studies with extensive sample sizes are required to verify the findings.

Prognostic value of myocardial flow reserve by PET imaging in patients with suspected coronary artery disease: A systematic review and meta-analysis

Purpose

We performed a systematic review and meta-analysis of published studies evaluating the value of myocardial flow reserve (MFR) assessed by positron emission tomography (PET) imaging in predicting adverse cardiovascular events in patients with suspected coronary artery disease (CAD).

Material and methods

Studies published until December 2024 were identified by database search. We included studies evaluating MFR by PET imaging with data on adjusted hazard ratio (HR) for the occurrence of adverse cardiovascular events.

Results

We identified 8 eligible articles including 12.087 patients with a mean follow-up of 2.98 ± 0.69 years. The pooled HR for the occurrence of events was 2.19 (95 % CI 1.80-2.68) and no heterogeneity was observed. The pooled incidence rate ratio (IRR) was 3.26 (95 % CI 2.43-4.37) and the heterogeneity was 37.7 %. At meta-regression analysis no significant association was found between HR for adverse events and demographic and clinical variables considered.

Conclusion

MFR assessed by PET imaging is a valuable noninvasive prognostic indicator in the evaluation of patients with suspected CAD.

Risk and triggering factors for diffuse alveolar hemorrhage in primary antiphospholipid syndrome. An observational follow-up study and a systematic review of the literature

BACKGROUND

Diffuse alveolar hemorrhage (DAH) represents a serious, life-threatening complication of primary antiphospholipid syndrome (PAPS), a thrombophilic disorder mainly characterized by vascular thrombosis and/or pregnancy morbidity. Risk factors for DAH in PAPS patients and the comorbidities that may trigger DAH were investigated here in the effort to identify possible independent predictors of DAH in PAPS patients.

METHODS

Only PAPS patients fulfilling the Sydney criteria were taken into consideration. The DAH diagnosis was based on the patient's clinical presentation (acute illness manifesting with dyspnoea, hypoxia, cough, anemia and less frequently hemoptysis and fever), the presence of transient lung infiltrates on chest radiographs, a rapidly changing ground-glass appearance on computed tomography, and a positive response to high dose steroid therapy prescribed during an acute phase. The PAPS patients manifesting DAH signs and symptoms were considered the study group; the remaining served as the control group. The following comorbidities were investigated: i) left-sided heart valve diseases, ii) left heart failure and iii) hemolytic anemia. The clinical and laboratory characteristics and comorbidities of the PAPS-associated DAH patients were recorded and compared with those of the control group and those of the PAPS-associated DAH patients identified by a literature review.

RESULTS

The subjects considered for inclusion were 197 PAPS patients (142 women and 55 men) all suffering from thrombosis, which was associated with pregnancy morbidity in 30 (21.1 %) of the women. Eight (4.1 %) of these patients (five men and three women) experienced one or more episodes of DAH. When the clinical and laboratory characteristics of the PAPS-associated DAH patients were compared with those of the controls a significant prevalence of the male gender (p = 0.0399), of the multiple types of vascular involvement profile (p = 0.0048) and of high antiphospholipid antibody (aPL) titers (p = 0.0011) was noted in the former. Triple aPL positivity and microcirculation thrombosis were also more frequent in that group, although not to a significant degree. The prevalence of comorbidities including left-sided heart valve diseases, left heart failure and hemolytic anemia was likewise significantly higher in the PAPS-associated DAH patients (p = 0.0253, 0.0451 and 0.0358, respectively). According to logistic regression analysis, multiple types of vascular involvement profile, left-sided heart valve diseases and hemolytic anemia were found to be independent risk factors for DAH (p = 0.030, 0.022 and 0.007, respectively). Twenty-four studies (one case-control, three small case series, and 20 case reports) reporting on 55 PAPS-associated DAH patients were identified by a review of the literature. The clinical and laboratory characteristics and comorbidities of our PAPS-associated DAH patients were not significantly different from those of the DAH patients identified by literature review. Only hemolytic anemia was significantly less frequent in the literature-review DAH patients than in ours.

CONCLUSION

Some risk factors and comorbidities characterizing PAPS-associated DAH patients were identified when the clinical and laboratory characteristics of a group of these subjects were compared with those of a control group and of PAPS-associated DAH patients pinpointed by a literature review. In the event that these results are confirmed by larger multicenter studies, they could contribute to identifying PAPS patients at risk of developing DAH.

Apolipoprotein C-III inhibitors for the treatment of hypertriglyceridemia: a meta-analysis of randomized controlled trials

INTRODUCTION

Hypertriglyceridemia is related to atherosclerotic cardiovascular risk and pancreatitis risk. The efficacy and safety of apolipoprotein C-III (APOC-III) inhibitors remains unclear.

AIM

To investigate the effects of APOC-III inhibitors on hypertriglyceridemia and its complications.

METHODS

We systematically searched PubMed, Embase, and Cochrane Central databases from inception to May 2024 for randomized controlled trials (RCTs) comparing APOC-III inhibitors to placebo in patients with hypertriglyceridemia. We pooled percentage standardized mean difference (SMD) changes and risk ratio (RR) for continuous and binary outcomes, respectively, with 95 % confidence interval (CI). Subgroup analyses were performed with APOC-III inhibitors drugs doses (Olezarsen, Volanesorsen and Plozasiran), and primary and secondary hypertriglyceridemia.

RESULTS

10 RCTs with 1204 participants were included, of which 46 % were men. APOC-III inhibitors significantly reduced triglycerides (TG) (SMD: -60.56 %; 95 % CI -68.94 to -52.18; p < 0.00001), APOC-III (SMD: -75.44 %; 95 % CI -80.81 to -70.07; p < 0.00001) and non-HDL-c (SMD: -27.49 %; 95 % CI -34.16 to -20.82; p < 0.00001) levels. Consistent results were found for all subgroup analyses. APOC-III inhibitors were capable to normalize TG levels in patients with severe hypertriglyceridemia (RR: 7.92; 95 % CI 4.12 to 15.23; p < 0.00001). There was a significant increase in HDL-c (SMD: 43.92 %; 95 % CI 37.27 to 50.57; p < 0.00001) and LDL-c (SMD: 33.05 %; 95 % CI 9.08 to 57.01; p = 0.007) levels. There was a significant relative risk reduction in acute pancreatitis in the APOC-III inhibitors group (RR 0.17; 95 % CI 0.05 to 0.53; p = 0.007). Adverse events were similar in both groups.

CONCLUSION

APOC-III inhibitors improve TG levels and other lipid panel parameters, as well as reduce episodes of acute pancreatitis in patients with primary and secondary hypertriglyceridemia.

A systematic review and meta-analysis of factors associated with adolescent substance use in Africa, 2000 to 2020

BACKGROUND AND AIMS

Adolescent substance use is a growing public health concern in Africa, yet little is known about the contextual factors of substance use among young African populations. This systematic review identified factors associated with substance use among adolescents (aged 10-19 years) in Africa.

METHODS

This review was conducted in line with PRISMA guidelines. We searched six databases (from January 2000 to December 2020): PubMed, Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and World Health Organization (WHO) African Index Medicus. We included population-based observational studies reporting on factors associated with adolescent substance use across Africa. Study screening was conducted by at least four independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analysed in a narrative synthesis. Studies providing sufficient statistics, i.e. three or more reporting the same outcome and exposure/predictor, were included in meta-analyses.

RESULTS

Sixty-three peer reviewed studies that were full text accessible were included. The majority were cross-sectional surveys. Factors associated with adolescent substance use identified were linked to individual, family, socioenvironmental and non-familial social networks determinants. Results from both the narrative synthesis and meta-analysis revealed that being male and an older adolescent were significantly associated with adolescent substance use. Combined odds ratio (OR) of males who currently smoke compared with females was 1.81 [95% confidence interval (CI) = 1.37-2.39; 6 studies, 13 443 participants, I2 = 59.67%]. Additional meta-analysis outcomes found that having a friend who smokes was associated with tobacco smoking. Combined OR of 'ever-smokers' with a friend who smoked was 4.83 (CI = 2.56-9.10; 3 studies, 18 858 participants, I2 = 79.21%). Having a family member who smokes was associated with smoking initiation (OR = 2.99; CI = 2.67-3.35; 3 studies, 18 858 participants, I2 = 0%) and current smoking (OR = 2.33; CI = 2.23-2.45; 4 studies, 13 282 participants, I2 = 0%).

CONCLUSION

Multiple factors that operate on individual, family and societal levels influence adolescent substance use in Africa. Key factors of adolescent substance use in Africa appear to include being male, being an older adolescent and being exposed to peer substance use.

Efficacy of Customized Photorefractive Keratectomy With Cross-Linking Versus Cross-Linking Alone in Progressive Keratoconus: A Systematic Review and Meta-Analysis

TOPIC

This review evaluates the effectiveness and safety of combining cPRK with CXL versus CXL alone in improving visual outcomes for patients with progressive keratoconus.

DESIGN

Systematic review and meta-analysis.

CLINICAL RELEVANCE

Keratoconus leads to vision loss and affects quality of life. While CXL is the current standard for halting progression, it does not correct the visual impairment. This review explores whether adding cPRK to CXL offers better visual outcomes while maintaining the same safety, potentially refining treatment approaches.

METHODS

A systematic search of MEDLINE, PubMed, Cochrane Library and EMBASE was conducted through September 2024, following PRISMA guidelines. The initial study design aimed to include randomized controlled trials (RCTs) as well as comparative nonrandomized prospective or retrospective studies evaluating CXL+cPRK versus CXL alone, with a minimum follow-up of six months. However, only nonrandomized studies were retrieved. As a result, all included studies were assessed for the risk of bias using the ROBINS-I tool. The primary outcomes were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Secondary outcomes included refraction, corneal structure, and higher-order aberrations (HOA). Meta-analysis was performed using standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity was assessed using a random-effects model where necessary. Sensitivity analysis was conducted using a leave-one-out approach to assess the robustness of the results. This study is registered in the PROSPERO database (CRD42024594757).

RESULTS

Eight nonrandomized studies involving 731 eyes from 706 patients were analyzed. Compared to CXL alone, the combination of CXL+cPRK significantly improved postoperative UDVA (SMD = -0.39, 95% CI: -0.69 to -0.08, P = .01) and CDVA (SMD = -0.57, 95% CI: -0.96 to -0.18, P = .004), while also reducing refractive cylinder error. Additionally, CXL+cPRK led to reductions in coma, total HOA, coma-like aberrations, mean keratometry (KM), and central corneal thickness (CCT). No significant differences were observed between the groups in endothelial cell count (ECC). The rate of postoperative ectasia progression was comparable between both groups. All included studies exhibited at least one ROBINS-I domain at high risk of bias, particularly related to confounding. The heterogeneity observed in this analysis was primarily attributed to differences in surgical techniques, patient selection criteria, and study designs across the included studies.

CONCLUSIONS

Customized PRK combined with CXL provides superior postoperative visual acuity (UDVA, CDVA) and visual quality compared to CXL alone while maintaining the same corneal stability in the management of progressive keratoconus. Only nonrandomized studies could be retrieved for the purpose of the study.

Herbal medicine for treating psoriasis: A systematic review

BACKGROUND

Psoriasis, a chronic skin condition influenced by both genetic and environmental factors, affects approximately 2 % of the global population. Treatment approaches range from topical agents for mild to moderate cases to systemic therapies for moderate to severe forms. Complementary and integrative medicine, including herbal remedies, is increasingly utilized by psoriasis patients, with herbal medicine being the most prevalent choice.

METHODS

This systematic review adhered to PRISMA guidelines and Cochrane recommendations, with prior registration. Searches were conducted in Medline/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials through June 2024. Inclusion criteria encompassed randomized controlled trials (RCTs) evaluating herbal therapies in psoriasis patients of any age. Data extraction and risk of bias assessment were performed independently by two authors, with discrepancies resolved through discussion.

RESULTS

A total of 20 RCTs involving 1115 patients were included. Overall risk of bias varied across studies. Herbal interventions evaluated included Aloe vera, avocado oil, chamomile-pumpkin seed oleogel, indigo naturalis, kukui oil, mahonia aquifolium, turmeric, St. John's wort, and various complex herbal preparations. Some herbal therapies, such as Mahonia aquifolium and Indigo naturalis, showed promise in reducing psoriasis severity, while others demonstrated mixed results.

CONCLUSIONS

Herbal therapies present a diverse array of options for psoriasis management, but further research is essential to elucidate their safety profile and true effectiveness. Healthcare providers should engage in shared decision-making with patients, considering individual preferences and treatment goals while remaining vigilant in guiding towards evidence-based treatments.

Mercury exposure and childhood outcomes: An overview of systematic reviews

OBJECTIVE

The objective of this review was to summarize recent and relevant systematic reviews (SRs) that assessed relationships between mercury (Hg) exposure during pregnancy, lactation, and childhood and child outcomes.

EVIDENCE REVIEW

Three electronic databases were searched for SRs published between January 2018 to December 2024 about Hg exposure (of any form or source, including seafood), during pregnancy, lactation or childhood and child outcomes including: anthropometrics, neurodevelopment, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), exposure biomarkers, cardiometabolic health, immunity, and birth outcomes. All articles were screened at title/abstract and full-text levels by two independent reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 critical appraisal tool was used to assess the methodological quality of the included SRs.

FINDINGS

Twenty-nine SRs of observational studies were identified that assessed Hg during pregnancy (n = 19) and/or childhood (n = 17). During pregnancy, results from the SRs suggested that higher Hg may be associated with higher risk of birth defects, pre-term birth, ADHD, ASD, and low birth weight, length, and head circumference. Results varied for neurodevelopment outcomes in the child, likely due to co-exposure with seafood during pregnancy, variation in response by sex of the child, and etiological differences among developmental domains. During childhood, SRs suggested that higher Hg may be associated with higher risk of ADHD and adverse neurodevelopment, growth, and body composition outcomes. Also, Hg concentrations were higher in children with ASD than those without in case-control studies but longitudinal data were lacking. Evidence on methylmercury exposure from seafood during pregnancy and childhood was limited and inconclusive.

CONCLUSION AND RELEVANCE

Mercury exposure during pregnancy and childhood is recognized as a major public health concern. However, more research is needed that specifically examines methylmercury from seafood to better inform future dietary recommendations.

Postpartum remote blood pressure monitoring and risk of hypertensive-related readmission: systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

To assess the efficacy of remote blood pressure monitoring to prevent readmission due to complications of hypertensive disorders of pregnancy.

METHODS

The search was conducted using MEDLINE, EMBASE, Web-of-Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane-Library as electronic databases from the inception of each database to November 2023. Selection criteria included randomized controlled trials of postpartum individuals randomized to remote blood pressure monitoring or telehealth strategies vs. routine-care. The primary outcome was postpartum readmission, defined as postpartum hospital admission after discharge. Secondary maternal outcomes included stroke, eclampsia, ICU-admission, maternal death, emergency department visit, ascertainment of a blood pressure measurement within 7-10 days after delivery, attendance of the 4-6-week postpartum visit. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95 % confidence intervals (CI).

RESULTS

Four RCTs including 714 individuals randomized to either telematic reporting of blood pressure measurements (n=356, 49.8 %) or standard postpartum care (n=358, 50.1 %). There were no significant differences in the rate of hospital readmission due to hypertensive related causes (5.3 % vs. 11.8 %). However, emergency department visit rate differed significantly among the two groups (9.0 % vs. 4.4 %). With regards to postpartum follow up, blood pressure assessment at 10 days postpartum and 4-6-week postpartum visit attendance rate were similar. No included RCT provided data on maternal secondary outcome like pulmonary edema, stroke, maternal death, and ICU admission.

CONCLUSIONS

Remote blood pressure monitoring is not superior to standard care to prevent hypertensive related readmission and increases emergency department visits.

Microbiota as a state-of-the-art approach in precision medicine for pancreatic cancer management: A comprehensive systematic review

Emerging evidence suggests that harnessing the microbiome holds promise for innovative diagnostic and therapeutic strategies in the management of pancreatic cancer (PC). This study aims to systematically summarize the microbial markers associated with PC and assess their potential application in clinical outcome. Forty-one studies were included to assess the associations between microbial markers and PC. Among these, 13 were developed prediction models related to the microbiome in which the highest diagnostic and prognostic model belong to blood and intratumor markers, respectively. Notably, findings that utilize microbiotas from various body sites were elucidated, demonstrating their importance as unique signatures in biomarker discovery for diverse clinical applications. This review provides unique perspectives on overcoming challenges in PC by highlighting potential microbial-related markers as non-invasive approaches. Further clinical studies should evaluate the utility and accuracy of key indicators in the microbiome as a personalized tool for managing PC.

Adjunctive middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis of clinical trials

BACKGROUND

Chronic subdural hematoma (cSDH) is a common neurosurgical condition with high recurrence rates, particularly in elderly patients. The pathophysiology involves complex mechanisms of angiogenesis, fibrinolysis, and inflammation, leading to progressive hemorrhage and fluid accumulation.

AIM

To systematically review and meta-analyze the clinical benefits and safety of middle meningeal artery embolization (MMAE) as an adjunctive treatment to usual care for cSDH.

METHODS

A comprehensive literature search was conducted across four electronic databases following PRISMA guidelines. Four clinical trials were included, involving 1680 patients with cSDH. Meta-analysis was performed using the Mantel-Haenszel method to calculate risk ratios and 95 % confidence intervals for key outcomes, including recurrence, mortality, functional outcomes, and complications.

RESULTS

MMAE plus usual care significantly reduced cSDH recurrence (Risk Ratio 0.56, 95 % CI [0.39 to 0.80], P = 0.001) and mortality (Risk Ratio [RR] 0.53, 95 % CI [0.31 to 0.91], P = 0.02) compared to usual care alone. No statistically significant differences were observed in functional outcomes (mRS 0-2 at 90 days), serious adverse events, or major disabling stroke between the two groups.

CONCLUSION

MMAE as an adjunctive treatment shows promising results in reducing cSDH recurrence and mortality without increasing procedural risks, suggesting potential benefits in managing this challenging neurosurgical condition.

Meta-analysis reveals the effectiveness and best practices for the iconic Mediterranean seagrass restoration

Seagrass forest restoration programs have become a global priority to reverse their decline and regain their ecosystem services. However, defining the restoration effectiveness has remained controversial, probably due to the wide selection of procedures experienced mainly on short-term periods and local scales. Here, scientific literature from 40 years of experience on experimental works and active restoration interventions of the Mediterranean foundation seagrass Posidonia oceanica has been systematically summarized through a meta-analysis. Twenty-five variables concerning the characteristics of the site selection, procedural context, and plant performance evidenced the best practices for the seagrass restoration. Results have evidenced the importance of the correct selection of the donor and receiving site, the use of plagiotropic cuttings bearing at least three shoots, and the need of monitoring the total extent of restored area for long term periods, considering more than one plant trait to define the plant performance. Higher biological levels should be also considered to estimate the recovery of the habitat structure and ecosystem functioning.

Adjuvant chemotherapy compared to observation in resected biliary tract cancers: Survival meta-analysis of phase-III randomized controlled trials

BACKGROUND

A limited number of randomized controlled trials (RCTs) investigated adjuvant chemotherapy in biliary tract cancers (BTCs). Recurrences and deaths are common in the first 2 years and survival remains poor despite adjuvant treatment.

METHODS

Phase-III RCTs were included comparing adjuvant chemotherapy and observation in resected BTCs. The primary endpoints were recurrence-free (RFS) and overall survival (OS). Proportional hazard results were used for trial-based analyses. Patient data was curated from published Kaplan-Meier curves to analyze short-term (2-year) hazards. The Parmar and generic inverse variance methods were used.

RESULTS

1308 patients in 4 trials (BILCAP, ASCOT, BCAT, PRODIGE-12) were included. Capecitabine (BILCAP) and S-1 (ASCOT) were grouped as 5-FU-based, gemcitabine (BCAT) and gemcitabine-oxaliplatin (PRODIGE-12) were grouped as gemcitabine-based chemotherapy. Adjuvant 5FU-based chemotherapy improved RFS [HR: 0.80 (95 % CI:0.68-0.95), p = 0.012] and OS [HR: 0.78 (95 % CI:0.65-0.94), p = 0.009]. However, gemcitabine-based chemotherapy did not provide benefit in RFS [HR: 0.90 (95 % CI:0.70-1.15), p = 0.428] and OS [HR: 1.03 (95 % CI:0.78-1.36), p = 0.794]. The benefit of 5-FU-based chemotherapy was more apparent in the short-term (2-year hazards) (RFS: [HR: 0.67 (95 %CI:57-0.79), p < 0.001] and OS: [HR: 0.61 (95 % CI:59-0.64), p < 0.001]). However, gemcitabine-based chemotherapy did not provide RFS benefit in the short term either [HR: 0.80 (95 % CI:0.64-0.1.01), p = 0.067] and seemed to be even detrimental for OS [HR: 1.22 (95 % CI:1.14-1.31), p < 0.001] in the first 2 years.

CONCLUSION

This study confirms using 5FU-based monotherapy in the adjuvant treatment of resected BTCs. The more prominent benefit in the first 2 years emphasizes that more effective adjuvant treatments with sustained long-term benefits are needed. Two-year proportional hazards OS and RFS are proposed here as an additional secondary end-point to consider in future clinical trials. in this setting. Registration ID (PROSPERO): CRD42024614444.

Glucagon-Like Peptide-1 Receptor Agonists and Risk of Venous Thromboembolism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Limited data exist on the association of glucagon-like peptide 1 receptor agonists (GLP-1RAs) with the risk of venous thromboembolism. This meta-analysis aimed to investigate the association between GLP-1RAs and the risk of venous thromboembolism including deep vein thrombosis (DVT) and pulmonary embolism.

METHODS AND RESULTS

A systematic search of PubMed, Web of Science, EMBASE, and Cochrane library was conducted from inception until July 3, 2024, to identify randomized controlled trials comparing GLP-1RAs with placebo or other anti-iabetic drugs, with reported data on DVT and pulmonary embolism. The primary outcome was venous thromboembolism, and secondary outcomes included DVT and pulmonary embolism. Pooled odds ratios (ORs) were calculated using fixed-effects models with Mantel-Haenszel method and treatment arm continuity correction for zero-event trials. A total of 39 randomized controlled trials involving 70 499 participants were included. A nonsignificant upward trend in the risk of venous thromboembolism was observed among participants using GLP-1RAs (OR, 1.19 [95% CI, 0.94-1.50]). GLP-1RAs were significantly associated with an increased risk of DVT (OR, 1.64 [95% CI, 1.14-2.36]); risk difference 25 (5-52) more events per 10 000 person-years). Subgroup analyses revealed that increased risk of DVT was particularly prominent in randomized controlled trials with treatment duration >1.5 years (OR, 2.32 [95% CI, 1.49-3.60]) and in cardiovascular outcome trials (OR, 2.18 [95% CI, 1.36-3.49]). No significant association was observed between GLP-1RAs and risk of pulmonary embolism.

CONCLUSIONS

GLP-1RAs might increase the risk of DVT, especially for long-term use of GLP-1RAs. Clinicians should be aware of this potential risk when prescribing GLP-1RAs.

Long-term results of retrograde endopyelotomy: a narrative review

PURPOSE

Retrograde endopyelotomy has emerged as a minimally invasive alternative for treating ureteropelvic junction obstruction (UPJO), characterized by impaired urinary transport due to intrinsic or extrinsic factors. This narrative review evaluates the long-term outcomes of retrograde endopyelotomy, focusing on effectiveness, safety, complications, and reoperation requirements.

METHODS

A systematic search of PubMed, Google Scholar, and Scopus from 1990 to March 2024 identified 29 studies comprising 1238 adult patients.

RESULTS

Findings indicate that retrograde endopyelotomy, predominantly performed using Holmium:YAG lasers, achieved a mean success rate of 76.9%, with variability based on the type of obstruction and intervention methods. Success was inconsistently defined across studies, ranging from symptom resolution to imaging-based criteria. Complication rates averaged 12.5%, with urinary tract infections being the most common. Hospital stays were typically brief, with most patients discharged within 1-3 days.

CONCLUSION

Retrograde endopyelotomy, has the advantage of shorter recovery times and reduced invasiveness compared to open or laparoscopic approaches. Future studies should also explore advancements in laser technology, such as Thulium Fiber Laser, to optimize outcomes.

Efficacy and safety of cholinergic modulators in patients with schizophrenia: meta-analysis of randomised controlled trials

BACKGROUND

One-third of schizophrenia patients show a lack of response to conventional antipsychotic drugs because of adverse effects and limited efficacy. Emerging treatments target muscarinic and nicotinic receptors, leveraging cholinergic dysfunction implicated in the pathophysiology of schizophrenia.

AIMS

To evaluate the efficacy and safety of cholinergic modulators in schizophrenia.

METHODS

Reviewers extracted data from clinical trials sourced via MEDLINE/PubMed, Embase, Scopus, Cochrane databases and registries. Quality was assessed with a risk-of-bias tool and a random-effects model estimated effect size. Subgroup analysis, meta-regression and sensitivity analysis were performed as needed, adhering to PRISMA guidelines.

RESULTS

A total of 30 randomised controlled trials (3128 participants) tested cholinergic modulators as monotherapy or adjunct therapy. They did not significantly improve Positive and Negative Syndrome Scale (PANSS) total scores (standardised mean difference (SMD): -0.38; 95% CI: -0.93, 0.18; moderate certainty evidence) but did improve negative symptom scores (SMD: -0.42; 95% CI: -0.59, -0.25; moderate certainty evidence). Muscarinic agonists improved total (SMD: -0.57; 95% CI: -0.72, -0.42), positive (SMD: -0.58; 95% CI: -0.73, -0.43) and negative symptoms of PANSS (SMD: -0.40; 95% CI: -0.59, -0.21), as well as Clinical Global Impression-severity (CGI-S) (SMD: -0.48; 95% CI: -0.65, -0.31). Nicotinic agonists aided negative symptoms (SMD: -0.28; 95% CI: -0.47, -0.09) and CGI-S (SMD: -1.31; 95% CI: -2.38, -0.24). Adverse events were higher (odds ratio: 1.21; 95% CI: 0.94, 1.56) in the experimental group.

CONCLUSION

Cholinergic modulators significantly improve negative symptoms, with muscarinic agonists showing improvement across symptom domains and severity, without notable differences in adverse effects from placebo. Most studies were at low bias risk; evidence quality ranged from very low to moderate.

Immunotherapy and PARP inhibitors as first-line treatment in endometrial cancer: A systematic review and network meta-analysis

BACKGROUND

Several first-line therapeutic strategies have been evaluated alongside platinum-based chemotherapy in advanced or recurrent endometrial cancer (a/rEC). However, the optimal approach remains unclear.

METHODS

A systematic review was conducted to identify randomized control trials (RCTs) that evaluate first-line therapeutic strategies in a/rEC involving immune checkpoint inhibitors (ICI) and PARP inhibitors (PARPi). A network meta-analysis with a frequentist framework using random-effects and an extracted individual patient data meta-analysis were performed. The primary endpoint was progression-free survival (PFS) by MMR status, p53 status within the MMRp population and PD-L1 status.

RESULTS

A total of 3210 patients with EC were included. In the MMRp population, the combination (ICI and PARPi) showed a not statistically significant PFS benefit compared with each agent alone. In MMRp p53-abnormal patients (n = 590), combining PARPi and ICI statistically improved PFS compared to ICI alone (HR=0.47, 95 %CI 0.40-0.94) with a numerically better outcome compared to PARPi alone (HR=0.63, 95 %CI 0.26-1.57). No benefit from PARPi was observed in the p53 wild-type MMRp population. PD-L1-positivity (n = 1121) appears to predict more benefit from the addition of ICI and PARPi, with a larger benefit of combination therapy. In the MMRd population (n = 769), the best outcomes were observed with ICI alone, with no additional benefit of PARPi. Grade 3 or greater treatment-related adverse events were seen in 75.1 % patients treated with the combination.

CONCLUSIONS

The addition of the combination of ICI and PARPi to platinum-based chemotherapy provides greatest benefit to p53-abnormal MMRp patients. PD-L1 is a potentially useful biomarker with PD-L1-positive tumors more likely to respond to ICI. Implementation of biomarkers is crucial to redefine the treatment paradigm in a/rEC.

Complicated pneumococcal pneumonia in the era of higher-valent pneumococcal conjugate vaccines: a systematic literature review and meta-analysis, 2001-2022

PURPOSE

To estimate pneumococcal conjugate vaccine (PCV) national program impact on pneumococcal complicated pneumonia (PnCP) based on changes in PnCP population-based incidence, PnCP proportion of all-cause complicated pneumonia (or invasive pneumococcal disease), and PnCP serotype distribution.

METHODS

MEDLINE, EMBASE, and Global Index Medicus articles (2001-March 2022) reporting laboratory-confirmed PnCP studies were stratified by age group, outcome measure, PCV program period(s) (pre-PCV, transition, and post-PCV), serotype distribution (based on serotyping methodology used), and PCV serotype formulation. Random effect meta-analysis of the total number of serotyped isolates within each study was used to calculate pooled serotype-specific percentages.

RESULTS

Of 1360 publications screened, the 134 studies included from 30 countries differed widely by methodological approaches. Pediatric PnCP incidence tended to decline from pre-PCV to post-PCV periods, as did PnCP as a proportion of all-cause complicated pneumonia from transition to post-PCV periods. Studies describing changes in serotype distribution by PCV program period applied detection methods that varied from pre-PCV period microbiological culture with Quellung serotyping to in the transition and post-PCV periods molecular methods like PCR. Meta-analysis revealed near elimination of pediatric PCV7-serotype PnCP between pre- and post-PCV, while the PCV13nonPCV7 percentage increased from 51.1% pre-PCV period to 76.5% in the transition period, remaining stable post-PCV period. Non-PCV13 serotypes increased slightly from low baseline numbers. Adult data were lacking or inconsistent.

CONCLUSIONS

Although studies were heterogeneous, pediatric PnCP incidence and proportion tended to decline from pre-PCV to post-PCV periods, and PCV13nonPCV7 serotype distribution percentage remained unchanged from transition to post-PCV period. Standardization of PnCP surveillance methods, definitions, and reporting is needed to evaluate accurately PCV program impact.

A Systematic Review on the Prevalence of Tick-Borne Encephalitis Virus in Milk and Milk Products in Europe

BACKGROUND

Tick-borne encephalitis virus (TBEV) is one of the most significant zoonotic diseases in Europe. It primarily spreads through the bites of infected ticks and, less frequently, through consumption of raw milk and dairy products from viremic domestic ruminants.

AIMS

Assess the prevalence of TBEV or anti-TBEV antibodies in milk and milk products from domestic ruminants in Europe.

MATERIALS AND METHODS

Systematic literature review adhering to the JBI methodology, and reported following the PRISMA framework.

RESULTS

From the 16 included scientific articles, we extracted 35 data collections (31 on raw milk and 4 on raw milk cheese); studies focused on cow (n = 15), goat (n = 11) and sheep milk (n = 5), goat (n = 3) and cow/goat cheese (n = 1). Fifteen data collections involved individual milk and 16 bulk milk samples. The estimated prevalence of TBEV in individual raw milk and cheese was 6% and 3%, respectively. TBEV prevalence in bulk milk was very heterogeneous, with most values either 0% or 100%.

DISCUSSION

Although published research on TBEV transmission to humans through milk and dairy products in the EU countries is limited, our results highlight the potential infection risk for consumers. The variable prevalence reported in the studies may reflect the focal nature of TBEV.

CONCLUSION

Studies on unpasteurised dairy products from domestic ruminants can be valuable for the detection of TBEV presence in a geographic area, even when human cases are not reported. Thanks to the ease of sample collection, their testing could be adopted in monitoring plans on TBEV.

Comparison of Intrauterine and Postnatal Brain Magnetic Resonance Imaging: Systematic Review

BACKGROUND

Fetal magnetic resonance imaging (MRI) identifies brain abnormalities better than transabdominal ultrasound. Most studies compare fetal MRI with postnatal cranial ultrasound or postmortem, so it is unclear how useful postnatal MRI is after fetal MRI. This work aimed to review the literature on postnatal MRI compared with fetal MRI to determine whether it provided useful clinical information.

METHODS

A literature search to April 2024 was performed to identify publications on fetal brain abnormalities examined using both fetal MRI and postnatal MRI. A systematic review was performed. The quality of research was evaluated using Joanna Briggs Institute checklists.

RESULTS

We identified 24 studies of 401 participants. All identified papers were retrospective or prospective case series at high risk of bias. Fourteen (58.3%) of the studies were high or moderate quality and 10 (41.7%) were low. Postnatal MRI confirmed the findings of fetal MRI in 296 (73.8%), refuted the diagnosis on fetal MRI in 24 (6.2%), and found additional abnormalities in 81 (20.2%). The suspected abnormalities on fetal MRI not confirmed on postnatal MRI were 12 isolated inferior cerebellar vermis hypoplasia, eight cerebellar vermis cysts, one mild ventriculomegaly, and one each of focal white matter abnormality, mega cisterna magna, and an unstated abnormality. Two papers including 17 participants reported that postnatal MRI changed the management or prognosis in nine (52.9%) participants.

CONCLUSIONS

The evidence on the value of postnatal MRI following a diagnosis of fetal brain abnormality is limited in size and quality, and further prospective research evidence is required.

Real-World Evidence for Baricitinib in the Treatment of Rheumatoid Arthritis in Spain: A Systematic Literature Review

INTRODUCTION

Baricitinib is a Janus kinase inhibitor approved for the treatment of moderate-to-severe rheumatoid arthritis (RA) in adults who have responded inadequately, or are intolerant, to disease-modifying antirheumatic drugs (DMARDs). This systematic literature review was conducted to understand the use of baricitinib in RA in the real-world setting in Spain.

METHODS

Embase and MEDLINE databases were systematically searched for publications (in English or Spanish) published between March 2017 and June 2023; Spanish data presented at national rheumatology congresses were also obtained, with a date limitation of 2021-2023.

RESULTS

Nineteen eligible publications were identified (5 full papers, 14 conference abstracts), including more than 1000 patients who received baricitinib for RA in Spain. Most patients were older and female with long disease duration, and moderate-to-severe active disease. Studies included both biologic DMARD-experienced and DMARD-naïve patients, and most patients received baricitinib 4 mg/day. Baricitinib persistence ranged from 6 to 48 months, with ineffectiveness (primary or secondary) being the most frequently reported reason for discontinuation. Baricitinib was consistently shown to decrease disease activity, across all outcome measures (Disease Activity Score-28 for RA, the Simplified and Clinical Disease Activity Indexes, swollen and tender joint counts and patient-reported outcomes). Thirteen studies reported safety outcomes, with discontinuation rates due to adverse events ranging from 9.5 to 20%. Across these studies, adverse events of interest included eleven cases of herpes zoster, six serious infections, two major adverse cardiovascular events, and three malignant neoplasms.

CONCLUSION

These results suggest baricitinib is effective in the real-world setting in Spain, with a consistent safety profile, similar to findings reported in clinical studies and in real-world studies conducted in other countries.

The accuracy of DNA methylation detection in endometrial cancer screening: A systematic review and meta-analysis

OBJECTIVE

DNA methylation is the hallmark of early endometrial cancer and can be detected through non-invasive methods. The present study systematically reviewed the efficacy of DNA methylation detection for endometrial cancer screening through exfoliative cytology.

METHODS

A systematic literature review was performed through the following databases from inception to October 7, 2024: PubMed, Embase, and the Cochrane Library. Studies on DNA methylation detection for endometrial cancer screening through exfoliative cytology were included. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relevant variables included cytologic sample type, methylated genes, and marker performance (i.e., AUC value, sensitivity, specificity, and the corresponding 95% confidence interval [CI]), as well as the bias risk assessment according to the Cochrane Collaboration tool (Cochrane Intervention Systematic Review Guide 5.1.0).

RESULTS

A total of 31 genes were selected from 20 studies as methylation markers for endometrial cancer detection in cytologic specimens. A total of 19 methylation markers for endometrial cancer detection with an area under the curve value from 0.80 to 0.97 were selected from 10 studies.

CONCLUSION

Cytology-based DNA methylation markers are feasible and accurate non-invasive methods for the early detection of endometrial cancer screening in high-risk populations.

Neurobehavioral characteristics and symptomatic correlations of audiovisual multisensory integration in schizophrenia: A systematic review and meta-analysis

BACKGROUND

Multisensory integration (MSI) avoids cognitive overload, and the traditional all-or-nothing perspective for dysfunctional MSI in schizophrenia has been increasingly challenged. This study aimed to systematically review and meta-analyze extant evidence on audiovisual MSI in schizophrenia.

METHODS

We searched Web of Science, PubMed, PsycINFO and PsycARTICLES databases from inception until April 16th, 2024. Studies using appropriate audiovisual integration tasks to compare either behavioral or neural responses between schizophrenia individuals and healthy controls were included. Primary outcome measures included between-group differences (Hedge's g) and symptomatic correlations (Fisher's z) in three components of audiovisual integration tasks, including audiovisual processing, adaptation and integration. The multilevel random-effects models were used to address statistical dependency.

RESULTS

In total, 209 between-group and 116 correlational effect sizes were synthesized from 46 studies, representing 1108 non-overlapped schizophrenia participants and 1084 healthy controls. The overall dysfunctional audiovisual MSI in schizophrenia (g = -0.50, [95 % CI, -0.64 to -0.37]) was primarily ascribed to the impaired audiovisual processing (g = -0.53, [95 % CI, -0.71 to -0.35]) and adaptation (g = -0.71, [95 % CI, -0.99 to -0.42]), rather than integration itself (g = -0.23, [95 % CI, -0.56 to 0.11]). Pooled correlational effect size was extremely small (z = 0.16, [95 % CI, 0.03 to 0.30]).

CONCLUSIONS

Individuals with schizophrenia show dysfunctional multisensory processing and adaptation, but preserve a less impaired multisensory integration ability. Our findings provide implications for clinical interventions, as the relatively preserved audiovisual integration ability may serve as a possible avenue for cognitive training programs.

What affects operating room turnover time? A systematic review and mapping of the evidence

BACKGROUND

The operating room environment is a complex system associated with high operating costs and requires careful management to optimize patient outcomes and productivity. One of the most studied metrics of operating room efficiency is turnover time. This study systematically reviews mutable factors associated with improvements in operating room turnover time.

METHODS

In accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified observational and interventional approaches analyzing an association between a mutable factor and operating room turnover time (defined as the time between closure and next incision on the subsequent patient). We defined mutable factors as any generalizable element of the operating room environment amenable to change with intervention. Each study was categorized by the type of mutable factor and specific phase of turnover time affected.

RESULTS

Of 1,507 studies identified, 551 underwent abstract review with 105 meeting eligibility for this systematic review. There were 136 unique analyses of a relationship between a mutable factor and operating room turnover time. The mutable factors analyzed in these studies varied widely, including changes in anesthetic approach, communication/goal setting, allied health staff, artificial intelligence/information technology, operating room management, setup standardization, prearrival optimization, and operating room type. The analyzed literature showed the potential for mutable factors in each of these domains to improve operating room efficiency by reducing turnover time.

CONCLUSION

Operating room efficiency is critical to the financial health and success of a hospital. This review organizes a large body of information relating to turnover time with an approach that can guide scientists and leaders interested in operating room efficiency. The most impactful areas discovered were related to parallel processing, team dynamics, and a "focused factory" approach.

Timing of Complementary Feeding and Infant Growth Trajectories in Prospective Cohort Studies: A Systematized Review and Analysis of Socioecological Variation

Complementary feeding (CF) before 6 months of age is associated with both infant growth faltering and rapid growth. This disparity may reflect reverse causality and local norms. We conducted a systematized review of prospective studies examining infant growth and CF. We examined the potential for reverse causality and socioecological factors that appeared to influence feeding and growth outcomes. In 22 studies that met inclusion criteria, growth trajectories following earlier CF largely tracked prior growth. Earlier CF was generally associated with slower growth in lower resource populations, and more rapid growth in higher resource contexts. Local norms and caregivers' perceptions of growth were often discussed as factors impacting feeding decisions, but were not explicitly modeled. Future research may benefit from bioethnographic approaches that integrate contextual understanding of local dynamics to more comprehensively examine interactions between growth trajectories, caregiver perceptions, local norms, and health risks that influence CF timing and growth outcomes.

Current surgical outcomes of free functional muscle transfer for Volkmann's ischemic contracture: A scoping review

Purpose

Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to procedural complexity and lack of microsurgical availability. While FFMT is well described for brachial plexus injury and facial trauma, its application in Volkmann's ischemic contracture (VIC) is underexplored, with variable operative timelines and postoperative outcomes.

Methods

Following PRISMA-ScR guidelines, PubMed and Ovid electronic databases were searched using the following keywords: "Volkmann," "compartment syndrome," "muscle transfer," "muscle transplantation," and/or "reconstruction." Studies were imported into Covidence, and screening was performed by two independent reviewers. Patient characteristics, surgery information, and postoperative clinical data were extracted.

Results

The scoping review included 21 studies. In total, 163 FFMTs for VIC were performed, most commonly using the gracilis muscle (64.4 %) for finger flexion deficits (91.4 %). Nerve selection was variably reported, with the anterior interosseus nerve (AIN) used most frequently. Grip strength, range of motion, and total active motion were the most frequently utilized outcome measures. FFMT success rates were high (96 %), and 34.6 % of all-comers experienced tendon or muscle adhesions that required subsequent tenolysis or adhesiolysis. Several studies recommended early exploration within 3 weeks, and FFMT within 6 months of the initial injury; however, successful FFMT cases were reported up to 20 years post-injury.

Conclusions

FFMT remains a viable option for VIC treatment, with a 96 % success rate. There is a relatively high incidence of tendon or muscle adhesions (34.6 %) that require secondary procedures.

Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis

BACKGROUND

 Large defects of the lower lip often require free tissue coverage. Fasciocutaneous free flaps have been traditionally used, but innervated muscular free flaps may fundamentally address orbicularis oris deficiency and improve dynamic competence. This review aimed to determine if innervated muscular free flaps provided benefit over fasciocutaneous free flaps for reconstruction of defects of more than 50% of the lower lip. Outcomes of interest included functional oral outcomes including oral competence, aesthetic outcomes, and patient-reported outcome measures.

METHODS

 Five databases (PubMed, Embase, Web of Science, CINAHL, and CENTRAL) were searched for variations of "lip" and "free flap." Two authors screened articles and included primary research of free flap reconstruction of more than 50% of the lower lip from any etiology in living humans with an English full-text available. Composite bony flaps were excluded. Oral competence and aesthetic satisfaction, reconstruction details, and complications were extracted. Proportional meta-analyses were used to synthesize results for fasciocutaneous free flaps, which were compared with those for muscular free flaps.

RESULTS

 Fifty-nine articles describing 242 patients were included. Muscular free flaps reported significantly higher proportional oral competence than fasciocutaneous free flaps (98 vs. 83%, p = 0.01). Aesthetic outcomes (98 vs. 97%, p = 0.22) and complications (17 vs. 18%, p = 0.79) were equivalent between fasciocutaneous and muscular free flaps.

CONCLUSION

 Muscular free flaps may address the fundamental orbicularis oris defect that causes oral incompetence and seem to provide better functional results. Aesthetic outcomes and complications seem to be equivalent.

Total ankle arthroplasty versus ankle arthrodesis in end-stage osteoarthritis: A meta-analysis of comparative outcomes

The treatments for end-stage ankle arthritis are challenging. Standard treatment methods include ankle arthrodesis (AA) and total ankle arthroplasty (TAA). This meta-analysis compares the outcomes of TAA and AA based on comparative studies. Literature databases include PubMed, Embase, and Google Scholar. Keywords related to the treatment of end-stage ankle osteoarthritis with AA compared to TAA were used. The outcome measurements include functional outcomes and revision rates. Review Manager 5.4 was used to conduct statistical analysis. A standard p-value of <0.05 indicated statistical significance. 27 comparison articles, including data from 12,341 patients, were included in the meta-analysis. 4917 patients underwent total ankle arthroplasty, while 7440 underwent ankle arthrodesis. The results showed a significant difference in the AOFAS score favoring TAA (p < 0.001). Dorsiflexion range of motion (ROM) also showed a significant difference in favor of TAA (p < 0.001). Additionally, the TAA group's plantarflexion ROM was significantly superior (p < 0.001). The overall SF-36 score, which measures quality of life, reported improved outcomes for patients who underwent TAA compared to those with AA (p < 0.001). The Activities of Daily Living, calculated by the Foot and Ankle Ability Measure (FAAM) score, also showed significant improvement in patients who had TAA compared to those who received AA (p < 0.001). When both the Activities of Daily Living and Sports subscales were combined, there was a significant improvement in the total FAAM score for TAA patients (p < 0.001). However, there was a significant difference in revision rates favoring AA (p < 0.001). This meta-analysis compared postoperative outcomes of ankle arthrodesis (AA) and total ankle arthroplasty (TAA) through patient-reported and functional measures. By synthesizing qualitative and quantitative data, we identified TAA as the superior intervention, demonstrating significant advantages in AOFAS scores, FAAM activities of daily living, FAAM total scores, SF-36 total scores, and range of motion. These findings aid in tailoring surgical decisions for end-stage ankle osteoarthritis, particularly when patient-specific factors such as anatomical suitability, comorbidities, or access to advanced care limit treatment options. Additionally, this study supports the recent trend of showing comparable revision rates between TAA and AA.

Level of evidence

3.

Exploring reconstructive alternatives to pollicization for modified Blauth type IIIB-V congenital thumb hypoplasia: A systematic review

Background

Although pollicization remains the traditional treatment strategy for modified Blauth type IIIB-V grade congenital thumb hypoplasia, many patients and parents express interest in alternative reconstructive approaches that maintain a five-digit hand. The aim of this study was to provide a summary of these alternative techniques and to assess for differences in their outcomes, with the hypothesis that techniques featuring vascularized bone grafts would have fewer instances of bone resorption or nonunion relative to non-vascularized techniques.

Methods

A systematic literature review was conducted in PubMed, Embase, and CINAHL using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the reconstruction of modified Blauth type IIIB-V hypoplastic thumbs were included. Chi squared tests (or Fisher exact tests where appropriate) were performed to compare aggregate complication data.

Results

Twenty-four articles met inclusion criteria, yielding 207 patients with 210 thumbs undergoing reconstruction. Mean patient age at surgery was 3.4 years, while the mean follow-up time was 4.2 years. 203 of the 207 patients underwent reconstruction using one of five techniques: PIPJ/MTPJ transfer, hemi-metatarsal transfer, toe and metatarsal transfer, iliac crest transfer, and toe phalanx transfer. PIPJ and MTPJ transfers were the most performed procedures (n = 54, 26 %). Vascularized grafts were used in 89 cases (43 %), while non-vascularized grafts comprised 114 cases (55 %). Rates of bone resorption and nonunion were higher in non-vascularized grafts, though not significantly so (n = 203, p = 0.19). Conversely, donor site complications were significantly higher in vascularized bone grafting techniques (n = 203, p = 0.0056). The most frequently reported outcome measures were Kapandji scores (46 %) and key pinch strength (46 %). Kapandji scores had a weighted mean of 5.6 (range 3.1-6.7).

Conclusion

A variety of alternative techniques exist for reconstructing severely hypoplastic thumbs, though no technique demonstrates clear superiority. Vascularized grafts trend towards a lower bone resorption/nonunion rate relative to non-vascularized grafts, though there is evidence of heightened risks of donor site complications when taking vascularized bone grafts from the foot. Objective outcome measures showed variability across studies limiting comparisons between techniques.