An overview of meta-analysis for clinicians

Association between chemokine genes polymorphisms and susceptibility to Parkinson's disease: a meta-analysis and systematic review

OBJECTIVE

This study aimed to investigate the potential association between polymorphisms in monocyte chemoattractant protein-1 (MCP-1), chemokine receptor type 2 (CCR2), type 5 (CCR5), regulated on activation, normal T cell expressed, and secreted (RANTES) and susceptibility to Parkinson's disease (PD).

METHODS

The MEDLINE, EMBASE, and Web of Science databases were searched for relevant articles, and a meta-analysis was conducted to assess the associations between the MCP-1 -2518 G/A, CCR2 V64I, CCR5-Δ32, RANTES - 405 G/A, -28 G/A polymorphisms and the risk of PD.

RESULTS

Six studies with 1,416 patients with PD and 1,715 controls that met the inclusion criteria were identified. Meta-analysis of all study participants demonstrated no association between PD and the MCP-1 -2518 G allele (odds ratio [OR] = 1.089, 95% confidence interval [CI] = 0.980-1.211, p = 0.114). Stratification by ethnicity indicated no association between the MCP-1 -2518 G allele and PD in the European and Asian populations. Meta-analysis demonstrated no association between PD and the MCP-1-2518 A/G polymorphism in recessive and dominant models and homozygote contrast. However, meta-analysis revealed a significant association between the risk of PD and the CCR2-V64I AA + GG genotype in all study participants (OR = 0.418, 95% CI = 0.232-0.753, p = 0.004). Stratification based on ethnicity validated this association between the CCR2-V64I AA + GG genotype and PD in the Asian population (OR = 0.460, 95% CI = 0.243-0.870, p = 0.017), but not in European populations. Analysis using the homozygous contrast model revealed the same pattern for the CCR2-V64I AA + GG genotype. Meta-analysis revealed no association between the CCR5-Δ32 allele and the risk of PD (OR = 0.972, 95% CI = 0.377-2.501, p = 0.952). Moreover, the meta-analysis demonstrated no allelic association between RANTES - 405 G/A and - 28 G/A polymorphisms and the risk of PD.

CONCLUSIONS

Our meta-analysis showed that the CCR2 V64I polymorphism is associated with PD, especially in Asian populations.

Inflammation-related biomarkers as predictors of pathological complete response in early-stage breast cancer

BACKGROUND

Neoadjuvant systemic therapy (NAT) represents an attractive option for improved outcomes of early-stage breast cancer (BC) patients, as it can significantly reduce tumor burden thus permitting breast-conserving resections. Equally important, the eradication of viable cancer cells post-NAT, also known as pathological complete response (pCR), has emerged as a strong prognostic biomarker, reflecting tumor's biology and subsequent treatment responses. Yet to date, no validated markers predictive of pCR have been identified.

METHODS

The present retrospective study aimed to explore the value of neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as potential predictors of pCR.

RESULTS

Despite no statistically significant associations have been reported, NLR and PLR dynamics during NAT, as longitudinal inflammatory phenotypes, merit further investigation in larger cohorts.

CONCLUSION

In the future, the integration of a comprehensive inflammatory biomarker panel into clinical practice could assist in a priori treatment selection process.

Mini meta-analysis of anticholinesterase actions of atorvastatin, simvastatin and rosuvastatin, and in silico identification of their protein targets in Mus musculus

Dyslipidemic statins reduce blood and brain cholinesterase (ChE) activities in mice, with scarce information on other protein/enzyme targets. The study aims at conducting a mini meta-analysis on in vivo and in vitro adverse anti-ChE effects of atorvastatin, simvastatin and rosuvastatin in mice, and using the SwissPrediction to identify in silico body target proteins. The data comprised 72 records of plasma, erythrocytes and brain ChE activities, expressed as percent mean ± SD of respective controls. We conducted a randomized effects size single-arm meta-analysis. The risk of bias scoring was according to those of animal experiments. The effect size (% ChE activity) of statin treatments was significantly decreased by 25.85 % (combined effect size=74.15, p = 0.0001), with significant heterogeneity (Q=1133.19, p < 0.0001, I2=93.73 %). Subgroup analysis was significantly dose and concentration-dependent. The funnel plot showed non-symmetrical data distribution, with no imputed points. The risk of bias was moderate. In silico mouse body protein targets for the statins were mainly classes of Family AG protein- coupled receptor (20.0 %-33.3 %), Oxidoreductase (6.7-13.3 %) and Eraser (13.3 % each), with others at 0-26.7 %. The findings highlight statin effects in mice by reducing blood and brain ChE activities, in a dose/concentration-dependent manner, that would potentially modulate the cholinergic system. This anti-ChE effect together with in silico protein targets recognized could be the basis of further experimental explorations of adverse effects of statins.

Assessment of quality of reporting and methodology in systematic reviews of moxibustion for chronic diseases using PRISMA 2020 and AMSTAR 2

BACKGROUND

Moxibustion is a simple and low-cost technique for chronic diseases. This study aimed to evaluate the quality of reports and methodologies of systematic reviews (SRs) related to the treatment of chronic diseases with moxibustion.

METHODS

Six databases were searched to identify moxibustion SRs for the treatment of chronic diseases. The reporting and methodological quality were evaluated based on the PRISMA 2020 statement and AMSTAR 2 standard, respectively. Univariate and multivariate analyses were used to explore impact factors.

RESULTS

A total of 200 SRs were included. The median reporting quality score based on the PRISMA 2020 evaluation was 58.33. The incomplete reports involved search strategies, assumptions about missing information, and methods to synthesize and display results. The median methodological quality score of AMSTAR 2 was 40.63. The substandard methodologies included lack of a prespecified protocol, analyses for impacts of the risk of bias, and reports of funding sources. The characteristics of SRs with higher PRISMA 2020 and AMSTAR 2 scores mainly included funding support, English publications, protocol registration, application of PRISMA guidelines, and conduct of GRADE evaluation.

CONCLUSION

Over time, the reporting quality of SRs of moxibustion for chronic diseases has generally improved, but the methodological quality remains unsatisfactory. Conducting a GRADE evidence quality evaluation is crucial for improving the reporting and methodological quality. In the future, it is necessary for both PRISMA 2020 and AMSATR 2 to develop specific extensions for moxibustion to better guide the reporting and methodology of moxibustion SRs.

STUDY REGISTRATION

PROSPERO ID CRD42020149024.

Impact of Flipped Classroom Instruction on Brain-Mediated Motor Skill Performance in University Students: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis evaluates how the flipped classroom model-considered as a neurocognitive training environment-affects cognitive-motor integration and brain-mediated motor skill performance in university students, providing scientific evidence for optimizing higher-education physical education pedagogy (a course related to physical literacy and the cultivation of physical and mental health, rather than a training program for professional physical education teachers).

METHODS

In order to compare the effects of flipped classroom and traditional teaching on the motor skill performance of university students, this study conducted a systematic review and meta-analysis according to PRISMA rules, whereby studies were screened according to specific inclusion criteria and data were extracted, assessed for quality, and then meta-analyzed to assess the effectiveness of the flipped classroom model in improving motor skill performance.

RESULTS

A total of 12 original randomized controlled trials (RCTs) were included in the study. The meta-analysis results indicated that the flipped classroom model significantly outperformed traditional teaching methods in improving university students' motor skill scores (standardized mean difference (SMD) = 1.22, 95% CI = 0.64-1.79, p < 0.0001). Subgroup analysis showed significant effects in both general major students and sports science major students, with no significant difference between studies conducted in China and those conducted in non-China regions.

CONCLUSIONS

The flipped classroom model demonstrates significant advantages over traditional PE teaching methods in improving motor skill performance. It enhances students' skill acquisition and classroom engagement, showing promising potential for future implementation in university PE programs. Further research should explore the model's applicability across different sports and student populations, as well as its long-term impact on skill retention and postgraduation sports participation.

Novel molecular mechanisms of immune evasion in hepatocellular carcinoma: NSUN2-mediated increase of SOAT2 RNA methylation

BACKGROUND

Hepatocellular carcinoma (HCC) is a deadly malignancy known for its ability to evade immune surveillance. NOP2/Sun RNA methyltransferase family member 2 (NSUN2), an RNA methyltransferase involved in carcinogenesis, has been associated with immune evasion and energy metabolism reprogramming. This study aimed to examine the molecular mechanisms underlying the involvement of NSUN2 in immune evasion and metabolic reprogramming of HCC.

METHODS

Single-cell transcriptomic sequencing was applied to examine cellular composition changes, particularly immune cell dynamics, in HCC and adjacent normal tissues. Bulk RNA-seq and proteomics identified key genes and proteins. Methylation sequencing and methylated RNA immunoprecipitation (MeRIP) were carried out to characterize the role of NSUN2 in 5-methylcytosine (m5C) modification of sterol O-acyltransferase 2 (SOAT2). Clinical samples from 30 HCC patients were analyzed using reverse transcription-quantitative polymerase chain reaction and Western blotting. Gene expression was manipulated using CRISPR/Cas9 and lentiviral vectors. In vitro co-culture models and metabolomics were used to study HCC cell-T cell interactions, energy metabolism, and immune evasion. Tumor growth in an orthotopic mouse model was monitored by bioluminescence imaging, with subsequent measurements of tumor weight, volume, and immunohistochemical staining.

RESULTS

Single-cell transcriptomic analysis identified a marked increase in malignant cells in HCC tissues. Cell communication analysis indicated that tumor cells might promote cancer progression by evading immune clearance. Multi-omics analyses identified NSUN2 as a key regulator in HCC development. MeRIP confirmed that NSUN2 facilitated the m5C modification of SOAT2. Analysis of human HCC tissue samples demonstrated pronounced upregulation of NSUN2 and SOAT2, along with elevated m5C levels in HCC tissues. In vitro experiments uncovered that NSUN2 augmented the reprogramming of energy metabolism and repressed the activity and cytotoxicity of CD8+ T cells, contributing to immune evasion. In vivo studies further substantiated the role of NSUN2 in fostering immune evasion and tumor formation of HCC by modulating the m5C modification of SOAT2.

CONCLUSIONS

The findings highlight the critical role of NSUN2 in driving HCC progression through the regulation of m5C modification on SOAT2. These findings present potential molecular markers for HCC diagnosis and therapeutic targets for its treatment.

Circulating VEGF levels and genetic polymorphisms in Behçet's disease: a meta-analysis

Objective

This study aimed to explore the relationship between circulating vascular endothelial growth factor (VEGF) levels and Behçet's disease (BD), as well as to examine the association between VEGF gene polymorphisms and BD.

Methods

We conducted a comprehensive search of the MEDLINE, Embase, and Web of Science databases to identify relevant research articles. A meta-analysis was performed to compare serum or plasma VEGF levels in BD patients with those in control groups. Additionally, we evaluated the potential associations between BD susceptibility and specific VEGF polymorphisms, namely -634 C/G, +936 C/T, and the 18 bp insertion/deletion (I/D) at -2549.

Results

The analysis included 15 studies with a total of 1,020 BD patients and 1,031 controls. BD patients exhibited significantly higher circulating VEGF levels compared to controls (standardized mean difference [SMD]=1.726, 95% confidence interval [CI]=1.030~2.421, p<0.001). Elevated VEGF levels were noted among BD patients from European and Arab populations. Subgroup analysis further confirmed the increase in VEGF levels across different data types and sample sizes. Patients with active BD had higher VEGF levels than those with inactive BD (SMD=0.635, 95% CI=0.092~1.177, p=0.022). However, no significant association was found between BD and the VEGF -634 C allele (odds ratio=1.023, 95% CI=0.707~1.481, p=0.904). Similarly, no association was detected between BD and the VEGF +936 C/T or 18 bp I/D at -2549 polymorphisms.

Conclusion

Our meta-analysis showed a strong association between elevated circulating VEGF levels and BD. However, the VEGF polymorphisms examined in this study do not appear to be associated with susceptibility to BD.

Diagnostic accuracy of IgG 4/IgG and IgG 4 in patients with IgG 4-related disease: a meta-analysis

OBJECTIVE

This study aimed to evaluate and compare the diagnostic performance of immunoglobulin G4/Immunoglobulin G (IgG 4/IgG) and immunoglobulin G4 (IgG 4) alone in identifying immunoglobulin G4-related disease (IgG 4-RD).

METHODS

A systematic review and meta-analysis were conducted using data from Medline, Embase, and the Cochrane Library from inception to November 2024. Two meta-analyses were performed to assess the diagnostic accuracies of IgG 4/IgG and IgG 4 in IgG 4-RD patients.

RESULTS

Eight studies encompassing 754 IgG 4-RD patients and 9496 non-IgG 4-RD controls were included in the analysis. IgG 4/IgG demonstrated a sensitivity of 89% and a specificity of 91.6%, accurately detecting IgG 4-RD in 89% of cases and correctly identifying non-IgG 4-RD in 91.6% of cases. IgG 4 alone exhibited a higher sensitivity (94.9%) and a similar specificity (91%), indicating a slightly improved ability to identify IgG 4-RD cases. The positive likelihood ratio (PLR) and the negative likelihood ratio (NLR) for IgG 4/IgG were 7580 and 0.132, respectively, while IgG 4 alone had a PLR of 6403 and a lower NLR of 0.066, confirming the high diagnostic reliability. The diagnostic odds ratio (DOR) was 62.97 for IgG 4/IgG compared to 105.6 for IgG 4 alone, reflecting enhanced accuracy. The area under the curve (AUC) was 0.949 for IgG 4/IgG and 0.986 for IgG 4. The Q* index was 0.889 for IgG 4/IgG and 0.949 for IgG 4, further underscoring the diagnostic effectiveness of IgG 4 alone.

CONCLUSION

Both IgG 4/IgG and IgG 4 are highly accurate markers for diagnosing IgG 4-RD, with IgG 4 alone showing marginally higher sensitivity, DOR, and AUC. This suggests that IgG 4 alone may offer a slight advantage as a diagnostic marker for IgG 4-RD.

Effects of water aerobics on body composition in obesity and overweight people: a systematic review and meta-analysis

OBJECTIVES

Obesity and overweight significantly impact public health. The benefits of water aerobics (WAs) have been shown in obesity and overweight people, but the effects of WAs on body composition improvement are still unclear.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A systematic literature search was conducted on 16 November 2024, across the PubMed MEDLINE, Ovid MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Only randomised controlled trials (RCTs) were included, which were independently screened by two researchers. All RCTs on WAs that evaluated the anthropometric and body composition parameters of overweight and obesity subjects were included. Eligible studies were reported following the Reporting Items for Systematic Reviews and Meta-Analysis statement.

DATA EXTRACTION AND SYNTHESIS

All process were independently screened by two researchers (ZD, HZ). A fixed-effects or random-effects model was chosen based on the heterogeneity of the studies. The risk of bias in the included studies was assessed using the Risk of Bias V.2.0 tool, and sensitivity and subgroup analyses were conducted for outcome indicators. The quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

A total of 10 studies involving 286 participants were included. Sensitivity analyses were performed for percent body fat (PBF) with high heterogeneity, and the results were robust. WAs were able to reduce body weight (BW) (weighted mean differences (WMD)=-2.69, 95% CI -4.10 to -1.27, p<0.05, I2=0.0%) and waist circumference (WC) (WMD=-2.75, 95% CI -4.41 to -1.09, p<0.05, I2=27.0%), but the effect on other body indicators was not significant. The GRADE assessment revealed that the certainty of evidence was low for body mass index, lean mass, fat mass, waist-hip ratio and hip circumference and very low for PBF. In contrast, the certainty of evidence for BW and WC was moderate.

CONCLUSION

For the obesity and overweight people, WAs interventions over 10 weeks (ie, 12 weeks) reduced BW and WC, with more significant effects in women and greater improvements in body composition in middle-aged and older adults (average age ≥45 years). The moderate certainty of evidence for BW and WC, as assessed using the GRADE framework, indicates that these findings are robust.

PROSPERO REGISTRATION NUMBER

CRD42023466969.

Healthcare research and education: actively constructed research knowledge-a model for online systematic reviews and meta-analyses courses

Employing a mixed-methods approach, this study: (a) scoped the literature for desirable characteristics of online learning environments; (b) analyzed and compared the available online systematic review and meta-analysis (SR/MA) courses; and (c) proposed an outline for a model online systematic review SR/MA course that is aligned with PRISMA principles, and (d) charted learning outcomes, module contents, interactive elements, feedback and module assessment, and course evaluation of the proposed course. The findings highlight the many distinctive aspects and design of the proposed model course, including its comprehensiveness, alignment with PRISMA principles, self-pace and self-direction, with high interactivity levels, augmented by the expert trainer guidance ('human' factor), and individualized feedback, and its conclusion with the incorporation of the learners in virtual research teams undertaking real SR/MA. The proposed model course integrates principles of problem-based learning, where in addition to the provided resources (interactive assignments and video tutorials), trainees will be actively conducting their own real SR/MA as part of the course, while receiving expert feedback to enhance learning outcomes. Assignments' scores will be used to evaluate the learners' proficiency levels, and to pinpoint strengths and areas requiring enhancement. Overall, the proposed model course stands out as an innovative initiative in online SR/MA training, offering a valuable and comprehensive online learner-centered, expert-guided, 'hands-on' educational approach to SR/MA training. This sets a benchmark for future online courses in research synthesis methodology within health, medical, surgical and related fields.

A Meta-analysis of the Regulation of Low-Density Lipoprotein Cholesterol and Proprotein Convertase Subtilisin-Kexin Type 9 with Inclisiran

OBJECTIVE

This study aimed to systematically evaluate the regulation of low-density lipoprotein cholesterol (LDL-C) and proprotein convertase subtilisin-kexin type 9 (PCSK9) with inclisiran using a meta-analysis.

METHODS

A comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted for randomized controlled trials of inclisiran published up to April 2024. Stata software was used for statistical analysis of outcome indicators from the included studies. Egger's test was employed to assess the risk of publication bias.

RESULTS

A total of 10 studies involving 5208 participants were included in this meta-analysis. The results indicated that inclisiran significantly reduced LDL-C levels (weighted mean difference [WMD] - 48.17%; 95% confidence interval [CI] - 51.78 to - 44.56%; P < 0.01) and PCSK9 levels (WMD - 77.91%; 95% CI - 82.99 to - 72.84; P < 0.01) compared with the control group. The incidence of adverse reactions in the inclisiran group did not differ significantly from that in the placebo group (relative risk [RR] 1.03; 95% CI 0.99-1.09; P = 0.15). Similarly, there was no significant difference in the incidence of cardiovascular adverse events between the inclisiran and placebo groups (RR 0.92; 95% CI 0.74-1.16; P = 0.49). Sensitivity analysis showed that the exclusion of any single study did not significantly affect the final results.

CONCLUSION

Current evidence suggests that inclisiran significantly lowers LDL-C and PCSK9 levels. The incidence of adverse events and cardiovascular adverse events was not significantly different from that with other drugs.

Comparative Efficacy of Surgical Strategies for Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis

OBJECTIVE

This study evaluated the therapeutic effects of open and minimally invasive surgeries in patients with drug-resistant epilepsy.

METHODS

This study systematically searched electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, subsequent open-label expansion studies, prospective studies and retrospective studies on surgical procedures for patients with drug-resistant epilepsy. The main outcome was seizure-free status. A one-arm meta-analysis integrating data from all studies was performed to evaluate the treatment outcomes at multiple time points.

RESULTS

A total of 62 studies were included, representing 5958 individuals who received five treatment regimens. The analysis results indicate that anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy is still the best choice for treating drug-resistant mesial temporal lobe epilepsy in adult epilepsy patients. During the overall follow-up period, the seizure free rates for ATL, selective amygdalohippocampectomy, laser interstitial thermal therapy, radiofrequency thermocoagulation, and gamma knife surgery were 62%, 70%, 58%, 47%, and 57%, respectively.

CONCLUSIONS

Among the five surgical methods included in this study, ATL and selective amygdala hippocampal resection seem to have more advantages in postoperative epilepsy control compared to laser interstitial hyperthermia, radiofrequency thermocoagulation, and gamma knife surgery. Each surgical treatment method has its unique focus, and when choosing a specific method, it is necessary to consider the patient's specific situation, the type and location of epileptic seizures, and possible side effects. Treating physician will develop personalized treatment plans based on these factors to maximize treatment effectiveness and reduce risks.

Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

BACKGROUND

The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI).

METHODS

A comprehensive search was conducted across PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases for relevant articles published up until September 28, 2024.

RESULTS

After screening, 8 articles were included in this study. The analysis revealed that following ICI treatment, the left ventricular global longitudinal strain (GLS) increased significantly [weighted mean difference (WMD) 2.33; 95% confidence interval (CI) 1.26, 3.41; p < 0.01], while the global radial strain (GRS) decreased [WMD -4.73; 95% CI -6.74, -2.71; p < 0.01]. Additionally, T1 and T2 values increased [standardized mean difference (SMD) 1.14; 95% CI 0.59, 1.68; p < 0.01] and [SMD 1.11; 95% CI 0.64, 1.58; p < 0.01], respectively. An elevated T2 was associated with a higher occurrence of major adverse cardiovascular events (MACE), with a hazard ratio of 1.36 (95% CI 1.12, 1.64).

CONCLUSIONS

Our findings demonstrate that T1, T2, and GLS increase, while GRS decreases following ICI administration. By consolidating these critical metrics, we propose a streamlined, abbreviated (non-contrast) CMR protocol that can be completed within 15 minutes, thereby facilitating the integration of CMR in cardio-oncology.

THE PROSPERO REGISTRATION

CRD42023437238, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437238.

Associations Between Interleukin-10 Polymorphisms and Susceptibility to Sjögren's Syndrome: A Meta-Analysis

This study sought to investigate the association between interleukin-10 (IL10) polymorphisms and susceptibility to Sjögren's syndrome. A systematic search of the Medline, Embase and Web of Science databases was conducted to identify relevant articles from inception to April 2024. No restrictions were placed on race, ethnicity or geographic area, but only studies published in English were included. A meta-analysis was conducted to evaluate the association among the IL10-1082 G/A (rs1800896), -819 C/T (rs1800871) and -592 C/A (rs1800872) polymorphisms, as well as their haplotypes and the risk of developing Sjögren's syndrome. The included studies involved 998 Sjögren's syndrome patients and 1576 controls. Ten studies were included in the meta-analysis. Meta-analysis of the IL10-1082 G/A polymorphism revealed no significant association with Sjögren's syndrome (odds ratio [OR] = 1.115, 95% confidence interval [CI]: 0.888-1.401, p = 0.343), with stratification by ethnicity yielding consistent results for Europeans and Latin Americans. Similarly, the IL10-819 C/T polymorphism was not associated with Sjögren's syndrome in any study subjects (OR = 0.859, 95% CI: 0.648-1.138, p = 0.290). The IL10-592 C allele also exhibited no association with Sjögren's syndrome (OR = 1.131, 95% CI: 0.776-1.646, p = 0.522). However, the GCC carrier status demonstrated a significant association with Sjögren's syndrome across all study subjects (OR = 1.496, 95% CI: 1.200-1.865, p < 0.001), particularly in Europeans (OR = 1.444, 95% CI: 1.085-1.921, p = 0.012) and Latin Americans (OR = 1.324, 95% CI: 1.115-2.366, p = 0.012). A significant protective effect of the homozygous ATA/ATA haplotype on Sjögren's syndrome was found in Europeans (OR = 0.320, 95% CI: 0.121-0.846, p = 0.022). This meta-analysis indicates a significant link between carrying the GCC haplotype of the IL10-1082 G/A, -819 C/T and -592 C/A polymorphisms and an increased susceptibility to Sjögren's syndrome. Conversely, the homozygous ATA/ATA haplotype appears to confer protection against the risk of Sjögren's syndrome, particularly in European populations.

Effectiveness of Digital-Based Interventions on Physical and Psychological Outcomes Among Cancer Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

Evolving digital technology has paved the way for endless potentiality. Leveraging on digital technology for healthcare purposes can target cancer patients, thus improving physical and psychological symptoms. Nevertheless, there is limited consolidated evidence on the effectiveness of virtual reality (VR) and mobile applications. This review aimed to synthesize evidence concerning the effectiveness of VR and mobile-based interventions on physical (pain, fatigue, and sleep) and psychological (anxiety and depression) outcomes among cancer patients.

METHODS

A comprehensive literature search was conducted on ten electronic databases, ongoing trials, and grey literature, reported between 2013 to 2023. All randomized controlled trials (RCTs) examining VR and mobile-based interventions on the physical or psychological outcomes among people with cancer were included. Two independent reviewers screened records for eligibility, appraised methodological quality, and extracted data from included studies. The Cochrane Risk of Bias tool was used for data appraisal, and a modified Cochrane data extraction form was used for data extraction. Meta-analysis and subgroup analysis were used to analyze data.

RESULTS

In total, 43 studies were included. VR relaxation videos and game-based activities were efficacious in improving cancer-related pain. Mobile applications with educational content, symptom monitoring, relaxation videos, teleconsultation, and regular reminders contributed to positive effects on all outcomes. Mindfulness practice appeared to improve sleep quality, anxiety, and depression. Intervention effects sustained at least 6 months for all outcomes, except sleep.

CONCLUSIONS

VR and mobile-based interventions had the potential to improve pain, fatigue, sleep, anxiety, and depression at post-intervention. Future RCTs are required to further test both digital interventions on specific types of cancer on multiple research settings.

IMPLICATIONS TO NURSING PRACTICE

VR and mobile-based interventions can be offered in clinical settings to help cancer manage their pain, fatigue, sleep, anxiety, and depression. VR relaxation videos, game-based activities, teleconferences, mindfulness, education, and system reminders can be included.

Uncovering the Potential Link Between Polychlorinated Biphenyls and Cardiovascular Diseases: A Comprehensive Analysis

BACKGROUND

A family of persistent organic pollutants, known as polychlorinated biphenyls (PCBs), are extensively found in the environment and may be harmful to the cardiovascular system. Systematic reviews and meta-analyses are required to thoroughly evaluate the association between PCB exposure and cardiovascular disease (CVDs), despite the fact that studies on the subject have produced inconsistent results.

OBJECTIVE

The purpose of this study was to investigate the relationship between PCBs exposure and cardiovascular disease risk in order to provide more conclusive data to promote public health actions.

METHODS

The studies that met the inclusion criteria were screened out using the databases PubMed, Web of Science, ScienceDirect, and Cochrane Library. The comprehensive effect size (OR) was calculated using the random-effects model; the study's heterogeneity was analyzed using I2 statistics; the major reasons of heterogeneity were identified using subgroup analysis; and publication bias graphically was measured using the Egger's test.

RESULTS

A meta-analysis of 11 studies revealed that total PCBs (OR = 1.56, 95% CI: 1.20-1.75), non-dioxin-like PCBs (NDL-PCBs) (OR = 1.33, 95% CI: 1.15-1.53), and dioxin-like PCBs (DL-PCBs) (OR = 1.31, 95% CI: 1.10-1.57) were all found to be positively associated with the risk of cardiovascular disease. Subgroup analysis revealed that study type, biomaterials, and literature quality were the most significant drivers of variation. Furthermore, certain PCB homologues, such as non-dioxin-like (NDL)-PCB153 and dioxin-like (DL)-PCB118, are highly related with cardiovascular disease.

CONCLUSIONS

According to this meta-analysis, exposure to PCBs may increase the risk of cardiovascular disease. Notwithstanding major drawbacks, our results emphasize the significance of lowering exposure to PCBs and offering a solid theoretical basis for public health initiatives.

Associations of RANKL levels and polymorphisms with rheumatoid arthritis: A meta-analysis

OBJECTIVES

This study examined the correlation between circulating receptor activator for nuclear factor-κB ligand (RANKL) levels and rheumatoid arthritis (RA), and investigated the association between polymorphisms in the RANKL gene and susceptibility to RA.

METHOD

We searched the Medline, Embase, and Cochrane databases for relevant publications up to September 2024. A meta-analysis was conducted to assess serum/plasma RANKL levels in patients with RA and controls, and to explore the relationship between RANKL rs9533156 and rs2277438 polymorphisms and RA susceptibility.

RESULTS

Ten studies encompassing 1,682 RA patients and 1,288 controls were analyzed. RANKL levels were significantly higher in RA patients compared to controls (SMD = 0.665, 95% CI = 0.290-1.040, P = 0.001). Subgroup analysis affirmed these findings' consistency across different sample sizes and publication years. RANKL levels were positively associated with rheumatoid factor (RF) and Disease Activity Score-28 (DAS28) (RF correlation coefficient = 0.157, 95% CI = 0.028-0.282, P = 0.018; DAS28 correlation coefficient = 0.151, 95% CI = 0.125-0.370, P < 0.001). Additionally, the meta-analysis revealed significant associations between the susceptibility to RA and the RANKL rs9533156 C allele (OR = 0.609, 95% CI = 0.520-0.714, P < 0.010) as well as the rs2277438 G allele (OR = 1.206, 95% CI = 1.003-1.451, P = 0.047). These associations were consistent across homozygote comparisons and different genetic models.

CONCLUSIONS

This meta-analysis underscores the elevated circulating RANKL levels in RA patients and their significant correlation with RF and DAS28. Additionally, the RANKL rs9533156 and rs2277438 polymorphisms were significantly associated with RA susceptibility.

Potential biomarkers for cerebral small vessel disease with cognitive impairment: a systematic review and meta-analysis

Cerebral small vessel disease (CSVD) is a common factor in age-related diseases such as stroke and dementia, and about half of dementia patients worldwide are caused by CSVD. CSVD-related cognitive impairment (CSVD-CI) affects more and more elderly people, resulting in economic losses and burdens on families and society. In recent years, circulating biomarkers have made breakthroughs and played an increasingly important role in the diagnosis, progression, and prognosis of CSVD-associated cognitive impairment, and are expected to be applied to the early clinical detection, diagnosis, and treatment of patients with cerebral small vessel disease. Through a systematic review and meta-analysis, this study aimed to assess the relationship between circulating factors and cognitive impairment associated with cerebral small vessel disease, especially the possibility of becoming the potential biomarkers for diagnosis. Articles published before November 2023 were searched in four databases, PubMed, Web of Science, Embase, and Cochrane Library, to identify all relevant studies reporting circulating markers in patients with CSVD. Twenty-nine articles out of 2,911 were finalized for this study. We meta-analyzed 2 or more articles that were jointly considered to be circulating biomarkers of CSVD-CI and summarized a total of 4 possible biomarkers: homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2), and neurofilament protein light chain (NfL). The results revealed that patients in the CSVD-related cognitive impairment group had significantly higher levels of Hcy and hs-CRP than those in the CSVD-without cognitive impairment group, whereas there was no statistically significant difference in Lp-PLA2 and NfL between the two groups. Therefore, Hcy, hs-CRP may be considered circulating markers of cognitive impairment associated with cerebral small vessel disease.

Impact of bortezomib on 1q21+ in multiple myeloma: A meta-analysis of treatment outcomes and prognostic implications

The gain of chromosomal region 1q21 is a significant risk factor in multiple myeloma (MM) and is associated with poor prognosis. The introduction of bortezomib has notably improved outcomes for patients with MM. However, recent studies have reported conflicting results regarding the efficacy of bortezomib in mitigating the adverse effects of 1q21 aberration in these patients. To address this, in the present study, a meta-analysis was conducted based on 6 studies encompassing 1,575 patients with MM. The prognosis of patients with 1q21+ who underwent treatment with a bortezomib-based regimen was evaluated in terms of complete response (CR), overall survival (OS) and progression-free survival (PFS) rates. The results demonstrated that patients with 1q21 aberration were more likely to achieve CR than those without 1q21+ under bortezomib-based treatment [odds ratio, 0.64; 95% confidence interval (CI), 0.49-0.83; P=0.0008]. However, 1q21+ remained a high-risk factor in patients with MM even after bortezomib treatment [PFS: hazard ratio (HR), 1.72; 95% CI, 1.53-1.93; P<0.00001; and OS: HR, 1.95; 95% CI, 1.58-2.42; P<0.00001]. In conclusion, although bortezomib improved the likelihood of achieving CR in patients with 1q21+, this genetic aberration continues to be considered a high-risk factor in patients with MM treated with a bortezomib-based regimen.

Associations between circulating interleukin-18 levels and adult-onset Still's disease: a meta-analysis

Objective

This study aimed to investigate the link between circulating interleukin-18 (IL-18) levels and adult-onset Still's disease (AOSD).

Methods

A thorough search was performed on MEDLINE, Embase, and Web of Science to find relevant articles. A meta-analysis was conducted to compare serum/plasma IL-18 levels in AOSD patients to those in control subjects.

Results

The meta-analysis included 13 studies with a total of 562 AOSD patients and 790 controls. The results showed a significant increase in IL-18 levels in the AOSD group compared to the control group (standard mean difference [SMD]=1.899, 95% confidence interval [CI]=1.078~2.720, p<0.001). When stratified by ethnicity, higher IL-18 levels were found in both Asian and European populations with AOSD. Subgroup analysis, regardless of variable adjustments, consistently indicated significantly higher IL-18 levels in the AOSD group. Significant elevations in IL-18 levels were observed in both small (n<50) and large groups (n>50), as well as in original and imputed data groups after data type stratification. Free IL-18 levels were significantly higher in the active group compared to the inactive group (SMD=0.900, 95% CI=0.532~1.268, p<0.001). The meta-analysis showed a positive correlation between IL-18 levels and ferritin (correlation coefficient=0.542, 95% CI=0.431~0.637, p<0.001) and C-reactive protein.

Conclusion

This meta-analysis demonstrated a significant increase in circulating IL-18 levels and a positive correlation between IL-18 levels and ferritin and C-reactive protein levels in patients with AOSD.

The Effectiveness of Telemedicine in Hypertension Management of Adults in Rural Communities: A Systematic Review and Meta-Analysis

BACKGROUND

Telemedicine has emerged as an effective approach for managing hypertension, particularly in rural areas where healthcare access is limited. This review evaluates telemedicine's role in providing essential remote healthcare services for hypertension management.

OBJECTIVE

We determined the effectiveness of telemedicine versus the usual care in hypertension management among adults living in rural settings.

METHODS

We conducted a systematic review of randomized controlled trials (RCTs) focusing on adults aged 18 and older with hypertension (blood pressure ≥ 140/90 mmHg) using telehealth services in rural or community-based settings. We searched nine databases, including PubMed, ScienceDirect, and ProQuest, up to April 2024, without restrictions on language or publication year, focusing only on human subjects. Five pairs of reviewers independently screened and selected studies using predefined eligibility criteria. Methodological quality was assessed using the Revised Cochrane Collaboration Risk of Bias tool, and data synthesis was performed using a random-effects model due to study heterogeneity. Evidence quality was evaluated using the GRADE approach.

RESULTS

Nine randomized trials were included. Pooled data showed no clinically significant differences between telehealth and control groups in improving systolic blood pressure (SBP), diastolic blood pressure (DBP), and their changes over time. The mean difference (MD) of SBP in five trials was 0.78 mmHg lower (95% CI: 2.49 lower to 0.94 higher), and the SBP change showed a mean reduction of 2.29 mmHg (95% CI: 4.76 lower to 0.19 higher). DBP in five trials had a mean increase of 0.46 mmHg (95% CI: 0.73 lower to 1.64 higher), and DBP change in six trials showed a mean decrease of 0.83 mmHg (95% CI: 2.34 lower to 0.68 higher). Additionally, telehealth showed varying impacts on BMI and HbA1c levels, with one study reporting a higher BMI increase in the intervention group, while two other studies indicated that mobile health improved HbA1c levels and controlled blood pressure as effectively as standard care.

LIMITATIONS

Study heterogeneity, selection, and performance biases, as well as varying healthcare contexts, limited the generalizability of findings.

CONCLUSION

Telemedicine is as effective as usual care in managing hypertension among adults in rural settings, providing a viable solution for improving healthcare access in these areas. Future research should address biases and explore long-term impacts to optimize telemedicine's effectiveness in diverse populations.

Open posterior approach versus endoscopic approach for thoracic ligamentum flavum ossification: a systematic review and meta-analysis

BACKGROUND

Thoracic ossification of the ligamentum flavum (TOLF), a rare condition more prevalent in East Asia, is managed through open and endoscopic surgical approaches. Determining the superior surgical option remains unclear. This study assesses the safety and clinical outcomes associated with these approaches in TOLF patients.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search up to August 5, 2023, across PubMed, Scopus, EMBASE, Web of Science, Cochrane, and ClinicalTrials.gov. We included randomized controlled trials and cohort studies reporting complication rates, mJOA (modified Japanese Orthopedic Association) scores, JOA scores, VAS (Visual Analog Scale) scores, or hospitalization duration for both open and endoscopic surgeries in TOLF patients.

RESULTS

We analyzed 37 studies encompassing 1,646 TOLF patients using a random-effects model. Our findings revealed a significant difference in complication rates (overall complication rates: 0.12; 95% CI: 0.07, 0.19; p < 0.01; I2: 69%; quality of evidence: moderate), with lower complication rates in the endoscopy group. However, no significant differences were observed in JOA scores (overall JOA: 8.35; 95% CI: 7.16, 9.54; p = 0.12; I2: 99%; quality of evidence: very low), VAS scores (overall VAS: 1.31; 95% CI: 1.03, 1.59; p = 0.35; I2: 91%; quality of evidence: very low), or hospitalization duration (hospital stay: 10.83 days; 95% CI: 6.86, 14.80; p = 0.35; I2: 91%; quality of evidence: very low) between the open and endoscopic groups.

CONCLUSIONS

This meta-analysis reports lower complication rates and improved postoperative mJOA scores for endoscopic surgery in TOLF patients compared to open surgery. It represents the first comprehensive evaluation of clinical outcomes and safety of different surgical approaches for TOLF patients. Further randomized controlled trials are essential to validate these findings.

Influence of melatonin supplementation on cancer-related fatigue: a meta-analysis of randomized controlled trials

PURPOSE

Previous studies that evaluated the influence of melatonin supplementation on cancer-related fatigue (CRF) revealed inconsistent results. The present meta-analysis was performed to systematically evaluate the influence of melatonin on the severity of fatigue in patients with cancer.

METHODS

Relevant randomized controlled trials (RCTs) were acquired by conducting a comprehensive search in the PubMed, Embase, and Cochrane Library databases. Only RCTs published as full-length English-language articles were included. A random-effects model was utilized to combine the findings by incorporating its potential influence.

RESULTS

Nine RCTs were included for the meta-analysis. Compared to the placebo, melatonin supplementation improved the symptoms of fatigue of these patients (standardized mean difference [SMD]: -0.23, 95% confidence interval [CI]: -0.44 to -0.01, p = 0.04, I2 = 53%). The univariate analysis suggested that the treatment duration was significantly correlated with the improvement of melatonin supplementation on CRF (coefficient =  -0.0063, p = 0.02), which largely explains the source of heterogeneity (adjusted R2 = 83.7%). The subgroup analysis revealed significantly improved fatigue in studies with treatment durations of ≥13 weeks, but not in studies with treatment durations of <13 weeks (SMD: -0.38 vs. 0.06, p for subgroup difference = 0.02). The further subgroup analysis suggested that the results were not significantly influenced by the type of cancer, status (advanced cancer or overall cancer), sample size, treatment (active anticancer treatment or palliative care only), dose of melatonin, or scale for evaluating fatigue symptoms.

CONCLUSIONS

Melatonin supplementation may relieve CRF, especially for intervention durations of ≥13 weeks.

Efficacy and safety of brivudine for the treatment of herpes zoster: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Brivudine has been used in herpes zoster (HZ) treatment for years, but the safety and efficacy of brivudine are inconclusive. Here we perform a meta-analysis to assess the efficacy, safety, incidence of postherpetic neuralgia of brivudine.

METHODS

Data of randomized controlled Trials (RCTS) were obtained from the databases of both English (PubMed, Embase, and Cochrane Library) and Chinese (China National Knowledge Infrastructure, China Science Journal Database, and WanFang Database) literatures from inception to 12 September 2022. Meta-analyses of efficacy and safety of Brivudine for the treatment of herpes zoster for RCTS were conducted.

RESULTS

The analyses included seven RCTS (2095 patients in experimental group and 2076 patients in control group) in the treatment of HZ with brivudine. It suggested that the brivudine group was superior to the control group in terms of efficacy (p = .0002) and incidence of postherpetic neuralgia (p = .04). But the incidence of adverse reactions has no significant difference between the brivudine and the control groups (p = .22). In addition, subgroup analysis of adverse events also showed that brivudine was about the same safety as other modalities in the treatment of HZ (p > .05).

CONCLUSIONS

Brivudine is effective for HZ. However, the evidence on the safety of brivudine is insufficient.

Advances of NOTCH2NLC Repeat Expansions and Associated Diseases: A Bibliometric and Meta-analysis

The unclear pathogenic mechanisms of neurodegenerative disorders stemming from NOTCH2NLC GGC repeat expansions drive focused research. Thus, a bibliometric and meta-analysis was conducted to uncover research trends and positivity rates in NOTCH2NLC. We conducted systematic searches in the Web of Science, PubMed, Embase, and Scopus databases for studies related to NOTCH2NLC up until August 2, 2023. Information regarding countries, institutions, authors, journals, and keywords of studies included in the Web of Science was analyzed and visualized. The positivity rates of NOTCH2NLC GGC repeat expansions across all screened patients and patients' families were pooled under the random-effects model. Publication bias and its impact were examined using funnel plots, Egger's linear regression, and trim-and-fill method. The bibliometric analysis, revealing pronounced publication growth, comprised 119 studies, which came from China and Japan particularly. "Neuronal intranuclear inclusion disease" emerged as a frequently used keyword. The meta-analysis comprised 36 studies, indicating global positivity rates of 1.79% (95% CI, 0.75-3.17) for all patients and 2.00% (95% CI, 0.26-4.78) for patients' families. Subgroup analyses based on region and phenotype suggested the highest NOTCH2NLC positivity rates in Taiwan population (5.42%, 95% CI 0.08-16.89) and in leukoencephalopathy-dominant patients (8.25%, 95% CI, 3.01-15.60). Sensitivity analysis affirmed the robustness of results. In conclusion, NOTCH2NLC GGC repeat expansions exhibit rare globally, primarily in East Asia, and leukoencephalopathy-dominant patients, emphasizing regional and phenotypic distinctions. Emerging focal points in NOTCH2NLC researches underscore the need for collaborative exploration.

Identification of psoriasis-associated immune marker G3BP2 through single-cell RNA sequencing and meta analysis

Psoriasis is a chronic skin disease with an increasing prevalence each year. However, the mechanisms underlying its onset and progression remain unclear, and effective therapeutic targets are lacking. Therefore, we employs an innovative approach by combining single-cell RNA sequencing (scRNA-seq) with meta-analysis. This not only elucidates the potential mechanisms of psoriasis at the cellular level but also identifies immunoregulatory marker genes that play a statistically significant role in driving psoriasis progression through comprehensive analysis of multiple datasets. Skin tissue samples from 12 psoriasis patients underwent scRNA-seq, followed by quality control, filtering, PCA dimensionality reduction, and tSNE clustering analysis to identify T cell subtypes and differentially expressed genes (DEGs) in psoriatic skin tissue. Next, three psoriasis datasets were standardised and merged to identify differentially expressed genes (DEGs). Subsequently, weighted gene co-expression network analysis (WGCNA) was applied for clustering analysis of gene co-expression network modules and to assess the correlation between these modules and DEGs. Least absolute shrinkage and selection operator (LASSO) regression and receiver operating characteristic (ROC) curve analyses were conducted to select disease-specific genes and evaluate their diagnostic value. Single-cell data revealed nine cell types in psoriatic skin tissue, with seven T cell subtypes identified. Intersection analysis identified ADAM8 and G3BP2 as key genes. Through the integration of scRNA-seq and Meta analysis, we identified the immunoregulatory marker gene G3BP2, which is associated with the onset and progression of psoriasis and holds clinical significance. G3BP2 is speculated to promote the development of psoriasis by increasing the proportion of CD8+ T cells.

Changes of blood cholinesterase activities among pesticides-exposed agricultural workers in Iraq: A meta-analysis

Numerous studies in Iraq have attempted to determine blood cholinesterase (ChE) activities with varying results in agricultural workers and veterinarians exposed to pesticides. This meta-analysis answers the specific inquiry of whether or not blood ChE activities decrease in agricultural workers exposed previously to pesticides. The meta-analysis included 14 records of blood ChE activities extracted from 12 studies after employing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). These records comprised ChE activities in agricultural workers exposed to pesticides (n = 635) versus their respective control cohorts (n = 416). We employed the one-group random effects model for the meta-analysis and the Newcastle-Ottawa Scale (NOS) to examine study quality. The combined effect size of pesticides exposed group (% ChE activity versus control) was significant at 86.13 %. Heterogeneity (I2 = 49.86 %) was moderate. Subgroup analysis of the enzyme source (plasma/serum and erythrocytes/whole blood) revealed that plasma effect size was significant at 82.36 % compared to erythrocytes (92.08 %), which was not significant. No publication bias existed. The studies were of high quality (NOS ≥ 7). The present study is the first meta-analytic report of associating reduced blood ChE activities with pesticides exposure in Iraqi agricultural workers. Reduced pseudo ChE (plasma, serum) activity was the most significant indicator of pesticides exposure. Nevertheless, we recommend biomonitoring erythrocyte and even whole blood ChE activities in pesticides-exposed individuals, because of scarce information on the type and frequency of pesticides employed by Iraqi agricultural workers. Our findings call for a national integrated plan and improved regulations for safer and judicious pesticides applications and follow-up practices in Iraq in order to reduce potential health hazards and environmental risks.

Effect of urate-lowering therapy on all-cause and CVD-specific mortality in gout and hyperuricemia: a meta-analysis

OBJECTIVE

The aim of this study was to assess the relationships between urate-lowering therapy (ULT) and both all-cause and cardiovascular disease (CVD)-specific mortality in patients diagnosed with gout or hyperuricemia.

METHODS

The PubMed, Embase, and Cochrane databases were thoroughly searched to gather literature on overall and/or CVD-specific hazard ratios (HRs) of patients with gout or hyperuricemia. A meta-analysis was conducted to evaluate the mortality risks of UTL users in gout or hyperuricemia populations.

RESULTS

This meta-analysis included 11 comparative studies encompassing 38,396 ULT users and 47,530 controls for evaluating all-cause mortality in gout or hyperuricemia. ULT treatment in patients with gout or hyperuricemia led to a significantly lower risk of all-cause mortality compared to patients not receiving ULT (HR = 0.783, 95% confidence interval [CI] = 0.702-0.874; p < 0.001). Both ULT and allopurinol were associated with decreased all-cause mortality rates (ULT HR = 0.651, 95% CI = 0.520-0.816; p < 0.001; allopurinol HR = 0.836, 95% CI = 0.731-0.957; p = 0.009). ULT initiation significantly reduced CVD-specific mortality in hyperuricemia patients, although the same was not observed in gout patients (HR for hyperuricemia = 0.872, 95% CI = 0.796-0.955; p = 0.003; HR for gout = 0.676, 95% CI = 0.296-1.544; p = 0.353).

CONCLUSION

This meta-analysis indicates that ULT substantially reduces all-cause mortality in patients with gout or hyperuricemia, although allopurinol does not significantly affect CVD-specific mortality. These results underscore the potential of ULT for enhancing survival rates in special patient populations.

Efficacy of mechanical debridement with adjunct antimicrobial photodynamic therapy against peri-implant subgingival oral yeasts colonization: A systematic review and meta-analysis

BACKGROUND

It is hypothesized that mechanical debridement (MD) with adjunct antimicrobial photodynamic therapy (aPDT) is more efficient in reducing peri-implant subgingival yeasts colonization (SYC) than MD alone. The aim of the present systematic review and meta-analysis was to evaluate randomized controlled trials (RCTs) that assessed the efficacy of MD with and without adjunct aPDT towards the reduction in peri-implant SYC.

METHODS

The focused question was "Is MD with adjunct aPDT more effective then MD alone in reducing peri-implant SYC?" Indexed databases were searched without time and language restrictions until February 2024. The Population/Patients, Intervention, Control, Outcome (PICO) strategy was adopted. The literature search was performed using the preferred reporting items for systematic reviews and meta-analysis guidelines. The risk of bias (RoB) was assessed using the Cochrane RoB tool.

RESULTS

Three randomized controlled trials with a follow-up duration of 90 days were included and processed for data extraction. In one study, all participants were male and in the remaining two studies, males and females were included. One study showed that peri-implant MD with adjunct aPDT is more effective in reducing SYC than MD alone. In another study, there was no significant difference in SYC following MD with or without adjunct aPDT. In one study, the role of peri-implant MD with adjunct aPDT remained unclear due to missing data. The overall RoB was high and low in one and two studies, respectively.

CONCLUSION

The role of MD with or without adjunct aPDT in reducing peri-implant SYC remains debatable.

Tandem autologous hematopoietic stem cell transplantation for patients with multiple myeloma: a systematic review and meta-analysis

To evaluate whether patients with multiple myeloma (MM) could benefit from tandem autologous hematopoietic stem cell transplantation (auto-HSCT), PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched, and 10 eligible studies were included after data extraction and quality evaluation. Meta-analysis showed that compared to single autologous hematopoietic stem cell transplantation, tandem auto-HSCT does not improve OS, EFS or efficacy in MM patients, and may even lead to higher treatment-related mortality (TRM). MM patients who received autologous tandem allogeneic HSCT did not achieve better response compared to tandem autologous HSCT. In summary, compared to single autologous hematopoietic stem cell transplantation, tandem autologous hematopoietic stem cell transplantation cannot provide survival advantages for MM patients, and MM patients cannot benefit from autologous tandem allogeneic hematopoietic stem cell transplantation.

A systematic review and meta-analysis exploring the bidirectional association between asthma and gastroesophageal reflux disease in children

Background: Asthma is the most prevalent chronic respiratory disease in children, and gastroesophageal reflux disease (GERD) is one of its extraesophageal complications of asthma. Both conditions are commonly observed in pediatric outpatient clinics, but the causality between them in children is still debated. Therefore, we conducted a systematic review and meta-analysis to evaluate the bidirectional association between asthma and GERD in children. Methods: We systematically reviewed original studies published from January 2000 to February 2024 by searching the data bases. We also performed manual retrieval and screening to identify studies that met the inclusion criteria. The quality of the final included studies was evaluated by using the Newcastle-Ottawa Scale, and outcome measures were extracted. Results: We identified nine eligible studies, which included 304,399 children of different ages from seven countries. Overall, the risk of developing GERD in children with asthma (odds ratio [OR] 2.16 [95% confidence interval [CI], 1.6-2.91) was higher than the risk of developing asthma in children with GERD (OR 1.55 [95% CI, 1.32-1.82]). Conclusion: Based on the available studies, it can be concluded that asthma and GERD are mutually aggravating factors in children, presenting a bidirectional association. However, the risk of developing GERD in children with asthma is higher to some extent. More large-scale and high-quality prospective cohort studies are needed in the future to provide richer evidence and more research opportunities.

A Methodological Quality Assessment of Meta-Analyses on Sleep Disorder Treatments Using AMSTAR 2

BACKGROUND

Meta-analyses (MAs) provide up-to-date, quantified evidence on treatment effects, which may be useful for clinical and policy decision-making. However, the quality of MAs varies, and methodological flaws can limit their reliability.

AIMS

This review evaluated the methodological quality of MAs on sleep disorder treatments.

METHODS

We searched MEDLINE, EMBASE, and PsycINFO for eligible MAs on randomized controlled trials of sleep disorder treatments published between 2018 and 2023. We extracted MAs' bibliographical characteristics with a predesigned form and appraised their methodological quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2. We explored the associations between bibliographical characteristics and methodological quality ratings using Kruskal-Wallis tests and Spearman's rank correlation coefficients.

RESULTS/OUTCOMES

Among the 104 MAs, the majority (n = 82; 78.9%) had critically low quality, 19 (18.3%) had low quality, and only 3 (2.9%) had high quality. Regarding AMSTAR 2 critical domains, 97 (93.3%) MAs did not provide a list of excluded studies and justify the exclusions, 75 (72.1%) did not use a comprehensive literature search strategy, and 56 (53.9%) lacked a registered protocol and did not justify protocol deviations. Cochrane reviews (p = 0.018), MAs with European corresponding authors (p < 0.001), and MAs receiving European funding (p < 0.001) performed better than their counterparts.

CONCLUSIONS/INTERPRETATION

The methodological quality of recent MAs on sleep disorder treatments is unsatisfactory. Future reviewers should address the identified critical methodological issues. In addition, substantial resources and funding should be allocated to support training in evidence synthesis and critical appraisal for researchers and clinicians.

Effectiveness of low-dose rivaroxaban in preventing recurrent major adverse cardiovascular events in coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Despite advancements in coronary artery disease (CAD) management, major adverse cardiovascular events persist. Vitamin K antagonists and direct oral anticoagulants present bleeding risks. Low-dose rivaroxaban (2.5 mg) is approved by the European Society of Cardiology and the US Food and Drug Administration for CAD. The survival advantage and risk-benefit profile of combining low-dose rivaroxaban with aspirin for CAD patients remain uncertain. This meta-analysis aims to compare the efficacy of low-dose rivaroxaban plus aspirin versus aspirin monotherapy in CAD patients.

METHODS

We systematically searched databases for randomized controlled trials exploring low-dose rivaroxaban with aspirin in CAD patients. Of the 6220 studies screened, five met the inclusion criteria. Primary outcomes included myocardial infarction, stroke, major bleeding events, and all-cause mortality. The analysis employed a fixed-effects model, calculating hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Five randomized controlled trials involving 41,351 participants were included. Rivaroxaban (2.5 mg) significantly reduced all-cause mortality (HR, 0.88; 95% CI, 0.81-0.95; P = 0.002), myocardial infarction (HR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and stroke (HR, 0.61; 95% CI, 0.49-0.76; P < 0.00001) compared to aspirin alone. However, it increased major bleeding risk (HR, 1.66; 95% CI, 1.40-1.97; P < 0.01). Meta-regression revealed no dose-dependent impact on all-cause mortality.

CONCLUSION

Low-dose rivaroxaban demonstrates survival benefits and reduces myocardial infarction and stroke risks in CAD patients, albeit with an increased risk of major bleeding. Consideration of patient bleeding risk is crucial when adding rivaroxaban to antiplatelet therapy. Further research is warranted to compare its effectiveness and safety with dual antiplatelet therapy or P2Y12 inhibitors.

Meta-analysis of natural killer cell cytotoxicity in myalgic encephalomyelitis/chronic fatigue syndrome

Reduced natural killer (NK) cell cytotoxicity is the most consistent immune finding in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Meta-analysis of the published literature determined the effect size of the decrement in ME/CFS. Databases were screened for papers comparing NK cell cytotoxicity in ME/CFS and healthy controls. A total of 28 papers and 55 effector:target cell ratio (E:T) data points were collected. Cytotoxicity in ME/CFS was significantly reduced to about half of healthy control levels, with an overall Hedges' g of 0.96 (0.75-1.18). Heterogeneity was high but was explained by the range of E:T ratios, different methods, and potential outliers. The outcomes confirm reproducible NK cell dysfunction in ME/CFS and will guide studies using the NK cell model system for pathomechanistic investigations.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024542140.

Usefulness of computed tomography-guided puncture biopsy coupled with rapid on‑site evaluation for diagnosis of pulmonary lesions: a systematic review and meta‑analysis

INTRODUCTION

Accurate identification of lung lesions during lung biopsy (LB) surgery can be achieved with the use of computed tomography (CT) guidance. The rapid on‑site evaluation (ROSE) method allows for quick assessment of the features, cytomorphological traits, and appropriateness of the obtained tissue samples, and might further accelerate the diagnostic workup.

AIM

We aimed to investigate the diagnostic value of CT‑guided aspiration biopsy combined with ROSE for assessment of pulmonary lesions.

MATERIALS AND METHODS

A PubMed and Embase search was undertaken until October 2023 to find studies on lung lesion diagnosis utilizing CT‑guided needle biopsy and ROSE. The main method for assessing bias and relevance was the updated Quality Assessment of Diagnostic Accuracy Research 2 tool. The threshold effect and subgroup analysis were used to determine the source or heterogeneity. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristics curve (SROC AUC), and the Q‑index were calculated. The Deek funnel plot was used to evaluate publication bias.

RESULTS

A total of 6 studies (n = 951) with mild heterogeneity were included in this meta‑analysis, yielding a pooled sensitivity, specificity, and DOR of 0.94 (95% CI, 0.91-0.96), 0.95 (95% CI, 0.9-0.98), and 159.05 (95% CI, 69.59-363.49), respectively. The SROC AUC, calculated using a random‑effects model, was 0.98. Subgroup analysis showed that study design (prospective vs retrospective) had an impact on sensitivity. Further analysis of 3 studies that established control groups showed that the ROSE group had by 12% (95% CI, 0.08-0.16; I2 = 0) higher sampling adequacy and diagnostic accuracy than the non‑ROSE group, while there was no significant difference in the rate of complications.

CONCLUSIONS

For assessment of pulmonary lesions, CT‑guided puncture biopsy combined with ROSE has high sensitivity, specificity, and diagnostic accuracy, and is a practical operational method that merits wide clinical application.

Association between perfluoroalkyl substances and breast cancer on the National Health and Nutrition Examination Survey Database and meta-analysis

The relationship between perfluoroalkyl substances (PFASs) and the risk of breast cancer has been controversial. Here, we used the National Health and Nutrition Examination Survey (NHANES) database and a meta-analysis to examine the association between PFASs and breast cancer incidence. From the NHANES database, we obtained data on PFASs and breast cancer from 2003 to 2014. We searched PubMed, Web of Science, Scopus and PsycINFO from the establishment of the databases to August 24, 2023, for research on PFASs related to breast cancer. A meta-analysis was performed using Stata 12.0. A total of 1430 subjects aged 20 years or older were selected from the NHANES. The logistic regression results indicated that there was no correlation between breast cancer and PFASs (P > 0.05). The meta-analysis, included nine studies with a total of 2399 breast cancer patients, included in the meta-analysis, revealed no statistically significant association between PFASs and the risk of breast cancer (odds ratio = 1.04; 95 % confidence interval, 0.88-1.21; P > 0.05). The results show that PFASs are not associated with breast cancer risk.

The effect of computerized cognitive training and transcranial direct current stimulation on working memory among post-stroke individuals: a systematic review with meta-analysis and meta-regression

BACKGROUND

Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals.

METHODS

The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences.

RESULTS

The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression.

CONCLUSIONS

In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies.

TRIAL REGISTRATION

The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182).

Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis

Background

Levetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV's efficacy and safety for pediatric migraine prophylaxis.

Methods

We reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate.

Results

Eight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: -5.19, 95% CI: -7.11 to -3.27, p < 0.00001) and improved headache-free rates to 28% (95% CI: 0.17-0.41). More than 83% experienced a >50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: -33.51, 95% CI: -38.46 to -28.55, p < 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13-0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05-0.30).

Conclusion

LEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs.

Systematic Review Registration

Identifier PROSPERO CRD42024497643.

Mortality in patients with systemic lupus erythematosus: A meta-analysis of overall and cause-specific effects

OBJECTIVES

Our objective was to assess the overall and cause-specific standardized mortality ratios (SMRs) among patients diagnosed with systemic lupus erythematosus (SLE).

METHODS

An exhaustive systematic review was undertaken, encompassing studies that scrutinized SMRs, both overall and for specific causes, in patients diagnosed with SLE compared to the general populace. The databases of PUBMED, EMBASE, and Cochrane were meticulously searched to collate relevant literature. Following this comprehensive search, a meta-analysis was executed to methodically assess all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in individuals with SLE.

RESULTS

The inclusion criteria were met by 29 studies encompassing 72,342 patients with SLE and documenting 7352 deaths. The meta-analysis disclosed a pronounced 2.87-fold elevation in the SMR for all-cause mortality in SLE patients relative to the general population (SMR, 2.866; 95% confidence interval [CI], 2.490-3.242; p < .001). Region-specific assessments showed variable all-cause SMRs, with Europe reporting 2.607 (95% CI, 1.939-3.275; p < .001), Asia revealing 3.043 (95% CI, 2.082-4.004; p < .001), and particularly high SMRs noted in North America and Oceania. Gender-focused analyses presented a pooled SMR of 3.261 (95% CI, 2.674-3.848; p < .001) for females, and 2.747 (95% CI, 2.190-3.304; p < .001) for males. Evaluations specific to cause of death illustrated notably elevated SMRs for renal disease (SMR, 4.486; 95% CI, 3.024-5.948; p < .001), infections (SMR, 4.946; 95% CI, 4.253-5.639; p < .001), cardiovascular diseases (CVD) (SMR, 2.931; 95% CI, 1.802-4.061; p < .001), cerebrovascular accidents (CVA) (SMR, 1.588; 95% CI, 0.647-2.528; p = .001), and cancer (SMR, 1.698; 95% CI, 0.871-2.525; p < .001).

CONCLUSIONS

This meta-analysis underscores a significant 2.87-fold elevation in the SMR among patients with SLE compared to the general population, transcending differences in sex or geographical regions. Moreover, an appreciable increase in mortality due to specific causes, including renal disease, infection, CVD, CVA, malignancy, and neuropsychiatric SLE, accentuates the imperative for targeted interventions to mitigate these elevated risks in SLE patients.

Safety of immune checkpoint inhibitors: An updated comprehensive disproportionality analysis and meta-analysis

BACKGROUND

The exact safety profile of Immune checkpoint inhibitors (ICIs) is unclear so far.

AIM

The aim of the current study is to analyse the safety profile of ICIs in cancer patients.

METHODOLOGY

The updated comprehensive disproportionality analysis of post-marketing data using the FAERS database and meta-analysis of randomized clinical trials (RCTs) was conducted. Disproportionality measures were calculated in terms of PRR associated with chi-square value and ROR with 95% confidence intervals whereas overall estimate measures with 95% CIs, publication bias and heterogeneity were calculated using RevMan 5.4. The GRADE analysis was also done to check the quality of evidence for each outcome.

RESULTS

Various novel signals such as cholangitis, encephalitis, anuria, myelosuppression, and cachexia related to different system organ class were identified with ICIs. The sensitivity analysis results have indicated the influence of concomitant drugs on the identified signals. The meta-analysis results have shown a good safety profile of atezolizumab in non-small cell lung cancer (NSCLC) and melanoma, pembrolizumab in gastro-oesophageal cancer, urothelial cancer and head and neck squamous cell carcinoma (HNSCC), nivolumab in HNSCC as compared to the non-ICI group.

CONCLUSION

The safety of ICIs is dependent on their types as well as on the types of cancer.

Combination of graduated compression stockings and intermittent pneumatic compression is better in preventing deep venous thrombosis than graduated compression stockings alone for patients following gynecological surgery: a meta-analysis

BACKGROUND

Deep vein thrombosis (DVT) is common in patients undergoing gynecological surgery. We aimed to investigate the preventive efficacy in DVT of graduated compression stockings (GCS) alone and in combination with intermittent pneumatic compression (GCS + IPC) after gynecological surgery.

METHODS

In November 2022, studies on the use of GCS and GCS + IPC for the prevention of DVT after gynecological surgery were searched in seven databases. After literature screening and data extraction based on specific inclusion and exclusion criteria, preventive efficacies, including the risk of DVT and anticoagulation function, of GCS and GCS + IPC were compared. Finally, sensitivity analysis and Egger's test were performed to evaluate the stability of the meta-analysis.

RESULTS

Six publications with moderate quality were included in this meta-analysis. The results showed that GCS + IPC significantly reduced DVT risk (P = 0.0002) and D-dimer levels (P = 0.0005) compared with GCS alone. Sensitivity analysis and Egger's test showed that the combined results of this study were stable and reliable.

CONCLUSIONS

Compared with GCS alone, GCS + IPS showed a higher preventive efficacy against DVT in patients following gynecological surgery.

Assessing the benefits and safety profile of incorporating poly ADP-ribose polymerase (PARP) inhibitors in the treatment of advanced lung cancer: a thorough systematic review and meta-analysis

Background

Poly (ADP-Ribose) Polymerase (PARP) inhibitors represent a novel class of drugs that hinder DNA repair mechanisms in tumor cells, leading to cell death. This systematic review aims to evaluate the effectiveness, safety, and potential adverse effects of PARP inhibitors (PARPi) in the management of patients with advanced lung cancer.

Materials and Methods

We conducted a comprehensive search for relevant studies in PubMed, Embase, Cochrane, and ClinicalTrials.gov. We extracted primary and secondary outcome measures, including progression-free survival (PFS), overall survival (OS), and adverse events (AEs), from the identified literature for subsequent meta-analysis and systematic review.

Results

This study encompassed twelve randomized controlled trials, involving 3,132 patients with advanced lung cancer. In comparison to non-PARPi treatments, the administration of PARPi significantly extended OS (hazard ratio (HR) = 0.90, 95% CI = 0.83-0.97, p = 0.006). However, the difference in PFS did not reach statistical significance.

Conclusion

In summary, therapies incorporating PARPi provide a degree of benefit by extending OS in patients with advanced lung cancer. Nonetheless, further trials are necessary to furnish additional evidence regarding the efficacy and safety of PARPi in the treatment of lung cancer.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier number: CRD42023424673.

Gastroesophageal reflux disease and non-alcoholic fatty liver disease: a two-sample Mendelian randomization combined with meta-analysis

Accumulating evidence from observational studies have suggested an association between gastroesophageal reflux disease (GERD) and non-alcoholic fatty liver disease (NAFLD). However, due to that such studies are prone to biases, we imported Mendelian randomization (MR) to explore whether the causal association between two diseases exsit. Hence, we aimed to analysis the potential association with MR. The single nucleotide polymorphisms (SNPs) of GERD were retrieved from the genome-wide association study dataset as the exposure. The SNPs of NAFLD were taken from the FinnGen dataset as the outcome. The relationship was analyzed with the assistance of inverse variance weighted, MR-Egger, and weighted median. We also uitilized the MR-Egger intercept, Cochran's Q test, leave-one-out analysis, MR-PRESSO, and Steiger directionality test to evaluate the robustness of the causal association. The meta-analysis were also implemented to give an overall evaluation. Finally, our analysis showed a causal relationship between GERD and NAFLD with aid of MR and meta-analysis (OR 1.71 95% CI 1.40-2.09; P < 0.0001).

Effectiveness of non-pharmacological interventions in improving sleep quality after cardiac surgery: A systematic review and meta-analysis

BACKGROUND

Sleep disturbance is highly prevalent among post-operative cardiac patients, with negative impacts on surgical recovery and rehabilitation. Post-operative pain and anxiety commonly seen in cardiac surgery patients are associated with poor sleep. Sleep medications commonly used are not ideal with prolonged usage, and non-pharmacological interventions can be good alternatives or complements.

AIM

To examine effectiveness of non-pharmacological interventions in post-operative cardiac settings on sleep quality, pain intensity and anxiety.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, CENTRAL, Embase, CINAHL, Scopus, CNKI and ProQuest Dissertations and Theses were searched on 12 October 2022. Randomised controlled trials of non-pharmacological interventions examining sleep quality for adult post-operative cardiac patients were included. Included studies were appraised using Cochrane Risk of Bias tool version 1. Meta-analysis was conducted using RevMan version 5.4.1, and heterogeneity was assessed using I2 statistics and Cochran Q's test.

RESULTS

Eighteen studies involving 1701 participants were identified. Coronary artery bypass graft was most common. Non-pharmacological interventions varied in types and duration. All intervention groups were compared to usual care, placebo, no interventions or active comparators. Statistically significant improvement in sleep quality (SMD = -.91, 95% CI = -1.17 to -.65) was found among intervention groups that explored cognitive behavioural therapy, relaxation techniques, exercise, massage, acupressure, aromatherapy, music, eye mask and earplugs. Pain intensity was reduced (SMD = -.63, 95% CI = -1.05 to -.20) with cognitive behavioural therapy, relaxation techniques, massage, music and eye mask. Anxiety was improved (SMD = -.21, 95% CI = -.38 to -.04) with exercise and music.

CONCLUSION

The overall use of non-pharmacological interventions can optimise sleep after cardiac surgery. Further research with greater methodological rigour is needed to investigate different intervention-related characteristics while considering potential confounders.

RELEVANCE TO CLINICAL PRACTICE

Post-operative cardiac settings can consider incorporating non-pharmacological interventions. Patients and healthcare providers can be better informed about the use of such interventions to improve sleep.

REGISTRATION

PROSPERO CRD42022384991.

Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis

INTRODUCTION

Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case-control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia.

METHOD

This meta-analysis gathered data from 25 case-control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the "Leave one out" method, and we used the Egger test and Begg's funnel plot to identify publication bias.

RESULTS

Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value>.05.

CONCLUSIONS

Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case-control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.

Magnetic resonance imaging-based rim enhancement could effectually predict poor prognosis in hepatocellular carcinoma: a meta-analysis

Recent studies have initially shown that MRI-based rim enhancement associates with poor prognosis in hepatocellular carcinoma (HCC) patients, but their sample sizes are small, leading to a necessary of comprehensive analyses to make a relatively solid statement. Thus, this meta-analysis aimed to summarize the correlation between MRI-based rim enhancement and prognosis in HCC patients. Until March 2023, a literature search was conducted on Web of Science, PubMed, EMBASE, Cochrane, CNKI, Wangfang, and CQVIP databases in order to identify studies that report the correlation between MRI-based rim enhancement and the prognosis of HCC patients. MRI-based rim enhancement and prognostic data were extracted and analyzed. In our study, eight studies containing 1816 HCC patients were analyzed. Generally, the presence of MRI-based rim enhancement was related to shortened disease-free survival (DFS) [hazard ratio (HR): 2.77, 95% confidence interval (CI): 2.11-3.62, P < 0.001], and worse overall survival (OS) (HR: 5.43, 95% CI: 2.14-13.79, P < 0.001). While no other prognostic data could be retrieved. Funnel plots, Begg's test, and Egger's test all indicated that no publication bias existed; and the risk score by Newcastle-Ottawa Scale criteria ranged from 7-9 points, suggesting a generally low risk of bias. Meanwhile, the sensitivity analysis showed that the significant findings did not change by omitting each study. Then, subgroup analyses revealed that no matter stratified by tumor size, treatment option, or sample size, rim enhancement was linked with unsatisfied DFS (all P < 0.05). Conclusively, MRI-based rim enhancement could effectually estimate poor survival in HCC patients, indicating its good prognostic value.

Reply to Shah, J.S.; Ramasamy, R. Target Antigens in Western and Line Immunoblots for Supporting the Diagnosis of Lyme Disease. Comment on "Porwancher et al. Immunoblot Criteria for Diagnosis of Lyme Disease: A Comparison of CDC Criteria to Alternative Interpretive Approaches. Pathogens 2023, 12, 1282"

We are writing in response to comments made by Shah and Ramasamy [...].