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Background The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control. Objective The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment. Methods A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°–30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis. Results In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27–0.87, p n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20–1.34, p n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI − 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI − 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance. Conclusion The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6–24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed. Trial Registration The present systematic review was registered in PROSPERO (CRD42021198617).

OBJECTIVES The purpose of this study was to evaluate whether the clinical outcome of socket shield technique (SST) is superior to that of conventional immediate implantation (CII). MATERIALS AND METHOD Five electronic databases (PubMed, Cochrane, Web of Science, CNKI, and Google Scholar) were searched to identify randomized controlled trials up to June 31, 2021. Five evaluation indexes were extracted, namely, buccal bone resorption at the horizontal and vertical levels (BBH and BBV), the soft tissue recession assessed by pink evaluation scores (PES), patient satisfaction (PS), ISQ, and the success rate of implantation (SRI), to compare the superiority between SST and CII operations. All data analyses were performed using Review Manager (version 5.4). RESULTS Ten studies were included in this review. The sample included 388 implants, with 194 in the SST group and 194 in the CII group. Compared with the CII group, the SST group had a lower BBH and BBV (standardized mean difference (SMD), - 1.77; 95% CI, - 2.26 to - 1.28; P

According to criteria recommended by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), we analyzed the effects of branched-chain amino acid (BCAA)-rich supplements on muscle strength, muscle mass, and physical performance in older people. We searched PubMed, Embase, Cochrane Library, and CINAHL from inception until March 2021. Randomized controlled trials that examined the effect of BCAA-rich supplements on older people were included. Random-effects meta-analyses and sensitivity analyses were performed. Subgroup analyses were stratified by participant and supplementation characteristics. Meta-regression analyses were performed to examine the effect of continuous variables. Thirty-five studies were included in this meta-analysis. Quality assessment revealed that 14 of 35 RCTs had some potential bias. The overall standardized mean difference (SMD) in muscle strength, muscle mass, and physical performance between the supplement and control groups was 0.35 (95% CI = [0.15, 0.55], P = 0.0007), 0.25 (95% CI = [0.10, 0.40], P = 0.0008), and 0.29 (95% CI = [0.00, 0.57], P = 0.05), respectively. Subgroup analysis revealed that essential amino acid supplementation improved handgrip strength more significantly than whey protein supplementation in older people. Meta-regression analysis revealed a significant linear relationship between improvements in handgrip strength and body mass index. BCAA-rich supplementation by older people may have beneficial effects on muscle mass and strength. However, the included studies had high heterogeneity, and the results must be interpreted with caution. CRD42020206674.

Sclerostin, a regulator of bone metabolism and vascular calcification involved in regulating the Wnt/β-catenin signaling pathway, has been shown to be involved in the pathogenesis of rheumatoid arthritis (RA). However, current results regarding the circulating sclerostin level of RA patients are debatable. This study aimed to evaluate the circulating level of sclerostin in RA patients and briefly summarize its role.PubMed, EMBASE, and the Cochrane Library databases were systematically searched till May 27, 2021, for eligible articles. Useful data from all qualified papers were systematically extracted and analyzed using Stata 12.0 software (Stata Corp LP, College Station, TX, USA).Overall, 13 qualifying studies including 1030 cases and 561 normal controls were analyzed in this updated meta-analysis. Forest plot of this meta-analysis showed that RA patients had higher circulating sclerostin levels (P 0.001, standardized mean difference [SMD] = 0.916, 95% CI: 0.235-1.597) compared to normal controls. Subgroup analyses implied that age, region, and assay method were associated with sclerostin level in RA patients.RA patients have higher circulating sclerostin levels, and these was influenced by age, region, and assay method.HINTERGRUND: Für Sclerostin, ein Regulator des Knochenstoffwechsels und der Gefäßkalzifizierung, der an der Regulierung des Wnt/β-Catenin-Signalwegs beteiligt ist, wurde nachgewiesen, dass es auch in der Pathogenese der rheumatoiden Arthritis (RA) eine Rolle spielt. Jedoch sind die aktuellen Ergebnisse in Bezug auf die Werte für zirkulierendes Sclerostin bei RA-Patienten umstritten. Ziel der vorliegende Studie war es, die Werte für zirkulierendes Sclerostin bei RA-Patienten zu untersuchen und dessen Rolle kurz zusammenzufassen.Die Datenbanken PubMed, EMBASE und der Cochrane Library wurden systematisch bis 27. Mai 2021 auf infrage kommende Artikel hin durchsucht. Nützliche Daten aus allen geeigneten Arbeiten wurden systematisch erfasst und mittels der Software Stata 12.0 analysiert (Stata Corp LP, College Station, TX, USA).In dieser aktualisierten Metaanalyse wurden 13 geeignete Studien mit 1030 Fällen und 561 normalen Kontrollen ausgewertet. Das Walddiagramm dieser Metaanalyse zeigte, dass RA-Patienten höhere Werte für Werte für zirkulierendes Sclerostin aufwiesen als die normalen Kontrollen (p 0,001; standardisierte mittlere Differenz, SMD: 0,916; 95%-Konfidenzintervall, 95%-KI: 0,235–1,597). Untergruppenanalysen ergaben, dass Alter, Region und Bestimmungsmethode mit dem Sclerostinwert bei RA-Patienten in Zusammenhang standen.Bei RA-Patienten fanden sich höhere Werte für zirkulierendes Sclerostin auf als bei normalen Kontrollen. Dieser Zusammenhang wurde durch die Faktoren Alter, Region und Bestimmungsmethode beeinflusst.

Although it has been reported that superoxide dismutase (SOD) is related to obstructive sleep apnea (OSA), the results are controversial. In addition, the effects of the continuous positive airway pressure (CPAP) treatment on SOD levels are also inconsistent. The primary purpose of the present meta-analysis is to determine the relationship between the circulating SOD levels and OSA. The studies included in this meta-analysis were selected from the PubMed, Embase, Cochrane Library, and Scopus databases. Two researchers independently reviewed the studies. Data analysis was performed using Stata 15.1. The overall effects were measured using the standardized mean difference (SMD) with a 95% confidence interval (CI). A random-effects model or a fixed-effects model was used, depending on the heterogeneity of the studies. A total of 14 studies were included, comprising 1240 patients and 457 controls. The results showed that the circulating SOD levels of the patients with OSA were significantly lower than that of the control group (SMD = − 1.645, 95% CI = − 2.279 to − 1.011, P

Hypertonic dextrose prolotherapy (HDP) is an injection of a concentrated dextrose solution for the purpose of local treatment of musculoskeletal pain and possible enhancement of repair mechanisms. This systematic review and meta-analysis examines the clinical utility of HDP injection for treatment of knee osteoarthritis (OA). Randomized controlled trials (RCTs) utilizing HDP to treat knee OA were retrieved from MEDLINE, EMBASE, and Cochrane Library (CENTRAL). Identification and inclusion of RCTs utilizing intra-articular and extra-articular administration of HDP vs administration of other injectate or physical therapy as control for knee OA were included. Primary clinical outcomes were changes in knee WOMAC, pain and function score. Secondary outcomes were adverse events related to HDP. For continuous outcomes with same or different measurements, we calculated, respectively the weighted mean difference (WMD) or the standardized mean difference (SMD), respectively. Results were pooled using DerSimonian and Laird random effect models across the included studies and heterogeneity between studies was estimated using the I2 index. Five studies comprising a total of 319 treated patients met inclusion criteria and were included in the final analysis. At a mean of 22.8 weeks follow-up, HDP treatment significantly improved total WOMAC score (WMD = 13.77, 95% CI: 6.75–20.78; p

Rationale Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. Objective The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. Methods While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. Results Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing ‘wearing off’ (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35–0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23–0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). Conclusions There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.

Traditional Chinese medicine (TCM) based exercises have been widely used in the prevention and treatment of balance, cardiopulmonary, and other related diseases in older adults. However, there seems to be no consensus on the improvement and comparison of physical performance, balance, and muscle strength in the elderly population. To systematically examine the impact of different TCM-based exercises on physical performance, balance, and muscle strength outcomes in the elderly. We searched PubMed, EMBASE, Scopus, and Cochrane Center, CNKI and Wan Fang between their date of inception and March 2021. This meta-analysis was performed using RevMan5.3 software. Only randomized controlled trials (RCT) or controlled clinical trials (CCT) were considered in TCM-based exercises (Tai Chi, Ba Duan Jin, Qigong). The overall mean difference (MD) or standardized mean difference (SMD), and its 95% confidence interval (CI) were calculated. A total of 27 studies with 2580 older adults met the inclusion criteria. The pooled analysis indicated that Tai Chi could be more effective in Times up and go (TUG) (MD = − 2.62, 95% CI − 4.00 to − 1.24, P = 0.0002), 5 times sit-stand (MD = − 1.89; 95%CI − 3.38 to − 0.40; P = 0.01), and handgrip strength outcomes (SMD = 0.69; 95%CI 0.52–0.86; P

The purpose of this study was to evaluate whether Kinesio taping (KT) can improve patient discomfort after mandibular third molar surgery. This systematic review and meta-analysis was conducted according to the PICO strategy. We searched 4 databases for related articles. All controlled trials or randomized controlled trials that evaluated the application of KT after mandibular third molar surgery were included. Screening and article selection were carried out by two independent reviewers. The main evaluation indicators were facial swelling, pain, and trismus. All statistical analyses were conducted using Review Manager 5.3 software. This analysis included 8 articles. The combined results showed that compared with the control group, the postoperative application of KT significantly reduced pain in the early (early stage mean difference (MD), − 2.00; 95% confidence interval (CI), − 2.40 to − 1.60; P

The study objective was to conduct a systematic review and meta-analysis to assess the effectiveness of immersive virtual reality (VR)-supported interventions for patients with disorders or impairments. Web Science, MEDLINE, CINAHL Plus, and PsycINFO databases were searched from January 1990 to December 2020. We performed random-effects meta-analyses and calculated the standardized mean difference in the health outcomes before and after applying immersive VR-supported interventions. Forty-eight studies representing 52 experiments were meta-analyzed. Six different disorders or impairments were found to be examined in the experiments: anxiety disorders (n=40), psychotic disorders (n=3), poststroke motor impairment (n=3), mild cognitive impairment (MCI) (n=2), amblyopia (n=2), and unilateral vestibular hypofunction (UVH) (n=2). The use of VR interventions resulted in improvement in the following outcomes for the six disorders or impairments: anxiety-related symptoms (e.g., depression, anxiety), psychiatric symptoms, upper extremity function, cognitive function, visual acuity, and confidence in balance during daily activities and vestibulo-ocular reflex. Immersive VR has been mostly studied in individuals with anxiety disorders and can be effective in improving anxiety-related symptoms. Additionally, immersive VR has shown potential in motor rehabilitation after stroke and treating psychotic disorders, MCI, amblyopia, and UVH, and more research is recommended to further validate the current findings.

Purpose To determine the efficacy of physical therapy interventions on quality of life (QoL) and pain severity in post-mastectomy pain syndrome (PMPS). Methods Multiple databases were searched from database inception to October 2020. Searches were limited to human studies published in either English or Chinese in peer-reviewed journals with full text available for randomized controlled trials conducted on females. Trials comparing the effectiveness of physical therapy interventions against control conditions on QoL and pain were included. Results Eighteen trials were included in the review. The pooled analysis of the four exercise trials revealed a significant effect of the intervention on general [standardized mean difference [SMD]: 0.87 (95%CI: 0.36, 1.37); p = 0.001], physical [SMD: 0.34 (95%CI: 0.01, 0.66); p = 0.044], and mental health components [SMD: 0.27 (95%CI: 0.03, 0.51); p = 0.027] of QoL compared with the control condition. Meta-analyses of six exercise trials, two myofascial release trials, and two acupuncture trials revealed a significant improvement in pain severity in the treatment group than in the control group. However, meta-analyses of two studies revealed a non-significant effect of compression therapy compared to control on pain severity. Conclusion Our meta-analyses found that exercise is beneficial for improving the QoL and pain severity of women with PMPS. Future studies are needed to determine the optimal parameters for exercise interventions designed to improve QoL and pain severity in women with PMPS. The effect of acupuncture, myofascial release, and compression therapy remains inconclusive, and future research is required to validate the effect of these interventions on PMPS.

Postoperative cognitive dysfunction (POCD) is a poorly understood disorder, very common even after total hip arthroplasty (THA). It is widely considered that inflammation response play a role in the pathogenesis of POCD. The aim of the present study was to investigate whether inflammation cytokine concentrations could serve as biomarkers for POCD in patients undergoing THA. A systematic search of databases was conducted to retrieve publications measuring circulating inflammatory markers of patients with and without POCD after THA. Inflammatory markers identified in more than two studies were pooled. The standardized mean difference (SMD) and the 95% confidence interval (95% CI) were calculated for each outcome. Fail-safe N statistics was calculated to estimate possible publication bias. The pooled incidence rate of POCD after THA by combining 11 cohort studies was 31%. A total of five inflammatory markers, CRP, S-100B, IL-1β, IL-6 and TNF-α, were assessed. Significantly higher pre-operative CRP (P = 0.012) and S-100B (P

This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy (pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50). The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708). Supplementary Information The online version contains supplementary material available at 10.1007/s00270-021-02877-3.

To assess through a systematic review and meta-analysis of in vitro studies, the influence of the etching strategy (etch-and-rinse versus self-etch) of universal adhesive systems on bonding to primary teeth. A systematic search was carried out in PubMed, Web of Science and Scopus. In vitro studies that compared the bond strength of the etching strategies of universal adhesives to primary teeth were included. Pooled-effect estimates were derived from a random-effects model by comparing the standardized mean difference between the etching strategies (α

Venous access procedures are painful and feared by children and their parents. Virtual reality has become increasingly prominent and has been shown to be effective in various procedures. The aim of this meta-analysis was to examine virtual reality’s effect on pain and fear in children from 4 to 12 in the context of vascular access. From the 20th to the 26th December 2020, we searched Sciencedirect, Springerlink, CENTRAL, Pubmed and PMC. Studies using virtual reality versus a control in vascular access for children were included in a meta-analysis to evaluate the effect of virtual reality regarding pain as a primary and fear/anxiety as a secondary endpoint during the procedures. The Jadad scale and Delphi List were used to assess study quality. 20,894 citations were identified, 9 met our inclusion criteria. One publication was conducted in two different situations and was thus considered as 2 studies. Compared to standard of care, virtual reality significantly reduced pain (10 studies, 930 participants: standardized mean difference [SMD] 2.54, 95%CI 0.14–4.93, p = 0.038), and fear/anxiety (6 studies, 648 participants: SMD 0.89, 95%Cl 0.16–1.63, p = 0.017). For both parameters, we found significant heterogeneity between studies. This is the first meta-analysis to look at the use virtual reality in young children undergoing vascular access procedures, providing weak to moderate evidence for its use. Although large effect sizes provide evidence for a positive effect of virtual reality in reducing pain and fear, there is significant heterogeneity between studies. More research with larger groups and age stratification is required.

Applying digital games (DG) in medical education and learning is increasing. The purpose of this meta-analysis was to determine the effectiveness of DG compared with other methods in terms of improving knowledge or satisfaction of learners in the medical field. An extensive search of publications dated between 2010 and 2020 was carried out through five databases. The citations as well as extracted data from articles were independently assessed, and randomized controlled trials (RCTs) were eligible acceding to inclusion. The methodological quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE). To screen the systematic results, standardized mean difference (SMD) was used, and the pooled effect sizes were calculated by random effects model. I2 statistics, meta-regression and subgroup analyses were applied to evaluate the heterogeneity. In total 13 RCTs with 1236 subjects were included in research. The systemic analysis indicated a significantly improved effectiveness in support of DG compared to controls in medical education (SMD = 0.58, 95% confidence interval (CI) [0.46–0.69], p

Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer’s disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 (95% Confidence Interval: 0.45, 2.89, p = 0.007; Q = 33.28, df = 8, p

The study sought to execute a systematic review and meta-analysis to describe the toxicological implications associated with exposures of humans and laboratory animals to Spent Crankcase Oil (SCO). Databases like PubMed, Scopus, Science Direct, Google Scholar, Web of Science, and PlosOne were searched systematically for all data that assessed the effects of SCO on humans and animals. For each parameter involved in the meta-analysis (those with extractable data), mean, standard deviation, the sample size was extracted for both exposure groups and control. This was then used to compute the standardized mean difference (SMD). Statistical analysis and forest plots were done with RevMan 5.3 software. Twenty-eight (28) studies fulfilled the pre-specified criteria for eligibility. Fourteen (14) of the studies were used for the meta-analysis, which included a total of 1243 subjects from different human epidemiological occupational exposure studies and animal experimental studies. The meta-analysis revealed that SCO exposure caused a significant reduction in the body weight of animals (n = 5, SMD; − 1.2; 95% CI; (− 1.78, − 0.67), p = 0.0001, I(2) = 22%), and in the red blood cell count (n = 5, SMD; − 1.28; 95% CI; (− 2.18, − 0.38, p = 0.02); I(2) = 78%) and haemoglobin (n = 4, SMD; − 1.12, 95% CI; (− 2.71, 0.46); p = 0.16; I(2) = 89%) in animal models. While there was a significant elevation of the aspartate amino transferase (AST) (n = 6, SMD; 0.76; 95%CI; (0.41, 1.11), p = 0.0001, I(2) = 89%), alkaline phosphatase (ALP) (n = 5, SMD; 1.92; 95% CI; (0.02, 3.83), p = 0.05, I(2) = 92%), and creatinine (n = 4, SMD = 1.56; 95% CI; (0.05, 3.07), p = 0.04, I(2) = 90%) concentrations in comparison to the control. On the other hand, there was a non-significant effect on the alanine amino transferase (ALT) (n = 5, SMD; 1.13; 95% CI; (− 0.37, 2.62); p = 0.14; I(2) = 92%), urea (n = 4, SMD; 1.23; 95% CI; (− 1.18, 3.65), p = 0.32, I(2) = 94%), packed cell volume (PCV) (n = 5, SMD; 0.10; 95% CI; (− 0.36, 0.56), p = 0.67; I(2) = 47%); and the haemoglobin (n = 6; SMD; − 0.74; 95% CI; (− 1.73, 0.26), p = 0.15; I(2) = 89%) concentrations. Oxidative stress, heavy metals bioaccumulation, immunotoxic, genotoxic, and carcinogenic effects were also in the list of findings. The toxicological implications associated with SCO exposure points to the need for immediate establishment of policies that regulate the disposal of spent crankcase oil in the environment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43188-021-00093-2.

Different methods have been suggested for calculating “exact” confidence intervals for a standardized mean difference using the noncentral t distributions. Two methods are provided in Hedges and Olkin (1985, “H”) and Steiger and Fouladi (1997, “S”). Either method can be used with a biased estimator, d, or an unbiased estimator, g, of the population standardized mean difference (methods abbreviated Hd, Hg, Sd, and Sg). Coverages of each method were calculated from theory and estimated from simulations. Average coverages of 95% confidence intervals across a wide range of effect sizes and across sample sizes from 5 to 89 per group were always between 85 and 98% for all methods, and all were between 94 and 96% with sample sizes greater than 40 per group. The best interval estimation was the Sd method, which always produced confidence intervals close to 95% at all effect sizes and sample sizes. The next best was the Hg method, which produced consistent coverages across all effect sizes, although coverage was reduced to 93–94% at sample sizes in the range 5–15. The Hd method was worse with small sample sizes, yielding coverages as low as 86% at n = 5. The Sg method produced widely different coverages as a function of effect size when the sample size was small (93–97%). Researchers using small sample sizes are advised to use either the Steiger & Fouladi method with d or the Hedges & Olkin method with g as an interval estimation method.

The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types. Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg’s test, Egger’s test, and Cochrane Collaboration’s tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2. A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being –0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies. Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area. CRD42020218991

To provide evidence on the effects of vitamin D supplementation on knee osteoarthritis (KOA) and new targets for clinical prevention and treatment of KOA. The PubMed, Embase, Web of science, Wanfang, CNKI and SinoMed databases were retrieved to investigate the effects of vitamin D supplementation on patients with KOA. The search time was from databases establishment to 15 November 2020. RevMan5.3 software was used for meta-analysis. The results were expressed as standardized mean difference (SMD) with 95% confidence interval (CI) or weighted mean difference (WMD) with 95% confidence interval (CI). A total of 1599 patients with osteoarthritis of the knee were included in the study, which involved six articles. The results of the meta-analysis showed that vitamin D supplementation is statistically significant for WOMAC score (SMD = − 0.67, 95% CI − 1.23 to − 0.12) in patients with KOA, including WOMAC pain score (SMD = − 0.32, 95% CI − 0.63 to − 0.02), function score (SMD = − 0.34, 95% CI − 0.60 to − 0.08) and stiffness score (SMD = − 0.13, 95% CI − 0.26 to − 0.01). In subgroup analysis, vitamin D supplementation less than 2000 IU was statistically significant for the reduction of stiffness score (SMD = − 0.22, 95% CI − 0.40 to − 0.04). Vitamin D supplements can reduce synovial fluid volume progression in patients with KOA (SMD = − 0.20, 95% CI − 0.39 to − 0.02). There was no statistical significance in improving tibia cartilage volume (SMD = 0.12, 95% CI − 0.05 to 0.29), joint space width (SMD = − 0.10, 95% CI − 0.26 to 0.05) and bone marrow lesions (SMD = 0.03, 95% CI − 0.26 to 0.31). Vitamin D supplements can improve WOMAC pain and function in patients with KOA. But there is a lack of strong evidence that vitamin D supplementation can prevent structural progression in patients with KOA.

Previous studies suggest that sleep apnea hypopnea syndrome (SAHS) is an independent risk factor that contributes to certain cardiovascular events. However, there are studies arguing that patients with SAHS had lower peak troponin levels when suffering cardiovascular events compared to patients without SAHS, which indicates that there may potentially be a protective effect of SAHS. This meta-analysis aimed to assess the impact of SAHS on cardiovascular events. Databases were searched for studies that examined cardiac biomarkers or reported angiographic data when patients with SAHS experienced cardiovascular events. The data about peak cardiac biomarkers and angiographic coronary lesion were extracted and then used to compute the pooled standardized mean difference (SMD) and 95% confidence interval (95% CI). Among 26 studies included in the meta-analysis, there was not a definite difference between the SAHS group and the control group for troponins (SMD, 0.05; 95% CI, [− 0.16, 0.26]), creatine kinase (SMD, − 0.08; 95% CI, [− 0.38, 0.22]), and CK-MB (SMD, − 0.11; 95% CI, [− 0.51, 0.29]). However, patients with SAHS revealed worse coronary lesion condition grading via both Gensini score (SMD, 0.63; 95% CI, [0.31, 0.95]) and SYNTAX score (SMD, 0.99; 95% CI, [0.31–1.67]). Ischemic preconditioning induced by the intermittent hypoxia at the early stage could generate a cardiac protection effect, which would then benefit SAHS patients encountering a major adverse cardiovascular event.

Some studies have reported the association between maternal serum zinc (Zn) levels and pre-eclampsia. However, many studies have reported controversial results. Hence, this systematic review and meta-analysis was planned to generate summarized evidence on the association between maternal serum Zn levels and pre-eclampsia in African women. Four electronic databases such as PubMed, Hinari, Google Scholar, and African Journals Online were searched for studies published in English. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta-regression analysis was performed by the Stata 14 software. The standardized mean difference (SMD) values of lipid profiles were computed to assess their association with pre-eclampsia at 95% CI. A total of 12 observational studies were included. The mean values of serum Zn level were significantly lower in pre-eclamptic women as compared with normotensive pregnant women (Zn = 59.40 ± 22.80 μg/dL and 80.24 ± 16.04 μg/dL), respectively. The pooled SMD of Zn was significantly reduced in pre-eclamptic women as compared with normotensive pregnant women with the SMD of −1.45 (95% CI −2.26, −0.65) at 95% CI. In this review, we found that the maternal Zn serum level was significantly reduced in pre-eclamptic women than normotensive pregnant women. This suggests that Zn could be involved in the etio-pathogenesis of pre-eclampsia. However, the specific functions of Zn in pre-eclampsia pathogenesis should be proved in large-scale clinical trial studies. Supplementary Information The online version contains supplementary material available at 10.1007/s12011-021-02611-7.

Purpose There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with nail fixation for humeral shaft fractures regarding healing, complications and functional results.Methods PubMed/Medline/Embase/CENTRAL/CINAHL were searched for randomized clinical trials (RCT) and observational studies comparing MIPO with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Analyses were repeated stratified by study design (RCTs and observational studies).Results A total of 2 RCTs (87 patients) and 5 observational studies (595 patients) were included. The effects estimated in observational studies and RCTs were similar in direction and magnitude for all outcomes except operation duration. MIPO has a lower risk for non-union (RD 7%; OR 0.2, 95% CI 0.1-0.5) and re-intervention (RD 13%; OR 0.3, 95% CI 0.1-0.8). Functional shoulder (SMD 1.0, 95% CI 0.2-1.8) and elbow scores (SMD 0.4, 95% CI 0-0.8) were better among patients treated with MIPO. The risk for radial nerve palsy following surgery was equal (RD 2%; OR 0.6, 95% CI 0.3-1.2) and nerve function recovered spontaneously in all patients in both groups. No difference was detected with regard to infection, time to union and operation duration.Conclusion MIPO has a considerable lower risk for non-union and re-intervention, leads to better shoulder function and, to a lesser extent, better elbow function compared to nailing. Although nailing appears to be a viable option, the evidence suggests that MIPO should be the preferred treatment of choice. The learning curve of minimal-invasive plating should, however, be taken into account when interpreting these results.

Correlation between blood inflammatory parameters and acute appendicitis (AA) remains controversial. This meta-analysis aims to evaluate whether platelet (PLT) indices including mean platelet volume (MPV), PLT count, and platelet distribution width (PDW) are associated with AA. Pubmed, Embase, and Cochrane Library databases were searched for observational studies published from inception through April 2020 by two independent investigators. Studies reporting associations between platelet indices and AA were selected for inclusion. Standardized mean difference (SMD) and 95% confidence interval (CI) were estimated for continuous outcomes using a DerSimonian-Laird random-effects model. Of 842 records identified, 17 studies with a total of 6793 subjects met our inclusion criteria. Meta-analysis indicated that compared with those in healthy controls, significant decrease in MPV levels was observed in subjects with AA (SMD - 0.34; 95% CI - 0.56 to - 0.12; P = 0.003). Subgroup analyses represented a significant reduction of MPV levels in patients aged ≥ 30 years and non-complicated/non-perforated AA. Due to the small number of studies and patients included in each subgroup, these subgroup analyses need to be interpreted with caution. However, none of the levels of PLT (SMD - 0.13; 95% CI - 0.28-0.012; P = 0.071) or PDW (SMD 0.30; 95% CI - 0.22-0.83; P = 0.257) was seen decrease or increase in subjects with AA. This meta-analysis indicates a significant decrease in MPV levels in patients with AA, which makes MPV have the potential of serving as a biomarker for AA. The associations of other PLT indices with AA need to be further examined.

The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.

Animal studies have suggested that angiotensin II receptor blockers (ARBs) can attenuate or reverse the progression of hypertrophic cardiomyopathy, while clinical studies yielded conflicting results. We sought to conduct a meta-analysis to investigate the effect of ARBs in patients with hypertrophic cardiomyopathy. PubMed and EMBASE databases were searched through June 2020. Only randomized controlled trials (RCTs) were included, and each study’s quality was assessed using the Jadad scale. The primary outcome was left ventricular mass reduction, and the secondary outcome was the change in left ventricular ejection fraction (LVEF). Data were pooled using the random effects model. A total of 1294 articles were screened. Five RCTs were included in the final analysis, enrolling 209 patients with hypertrophic cardiomyopathy (101 patients were in the ARB arm). ARB treatment was not associated with either significant left ventricular mass reduction (standardized mean difference: − 0.25; 95% CI: − 0.73, 0.22; p = 0.29) or change in LVEF (weighted mean difference: 0.73%; 95% CI: − 1.10%, 2.56%; p = 0.43). Subgroup analysis showed that losartan, one of the most investigated and commonly used ARBs, was also not associated with significant decreases of left ventricular mass (standardized mean difference: − 0.13; 95% CI: − 0.61, 0.36; p = 0.61). This meta-analysis showed that ARB treatment is not associated with reduced left ventricular mass nor remarkable LVEF change among patients with hypertrophic cardiomyopathy. Further studies with a larger number of patients will be required to confirm these findings.

To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients’ quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients’ QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen’s d index. Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37–4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99–3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35–3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98–2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83–3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93–1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10–3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51–4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23–3.09, I2 = 78.5%) for percutaneous surgery. Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients’ QoL, after both open and percutaneous surgery, without differences between them.

To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars. Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The “JBI Critical Appraisal Tools for Systematic Reviews” was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence. The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = − 1.44; − 2.72 to − 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = − 1.36; − 2.13 to − 0.59). The certainty of evidence varied between very low to moderate. 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars. The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

The aim of this study was to quantify circulating fibroblast growth factor 21 (FGF-21) changes during and immediately after acute exercise and, based on body weight, to identify the subgroups exhibiting the largest response. The PubMed, Web of Science, and Cochrane Library electronic databases were searched up to December 2019 for studies published in English peer-reviewed journals. Studies that evaluated the effects of acute exercise on FGF-21 concentrations immediately after and 1 and 3 h post-exercise in adults were included. Random effects models were used for analyses, with data reported as standardized mean difference (SMD) and 95% confidence interval, and the risk of heterogeneity was evaluated. Subgroup analysis of subjects with normal weight and obesity/overweight was performed. A total of seven studies involving 125 participants (age 35.95 (21–64) years and BMI 25.89 (21.30–35.46) kg/m2) were included. Overall, acute exercise increased FGF-21 (d = 0.18; 95% CI 0.01 to 0.35, p = 0.02) and this remained for 1 h post-exercise FGF-21 (d = 0.59; 95% CI 0.33 to 0.86, p = 0.001). Three hours after exercise, FGF-21 was restored to near baseline values (d = − 0.05; 95% CI − 0.34 to 0.22, p = 0.68). Acute exercise raised FGF-21 concentrations in normal weight participants (d = 0.57, p = 0.001) and tended to increase in overweight and obese participants (d = 0.79, p = 0.05) 1 h post-exercise. Acute exercise increases circulating FGF-21, irrespective of body weight.

Cold-water immersion (CWI) is one of the main recovery methods used in sports, and is commonly utilized as a means to expedite the recovery of performance during periods of exercise training. In recent decades, there have been indications that regular CWI use is potentially harmful to resistance training adaptations, and, conversely, potentially beneficial to endurance training adaptations. The current meta-analysis was conducted to assess the effects of the regular CWI use during exercise training on resistance (i.e., strength) and endurance (i.e., aerobic exercise) performance alterations. A computerized literature search was conducted, ending on November 25, 2019. The databases searched were MEDLINE, Cochrane Central Register of Controlled Trials, and SPORTDiscus. The selected studies investigated the effects of chronic CWI interventions associated with resistance and endurance training sessions on exercise performance improvements. The criteria for inclusion of studies were: (1) being a controlled investigation; (2) conducted with humans; (3) CWI performed at ≤ 15 °C; (4) being associated with a regular training program; and (5) having performed baseline and post-training assessments. Eight articles were included before the review process. A harmful effect of CWI associated with resistance training was verified for one-repetition maximum, maximum isometric strength, and strength endurance performance (overall standardized mean difference [SMD] = − 0.60; Confidence interval of 95% [CI95%] = − 0.87, − 0.33; p < 0.0001), as well as for Ballistic efforts performance (overall SMD = − 0.61; CI95% = − 1.11, − 0.11; p = 0.02). On the other hand, selected studies verified no effect of CWI associated with endurance training on time-trial (mean power), maximal aerobic power in graded exercise test performance (overall SMD = − 0.07; CI95% = − 0.54, 0.53; p = 0.71), or time-trial performance (duration) (overall SMD = 0.00; CI95% = − 0.58, 0.58; p = 1.00). The regular use of CWI associated with exercise programs has a deleterious effect on resistance training adaptations but does not appear to affect aerobic exercise performance. PROSPERO CRD42018098898.

The Quantitative Timed Up and Go (QTUG) test uses wearable sensors, containing a triaxial accelerometer and an add-on triaxial gyroscope, to quantify performance during the TUG test with potential to capture more minor changes in mobility. To examine the responsiveness, minimum detectable change (MDC) and observed effect size of QTUG in a cohort of socially active adults aged 50 years and over participating in a structured community exercise program. 54 participants (91% females, mean age 63.6 ± 6.5 years) completed repeated QTUG testing under single- and dual-task conditions. Responsiveness of the QTUG was assessed by correlation of change in standard TUG with QTUG change (Pearson’s correlation coefficient). MDC and effect sizes (standardized mean difference and Cohen’s d) were also calculated for QTUG. There was a strong positive correlation between change in the standard TUG and change in QTUG (single task r = 0.91, p

Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes. A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD). The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01–0.37), systolic blood pressure (OR 2.83; 95% CI 1.51–5.28), surgery duration (SMD, 0.51; 95% CI 0.2–0.81), length of anesthesia (OR 0.28; 95% CI 0.11–0.45), 6-month mortality (OR 1.11; 95% CI 1.03–1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07–4.28), respiratory failure (OR 8.26; 95% CI 1.38–49.4), fat embolisms (OR 1.58; 95% CI 1.29–1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3–4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26–0.45), postoperative fractures (OR 0.27; 95% CI 0.21–0.34), reoperations (OR 0.59; 95% CI 0.53–0.65), and revisions (OR 0.62; 95% CI 0.44–0.88). Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks.

Background Fixture congestion (defined as a minimum of two successive bouts of match-play, with an inter-match recovery period of Objective We sought to conduct a systematic review and meta-analysis of the literature related to the effects of fixture congestion on physical, technical, and tactical performance in professional soccer match-play. Methods Adhering to PRISMA guidelines and following pre-registration with the Open Science Framework (https://osf.io/fqbuj), a comprehensive and systematic search of three research databases was conducted to identify articles related to soccer fixture congestion. For inclusion in the systematic review and meta-analysis, studies had to include male professional soccer players, a congestion period that contained two matches ≤ 96 h, and have outcome measures related to physical, technical or tactical performance. Exclusion criteria comprised non-male and/or youth players, data that only assessed impact of congestion on injury, used simulated protocols, or were grey literature, such as theses or dissertations. Results Out of sixteen articles included in the systematic review, only five were eligible for the meta-analysis, and the only variable that was measured consistently across studies was total distance covered. Fixture congestion had no impact on total distance covered [p = 0.134; pooled standardized mean difference; Hedge’s G = 0.12 (− 0.04, 0.28)]. Between-study variance, heterogeneity, and inconsistency across studies were moderate [Cochrane’s Q = 6.7, p = 0.150, I2 = 40.7% (CI 0.00, 93.34)]. Data from articles included in the systematic review suggest fixture congestion has equivocal effects on physical performance, with variation between studies and low quality of research design in some instances. Tactical performance may be negatively impacted by fixture congestion; however, only one article was identified that measured this element. Technical performance is unchanged during fixture congestion; however, again, research design and the sensitivity and relevance of methods and variables require improvement. Conclusion Total distance covered is not impacted by fixture congestion. However, some studies observed a negative effect of fixture congestion on variables such as low- and moderate-intensity distance covered, perhaps suggesting that players employ pacing strategies to maintain high-intensity actions. There is a lack of data on changes in tactical performance during fixture congestion. With ever increasing numbers of competitive matches scheduled, more research needs to be conducted using consistent measures of performance (e.g., movement thresholds) with an integration of physical, technical and tactical aspects.

The S100 calcium-binding protein beta subunit (S100B) protein, which mostly exists in the central nervous system, is commonly noted as a marker of neuronal damage. We conducted the first systematic review with meta-analysis to compare peripheral blood S100B levels in individuals with ASD with those in healthy controls. A systematic search was carried out for studies published before May 5, 2020. In total, this meta-analysis involved ten studies with 822 participants and 451 cases. The meta-analysis revealed that individuals with ASD had higher peripheral blood S100B levels than healthy controls [standardized mean difference (SMD) = 0.97, 95% confidence interval (95% CI) = 0.41–1.53; p

The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH. A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle–Ottawa Scale. Seven retrospective cohort studies comparing LMH (n = 300) versus RMH (n = 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90–2.23; p = 0.13], severe complications (Clavien-Dindo grade ≥ 3) [risk difference (RD) 0.01, 95% CI − 0.03 to 0.05; p = 0.72], and overall mortality (RD 0.00, 95% CI − 0.02 to 0.03; p = 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI − 0.01 to 0.08; p = 0.15), margin-positive resection (OR 1.34, 95% CI 0.51–3.52; p = 0.55), and transfusion rate (RD − 0.03, 95% CI − 0.16 to 0.11; p = 0.67). No significant difference was observed for LMH versus RMH regarding blood loss [standardized mean difference (SMD) 0.27, 95% CI − 0.24 to 0.77; p = 0.30), operative time (SMD − 0.08, 95% CI − 0.51 to 0.34; p = 0.70), and length of stay (SMD 0.13, 95% CI − 0.58 to 0.84; p = 0.72). LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.

This systematic review and meta-analysis was conducted to identify if long-term bosentan is an effective and safe treatment for pulmonary arterial hypertension (PAH) regardless of type, including idiopathic PAH (IPAH), and PAH associated with congenital heart disease (APAH-CHD), connective tissue disease (APAH-CTD), and human immunodeficiency virus (APAH-HIV). All relevant observations were systematically searched by two independent investigators and obtained from three databases, including PubMed, EMBASE and the Cochrane Library, from the inception of each database to February 2020. Currently, long-term administration was defined as no less than 12 months. A random-effects or fixed-effects model was selected according to outcomes of the heterogeneity test for meta-analysis, where standardized mean difference (SMD) with 95% confidence intervals (CIs) was used for continuous outcomes, in addition to the estimated effect (ES; 95% CI) for the synthesized survival rate. Furthermore, subgroup analysis was applied to analyze the differences of efficacy and survivals in each type of PAH cohort. Fifteen studies including a total of 659 subjects undergoing oral bosentan administration for at least 12 months were pooled in this quantitative review. Meta-analysis and subgroup analysis indicated that significant clinical benefits existed, including an improved 6-min walk distance (6MWD) and functional class (FC), in patients with APAH-CHD (6MWD: SMD 0.72, 95% CI 0.52–0.93, p

The alteration of individual sets during resistance training (RT) is often used to allow for greater velocity and power outputs, reduce metabolite accumulation such as lactate and also reduce perceived exertion which can ultimately affect the resultant training adaptations. However, there are inconsistencies in the current body of evidence regarding the magnitude of the effects of alternative set structures (i.e., cluster sets and rest redistribution) on these acute mechanical, metabolic, and perceptual responses during and after RT. This study aimed to systematically review and meta-analyse current evidence on the differences between traditional and alternative (cluster and rest redistribution) set structures on acute mechanical, metabolic, and perceptual responses during and after RT, and to discuss potential reasons for the disparities noted in the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and five databases were searched until June 2019. Studies were included when they were written in English and compared at least one acute mechanical, metabolic, or perceptual response between traditional, cluster or traditional and rest redistribution set structures in healthy adults. Random-effects meta-analyses and meta-regressions were performed where possible. Thirty-two studies were included. Pooled results revealed that alternative set structures allowed for greater absolute mean [standardized mean difference (SMD) = 0.60] and peak velocity (SMD = 0.41), and mean (SMD = 0.33) and peak power (SMD = 0.38) during RT. In addition, alternative set structures were also highly effective at mitigating a decline in velocity and power variables during (SMD = 0.83–1.97) and after RT (SMD = 0.58) as well as reducing lactate accumulation (SMD = 1.61) and perceived exertion (SMD = 0.81). These effects of alternative set structures on velocity and power decline and maintenance during RT were considerably larger than for absolute velocity and power variables. Sub-group analyses controlling for each alternative set structure independently showed that cluster sets were generally more effective than rest redistribution in alleviating mechanical, metabolic, and perceptual markers of fatigue. Alternative set structures can reduce mechanical fatigue, perceptual exertion, and metabolic stress during and after RT. However, fundamental differences in the amount of total rest time results in cluster sets generally being more effective than rest redistribution in alleviating fatigue-induced changes during RT, which highlights the importance of classifying them independently in research and in practice. Additionally, absolute values (i.e., mean session velocity or power), as well as decline and maintenance of the mechanical outcomes during RT, and residual mechanical fatigue after RT, are all affected differently by alternative set structures, suggesting that these variables may provide distinct information that can inform future training decisions. The original protocol was prospectively registered (CRD42019138954) with the PROSPERO (International Prospective Register of Systematic Reviews).

Introduction To investigate the associations of alopecia areata (AA) with serum vitamin D and calcium levels. Methods A systematic review of all relevant articles published up to February 2020 in PubMed, Embase, and Cochrane Library databases was conducted. Primary endpoints were serum 25-hydroxyvitamin D [25(OH)D] levels and vitamin D deficiency, and the secondary endpoint was serum calcium level. Odds ratio (OR) and standardized mean difference (SMD) with 95% CI across studies were analyzed. Results Data on 1585 patients with AA and 1114 controls from 16 case–control studies and three cross-sectional studies were included in this meta-analysis. A pooled meta-analysis was conducted using the random-effects model because of inter-study heterogeneity (vitamin D level, I2 = 87.90%; vitamin D deficiency, I2 = 81.10%; serum calcium level, I2 = 83.80%). A combined analysis revealed that patients with AA had significantly lower mean serum 25(OH)D level compared with control (WMD − 9.08, 95% CI − 11.65, − 6.50, p

A total of 4.5–41.2% of orthopedic surgery patients experience delirium. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of delirium after orthopedic surgery. The present study aimed to comprehensively and quantitatively conclude the risk factors of delirium after orthopedic surgery in elderly patients. A search was applied to Medline, Chinese National Knowledge Infrastructure (CNKI), Embase, and Cochrane central database (all up to February 2020). All studies on the risk factors of delirium after orthopedic surgery in elderly patients without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis was completed. A total of 15 studies altogether included 10,053 patients with orthopedic surgery, 825 cases of delirium occurred after surgery, suggesting the accumulated incidence of 8.2%. Results of meta-analyses showed that age > 70 years (odds ratio (OR) 3.78, 95% confidence interval (CI) 2.97–4.80), advanced age (standardized mean difference 0.82, 95% CI 0.54–1.09), male sex (OR 1.78, 95% CI 1.13–2.79), medical comorbidities (OR 2.18, 95% CI 1.23–3.88), malnutrition (OR 3.10, 95% CI 2.19–4.38), preoperative and postoperative haemoglobin (SMD − 0.37, 95% CI − 0.54 to − 0.19; SMD − 0.33, 95% CI − 0.55 to − 0.11), postoperative sodium (SMD − 0.52, 95% CI − 0.74 to − 0.29) and longer hospitalization after surgery (SMD 0.27, 95% CI 0.11–0.43), hearing impairment (OR 2.78, 95% CI 1.98–3.90), multiple medications (OR 1.36, 95% CI 1.21–1.52), psychotic drugs(OR 4.27, 95% CI 1.37–13.24), morphine (OR 1.97, 95% CI 1.11–3.51), cognitive impairment (OR 2.72, 95% CI 1.96–3.78), length of stay (SMD 0.26, 95% CI 0.14–0.39) and hip surgery (OR 1.63, 95% CI 1.08–2.48) were more likely to sustain delirium after hip surgery in elderly patients. ASA I and II was less likely to develop delirium after orthopedic surgery (OR 0.52, 95% CI 0.34–0.79). Related prophylaxis strategies should be implemented in the elderly involved with above-mentioned risk factors to prevent delirium after orthopedic surgery.

To perform a comprehensive meta-analysis of all available evidence on the efficacy and safety of catheter-based renal denervation for heart failure with reduced ejection fraction. We searched English and Chinese databases and calculated the weighted mean difference or standardized mean difference and 95% confidence intervals to estimate the efficacy and safety of renal denervation for heart failure. All relevant studies were screened and a meta-analysis was conducted using Review Manager 5.4. A total of 11 studies were identified for the meta-analysis. For the primary outcomes, the results showed that renal denervation significantly improved ejection fraction (weighted mean difference 6.42), left ventricular end-systolic diameter (weighted mean difference −3.95), left ventricular end-diastolic diameter (weighted mean difference −4.17) and left atrial diameter (weighted mean difference −4.09). For the secondary outcomes, renal denervation reduced the B-type natriuretic peptide level, heart rate, systolic blood pressure and diastolic blood pressure. However, further analysis revealed that renal denervation improved heart function but did not further reduce the heart rate and blood pressure compared with the control group. Treatment with renal denervation can significantly improve heart function and structure in patients with heart failure. In addition, the level of B-type natriuretic peptide can be reduced after renal denervation treatment. Renal denervation did not further reduce heart rate and blood pressure compared with the control group. Therefore, the treatment of heart failure with renal denervation is effective and safe.

To obtain a reliable estimation on the sleep quality in patients with systemic lupus erythematosus (SLE) and identify the main sleep problems, a meta-analysis was performed.Up to March 21, 2020, PubMed, EMBASE, and Cochrane Library were searched; quality evaluation were conducted with Newcastle-Ottawa Scale; statistical analyses were performed by stata14.0 software; results were expressed by weighted mean difference or standardized mean difference (WMD/SMD) and 95% confidence interval (CI).Eighteen case-control studies were included in meta-analysis, 1086 SLE patients and 2866 controls were collected. The score of sleep quality in the case group was higher than that in the control group (SMD = 1.03, 95% CI: 0.80-1.27), and so was the Pittsburgh Sleep Quality Index (PSQI) (WMD = 3.45, 95% CI: 2.49-4.42). The first three complaints of sleep problems in PSQI were daytime dysfunction (WMD = 0.64, 95% CI: 0.36-0.92), subjective sleep quality (WMD = 0.62, 95% CI: 0.40-0.84), and habitual sleep efficiency (WMD = 0.54, 95% CI: 0.37-0.72). Subgroup analyses showed that the score of sleep quality in SLE patients were higher than controls among different regions, races, and disease duration. The sleep quality score of SLE patients with fibromyalgia (FM) was higher than that in general control, but no significant difference as compared with SLE patients without FM.Our meta-analysis indicates that the sleep quality of SLE patients is worse than that of the general population; thus, more attention should be paid to the sleep status among this disease. Key Points •The sleep quality of SLE patients is worse than that of the general population. •Region, race, and disease duration are correlated with sleep quality in SLE patients.

The purpose of the current study was to evaluate thyroid function in terms of serum thyroid-stimulating hormone (TSH, also known as thyrotropin), 3,5,3′-triiodo-l-thyronine (T3), and 3,5,3′,5′-tetraiodo-l-thyronine (T4, also known as thyroxine) levels in migraineurs in comparison with non-migraineurs using a systematic review of literature and a meta-analysis. This is a systematic review of case-control studies on serum TSH, T3, and T4 concentrations of migraineurs in comparison with non-migraineurs. After extracting the data from the finally included studies, the weighted overall standardized mean difference (SMD) was calculated. The weighted overall SMD for the impact of TSH, T3, and T4 blood levels for migraineurs in comparison with non-migraineurs was as follows: 0.804 (95% CI, 0.045–1.564), − 0.267 (95% CI, − 0.660–0.125), 0.093 (95% CI, − 0.077–0.263), respectively. It is noteworthy that only the p value for the significance of the overall SMD for serum TSH level was statistically significant (p = 0.038), as examined by the z-test. The results of the current study point to an association between migraine pathogenesis and changing TSH levels in comparison with those of controls.

Transcranial direct current stimulation (tDCS) has been used to reduce pain in range of chronic pain states. The aim of this review is to evaluate the effectiveness of tDCS on pain reduction and related disability in patients with non-specific chronic low back pain (CLBP). A computer-based systematic literature search was performed in five databases according to PRISMA guidelines. Randomized controlled trials (RCTs) that assessed the effects of tDCS on pain and related disability in patients with non-specific CLBP were included. Modified Jadad scale and Cochrane's risk of bias assessment were used to determine the studies' quality and risk of bias. Meta-analyses were performed by calculating the standardized mean difference (SMD) at 95% confidence interval (CI). Nine RCTs (411 participants) were included in the systematic review according to inclusion criteria, while only five studies could be included in the meta-analysis. The primary motor cortex (M1) was the main stimulated target. The meta-analysis showed non-significant effect of multiple sessions of tDCS over M1 on pain reduction and disability post-treatment respectively, (SMD = 0.378; 95% CI = - 0.264-1.020; P = 0.249), (SMD = 0.143; 95% CI = - 0.214-0.499; P = 0.434). No significant adverse events were reported. The current results do not support the clinical use of tDCS for the reduction of pain and related disability in non-specific CLBP. However, the limited number of available evidence limits our conclusions on the effectiveness of these approaches.

Background: Hand osteoarthritis (OA) is common, but the efficacy/safety of treatment interventions aimed to improve health outcomes in this population are not well understood. Therefore, the aim of this study was to map and grade the effect of interventions for health outcomes in hand OA. Methods: Umbrella review of systematic reviews with meta-analyses of randomized controlled trials (RCTs) using placebo/no intervention as control group. For outcomes with ap-value

OBJECTIVES: To comprehensively assess diabetic retinopathy neurodegeneration (DRN) as quantified by retinal neuronal and axonal layers measured with spectral-domain optical coherence tomography (SD-OCT) in subjects with diabetes mellitus (DM). METHODS: Articles on the topic of examining macular ganglion cell-inner plexiform layer (m-GCIPL), macular retinal nerve fibre layer (m-RNFL), macular ganglion cell complex (m-GCC), and peripapillary RNFL (p-RNFL) measured with SD-OCT in DM subjects without DR (NDR) or with non-proliferative DR (NPDR) were searched in PubMed and Embase up to November 31, 2019. Standardized mean difference (SMD) as effect size were pooled using random-effects model. RESULTS: Thirty-six studies searched from online databases and the CUHK DM cohort were included in the meta-analysis. In the comparison between NDR and control, macular measures including mean m-GCIPL (SMD = −0.26, p = 0.003), m-RNFL (SMD = −0.26, p = 0.046), and m-GCC (SMD = −0.28; p = 0.009) were significantly thinner in the NDR group. In the comparison between NPDR and NDR, only mean p-RNFL was significantly thinner in the NPDR group (SMD = −0.27; p = 0.03), but not other macular measures. CONCLUSIONS: Thinning of retinal neuronal and axonal layers at macula as measured by SD-OCT are presented in eyes with NDR, supporting DRN may be the early pathogenesis in the DM patients without the presence of clinical signs of DR. In the future, these SD-OCT measures may be used as surrogates of DRN to stratify DM patients with a high risk of DR, and may be used as a therapeutic target if neuroprotection treatment for DR is available.

Patients with schizophrenia have high rates of comorbid physical illness, but there has been less attention to dental diseases in these patients. This meta-analysis of case-control studies systematically examined the oral health in patients with schizophrenia. Case-control studies comparing the oral health in patients with schizophrenia and healthy controls were screened and identified. Standardized mean difference (SMD) with its 95% confidence interval (CI) was calculated using RevMan version 5.3. Three case-control studies comprising 306 patients with schizophrenia and 306 healthy controls were included in this meta-analysis. All studies were rated as “high quality”. Patients with schizophrenia had significantly higher scores of decayed, missing and filled teeth (SMD = 0.83, 95%CI: 0.57, 1.09, p

This systematic review and meta-analysis assessed the effects of early fortification (EF) versus late fortification (LF) of breast milk (BM) on growth of preterm infants. Randomized and quasi-randomized controlled trials (RCTs) dealing with the effects of EF versus LF on growth parameters, incidence of adverse events, and duration of hospital stay in preterm infants were included. Data were pooled using the RevMan 5.3 software. Quality of evidence for predefined outcomes was analyzed by GRADE. Available evidence (3 RCTs, 309 preterm infants) showed no statistically significant difference between EF and LF of BM for any of the growth parameters-weight (standardized mean difference (SMD) 0.13; 95% confidence interval (CI) - 0.09, 0.36); length (SMD 0.02; 95% CI - 0.20, 0.25); and head circumference (SMD - 0.10; 95% CI - 0.33, 0.12). Total parenteral nutrition days were similar. Duration of hospital stay was significantly higher with EF (MD 4.29; 95% CI 0.84, 7.75) with a trend of non-significant increase in feed intolerance and necrotizing enterocolitis (NEC).Conclusion: Very low quality evidence did not find any significant difference in growth parameters of preterm infants in association with EF or LF of BM. A significant increase in hospital stay and non-significant increase in feed intolerance and NEC were associated with EF.PROSPERO registration number: CRD42019139235What is Known:• Fortification of breast milk with essential macro- and micronutrients is necessary for optimization of nutrition in preterm infants.• There is no consensus regarding the breast milk feeding volume at which fortification should be initiated.What is New:• Very low quality evidence showed no significant difference between early and late fortification of breast milk on growth parameters of preterm infants.• Early fortification was associated with non-significant increase in feed intolerance and necrotizing enterocolitis and a significant increase in hospital stay.

Despite the major progress in the treatment of heart failure, the burden of heart failure is steadily increasing in the Western world. Heart failure is characterized by increased sympathetic activity, and chronic sympathetic activation is involved in the maintenance of the pathological state. Recent studies have shown that catheter-based renal denervation (RDN) presents a safe and minimally invasive treatment option for uncontrolled hypertension, a condition that is driven by increased sympathetic activity. Although randomized controlled trials (RCTs) have examined the effect of RDN in heart failure patients, results are inconsistent due partly to limited power with small sample sizes. We aimed to conduct a meta-analysis of RCTs on the effect of RDN in heart failure patients with reduced left ventricular (LV) ejection fraction (EF). Electronic search identified 5 RCTs including 177 patients. In the pooled analysis, RDN increased LVEF (weighted mean difference (WMD) [95% CI] = 6.289 [1.883, 10.695]%) and 6-min walk distance (61.063 [24.313, 97.813] m) and decreased B-type natriuretic peptide levels (standardized mean difference [95% CI] = − 1.139 [− 1.824, − 0.454]) compared with control. In contrast, RDN did not significantly change estimated glomerular filtration rate (WMD [95% CI] = 5.969 [− 2.595, 14.533] ml/min/1.73 m2) and systolic (− 1.991 [− 15.639, 11.655] mmHg) or diastolic (− 0.003 [− 10.325, 10.320] mmHg) blood pressure compared with control. Our meta-analysis suggests that RDN may improve LV function and exercise capacity in heart failure patients with reduced EF, providing the rationale to conduct large-scale multicenter trials to confirm the observed potential benefits of RDN.

To systematically investigate the relationship between circulating interleukin-23 (IL‑23) levels and ankylosing spondylitis (AS) and establish a correlation between these hematological indices and AS activity/severity. We searched the Medline, Embase, and Cochrane databases; performed a meta-analysis comparing serum/plasma IL‑23 levels in patients with AS to those of controls; and examined the correlation coefficients between serum/plasma IL‑23 levels and AS activity. Ten studies including 1724 patients with AS and 1589 controls were included in this meta-analysis. This meta-analysis showed that circulating IL‑23 levels were significantly higher in the AS than in the control group (standardized mean difference [SMD] 1.479; 95% confidence interval [CI] 0.308–2.650; p = 0.013). Stratification by ethnicity showed a significantly increased IL‑23 level in the AS group in an Asian population (SMD 1.551; 95% CI 0.543–2.558; p = 0.003). Stratification by adjustment for age and sex revealed significantly higher IL‑23 levels in the AS adjustment group. Subgroup analysis of sample size showed a significantly higher IL‑23 level for a small (n