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Purpose: Splenic artery embolization (SAE) has emerged as a promising alternative for managing variceal bleeding secondary to portal hypertension (PH). This study aims to elucidate the significance of SAE in managing esophageal variceal bleeding in patients with PH, providing an overview of its efficacy, safety, and role in PH management. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA standards. EMBASE, PubMed, Scopus, and Web of Science databases were searched from inception until April 14, 2024. Original observational and clinical studies on SAE in managing variceal bleeding due to PH were included. Meta-analyses were performed using a random-effects model, and publication bias was assessed using regression and rank correlation tests for funnel plot asymmetry. Results: Eighteen studies met the inclusion criteria, encompassing 531 patients. The meta-analysis revealed a significant reduction in variceal bleeding post-SAE (RD = -0.86; 95% CI: -0.97, -0.75; p < 0.001). Complete resolution of varices was observed in 26% of patients (95% CI: 11%, 45%; p = 0.006), and 78% showed improvement in variceal grade (95% CI: 43%, 88%; p < 0.001). SAE significantly increased platelet counts (SMD = 1.15; 95% CI: 0.63, 1.68; p < 0.001). Common complications included post-embolization syndrome, and the overall complication rate was low. Conclusions: This systematic review and meta-analysis study supports the efficacy and safety of SAE in managing variceal bleeding due to PH, demonstrating significant reductions in bleeding, improvements in variceal grade, and increases in platelet counts. [ABSTRACT FROM AUTHOR]

Objective: This work aims to explore the effectiveness and safety of doxofylline in asthma treatment. Data Sources: Relevant studies published before March 2023 were retrieved from EMBASE, Cochrane Library, PubMed, and Web of Science databases. Study Selections: Risk of Bias tool (RoB 2) was applied to determine the quality of randomized controlled trials (RCTs). Relative risks (RR, 95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI) were calculated for dichotomous and continuous outcomes, respectively, under fixed or random-effects models. Results: A total of eight clinical trials comprising 1627 patients were analyzed. The meta-analysis revealed no notable change in forced expiratory volume in 1 s (FEV1) (WMD = 0.48; 95% CI: −2.09 to 3.05), the use of albuterol as a rescue medication (WMD = −0.02; 95% CI: −0.57 to 0.52), forced vital capacity (FVC) (WMD = 0.19; 95% CI: −0.28 to 0.67) and FEV1 predicted value (WMD = 1.53; 95%CI: −0.88 to 3.94) between doxofylline and control groups. However, doxofylline treatment significantly reduced adverse reactions (RR = 0.71; 95% CI: 0.60 to 0.84) and decreased the incidence of asthma events (WMD = −0.18; 95% CI: −0.33 to 0.03). Subgroup analysis results indicated that the improvement in FEV1 with doxofylline combined with budesonide was superior to that of budesonide combined with montelukast or tiotropium but inferior to that of budesonide plus formoterol combination. Conclusion: Doxofylline treatment significantly reduces the risk of asthma events and adverse events (AEs), demonstrating good safety and longer-term benefits. [ABSTRACT FROM AUTHOR]

Background: Poly (ADP-ribose) polymerase inhibitors (PARPi) serve as crucial therapeutic agents in solid tumor treatment. Preclinical investigations suggest a potential protective function of PARPi against endocrine and metabolic impairments. Nevertheless, the existing body of evidence remains inconclusive on this aspect. Purpose: Our aim was to evaluate the potential impact of PARPi on endocrine and metabolic disruptions in clinical trials. Data sources: We conducted a comprehensive search across the Medline, EMBASE, PubMed, and Web of Science databases, along with the ClinicalTrials.gov registry. Study selection: Phase II/III randomized controlled trials (RCTs) investigating the effects of PARPi in metabolic and endocrine processes were selected for inclusion in patients with solid tumors. Data extraction: The primary outcomes of interest encompassed metabolic and endocrine dysfunctions. Data synthesis: A total of 26 trials (n = 9,590 patients) were included in our meta-analysis. Niraparib demonstrated an increased risk of any-grade hyperglycemia (OR = 2.15, 95% CI 1.28–3.62), with patients receiving PARPi for metastatic pancreatic cancer showing a higher susceptibility to any-grade hyperglycemia (OR = 1.78, 95% CI 1.04–3.04). Conversely, rucaparib exhibited a potential ameliorative effect on hyperglycemia (OR = 0.54, 95% CI 0.30–0.97). No statistically significant disparities were observed for other outcomes associated with PARPi utilization. Limitations: Among these RCTs included, 50% were assessed as low qualities due to high risk of bias. Conclusions: Our meta-analysis demonstrated that PARPi may exert adverse effects on endocrine and metabolic pathways. Close monitoring of hyperglycemia is recommended for patients undergoing niraparib therapy, especially those with pancreatic cancer. Trial registration: This meta-Analysis was prospectively registered in the PROSPERO database with ID CRD42023457959. Highlights: Preclinical studies indicate that PARPi may provide protection against endocrine and metabolic abnormalities. This systematic review and meta-analysis aimed to assess the association between PARPi and the incidence of endocrine and metabolic abnormalities in patients with solid tumors. Our findings revealed that PARPi adversely affect both endocrine and metabolic processes in patients with solid tumors. Special attention is warranted regarding hyperglycemia in patients treated with niraparib, particularly those with pancreatic cancer. The underlying mechanisms of PARPi's effects on endocrine and metabolic functions remain unclear, highlighting the need for further comprehensive research. [ABSTRACT FROM AUTHOR]

Objective: We employed a meta-analysis to investigate the risk factors associated with sarcopenia in patients undergoing dialysis. Methods: We conducted a search in PubMed, Embase, Cochrane Library, and Web of Science databases. Inclusion criteria included case–control and cohort studies on risk factors for sarcopenia in dialysis patients. The search period spanned from the inception of each database to September 20, 2024. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). Data analysis was performed using Stata 15.0. Result: A total of 625 articles were screened, with 610 articles excluded based on predefined eligibility criteria, resulting in 15 articles involving 2904 individuals were included in the final analysis, meta-analysis results indicate that older dialysis patients [SMD = 0.76, 95% CI (0.54, 0.99), I2 = 81%, P = 0.001], those with a lower BMI [SMD = -0.50, 95% CI (-0.80, -0.20), I2% = 87.4%, P = 0.02], a lower SMI [SMD = -2.67, 95% CI (-3.87, -1.47), I2% = 98.2%, P = 0.001], and those with diabetes [OR = 1.43, 95% CI (1.13, 1.82), I2% = 48.8%, P = 0.03] are more likely to develop sarcopenia. Conclusion: Based on current research, our study found that elderly dialysis patients, those with a lower BMI, lower SMI, and diabetic patients are more likely to develop sarcopenia. These findings highlight the necessity of early intervention for these high-risk groups. However, the study has limitations. Future research should address these limitations and investigate the mechanisms linking these risk factors to sarcopenia to develop targeted prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Objectives: Our systematic review and meta-analysis aimed to uncover the relationship between UPFs intake and neurodegenerative disorders, including multiple sclerosis (MS), Parkinson's disease (PD), Alzheimer's disease (AD), cognitive impairment, and dementia. Setting: A systematic search was conducted using the Scopus, PubMed/MEDLINE, and ISI Web of Science databases without any limitation until June 24, 2023. Relative risk (RR) and 95% confidence interval (CI) were pooled by using a random-effects model, while validated methods examined quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests, respectively. Results: Analysis from 28 studies indicated that a higher UPFs intake was significantly related to an enhanced risk of MS (RR = 1.15; 95% CI: 1.00, 1.33; I2 = 37.5%; p = 0.050; n = 14), PD (RR = 1.56; 95% CI: 1.21, 2.02; I2 = 64.1%; p = 0.001; n = 15), and cognitive impairment (RR = 1.17; 95% CI: 1.06, 1.30; I2 = 74.1%; p = 0.003; n = 17), although not AD or dementia. We observed that a 25 g increment in UPFs intake was related to a 4% higher risk of MS (RR = 1.04; 95% CI: 1.01, 1.06; I2 = 0.0%; p = 0.013; n = 7), but not PD. The non-linear dose–response relationship indicated a positive non-linear association between UPF intake and the risk of MS (Pnonlinearity = 0.031, Pdose-response = 0.002). This association was not observed for the risk of PD (Pnonlinearity = 0.431, Pdose-response = 0.231). Conclusion: These findings indicate that persistent overconsumption of UPFs may have an adverse impact on neurodegenerative conditions, potentially leading to a decline in quality of life and reduced independence as individuals age. [ABSTRACT FROM AUTHOR]

Limited data existed on the efficacy and safety of novel antiepileptic drugs (pregabalin and gabapentin) in treating pruritus. To assess their role in managing either acute or chronic pruritus. A systematic search was conducted in PubMed, EMBASE, the Cochrane Library, and Web of Science databases for relevant randomized controlled trials. Pooled odd ratio (OR) with 95% CI were performed using RevMan5.4 and R4.3.1. Analysis of 27 articles involving 2,016 patients showed significant reduction in pruritus incidence (OR, 0.30 [CI, 0.22–0.4]; I2=1%) and improvements in VAS (MD, 2.76 [CI, 0.95–4.57]; I2=98%) and 5-D scores (MD, 3.42 [CI, 2.10–4.75]; I2=92%) with pregabalin/gabapentin compared to controls. Adverse effects mainly included dizziness, somnolence, nausea and vomiting, dry mouth, constipation, and anxiety, with no significant difference between the groups (OR, 1.08 [CI, 0.32–3.59]; I2=76%). The novel antiepileptic drugs pregabalin and gabapentin demonstrated significant therapeutic value in the treatment of pruritus, with a favorable safety profile. Compared to commonly used pruritus treatments such as antihistamines and antidepressants, these medications offered a promising alternative. [ABSTRACT FROM AUTHOR]

Introduction: An abundance of experimental evidence indicates that icariin (ICA) could potentially exert an anti-tumor effect on ovarian cancer (OC). Nevertheless, the reliability of this evidence remains ambiguous. This study aimed to explore the impact of ICA on OC and the underlying mechanisms. Methods: Bioinformatics analysis was employed to pinpoint ICA-targeted genes and signaling pathways implicated in OC, utilizing network pharmacology. Subsequently, PubMed, EMBASE, and Web of Science databases were systematically searched from 2001 through June 2023 for in vitro trials evaluating the anti-tumor efficacy of conventional ICA versus placebo in OC. The pathways and genes identified in the literature were recorded, and the therapeutic targets were statistically analyzed and compared with the predicted targets from network pharmacology to confirm the precision of the targets. Results and Discussion: Fourteen target genes were validated with success. The pathways corresponding to the remaining genes—excluding these 14—were analyzed and found to be primarily associated with cell apoptosis, anti-tumor, and other related pathways. Out of the 76 studies retrieved, eight fulfilled the inclusion criteria. The subsequent meta-analysis suggested that ICA treatment was significantly correlated with reduced cell growth and induced apoptosis. This study demonstrated a certain efficacy of ICA compared to placebo in enhancing anti-tumor outcomes, characterized by increased abilities in reducing cell growth and inducing apoptosis. The pathways involved in the therapeutic effect may be linked to cell apoptosis and anti-tumor mechanisms. [ABSTRACT FROM AUTHOR]

Background: Glucose-to-lymphocyte ratio (GLR) plays an important role in the prognosis of various tumors. The aim of this study was to comprehensively evaluate the prognostic value of GLR in solid tumors through the meta-analysis. Methods: A comprehensive search of eligible studies was performed by scrutinizing the Pubmed, Embase and Web of science databases until May 30, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate overall survival (OS), disease-free survival (DFS) and recurrence free survival (RFS). Results: A total of 22 studies from 14 articles involving 9472 patients were included in the study. The pooled analysis showed that cancer patients with high GLR was significantly associated with unfavorable OS (HR:1.48,95% CI:1.34-1.63) and DFS/RFS (HR:2.20,95% CI:1.66-2.92). Subgroup analysis further showed that high GLR had better predictive value in liver cancer (HR:2.66, 95%CI:1.80-3.93), breast cancer (HR:2.13, 95%CI:1.10-4.13) and pancreatic cancer (HR:1.92, 95%CI:1.30-2.84). Conclusions: GLR can be used as an effective prognostic marker in patients with solid tumors. [ABSTRACT FROM AUTHOR]

Fructooligosaccharides (FOS) are prebiotics with great potential to improve constipation. This study set out to investigate the usefulness of consuming FOS as a dietary supplement on bowel movement frequency, stool consistency, abundance of Bifidobacteria, gastrointestinal transit time, and gastrointestinal symptoms through a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched the Cochrane Library, PubMed, EMBASE, and Web of Science databases up to 2 March 2024. Randomized controlled trials reporting the use of FOS as a supplement by participants were included. Bias risk was assessed using the Cochrane Risk of Bias assessment tool. Results were synthesized using a random-effects model or fixed-effects model, combining outcomes using odds ratios (OR), weighted mean differences (MD), or standardized mean differences (SMD) with 95% confidence intervals (CI). The meta-analysis encompassed 17 randomized controlled trials, involving a total of 713 study participants. Overall, the intake of FOS significantly increased bowel movement frequency (95% CI: 0.80, 1.50, p < 0.00001) and positively affected stool consistency, softening the stool (SMD: 0.36, 95% CI: 0.12, 0.60, p = 0.76). It also reduced the effort and pain during defecation (SMD: −0.60, 95% CI: −0.85, −0.34, p = 0.12). At the same time, mild bloating was noted as an adverse event associated with FOS ingestion (OR: 10.36, 95% CI: 3.32, 33.23, p = 0.24). No reports of serious adverse events were documented. Overall, FOS may enhance bowel movement frequency, stool consistency, and overall constipation symptoms, suggesting cautious optimism regarding their use as a dietary treatment alternative. Nevertheless, further robust and definitive randomized controlled trials are required to more accurately determine the most effective dosage and duration of use. Additional research and evidence are necessary before the efficacy of FOS as a therapeutic method for treating functional constipation can be firmly established. [ABSTRACT FROM AUTHOR]

Purpose: Vitamin D deficiency has been associated with higher rates of autoimmune disease, including noninfectious uveitis. This PRISMA-compliant review and meta-analysis aimed to analyze the correlation between noninfectious uveitis and vitamin D levels. Methods: We searched PubMed, Embase, Cochrane, and Web of Science databases for studies, published in English, assessing vitamin D levels in patients diagnosed with noninfectious uveitis. The outcomes of interest were vitamin D deficiency, vitamin D mean level, vitamin D supplementation, and smoking rates. A subgroup analysis of inactive uveitis and active uveitis was performed. The heterogeneity was assessed with Cochrane Q-test and I2 statistics; p > 0.10 and I2 > 50% were considered significant for heterogeneity. Statistical analysis was conducted using Review Manager 5.3. Results: 9 studies were included in the meta-analysis comprising a total of 10 711 patients, of whom 1,368 were diagnosed with noninfectious uveitis. Patients with noninfectious uveitis had worse results regarding vitamin D deficiency when compared with the control group (OR 0.58; CI 95% 0.44 to 0.77; p = 0.0002; I2 = 61%). Patients with inactive uveitis had better results towards vitamin D deficiency when compared with active uveitis (OR 5.00; CI 95% 2.84 to 8.81; p < 0.001; I2 = 0%). Conclusion: Our research supports the increasing evidence that associates vitamin D deficiency with noninfectious uveitis and its activity. Further investigation into the efficacy of vitamin D screening and supplementation in reducing the recurrence of uveitis is necessary. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer (GC) is a major global cause of cancer mortality, with a median overall survival of just 12 months. CLDN18.2, a specific isoform of Claudin18 normally expressed in the gastric mucosa, has emerged as a potential therapeutic target and prognostic biomarker due to its exposure on the surface of tumor cells following malignant transformation. This exposure allows CLDN18.2's extracellular loops to bind monoclonal antibodies, presenting new opportunities for targeted therapy and improved prognostic assessment. Methods: A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted for studies that addressed the correlation of CLDN18.2 with: (1) Progression-free survival (PFS) and (2) Overall Survival (OS). Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs) were calculated using a fixed-effects model. Heterogeneity was examined with I2 statistics. P values of ≤ 0.05 were considered statistically significant. Statistical analyses were performed using RStudio, version 4.2.3. Results: A total of 15 studies encompassing a total of 4,085 patients were included. There were 2,691 (65.8%) male and 1,394 (34.2%) female patients. In the histologic GC analysis, there were 1,582 (38.7%) patients that had intestinal type and 1,280 (31.3%) with diffuse type. Patients with CLDN18.2 negative status exhibited a non-significant trend towards prolonged PFS (HR: 1.25; 95% CI: 0.98–1.61; p = 0.07; I2 = 18%) and a significant prolonged OS (HR: 1.20; 95% CI: 1.07–1.34; p < 0.01; I2 = 37%) when compared to CLDN18.2-positive patients. Conclusion: Our findings establish CLDN18.2 as a robust negative prognostic indicator for overall survival in GC patients. While its impact on PFS was not statistically significant, the association with OS suggests CLDN18.2 may serve as a marker for complex biological processes underlying tumor advancement. [ABSTRACT FROM AUTHOR]

Background/objective: To compare the efficacy of budesonide/formoterol (BF) versus fluticasone/salmeterol (FS) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies comparing BF versus FS in the treatment of COPD from inception to July 17, 2023. Outcomes, including exacerbations, hospitalizations, pneumonia, emergency department (ED) visits for COPD, length of hospitalization, and number of exacerbations, were compared using risk ratio (RR) with corresponding 95% confidence interval (CI) or weighted mean difference (WMD) with 95% CI. All statistical analyses were performed using Stata version 12.0. Results: Ten studies comprising a total of 136,369 participants were included. Compared with those treated with FS, patients with COPD treated with BF experienced a reduced number of exacerbations (RR 0.91 [95% CI 0.83–1.00]; p = 0.040), hospitalizations (RR 0.77 [95% CI 0.67–0.88]; p < 0.001), and frequency of pneumonia (RR 0.77 [95% CI 0.64–0.92]; p = 0.05). However, no significant difference was observed between BF and FS in terms of ED visits for COPD (RR 0.87 [95% CI 0.69–1.10]; p = 0.243), length of hospitalization (WMD −0.18 [95% CI −0.62–0.27]; p = 0.437), and number of exacerbations (WMD −0.06 [95% CI −0.28–0.16]; p = 0.602). Notably, no significant heterogeneity was noted in length of hospitalization between the two groups, whereas clear heterogeneity was observed in other outcomes (I2 > 50%, p < 0.05). Conclusion: Compared with FS, BF therapy appears to be a more promising treatment strategy for patients with moderate-to-severe COPD; however, this should be verified in further high-quality studies. [ABSTRACT FROM AUTHOR]

Physical inactivity contributes to various health risks; however, approximately one-third of the global population remains insufficiently active. Many researchers have attempted to increase physical activity levels; however, the effectiveness and the specific components of these interventions remain unclear. This systematic review with meta-analyses utilized a behavior change technique taxonomy to identify and extract effective intervention components, aiming to develop more efficient programs to promote physical activity. We searched the PubMed and Ichu-shi Web databases for studies targeting healthy young and middle-aged adults with data on physical activity changes and extracted the intervention components. A random-effects model was used for the primary meta-analysis, and a meta-regression was conducted for the selected outcomes. Overall, 116 studies were included, with 102 used for the primary analysis. The interventions showed a small effect on overall physical activity promotion. Subsequent meta-regressions identified 1.5 Review behavior goal(s) as a significant positive intervention component, as well as four and three potential positive and negative components, respectively. This systematic review and meta-analysis demonstrated the effectiveness of physical activity interventions and highlighted effective and negative components. These findings may inform the design of future programs aimed at promoting physical activity. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) is a common issue among males, and the use of platelet-rich plasma (PRP) therapy for treating ED has gained increasing attention, but there is still no conclusive evidence regarding its efficacy. Aim: To evaluate the efficacy of PRP therapy for ED. Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases up to November 2023 to identify randomized controlled trials (RCTs) on PRP therapy for ED. We used Review Manager version 5.4 for data analysis and management. Result: After applying inclusion and exclusion criteria for screening, a total of 4 studies involving 413 patients were finally included in our meta-analysis. According to our analysis, the PRP group showed significant advantages over the placebo group in terms of MCID at the first month (p = 0.03) and sixth months (p = 0.008), while there was no significant difference between the two groups at the third month (p = 0.19). Additionally, in terms of IIEF, PRP showed significantly better efficacy than placebo at the first, third, and sixth months (p < 0.00001). Conclusions: PRP shows more effectiveness in treating ED compared to placebo, offering hope as a potential alternative treatment for ED. [ABSTRACT FROM AUTHOR]

Background and objectives: Although recent meta-analyses have shown that the association between physical activity (PA) and the risk of developing Parkinson's disease (PD) is influenced by gender differences, a growing number of studies are revealing the general applicability of this association across genders. This study aimed to reassess the association and dose–response relationship between PA and PD risk in populations. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted in this study from inception to February 1, 2024, without language restrictions. Stratified analyses were conducted to explore the association between PA and PD risk, combining multivariate-adjusted effect estimates via random-effects models, and to validate the dose–response relationship between the two. Results: This study included 21 observational studies, comprising 13 cohort studies and 8 case–control studies. The pooled analysis revealed that PA significantly reduced the risk of developing PD [relative risk (RR) = 0.77, 95% CI 0.70–0.85]. In addition, the dose–response analysis revealed both linear and nonlinear associations, with linear results indicating a 9% reduction in PD risk for every 10 MET-h/wk increase in PA. The study also demonstrated that the protective effect of PA against PD was significant for both sexes. Moreover, no statistically significant effects of PA on preventing PD were observed in individuals with a BMI > 26 (RR = 0.35, 95% CI 0.12–1.02) or in Asian populations (RR = 0.78, 95% CI 0.60–1.01); however, the trends suggest potential protective effects, warranting further investigation. Sensitivity analyses confirmed the robustness of these findings. Conclusion: This meta-analysis produced substantial evidence to reaffirm the protective effect of high PA on PD across various population groups and the inverse dose–response relationship with PD risk, and to validate the protective effect of PA among different demographic groups. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta-analysis aimed to evaluate the impact of perioperative immunonutrition on postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD). Methods: Conducted a comprehensive search in PubMed, Embase, Cochrane Library, Medline, and Web of Science databases to identify all randomized controlled trials (RCTs) on the topic of immunonutrition and PD. Subsequently screened literature, extracted data, and assessed the risk of bias in the included studies, and finally conducted a meta-analysis using RevMan 5.3 software. Results: The analysis included a total of 10 RCTs with 574 patients, among whom 288 were in the immunonutrition group and 283 in the control group. The meta-analysis revealed a significantly lower incidence of postoperative infection-related complications (OR = 0.45; 95% CI: 0.27–0.74; P = 0.002) and severe postoperative complications (OR = 0.61; 95% CI: 0.38–0.98; P = 0.04) in the immunonutrition group compared to the control group. Additionally, patients in the immunonutrition group had a significantly shorter length of hospital stay (MD= -1.87; 95%CI -3.29 - -0.44; P = 0.01). However, the analysis revealed no statistically significant difference in the overall complication rate between the two groups (P = 0.67). Furthermore, the incidence of specific complications and perioperative mortality rates also did not demonstrate any statistically significant differences (all P > 0.05). Conclusions: Perioperative immunonutrition in PD patients can reduce postoperative infection-related complications, but more high-quality RCTs are needed for further validation. [ABSTRACT FROM AUTHOR]

ABSTRACT 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. [ABSTRACT FROM AUTHOR]

Background: Upper limb rehabilitation robot is a relatively new technology, but its effectiveness remains debatable due to the inconsistent results of clinical trials. This article intends to assess how upper limb rehabilitation robots help the functional recovery of stroke patients. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies to explore the effect of upper limb rehabilitation robots on upper limb motor function, muscle tone, and daily living activities. Results: Eighteen trials with 573 stroke patients met the inclusion criteria. The results showed that compared to conventional rehabilitation training, patients who received upper limb robotic therapy (RT) had significantly improved Fugl‐Meyer Upper Extremity Motor Assessment (FMA‐UE) scores (weighted mean differences [WMD]: 5.27, 95% confidence intervals [CI]: 3.36, 7.17), Action Research Arm Test (ARAT) scores (WMD: 4.07, 95% CI: −4.14, 12.28), Modified Barthel Index (MBI) scores (WMD: 9.55, 95% CI: 6.37, 12.73), and modified Ashworth Scale (MAS) scores (WMD: −0.28, 95% CI: −0.50, 0.06), with no significant heterogeneity. Conclusions: Upper limb robot–assisted training is superior to conventional training in terms of improving upper limb motor impairment, ability to perform daily living activities, and muscle tone recovery, which supports the application of robots in clinical practice. [ABSTRACT FROM AUTHOR]

The demand for chicken meat has surged globally due to its status as a primary protein source in human diets. However, ensuring high‐quality meat products has become an increasingly important subject to consumers. In this study, 21 articles from PubMed and Web of Science databases published between 2005 and 2023 were examined to assess the influence of probiotic supplementation on broiler meat quality. The meta‐analysis revealed significant findings across various meat quality parameters. Specifically, probiotics were found to significantly affect meat colour parameters, including redness, yellowness, and lightness, in both breast and thigh meat samples. Moreover, significant differences were observed in parameters such as water‐holding capacity (p < 0.001), cook loss (p = 0.047), and shear force (p = 0.025) between control and probiotic groups. However, it's essential to note the considerable heterogeneity among the studies, emphasising the need for a cautious interpretation of the results. Despite this variability, the study underscores the potential of probiotics to positively influence broiler meat quality, highlighting avenues for further research and standardisation in poultry production practices. These findings also contribute to a better understanding of probiotics' role in improving meat quality and meeting consumer preferences for nutritious and high‐quality poultry products. [ABSTRACT FROM AUTHOR]

Objective: The superiority of laparoscopic liver resection (LLR) and open liver resection (OLR) in obese patients remains controversial. The study aims to assess the available literature and compare the perioperative outcomes of LLR and OLR for liver tumors in obese patients. Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science databases for studies comparing LLR and OLR. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Nine studies were included, with a total of 1116 patients (LLR group: 482 patients; OLR group: 634 patients). Compared with OLR, LLR has lower overall morbidity (OR 0.47, 95% CI 0.34, 0.64), major complications (OR 0.45, 95% CI 0.25, 0.82), surgical site infection (OR 0.18, 95% CI 0.07, 0.48), bile leak (OR 0.45, 95% CI 0.22, 0.95), less blood loss (MD, -329.12 mL; 95% CI, -623.35, -34.88), and shorter length of stay (MD, -5.20 days; 95% CI, -7.43, -2.97). There were no significant differences in mortality, operation time, liver failure, and blood transfusion between the two groups. Conclusions: LLR for obese patients is safe and feasible. Compared to OLR, it offers better short-term outcomes. Further randomized controlled trials to verify the potential advantages of LLR over OLR are warranted. [ABSTRACT FROM AUTHOR]

Background: Early rehabilitation after acute ischemic stroke (AIS) contributes to functional recovery. However, the optimal time for starting rehabilitation remains a topic of ongoing investigation. This article aims to shed light on the safety and efficacy of very early rehabilitation (VER) initiated within 48 h of stroke onset. Methods: A systematic search in PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to January 20, 2024. Relevant literature on VER in patients with AIS was reviewed and the data related to favorable and adverse clinical outcomes were collected for meta-analysis. Subgroup analysis was conducted at different time points, namely at discharge and at three and 12 months. Statistical analyses were performed with the help of the Meta Package in STATA Version 15.0. Results: A total of 14 randomized controlled trial (RCT) studies and 3,039 participants were included in the analysis. VER demonstrated a significant association with mortality [risk ratio (RR) = 1.27, 95% confidence interval (CI) (1.00, 1.61)], ability of daily living [weighted mean difference (WMD) = 6.90, 95% CI (0.22, 13.57)], and limb motor function [WMD = 5.02, 95% CI (1.63, 8.40)]. However, no significant difference was observed between the VER group and the control group in adverse events [RR = 0.89, 95% CI (0.79, 1.01)], severity of stroke [WMD = 0.52, 95% CI (−0.04, 1.08)], degree of disability [RR = 1.06, 95% CI (0.93, 1.20)], or recovery of walking [RR = 0.98, 95% CI (0.94, 1.03)] after stroke. Subgroup analysis revealed that VER reduced the risk of adverse events in the late stage (at three and 12 months) [RR = 0.86, 95% CI (0.74, 0.99)] and degree of disability at 12 months [RR = 1.28, 95% CI (1.03, 1.60)], and improved daily living ability at 3 months [WMD = 4.26, 95% CI (0.17, 8.35)], while increasing severity of stroke during hospitalization [WMD = 0.81, 95% CI (0.01, 1.61)]. Conclusion: VER improves activities of daily living (ADLs) and lowers the incidence of long-term complications in stroke survivors. However, premature or overly intense rehabilitation may increase mortality in patients with AIS during the acute phase. PROSPERO registration number: CRD42024508180. Systematic review registration: This systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/). PROSPERO registration number: CRD42024508180. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic‐loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic‐loaded bone cement for the treatment of infected diabetic foot. Methods: The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic‐loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software. Results: Nine articles with 565 patients were analysed in our meta‐analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD = −1.64, 95% CI −2.27 to −1.02 p < 0.00001, I2 = 88%). The ABC group had a significantly decreased number of debridements (SMD = −2.47, 95% CI −4.24 to −0.70, p < 0.00001, I2 = 95%). The pooled data showed no significant difference (RR = 0.41, 95% CI 0.12 to 1.39, p = 0.84, I2 = 0%). Conclusion: This is the first meta‐analysis comparing the efficacy of antibiotic‐loaded bone cement for the treatment of infected diabetic foot. Antibiotic‐loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications. Trial Registration: PROSPERO CRD42023406017 [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Eosinophilic granulomatous polyangiitis (EGPA) is a rare autoimmune disease characterized by multisystemic inflammation, with eosinophils playing a central role in its pathogenesis. Traditional management relies heavily on corticosteroids and immunosuppressants, which are associated with significant side effects. The emergence of biologic agents, such as benralizumab, offers targeted therapeutic options by inhibiting the interleukin‐5 receptor α, thereby reducing eosinophilic inflammation.This systematic review and meta‐analysis comprehensively evaluate the efficacy and safety of benralizumab in EGPA patients, focusing on its ability to reduce oral corticosteroid (OCS) use, facilitate remission and spare immunosuppressants. We searched MEDLINE, LILACS and ISI Web of Science databases for relevant studies up to July 2024.Eight studies, including both randomized controlled trials (RCTs) and observational studies, were included in the meta‐analysis, involving a total of 396 EGPA patients. The pooled analysis demonstrated a significant reduction in OCS dose, with an overall estimated effect of −8.25 mg/day (95% CI, −9.39 to −7.10). Complete remission was achieved in 56.8% of patients, and immunosuppressants were reduced or discontinued in 28.1% of cases. Adverse events (AEs) were reported in 21.9% of patients, with only one discontinuation due to an AE.These findings provide robust evidence supporting the use of benralizumab as an effective and well‐tolerated treatment option for EGPA, significantly reducing OCS requirements and offering promising remission rates. Future research should focus on larger, multicentre RCTs to confirm these findings and further elucidate the long‐term benefits and safety profile of benralizumab in EGPA. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to emphasize the clinical importance of the Deep Inspiration Breath Hold (DIBH) technique by quantifying its dosimetric advantages over Free Breathing (FB) in reducing radiation exposure to the heart, liver, and lungs for right-sided breast cancer patients. This evidence supports its potential for routine clinical use to mitigate radiation-induced toxicity. Methods: A systematic retrieval of controlled trials comparing DIBH and FB techniques in postoperative radiotherapy for right-sided breast cancer was conducted utilizing the PubMed, Embase, Cochrane Library, and Web of Science databases. The primary outcomes assessed included the doses of adjacent normal tissues (heart, liver, and lungs). Summary standardized mean differences (SMD) along with 95% confidence intervals (CI) were computed, respectively. StataMP 17 software was selected to perform data analysis. Results: The study encompassed an analysis of 313 patients derived from seven online studies, comprising 168 individuals in the DIBH group and 269 individuals in the FB group. The findings indicated that the DIBH group received significantly lower irradiation doses to the heart, liver, and lungs in comparison to the FB group, with statistical significance (heart dose: SMD = -0.63, 95% CI -0.85 to -0.41, P < 0.05; liver dose: SMD = -1.15, 95% CI -1.91 to -0.38, P < 0.05; lung dose: SMD = -0.79, 95% CI -1.23 to -0.35, P < 0.05). Conclusion: This meta-analysis indicated that the application of DIBH during postoperative radiotherapy for right-sided breast cancer markedly decreases radiation exposure to the heart, liver, and lungs, while maintaining consistent tumor dose coverage. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

[Objectives] To investigate the evidence-based effect of electroacupuncture on the post stroke inflammatory response and elucidate its potential molecular mechanisms. [Methods] A systematic electronic search of the Medline, PubMed, and Web of Science databases was initially performed up to June 2024. The risk of bias of the included studies was evaluated using RevMan 5.4 software, in accordance with the guidelines set forth in the Cochrane Handbook for Systematic Reviews. The random-effects model or fixed-effects models was employed to estimate the standardized mean difference (SMD). [Results] A total of 15 studies, comprising a total of 182 rats or mice, were included in this review. The pooled analysis of these trials showed a statistically significant reduction in the level of TNF-ct (12 studies, SMD = - 2. 38, [95% CI, -2.86 to -1.90], P <0.000 01, Z2 =49), and IL-lß (11 studies, SMD= -2.41, [95% CI, -3.32 to -1.50], P <0.000 01, Z2=57). Additionally, the compiled data demonstrated a notable and statistically significant elevation in the IL-10 level (6 studies, SAZZ) = 1.56, [95% CI, 0.42 to 2.70], P = 0.008, Z2 =68). [Conclusions] The findings of this systematic review and meta-analysis demonstrate that electroacupuncture stimulation has the potential to regulate the inflammatory responses after stroke. [ABSTRACT FROM AUTHOR]

[Objectives] To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation (rTMS) on upper extremity functionality in patients with acute stroke. [Methods] A rigorous and systematic electronic search was conducted across the Medline, PubMed, and Web of Science databases, encompassing literature up to July 1, 2024. To ensure the reliability of the included studies, an assessment of their risk of bias was conducted using RevMan 5.4 software, in accordance with the rigorous standards outlined in the Cochrane Handbook for Systematic Reviews. Subsequently, we employed either the random-effects model or the fixed-effects model, depending on the heterogeneity of the data, to estimate the standardized mean difference (SMD) in outcomes, utilizing Stata 18.0 software for statistical analysis. [Results] Our review encompassed a total of five studies, involving 252 patients with acute stroke. The pooled analysis of these studies revealed a statistically significant improvement in Fugl - Meyer Assessment of the Upper Extremity (FMA-UE) scores among patients who received rTMS therapy {SMD = 2. 71, 95% CI; 0. 85 to 4. 56; P < 0. 000 1), albeit with considerable heterogeneity (72 - 97. 65%) across the trials. [Conclusions] The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke. These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population. [ABSTRACT FROM AUTHOR]

Background: Carcinoembryonic antigen (CEA) is one of the commonly used preoperative biomarkers for colorectal cancer (CRC), but no meta‐analysis has evaluated the findings of all recently published studies to determine whether its postoperative level can serve as a prognostic indicator. Methods: We conducted a systematic search for eligible literature from the PubMed, EMBASE, and Web of Science databases in October 2023. Studies that investigated the relationship between postoperative serum CEA levels and prognosis in CRC patients were included. Outcome indicators, including overall survival (OS), disease‐free survival (DFS), and progression‐free survival (PFS)/recurrence‐free survival (RFS), were analyzed using a fixed‐effects or random‐effects model. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values. Results: This meta‐analysis included 20 eligible studies involving 10,114 CRC patients from the East Asian and Western countries. A comprehensive analysis revealed that elevated postoperative CEA levels were associated with low OS (HR: 2.92, 95% CI: 2.36–3.62, and p < 0.000), DFS (HR: 2.81, 95% CI: 2.01–3.94, and p < 0.000), and RFS/PFS (HR: 2.52, 95% CI: 1.75–3.62, p < 0.000). A subgroup analysis by region, analysis type, distant metastasis, HR obtain method, sample size, postoperative measurement date, and study design demonstrated that the negative correlation observed between high serum CEA levels after surgery and poor prognosis was not significantly different between the subgroups. Conclusion: When CEA levels are found to be elevated during postoperative follow‐up, more active intervention measures should be implemented to further improve the patient's survival outcomes. [ABSTRACT FROM AUTHOR]

Background: Many studies have demonstrated the relationship between METTL3 protein expression and clinical outcomes in various cancers and elucidated the mechanism by which METTL3 disrupts the behavior of cancer cells. Here, we attempted to define the prognostic value of METTL3 protein in patients with cancer via systematic analysis and explored the potential effect of inhibiting METTL3 using its specific inhibitor. Methods: We searched PubMed, Embase, and the Web of Science databases for studies that elucidated the prognostic value of METTL3 protein expression in all cancer types and then calculated the pooled hazard ratios with 95% confidence intervals for the overall survival (OS) of all cancer types and subgroups. Data from The Cancer Genome Atlas dataset were used to study METTL3 mRNA expression in cancers. Further, the effects of a METTL3‐specific inhibitor were studied in cancer cells via the colony formation assay, the cell proliferation assay, and apoptosis detection. Results: Meta‐analysis of the 33 cohorts in 32 studies (3666 patients in total) revealed that higher METTL3 protein expression indicated poor OS in the majority of cancers. Bioinformatics analysis of METTL3 mRNA expression and cancer prognosis did not show the extremely prominent prognostic value of METTL3 mRNA. Nevertheless, the METTL3‐specific inhibitor attenuated cell proliferation and cell cloning formation and promoted apoptosis. Conclusions: METTL3 protein expression is associated with poor prognosis in most cancer types and could be a biomarker for OS. Further, METTL3 inhibition might be a potential treatment strategy for cancers. [ABSTRACT FROM AUTHOR]

Two rehydration protocols currently exist to treat diabetic ketoacidosis (DKA) in pediatric patients aged <21 years: the traditional "one-bag" system and the more recent "twobag" system. This study aimed to evaluate the safety and efficacy of the newer two-bag system versus the well-established one-bag system. The CiNAHL, Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases were comprehensively searched from inception to June 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework. Eligible studies were those that reported participants <21 years of age who presented to the emergency room with a clinical diagnosis of DKA. This review was prospectively registered on PROSPERO (CRD42023427551). From the initial screening of 42 studies, 8 unique studies encompassing 583 patients met the eligibility criteria. The analysis yielded no significant intergroup differences in hypoglycemia (odds ratio, 0.61; 95% confidence interval [CI], 0.20-1.87; I2=3%) or mean glucose correction rate (mean difference [MD], 0.04 mg/dL/hr; 95% CI, -13.10 to 13.17; I2=64%). The incidence of cerebral edema was as low (0.17%) across groups, with only one case reported in the one-bag group. Notably, the mean time to DKA resolution (MD, -3.24 h; 95% CI, -5.57 to -0.91; I2=0%) and mean response time for intravenous fluid changes (MD, -32.75 min; 95% CI, -43.21 to -22.29; I2=59%) was lower for the two-bag system. This meta-analysis presents preliminary evidence suggesting that the two-bag system may confer advantages over the one-bag system for selected patients. However, further studies with greater patient stratification based on DKA severity, fluid composition, and protocol are needed to draw definitive conclusions and elucidate the extent of these advantages. [ABSTRACT FROM AUTHOR]

Background: There has been a long debate whether delaying treatment with levodopa prevents motor complications in Parkinson's disease (PD). Objectives: We performed a meta‐analysis on randomized clinical trials (RCTs) that compared early‐ versus delayed‐start treatment with levodopa in PD. Methods: A systematic review was conducted in PubMed, EMBASE, and Web of Science databases from inception to July 1, 2023. Only RCTs that compared early and delayed levodopa treatment in PD were included. Non‐randomized comparisons from follow‐up studies were included as well. Our primary outcomes were occurrence of overall motor complications, motor fluctuations, and dyskinesias. Results: Seven studies with a total of 1149 patients (636 in the early‐start group and 513 in the delayed‐start) were included in our analysis. There was no difference between groups regarding motor complications (OR 1.39; 95% CI: 0.68–1.72; P = 0.37) or dyskinesias (OR 1.52; 95% CI: 0.90–2.57; P = 0.11). Motor fluctuations occurred less frequently in the early‐start group (OR 0.70; 95% CI: 0.52–0.95; P = 0.02). Nonetheless, on subgroup analysis of dopamine agonists, rate of dyskinesias was smaller in the delayed‐start group (OR 1.82; 95% CI: 1.08–3.07; P = 0.03). Conclusions: Delaying treatment with levodopa does not seem to prevent levodopa‐related motor complications in PD. Adjunct treatment with dopamine agonists may reduce the need for higher doses of levodopa and thus reduce the risk for dyskinesias but this practice is often associated with a higher frequency of adverse effects related to dopamine agonists. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a network meta-analysis to compare the diagnostic efficacy of diverse novel endoscopic techniques for detecting gastric Helicobacter pylori infection. Methods: From inception to August 2023, literature was systematically searched across Pubmed, Embase, and Web of Science databases. Cochrane’s risk of bias tool assessed the methodological quality of the included studies. Data analysis was conducted using the R software, employing a ranking chart to determine the most effective diagnostic method comprehensively. Convergence analysis was performed to assess the stability of the results. Results: The study encompassed 36 articles comprising 54 observational studies, investigating 14 novel endoscopic techniques and involving 7,230 patients diagnosed with gastric H. pylori infection. Compared with the gold standard, the comprehensive network meta-analysis revealed the superior diagnostic performance of two new endoscopic techniques, Magnifying blue laser imaging endoscopy (M-BLI) and high-definition magnifying endoscopy with i-scan (M-ISCAN). Specifically, M-BLI demonstrated the highest ranking in both sensitivity (SE) and positive predictive value (PPV), ranking second in negative predictive value (NPV) and fourth in specificity (SP). M-I-SCAN secured the top position in NPV, third in SE and SP, and fifth in PPV. Conclusion: After thoroughly analyzing the ranking chart, we conclude that M-BLI and M-I-SCAN stand out as the most suitable new endoscopic techniques for diagnosing gastric H. pylori infection [ABSTRACT FROM AUTHOR]

A meta-analysis including all relevant randomized controlled trials was conducted to compare soft bandage, splint and cast as the treatment of torus fracture. PubMed, Scopus, and Web of Science databases were searched in January 2023. Two comparisons were made: (1) splint versus cast, and (2) bandage versus rigid immobilization (i.e. splint or cast). Main outcomes were pain, clinical healing of the fracture and return to activities. Secondary outcomes were adverse events (skin issues, problems with cast/splint/bandage) and patient/parental satisfaction. Seven studies with 1550 patients were included. Splint was associated with higher pain scores at 3 days compared to cast (Mean difference [MD] 1.00, CI 0.06–1.94) and at 1 week (MD 1.46, CI 0.84–2.08, moderate-certainty evidence), but faster return to activities (at 3 weeks RR 1.77, CI 1.09–2.88, at 4 weeks RR 1.44, CI 1.11–1.82, moderate-certainty evidence). All torus fractures heal clinically within 3–4 weeks (low-certainty evidence). Bandage may lead to slightly higher pain score (MD 0.35, CI 0.04–0.66, moderate-certainty evidence) at first day after treatment compared to rigid immobilization, but no evidence of a difference was found in later time points. In conclusion, soft bandage or removable wrist splint seem to be optimal first-line treatment of distal forearm torus fracture. [ABSTRACT FROM AUTHOR]

Background: Voriconazole plasma concentration exhibits significant variability and maintaining it within the therapeutic range is the key to enhancing its efficacy. We conducted a systematic review and meta-analysis to estimate the prevalence of patients achieving the therapeutic range of plasma voriconazole concentration and identify associated factors. Methods: Eligible studies were identified through the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until 18 November 2023. We conducted a meta-analysis using a random-effects model to determine the prevalence of patients who reached the therapeutic plasma voriconazole concentration range. Factors associated with plasma voriconazole concentration were summarized from the included studies. Results: Of the 60 eligible studies, 52 reported the prevalence of patients reaching the therapeutic range, while 20 performedmultiple linear regression analyses. The pooled prevalence who achieved the therapeutic range was 56% (95% CI: 50%-63%) in studies without dose adjustment patients. The pooled prevalence of adult patients was 61% (95% CI: 56%-65%), and the pooled prevalence of children patients was 55% (95% CI: 50%-60%) The study identified, in the children population, several factors associated with plasma voriconazole concentration, including age (coefficient 0.08, 95% CI: 0.01 to 0.14), albumin (-0.05 95% CI: -0.09 to -0.01), in the adult population, some factors related to voriconazole plasma concentration, including omeprazole (1.37, 95% CI 0.82 to 1.92), pantoprazole (1.11, 95% CI: 0.17-2.04), methylprednisolone (-1.75, 95% CI: -2.21 to -1.30), and dexamethasone (-1.45, 95% CI: -2.07 to -0.83). Conclusion: The analysis revealed that only approximately half of the patients reached the plasma voriconazole concentration therapeutic range without dose adjustments and the pooled prevalence of adult patients reaching the therapeutic range is higher than that of children. Therapeutic drug monitoring is crucial in the administration of voriconazole, especially in the children population. Particular attention may be paid to age, albumin levels in children, and the use of omeprazole, pantoprazole, dexamethasone and methylprednisolone in adults. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate whether a combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) is more effective and safer than injection alone for treating KOA. Materials and methods: MEDLINE (PubMed), the Cochrane Library, EMBASE, and Web of Science databases were systematically searched for articles published until January 2024, and gray literature and bibliographic references were searched. All published randomized controlled trials (RCTs) compared pain, functional outcomes, and adverse events (AEs) associated with PRP + HA therapy vs. PRP or HA treatments. Two independent researchers extracted the pertinent data and evaluated the methodological quality following the PRISMA guidelines. The primary outcomes were pain, functional outcomes, and AEs. A fixed-effects model was used for data analysis in cases with low heterogeneity (P > 0.10 and I2 < 50%). Otherwise, a random effects model was used. Results: Ten RCTs involving 943 patients were included in the analysis. The statistical findings did not differ between the treatment of PRP + HA and PRP alone, while a discernible enhancement in treatment efficacy was observed when compared to HA monotherapy: the visual analog scale scores at 1- (mean difference[MD], −1.00; 95% CI: −1.37 − −0.62; P <.001), 6- (MD, −1.87; 95% CI: −3.46 − −0.28; P =.02), 12-months (MD, −2.07; 95% CI: −3.77 − −0.38; P =.02), and the Western Ontario and McMaster Universities Arthritis Index total scores at 12-months (MD, −8.82; 95% CI: −14.48 − −3.16; P =.002). The incidence of adverse events was notably lower with PRP + HA than with HA alone (OR, 0.37; 95% CI: 0.19 − 0.69; P =.00) or PRP alone (OR, 0.51; 95% CI, 0.30 − 0.87; P =.01). Conclusions: PRP + HA therapy resulted in more pronounced pain and functional improvement in symptomatic KOA patients than HA treatments, and combination therapy may have higher clinical safety than PRP or HA monotherapy. [ABSTRACT FROM AUTHOR]

The aim of the work was to systematically evaluate the efficacy and safety of Vandetanib in the treatment of advanced medullary thyroid carcinoma (MTC). MeSH entries to search for randomized controlled trials and clinical research literature on the application of Vandetanib in the treatment of medullary thyroid cancer from PubMed, Chinese national knowledge infrastructure (CNKI), and Web of Science databases since their establishment until March 2023 were used. In terms of efficacy, the analysis results showed that Vandetanib had a significantly higher objective response rate compared to the control group using placebo (OR=2.13, 95% CI: 1.38, 3.29). In terms of side effects, Vandetanib significantly increases the incidence of hypertension, rash, and diarrhea, and has statistical significance (p+<+0.05). Vandetanib has a better therapeutic effect on MTC, but it also increases the incidence of hypertension, rash, and diarrhea. Attention should be paid to the relief of side effects when using it. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes has been related to higher risk and poor prognosis of patients with tuberculosis, while the influence of prediabetes on the treatment outcome of patients with tuberculosis remains not determined. A meta‐analysis was performed to evaluate the influence of prediabetes on treatment outcome of patients with tuberculosis. Methods: Relevant cohort studies were acquired through a search of Medline, Embase, and Web of Science databases. To minimise the influence of between‐study heterogeneity, a randomised‐effects model was used to pool the results. Results: Eight prospective cohort studies including 3001 patients with tuberculosis were available for the meta‐analysis. Among them, 752 (25.1%) were with prediabetes at baseline, and the patients were followed for a mean duration of 17.7 months. It was shown that compared to patients with normoglycemia, those with prediabetes were associated with a higher incidence of unfavourable treatment outcome (risk ratio [RR]: 1.41, 95% confidence interval [CI]: 1.02 to 1.96, p = 0.04; I2 = 56%). Subgroup analysis did not support that difference in study country (Asian or non‐Asian), diagnosis (pulmonary tuberculosis only or also with extrapulmonary tuberculosis), mean age, follow‐up duration, or study quality score had significant influence on the results (p for subgroup difference all >0.05). However, prediabetes at baseline was not associated with an increased risk of all‐cause mortality during follow‐up (RR: 1.59, 95% CI: 0.75 to 3.38, p = 0.23; I2 = 54%). Conclusions: Patients with tuberculosis and prediabetes may have a higher risk of unfavourable treatment outcome compared to patients with normoglycemia. [ABSTRACT FROM AUTHOR]

The interest in Computational Thinking (CT) development among young learners increases with the number of studies located in literature. In this study, a meta-analysis was conducted to address two main objectives: (a) the effectiveness of empirical interventions on the development of CT in children aged of 3–8 years; and (b) the variables that influence the effectiveness of the interventions. Following PRISMA procedures, we identified 17 empirical studies with 34 effect sizes and 1665 participants meeting the inclusion criteria from Web of Science database. Overall, we found a statistically significant large effect size (d =.83 [95% CI: 730,.890]; p <.001) on the CT development of 3–8 years old children, which provides empirical support for having young children to engage in CT experiences. The effect size was significantly influenced by moderating variables including gender, scaffolding, and education level. Intervention length showed a marginally significant effect. Therefore, educators could refer to the significant moderators when designing tailored interventions for CT development in early childhood education while a call for more empirical studies of CT development in young children is proposed. [ABSTRACT FROM AUTHOR]

Background: Osteonecrosis of the femoral head (ONFH) is acknowledged as a prevalent, challenging orthopedic condition for patients. Purpose: This study aimed to evaluate the efficacy of various interventions for non-traumatic ONFH and provide guidance for clinical decision-makers. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases from inception to February 2023 for relevant randomized controlled trials evaluating treatments for femoral head necrosis, without language restrictions. Quality evaluation was performed using the Cochrane risk-of-bias assessment tool, and analysis was performed using Stata 15.1. Results: Eleven randomized controlled trials were included in this study. The metaanalysis results revealed that CellTherapy [MD= -3.46, 95%CI= (-5.06, -1.85)], InjectableMed [MD= -3.68, 95%CI= (-6.11, -1.21)], ESWT [MD= -2.84, 95%CI= (-4.23, -1.45)], ESWT+InjectableMed [MD= -3.86, 95%CI= (-6.22, -1.53)] were significantly more effective in improving VAS pain score than CD+PTRI, as well as CD+BG+CellTherapy, and CD+BG. Furthermore, CD+BG+CellTherapy was better than CD+BG [MD= -0.97, 95%CI= (-1.71, -0.19)]. The SUCRA ranking for HHS score indicated that CellTherapy (77%) has the best effectiveness rate, followed by ESWT+InjectableMed (72.2%), ESWT (58.3%), InjectableMed (50%), CD+PTRI (31.4%), and CD+BG (11%). In terms of WOMAC and Lequesne scores, the meta-analysis showed no statistically significant differences between the experimental group CD+BG+CellTherapy and the control group CD+BG. Conclusion: CellTherapy and non-surgical ESWT combined with medication or CellTherapy have the best effect on ONFH. Surgical CD+BG combined with CellTherapy is more effective than CD+BG alone. ESWT+InjectableMed is recommended for short-term or acute onset patients, while ESWT is recommended for long-term patients. [ABSTRACT FROM AUTHOR]

This study aimed to conduct a systematic review and meta‐analysis evaluating the inclusion of β‐glucan in aquaculture animal diets and its impact on their health outcomes. Relevant studies were identified from Scopus and Web of Science databases. A total of 82 primary studies published between 1996 and 2024 were reviewed, of which 70 were included in the meta‐analysis. The results revealed that the application of β‐glucan to aquaculture animal's diets significantly enhanced specific growth rate (SGR; mean effect, g = 2.71; p < 0.001), feed conversion ratio (FCR; g = −3.88; p < 0.0001) and lowered mortality after exposure to pathogens. Likewise, β‐glucan had a positive influence (p < 0.0001) on innate immune parameters (lysozyme and phagocyte activity, NBT, ACH50, and IgM). The study found that the effects of β‐glucans varied among marine and freshwater fish where freshwater fishes (g = 2.05–6.57) exhibit better performance. This study also found a negative correlation between fish's innate immune response and trophic level, suggesting that fish with higher trophic levels may be less efficient at absorbing this bio‐stimulant. Even though there were high heterogeneity (I2 = 73%–97%, p < 0.05) due to the diversity of tested organisms and publication bias, our model and findings are valid. The findings suggest that the dietary application of β‐glucans can have beneficial effects on growth and immune responses especially for freshwater species. The validity of these observations needs to be confirmed by further prospective studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recently, peptides have been studied in Caenorhabditis elegans for anti‐aging research. Due to the lack of sufficient evidence, we conducted this meta‐analysis focusing on the anti‐aging effect of peptides in C. elegans to provide more convincing evidence. RESULTS: A literature search in PubMed, SCOUPUS, and Web of Science databases yielded 2879 articles. After removing duplicates and based on inclusion criteria and STAIR checklist quality assessment, nine articles were selected. Data extraction and analysis showed that, compared to the control group without peptide intervention, peptide supplementation significantly reduced nematode mortality risk [hazard ratio = 0.54, 95% confidence interval (CI) = 0.47, 0.62; P < 0.05], significantly increased the pharyngeal pumping rate [standardized mean difference (SMD) = 1.64, 95% CI = 0.87, 2.41; P < 0.05], bending frequency (SMD = 1.67, 95% CI = 1.16, 2.18; P < 0.05), and significantly decreased the accumulation of lipofuscin levels within nematodes (SMD = −4.48, 95% CI = −6.85, −2.12; P < 0.05). Additionally, subgroup analysis showed that doses ranging from 0.1 to 1 mg/mL (HR = 0.50, 95% CI = 0.38, 0.65; P < 0.05) displayed better anti‐aging effects compared to other dose ranges. CONCLUSION: The findings suggest that peptides can significantly extend the lifespan of C. elegans under normal circumstances and improve three indicators of healthy life. More importantly, subgroup analysis revealed that a dosage of 0.1–1 mg/mL demonstrated superior anti‐aging effects. This meta‐analysis provides more convincing evidence that peptides can play an anti‐aging role in C. elegans. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background: Pancreatic head cancer patients who undergo pancreatoduodenectomy (PD) often experience disease recurrence, frequently associated with a positive margin status (R1). Total mesopancreas excision (TMpE) has emerged as a potential approach to increase surgical radicality and minimize locoregional recurrence. However, its effectiveness and safety remain under evaluation. Methods: We conducted a systematic review and meta-analysis to synthesize current evidence on TMpE outcomes. A systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases was conducted up to March 2024 to identify studies comparing TMpE with standard pancreatoduodenectomy (sPD). The risk ratio (RR) or mean difference (MD) was pooled using a random effects model. Results: From 452 studies identified, 9 studies with a total of 738 patients were included, with 361 (49%) undergoing TMpE. TMpE significantly improved the R0 resection rate (RR 1.24; 95% CI 1.11–1.38; P < 0.05), reduced blood loss (MD -143.70 ml; 95% CI -247.92, -39.49; P < 0.05), and increased lymph node harvest (MD 7.27 nodes; 95% CI 4.81, 9.73; P < 0.05). No significant differences were observed in hospital stay, postoperative complications, or mortality between TMpE and sPD. TMpE also significantly reduced overall recurrence (RR 0.53; 95% CI 0.35–0.81; P < 0.05) and local recurrence (RR 0.39; 95% CI 0.24–0.63; P < 0.05). Additionally, the risk of pancreatic fistula was lower in the TMpE group (RR 0.66; 95% CI 0.52–0.85; P < 0.05). Conclusion: Total mesopancreas excision significantly increases the R0 resection rate and reduces locoregional recurrence while maintaining an acceptable safety profile when compared with standard pancreatoduodenectomy. Further prospective randomized studies are warranted to determine the optimal surgical approach for total mesopancreatic resection. [ABSTRACT FROM AUTHOR]

Purpose: In the past few years, there has been a notable rise in the incidence and prevalence of idiopathic pulmonary fibrosis (IPF) on a global scale. A considerable body of research has highlighted the 'obesity paradox,' suggesting that a higher body mass index (BMI) can confer a protective effect against numerous chronic diseases. However, the relationship between BMI and the risk of mortality in IPF patients remains underexplored in the existing literature. We aim to shed light on this relationship and potentially offer novel insights into prevention strategies for IPF. Methods: We conducted a systematic search of the PubMed, Embase, and Web of Science databases to collect all published studies examining the correlation between Body Mass Index (BMI) and the mortality risk in patients with IPF, up until February 14, 2023. For the synthesis of the findings, we employed random-effects models. The statistical significance of the association between BMI and the mortality risk in IPF patients was evaluated using the hazard ratio (HR), with the 95% Confidence Interval (CI) serving as the metric for effect size. Results: A total of 14 data sets involving 2080 patients with IPF were included in the meta-analysis. The combined results of the random-effects models were suggestive of a significant association between lower BMI and a higher risk of death (HR = 0.94, 95% CI = 0.91–0.97, P < 0.001). For baseline BMI, the risk of death from IPF decreased by 6% for each unit increase. The results of the subgroup analysis suggest that geographic location (Asian subgroup: HR = 0.95, 95%CI = 0.93–0.98, P = 0.001; Western subgroup: HR = 0.91, 95%CI = 0.84–0.98, P = 0.014), study type (RCS subgroup: HR = 0.95, 95%CI = 0.92–0.98, P = 0.004; PCS subgroup: HR = 0.89, 95%CI = 0.84–0.94, P < 0.001), and sample size (< 100 groups: HR = 0.93, 95%CI = 0.87–1.01, P = 0.079; >100 groups: HR = 0.94, 95%CI = 0.91–0.97, P < 0.001) were not significant influences on heterogeneity. Of the included literature, those with confounding factors corrected and high NOS scores reduced heterogeneity (HR = 0.93, 95%CI = 0.90–0.96, P < 0.001). Sensitivity analyses showed that the combined results were stable and not significantly altered by individual studies (HR = 0.93 to 0.95, 95% CI = 0.90–0.96 to 0.92–0.98). Egger's test suggested no significant publication bias in the included studies (P = 0.159). Conclusions: Higher BMI (BMI ≥ 25 kg/m2) is negatively correlated to some extent with the risk of death in IPF patients, and BMI may become a clinical indicator for determining the prognosis of IPF patients. [ABSTRACT FROM AUTHOR]

Background: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan–Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to systematize the ability to use ROE to assess rhinoplasty outcomes in surgical approaches. Methods: The PubMed, Scopus, and Web of Science databases were searched for the following terms: "rhinoplasty and outcome" OR "prognosis" OR "outcomes" OR "satisfaction" OR "quality of life" OR QoL "rhinoplasty outcome evaluation". The timeframe of the included studies is from 2011 to May 2024. Ultimately, 17 papers were included in the conducted meta-analysis of ROE scores between pre- and post-treatment data. Results The mean value of the pre-treatment ROE score was 33.50 with a CI of 29.46 to 37.53 (p < 0.001), while the post-treatment ROE was 69.60 with a CI of 63.07 to 76.14 (t ≤ 6 months). At t = 12 months it was 80.25 with a CI of 75.79 to 84.70 (p < 0.001). The mean difference between pre-treatment and post-treatment scores (t ≤ 6 months) was −36.31 with a CI of −40.93 to −31.69. The mean difference between pre-treatment and post-treatment scores for 6 m < t ≤ 12 m was −47.36 with a CI of −53.89 to −40.83. Conclusions: The result was statistically significant (p < 0.001). [ABSTRACT FROM AUTHOR]

Background: Appendicitis is one of the most common acute surgical conditions globally. However, the association between nighttime appendectomy and patients' morbidity and mortality is unclear. This study aims to compare outcomes following nighttime versus daytime appendectomy. Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases up to March 26, 2024 (updated on July 1, 2024) were searched. The primary outcomes were postoperative complications and mortality. Secondary outcomes included intraoperative complications, reoperation, readmission, conversion to laparotomy, hospital stay and operation time. Mean difference (MD) or odds ratios (OR) and 95% confidence intervals were calculated. Results: Fifteen studies totaling 33,596 patients were included. There were no differences between nighttime and daytime appendectomy for rates of overall postoperative complications (OR 0.93, 95% CI 0.87, 1.00, 14 studies), mortality (OR 1.70, 95% CI 0.37, 7.88, 7 studies), intraoperative complications (OR 0.88, 95% CI 0.08, 9.86; 2 studies), reoperation (OR 0.39, 95% CI 0.06, 2.55; 3 studies) and readmission (OR 0.86, 95% CI 0.65, 1.13; I2 = 0%, 5 studies). However, the conversion to laparotomy risks (OR 1.92, 95% CI 1.12, 3.29; 6 studies) among patients who underwent appendectomy during nighttime was significantly elevated compared to daytime. Conclusions: There was no increased risk or difference in postoperative mortality and complication rates associated with nighttime compared with daytime appendectomy. However, future studies should assess the reasons for higher conversion rates during the night. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of drug therapies in managing neuropathic pain is constrained by their limited effectiveness and potential for adverse effects. In contrast, exercise has emerged as a promising alternative for pain relief. In this study, we conducted a systematic evaluation of the therapeutic impact of exercise on neuropathic pain resulting from sciatic nerve injury in rodent models. Methods: The PubMed, Embase, and Web of Science databases were retrieved before April 2024. A series of studies regarding the effect of treadmill, swimming, wheel and other exercises on neuropathic pain induced by sciatic nerve injury in rats and mice were collected. Using predefined inclusion criteria, two researchers independently performed literature screening, data extraction, and methodological quality assessment utilizing SYRCLE's risk of bias tool for animal studies. Statistical analysis was conducted using RevMan 5.3 and STATA 12.0 analysis software. Results: A total of 12 relevant academic sources were included in the analysis of controlled animal studies, with 133 rodents in the exercise group and 135 rodents in the sedentary group. The meta-analysis revealed that exercise was associated with a significant increase in paw withdrawal mechanical threshold [Standard Mean Difference1 (SMD) = 0.84, 95% confidence interval (CI): 0.28-1.40, p = 0.003] and paw withdrawal thermal latency (SMD = 1.54, 95%CI: 0.93-2.15, p < 0.0001) in rats and mice with sciatic nerve injury. Subgroup analyses were conducted to evaluate the impact of exercise duration on heterogeneity. The results showed that postoperative exercise duration =3 weeks could significantly elevate paw withdrawal mechanical threshold (SMD = 1.04, 95% CI: 0.62-1.46, p < 0.00001). Postoperative exercise duration =4 weeks could significantly improve paw withdrawal thermal latency (SMD = 1.93, 95% CI:1.19-2.67, p < 0.00001). Conclusion: Exercise represents an effective method for improving mechanical and thermal hypersensitivity resulting from sciatic nerve injury in rodents. Factors such as pain models, the initiation of exercise, the type of exercise, and the species of rodent do not significantly impact the development of exercise-induced hypoalgesia. However, the duration of postoperative exercise plays a crucial role in the onset of exercise-induced hypoalgesia. [ABSTRACT FROM AUTHOR]

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Background: Estrogen receptors express in nearly 70% of breast cancers (ER-positive). Estrogen receptor alpha plays a fundamental role as a significant factor in breast cancer progression for the early selection of therapeutic approaches. Accordingly, there has been a surge of attention to non-invasive techniques, including circulating Cell-free DNA (ccfDNA) or Cell-Free DNA (cfDNA), to detect and track ESR1 genotype. Therefore, this study aimed to examine the diagnosis accuracy of ESR1 mutation detection by cell-free DNA in breast cancer patientsthrough a systematic review and comprehensive meta-analysis. Methods: PubMed, Embase, and Web of Science databases were searched up to 6 April 2022. Diagnostic studies on ESR1 measurement by cfDNA, which was confirmed using the tumour tissue biopsy, have been included in the study. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were considered to analyse the data. Results: Out of 649 papers, 13 papers with 15 cohorts, including 389 participants, entered the meta-analyses. The comprehensive meta-analysis indicated a high sensitivity (75.52, 95% CI 60.19–90.85), specificity (88.20, 95% CI 80.99–95.40), and high accuracy of 88.96 (95% CI 83.23–94.69) for plasma ESR1. We also found a moderate PPV of 56.94 (95% CI 41.70–72.18) but a high NPV of 88.53 (95% CI 82.61–94.44). We also found an NLR of 0.443 (95% CI 0.09–0.79) and PLR of 1.60 (95% CI 1.20–1.99). Conclusion: This systematic review and comprehensive meta-analysis reveal that plasma cfDNA testing exhibits high sensitivity and specificity in detecting ESR1 mutations in breast cancer patients. This suggests that the test could be a valuable diagnostic tool. It may serve as a dependable and non-invasive technique for identifying ESR1 mutations in breast cancer patients. However, more extensive research is needed to confirm its prognostic value. [ABSTRACT FROM AUTHOR]

Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative and minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases is limited and conflicting. As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of degenerative lumbar diseases. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality. Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]: −0.09–0.07, P = 0.75), MacNab criteria (95% CI: 0.52–2.3, P = 0.82), fluoroscopy time (95% CI: −7.03 to –0.4, P = 0.08), and the incidence of complications (95% CI: 0.5–1.73, P = 0.82) were not significantly different, while the leg VAS score (95% CI: 0.01–0.18, P = 0.03), ODI score (95% CI: −1.03 to –0.09, P = 0.02), operation time (95% CI: 5.76–20.62, P = 0.0005), hospitalization length (95% CI: 0.41–2.76, P = 0.008), and intraoperative hemorrhage (95% CI: 21.92–72.44, P = 0.0003) were significantly different. UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach. [ABSTRACT FROM AUTHOR]

Direct carotid-cavernous fistulas (dCCFs) involve the abnormal shunting of blood between the internal carotid artery and the cavernous sinus. The use of covered stents (CSs) has been reported for the treatment of complex carotid artery lesions. However, the efficacy and safety of CS treatment for dCCFs remain controversial. Thus, we performed a systematic review and meta-analysis to evaluate these efficacy and safety endpoints. A systematic literature review was performed by comprehensively searching the Medline, Embase, and Web of Science databases to identify studies that were related to CS treatment for dCCFs. Then, a meta-analysis was conducted to pool the efficacy and safety outcomes from these studies based on perioperative and follow-up data. Fourteen noncomparative studies enrolling 156 patients with 160 dCCFs met the inclusion criteria. When analyzing perioperative outcomes, the technical success rate was 98.5% [95% confidence interval (CI), 0.948; 1.000], and the immediate complete occlusion rate was 90.9% (95% CI, 0.862; 0.959). Vasospasm and dissection occurred in 32.2% (95% CI, 0.238; 0.463) and 0.1% (95% CI, 0.000; 0.012) of patients, respectively. The in-stent acute thrombus formation rate was 0.1% (95% CI, 0.000; 0.013). Postoperatively, the mortality rate was 0.1% (95% CI, 0.000; 0.013). Based on available follow-up data, the final complete occlusion and parent artery stenosis rates were 99.3% (95% CI, 0.959; 1.000) and 18.6% (95% CI, 0.125; 0.277), respectively. CS placement can be used to safely and effectively treat dCCFs. These results provide a reference for future clinical trials. [ABSTRACT FROM AUTHOR]