Search

Background: Tension-type headache (TTH) is among the most common primary headache disorders, characterized by recurrent episodes that are difficult to manage, thus posing a significant public health challenge. Acupuncture, a well-recognized non-pharmacological treatment, is frequently employed for pain management, including TTH. However, the variety of acupuncture techniques and inconsistent treatment outcomes underscore the need for a thorough evaluation. This study aims to update the current evidence on acupuncture and related therapies for TTH, evaluate the efficacy and safety of various acupuncture therapies, and identify the most effective therapeutic strategies, providing valuable guidance for clinical practice. Methods: We systematically searched randomized controlled trials (RCTs) from four English databases (PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese databases (Wanfang, VIP, CNKI, and SinoMed), including gray literature, up to April 19, 2024. The outcome measures included headache frequency, duration, pain intensity, and responder rate. A Bayesian network meta-analysis was conducted using Stata 17.0 to assess the relative effectiveness and safety of the different acupuncture therapies. This study was registered with the Prospective Register of Systematic Reviews (CRD42024537187). Results: A total of 42 RCTs, encompassing 4,103 participants and 21 distinct treatment therapies, were included in the analysis. The network meta-analysis yielded the following findings: (1) regarding responder rate, several acupuncture or combined acupuncture and medication approaches, such as electro-acupuncture (EA) + cupping therapy (CT) [odds ratio (OR) = 28.66, 95% CI: 1.68 to 487.35], manual acupuncture (MA) + bloodletting therapy (BT) (OR = 6.07, 95% CI: 1.81 to 20.29), plum blossom needle tapping (PBNT) (OR = 3.76, 95% CI: 1.04 to 13.65), and scalp acupuncture (SPA) (OR = 3.65, 95% CI: 2.29 to 5.83), were significantly more effective than western medicine (WM) alone, with EA + CT (92.1%) being the most effective. (2) In terms of reducing headache frequency, EA (85.9%) was the most effective, followed by MA + PBNT (80.9%) and MA + WM (78.4%). Compared to WM, both MA + PBNT (SMD = −1.76, 95% CI: −3.31 to −0.22) and EA (SMD = −1.75, 95% CI: −3.30 to −0.20) significantly reduced headache frequency. (3) For shortening headache duration, EA (83.9%) emerged as the most effective treatment, followed by MA + WM (73.5%) and laser acupuncture (LA) (68.5%). (4) In terms of pain intensity reduction, the MA + WM combination (89.4%) was superior to other treatments, with SPA + WM (77.7%) being the next most effective. Compared to herbal medicine (HM), both MA + WM (SMD = −2.37, 95% CI: −4.20 to −0.55) and MA alone (SMD = −1.00, 95% CI: −1.75 to −0.24) significantly alleviated pain intensity. Conclusion: This comprehensive analysis of 21 acupuncture and related therapies demonstrates that EA is the most effective in reducing headache frequency and shortening headache duration, while EA + CT and MA + WM are the optimal therapies for enhancing responder rate and reducing pain intensity, respectively. However, clinical decisions should be individualized based on the specific needs of each patient. Systematic review registration: The study protocol was registered on the PROSPERO database under registration number CRD42024537187 (https://www.crd.york.ac.uk/prospero/#recordDetails). [ABSTRACT FROM AUTHOR]

Background: Relapsing multiple sclerosis (RMS) is a chronic, inflammatory disease of the central nervous system. Ublituximab, an anti-CD20 monoclonal antibody (mAb), is indicated for the treatment of RMS. We performed a systematic literature review (SLR) to identify randomized trials reporting the clinical efficacy and tolerability of ublituximab or comparator disease-modifying therapies (DMTs) for treatment of RMS, and assessed their comparative effects using network meta-analysis (NMA). Methods: The SLR involved a comprehensive search across various medical databases to identify relevant studies. Included studies were randomized controlled trials (RCTs) of an adult RMS population, focusing on treatment with at least one of ublituximab, alemtuzumab, natalizumab, ocrelizumab, or ofatumumab. For outcomes included in the NMA (annualized relapse rate (ARR), confirmed disability progression (CDP), and treatment discontinuation rate), rate ratios (RR) or hazard ratios (HR), along with their 95% confidence intervals (CIs), were calculated. We performed NMA using a contrast-based random-effects model within a frequentist framework for all outcomes. Ranking probabilities among comparators, and intervention rankings for the NMA, were estimated using surface under the cumulative ranking curve (SUCRA). Results: We included 15 RCTs in the review. For the ARR outcome, there was no statistically significant difference between ublituximab and the other included mAbs [ofatumumab (RR 1.02 (95% CI 0.64–1.62)), natalizumab (RR 0.99 (0.59–1.65)), alemtuzumab (RR 0.86 (0.51–1.46)), and ocrelizumab (RR 0.75 (0.44–1.28))]. For CDP at 6 months, our results showed no statistically significant difference between ublituximab and the comparator mAbs [ofatumumab (HR 0.97 (0.49–1.92)), natalizumab (HR 1.13 (0.53–2.40)), alemtuzumab (HR 1.25 (0.56–2.81)), and ocrelizumab (HR 1.29 (0.57–2.90))]. For CDP at 3 and 6 months, there was no statistically significant difference between ublituximab and placebo. The all-cause treatment discontinuation rate analysis showed no significant difference between ublituximab and other mAbs, except for alemtuzumab. Conclusions: Results of this SLR-informed NMA showed that there is no statistically significant difference between ublituximab and the other mAbs in terms of clinical efficacy. Additionally, the findings show that there is no statistically significant difference in discontinuation rates with the exception of the comparison with alemtuzumab, which may be attributed to its unique dosing schedule. [ABSTRACT FROM AUTHOR]

Background: Transitivity assumption is the cornerstone of network meta-analysis (NMA). Investigating the plausibility of transitivity can unveil the credibility of NMA results. The commonness of transitivity was examined based on study dissimilarities regarding several study-level aggregate clinical and methodological characteristics reported in the systematic reviews. The present study also demonstrated the disadvantages of using multiple statistical tests to assess transitivity and compared the conclusions drawn from multiple statistical tests with those from the approach of study dissimilarities for transitivity assessment. Methods: An empirical study was conducted using 209 published systematic reviews with NMA to create a database of study-level aggregate clinical and methodological characteristics found in the tracenma R package. For each systematic review, the network of the primary outcome was considered to create a dataset with extracted study-level aggregate clinical and methodological characteristics reported in the systematic review that may act as effect modifiers. Transitivity was evaluated by calculating study dissimilarities based on the extracted characteristics to provide a measure of overall dissimilarity within and between the observed treatment comparisons. Empirically driven thresholds of low dissimilarity were employed to determine the proportion of datasets with evidence of likely intransitivity. One-way ANOVA and chi-squared test were employed for each characteristic to investigate comparison dissimilarity at a significance level of 5%. Results: Study dissimilarities covered a wide range of possible values across the datasets. A 'likely concerning' extent of study dissimilarities, both intra-comparison and inter-comparison, dominated the analysed datasets. Using a higher dissimilarity threshold, a 'likely concerning' extent of study dissimilarities persisted for objective outcomes but decreased substantially for subjective outcomes. A likely intransitivity prevailed in all datasets; however, using a higher dissimilarity threshold resulted in few networks with transitivity for semi-objective and subjective outcomes. Statistical tests were feasible in 127 (61%) datasets, yielding conflicting conclusions with the approach of study dissimilarities in many datasets. Conclusions: Study dissimilarity, manifested from variations in the effect modifiers' distribution across the studies, should be expected and properly quantified. Measuring the overall study dissimilarity between observed comparisons and comparing it with a proper threshold can aid in determining whether concerns of likely intransitivity are warranted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of Chinese patent medicine combined with conventional western medicine in the treatment of emotional disorder in perimenopausal women. Methods: CNKI, VIP, Wanfang, SinoMed, Cochrane Library, PubMed, Embase, Web of Science were retrieved to acquire randomized controlled trials of Chinese patent medicine in the treatment of emotional disorder in perimenopausal women. RevMan 5.4 and Stata 15 were used to analyze the data. Results: Network meta-analysis showed that in the aspect of improve clinical effective, Shugan granule combined with conventional western medicine treatment had the best effect. In the aspect of reducing HAMD, Danzhi Xiaoyao pill combined with conventional western medicine treatment had the best effect. In the aspect of reducing HAMA, Kuntai capsule combined with conventional western medicine treatment had the best effect. In the aspect of reducing KI, Wuling capsule combined with conventional western medicine treatment had the best effect. In the aspect of regulate sex hormone, Kuntai capsules with conventional Western medicine treatment had the best effect. In the aspect of reducing adverse reactions, Xuefuzhuyu capsule/oral liquid with conventional Western medicine treatment had the best effect. Conclusion: Chinese patent medicines with conventional Western medicine are effective in the treatment of emotional disorder in perimenopausal women and each has its own advantages. However, due to the limitations of the quantity and quality of the included literatures, higher quality studies are needed in the future. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to systematically assess the efficacy and safety of tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), and Janus kinase inhibitors (JAKi) in patients with non-radiographic axial spondyloarthritis (nr-axSpA). Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Register of Clinical Trials, and Scopus to find randomized controlled trials in patients with nr-axSpA published until June 2023. Stata 17.0 software and Review Manager 5.4 software were used for data analysis. The results for binary and continuous variables were expressed as the values of odds ratio and mean difference and their 95% confidence interval, respectively. Results: For Assessment of SpondyloArthritis International Society Response Criteria for 40% improvement (ASAS40), the efficacy of the 12 interventions ranked as follows: certolizumab pegol (CZP) 200 mg every 2 weeks (Q2W) > CZP 400 mg Q4W > golimumab (GOL) > bimekizumab (BKZ) > adalimumab (ADA) > upadacitinib (UPA) > etanercept (ETN) > brodalumab (BRO) > ixekizumab (IXE) > secukinumab (SEC) 150 mg no loading (NL) > SEC 150 mg loading dose (LD) > placebo (PBO). For assessment of ASAS20, the NMA results were ranked as follows: GOL > CZP 400 mg Q4W> BKZ> ADA > UPA > CZP 200 mg Q2W > ETN > BRO > SEC 150 mg NL > SEC 150 mg LD > PBO, and GOL > ADA > PBO > UPA > SEC 150 mg NL > BKZ > IXE > SEC 150 mg LD > ETN > CZP 200 mg Q2W for adverse events. Conclusions: Most TNFi may be more effective than JAKi and IL-17i. They were all well tolerated. However, the efficacy and safety of TNFi/IL-17i/JAKi remain to be further analyzed in studies with larger sample sizes and longer follow-up times. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in treatment of Sjogren's syndrome (SS). Methods: CNKI, WanFang, VIP, CBM, Sinomed, PubMed, Embase, and Web of Science were searched to collect randomized controlled trials (RCTs) of TCM combined with conventional western medicine (CWM) in treating SS from the time of their estalishment to May 2023. The researchers independently screened the literature and extracted data for quality evaluation. Analyses were performed using Review Manager (version 5.4) and R-4.3.1. Results: A total of 66 RCTs were included, with a sample size of 5,052, involving four kinds of TCM (total glucosides of paeony capsules, tripterygium glycosides tablet, Xinfeng capsule and Jinju Qingrun capsule) and three kinds of CWM(hydroxychloroquine sulfate, Iguratimod and glucocorticoid). The network meta-analysis results showed that IGU + HCQ + TGP ranked the highest in reducing ESR and IgG and improving the Schirmer test when the three drugs were combined. When the two drugs are combined, IGU + GC and TGT + TGP are good choices for reducing erythrocyte sedimentation rate (ESR) and Immunoglobulin G (IgG). Although TGP + HCQ vs. HCQ had the most studies, TGP combined with HCQ did not rank high in each outcome indicator. It is recommended to use TGT and XFG in decreasing ESR and IgG for a single drug. JJQR have an advantageous role in relieving xerostomia and dry eyes. Conclusion: TCM combined with CWM has a very significant effect on treating SS compared with CWM alone. According to the network meta-analysis, the best intervention measures of different TCMs for different outcome indicators were obtained. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023451845]. [ABSTRACT FROM AUTHOR]

Aims Materials and Methods Results Conclusions We have compiled updated evidence on the benefits and drawbacks of dipeptidyl peptidase‐4 (DPP‐4) inhibitors in treating type 2 diabetes mellitus.We systematically searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov (as of 20 May 2024). Effect estimates were calculated using network meta‐analysis under the frequentist framework. The P‐score established the ranking of competing treatments.The authors incorporated 58 studies containing data from a substantial sample size of 21 332 patients. Based on evidence of high and moderate certainty, respectively, teneligliptin and vildagliptin were found to be superior to all other DPP‐4 inhibitors in lowering haemoglobin A1c (mean difference [MD] −0.81%, 95% CI −1.03, −0.60) and fasting blood glucose (MD −1.18 mmol/L, 95% CI −1.56, −0.81) compared to placebo. The absence of conclusive differences between interventions for serious adverse events was supported by evidence, which was interpreted with low to very low certainty.In adults with type 2 diabetes, teneligliptin was most effective for HbA1c control, and vildagliptin for fasting blood glucose. No significant differences in serious adverse events were noted among DPP‐4 inhibitors compared to placebo. Given the therapeutic significance of these findings, more studies are needed to explore this issue more thoroughly. [ABSTRACT FROM AUTHOR]

Objective: This study aims to conduct a systematic review and network meta-analysis to evaluate the efficacy and safety of specific corticosteroids, including but not limited to hydrocortisone, methylprednisolone, prednisolone, and dexamethasone, in the treatment of severe community-acquired pneumonia (SCAP). Efficacy will be assessed using specific outcomes, such as 30-day mortality and the requirement for mechanical ventilation. Safety evaluations will include adverse events like gastrointestinal bleeding and healthcare-associated infections. The study seeks to address the gaps identified in the latest guidelines regarding the optimal use of different corticosteroid types and to provide recommendations for clinical practice. Data Sources: This study conducted a comprehensive search of Medline, Embase, and the Cochrane Central Register of Controlled Trials, covering the period from inception until 22 June 2023. Randomized clinical trials for corticosteroid use among adults with SCAP were collected. Study Selection: Two researchers independently assessed study eligibility based on titles and abstracts, with any disagreements resolved through discussion or consultation with a third researcher. Data Extraction: Two researchers independently collected and clarified study details, with a third researcher adjudicating in case of disputes. Data Synthesis: The data from 13 randomized clinical trials involving 2,495 patients, were analyzed using a random-effects model. Eleven trials were assessed as low risk, while two were assessed as high risk. Trials were rated as having low bias risk. Results, presented as risk ratios (RR) with a 95% confidence interval (CI), indicated that hydrocortisone outperformed prednisolone (RR 0.35; 95% CI 0.10–0.94), methylprednisolone (RR 0.41; 95% CI 0.15–0.89), and placebo (RR 0.35; 95% CI 0.16–0.59) in reducing 30-day mortality. A rankogram plot suggested that hydrocortisone had the highest probability of being the most effective treatment for this outcome within the analyzed group. Conclusion: In this network meta-analysis, while hydrocortisone showed greater efficacy than prednisolone, methylprednisolone, and placebo in reducing 30-day mortality in patients with SCAP, further Randomized Controlled Trials (RCTs) are required to confirm these findings before drawing definitive conclusions. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display%5frecord.php?RecordID=438389, identifier CRD42023438389. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsPROSPERO registration number\nIMPLICATIONS FOR REHABILITATIONTo investigate effects of various cardiorespiratory physiotherapy interventions on balance and gait in patients with stroke.This systematic review and network meta-analysis searched PubMed, EMBASE, Cochrane Library, and Web of Science for articles from 2000 to 2023. Twenty-nine RCTs on stroke patients were selected, involving interventions like ground-based aerobic training (GBAT), resistance training (RT), aquatic training (AT), robot-assisted training (RAT), inspiratory training (IT), combined aerobic and resistance training (CART), and combined aerobic and breathing training (CABT). Outcome variables were Berg Balance Scale (BBS), 6-minute walk test (6MWT), and 10-meter walk test (10MWT) scores.The analysis included 29 articles with 1,370 participants. On the BBS, RT was the most effective (99.66%), significantly more than conventional training (CT) (mean, 95% CI: 1.538, 0.771–2.304). For the 6MWT, CABT ranked highest (85.39%), with all interventions except AT showing significant effects compared to no intervention (N). For the 10MWT, GBAT ranked highest (81.71%), with significant effects for N versus GBAT (0.744, 0.308–1.180) and CART (0.732, 0.257–1.207). Comparisons of CT versus CART and N versus IT in the 6MWT had moderate evidence quality.The findings emphasise the importance of incorporating aerobic, strength, and respiratory exercises alongside conventional physical therapy for optimal outcomes.CRD42023387282.Resistance training is recommended over other interventions to improve balance in stroke patients.Interventions including aerobic, strength, and respiratory training are recommended over conventional training or non-interventions to improve gait in stroke patients.Rather than relying on conventional training to improve balance and gait, interventions that focus on cardiopulmonary physiotherapy should be considered.Resistance training is recommended over other interventions to improve balance in stroke patients.Interventions including aerobic, strength, and respiratory training are recommended over conventional training or non-interventions to improve gait in stroke patients.Rather than relying on conventional training to improve balance and gait, interventions that focus on cardiopulmonary physiotherapy should be considered. [ABSTRACT FROM AUTHOR]

Immunosuppressants are widely used as the preferred treatment for primary focal segmental glomerulosclerosis (pFSGS). Nevertheless, controversies persist regarding the effectiveness and side effects of different immunosuppressive medications. From July 2023 until June 2024, we systematically searched PubMed, Cochrane Library, Web of Science, clinicalrials.gov, SinoMed, Chinese Biomedical, Chinese National Knowledge Infrastructure, Wanfang, and VIP information. Randomized controlled trials comparing different immunosuppressants were included in adult patients with pFSGS, with total remission (TR) and 24-h urine total protein (24-h UTP) as the main outcome measures. We identified 20 RCTs comparing nine different immunosuppressants for the final analysis. Most immunosuppressants showed better therapeutic effects in TR compared to non-immunosuppressive therapies (NIT), with risk ratios (RRs) of 2.22 (95% CI 1.41–3.50) for cyclosporin, 2.10 (1.57–2.80) for leflunomide-combined steroids, 2.01 (1.24–3.27) for chlorambucil-combined steroids, 1.98 (1.17–3.33) for tacrolimus-combined steroids, 1.89 (1.36–2.63) for cyclosporin-combined steroids, 1.67 (1.28–2.18) for mycophenolate mofetil-combined steroids, and 1.47 (1.21–1.80) for steroids. Only mycophenolate mofetil-combined steroids (SMD −11, 95% CI −21 to −0.64) showed significant superiority in reducing 24-h UTP when compared with NIT. The subgroup analyses of steroids-resistant nephrotic syndrome (SRNS) patients showed that CSA + STE was significantly superior than the NIT group, with RR of 10.5 (95% CI 2.28–44.35). Steroids remain the recommended initial treatment for pFSGS. For those patients with SRNS, CSA + STE might be the best choice for improving the rate of TR. LEF + STE and MMF + STE also appear to offer a steroid-saving alternative to high-dose glucocorticoids for patients. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy (CIN) is a potential complication associated with the administration of intravenous contrast agents. The objective of this study was to evaluate the effectiveness of remote ischemic preconditioning (RIPC) and two pharmacological interventions in preventing CIN. Randomized controlled trials (RCTs) examining the efficacy of RIPC, nicorandil, and trimetazidine in treating CIN were searched within databases such as PubMed, Cochrane Library, Embase, and Web of Science. The primary outcome was the incidence of CIN. The consistency model was used to address heterogeneity and enhance model fit. The assessment of consistency between direct and indirect evidence was conducted through the node-splitting method. Posterior probability estimates and surface under the cumulative ranking area (SUCRA) ranked interventions based on their effectiveness in preventing CIN. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to grade the quality of evidence. Based on hydration therapy, RIPC, nicorandil, and trimetazidine all showed prophylactic effects on CIN compared to control groups. The SUCRA results showed that RIPC (SUCRA = 37.7%, PrBest = 0.4%), nicorandil (SUCRA = 91.2%, PrBest = 74.7%), and trimetazidine (SUCRA = 71.0%, PrBest = 24.9%). However, there were no significant differences between the nicorandil, RIPC, and trimetazidine groups. Subgroup analysis suggested that there was still a protective effect in populations with mean estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 or with a high prevalence of diabetes mellitus. Nicorandil, trimetazidine, and RIPC all showed renal protective effects. Based on hydration, nicorandil, trimetazidine, and RIPC may show better prophylaxis against CIN than hydration alone after intravenous contrast administration. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness and safety of different B cell-targeting biological agents combining with standard of care in patients with lupus nephritis (LN). Comprehensive literature searches were conducted using PubMed, Embase, Web of Science, and Central in the Cochran Library, spanning from inception to May 20th, 2024. Randomized control trials (RCTs) comparing rituximab (RTX), belimumab, ocrelizumab, obinutuzumab, and anifrolumab in LN were selected. The primary outcomes of interest were related to complete renal remission (CRR), and partial renal remission (PRR). Additionally, we delved into safety outcomes, examining the occurrence of serious adverse events (SAEs), infections, and the discontinuation rates due to adverse events. A total of 6 RCTs with 1150 patients applying various B cell-targeting biological agents were included. Notably, ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that obinutuzumab (SUCRA 85.2%) has the highest potential superiority in improving CRR, followed by belimumab, ocrelizumab. Regarding the improvement in PRR, obinutuzumab (SUCRA 83.0%) has the highest potential superiority. In terms of safety, with a focus on SAEs, infections, and the discontinuation rates due to adverse events, the results were: SUCRA-based ranking indicated that RTX (SUCRA 74.1%) had the highest probability of postponing SAEs, followed by belimumab and obinutuzumab. Concerning infection reduction, anifrolumab (SUCRA 78.7%) had the highest potential superiority. Safety events monitoring infection occurred better with RTX than with standard therapy (OR = 3.57, 95% CI 1.02, 12.66) and were statistically different. For the discontinuation rates due to adverse events, RTX (SUCRA 88.6%) demonstrated the highest potential superiority. Concerning the effectiveness and safety outcomes, obinutuzumab, belimumab, and RTX plus standard of care may be superior to the current standard therapy as treatments for LN. This study protocol has been registered with PROSPERO, with a registration number of CRD42024548522. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy and safety of biologics, multitarget therapy, and standard therapy for the induction of lupus nephritis. A systematic search of electronic databases (EMBASE, Web of Science, PubMed, Cochrane Library, and ClinicalTrials.gov) was conducted from inception to 30 August 2023. Our study included randomized controlled trials enrolling adult lupus nephritis patients treated with biologics or multitarget therapy, in comparison with standard therapy. The primary outcomes were the rates of complete renal remission (CRR) and serious adverse events (SAE). Stata 15.0 was used to conduct the network meta-analysis. Ten randomized controlled trials with a total of 1989 patients met the inclusion criteria. The network meta-analysis indicated that compared with standard therapy, multitarget therapy, obinutuzumab, belimumab, and voclosporin therapy demonstrated superior efficacy in achieving complete renal remission. Among these options, multitarget therapy had the greatest effect (OR = 2.78, 95% CI = 1.81–4.26). Regarding safety, it was observed that there were no significant statistical differences among the various treatment options. Cluster analysis revealed that both obinutuzumab and belimumab exhibited good efficacy and safety. belimumab and obinutuzumab stood out as promising treatments due to their good performance in terms of efficacy and safety. Multitarget therapy may be the most effective approach for treating lupus nephritis. However, since the study population consists exclusively of Asian patients, further research is needed to verify the efficacy of multitarget therapy in lupus nephritis patients of non-Asian descent. [ABSTRACT FROM AUTHOR]

This study aims to conduct a systematic review and network meta-analysis to comprehensively evaluate the efficacy of various dressings in preventing exit-site infection (ESI) and peritonitis. We searched PubMed, Embase, Web of Science, CINAHL Plus with Full Text (EBSCO), Sino Med, Wan Fang Data, China National Knowledge Infrastructure (CNKI) from 1 January 1999 to 10 July 2023. The language restrictions were Chinese and English. Randomized controlled trials, non-randomized controlled trials, and self-controlled trials were included in this study. We used ROB 2 tool to evaluate the quality of the included literature. Two authors independently extracted the data according to the Cochrane Handbook. A Frequentist network meta-analysis was performed using Stata17.0 according to PRISAMA with a random effects model. From 2092 potentially eligible studies, thirteen studies were selected for analysis, including nine randomized controlled studies, three quasi-experimental studies and one self-controlled trial. A total of 1229 patients were included to compare five types of exit site care dressings, named disinfection dressings, antibacterial dressings, non-antibacterial occlusive dressings, sterile gauze, and no-particular dressings. The outcome of prevention ESI is antibacterial dressings (SUCRA = 97.6) >non-antibacterial occlusive dressings (SUCRA = 68.3) >disinfection dressings (SUCRA = 50.6) >no-particular dressings (SUCRA = 23.9) >sterile gauze (SUCRA = 9.5). The antibacterial dressings were more effective than sterile gauze (OR = 0.13, 95%CI 0.04∼0.44), and no-particular dressing (OR = 0.18, 95%CI 0.07∼0.50) in preventing ESI; the non-antibacterial occlusive dressings were effective than sterile gauze (OR:0.30, 95%CI 0.16∼0.57). There is no statistical significance between no-particular dressings and other types of dressings in preventing the mature ESI. There is no statistical significance in the effectiveness of five types of dressings in preventing peritonitis. The no-particular dressings maybe more cost-effective for preventing mature ESI. None of the dressings was more effective than another in preventing peritonitis. Then, none of the different types of dressing is strongly recommended for preventing ESI or peritonitis. RegistrationCRD42022366756 [ABSTRACT FROM AUTHOR]

Exercise therapy can effectively manage chronic kidney disease (CKD) risk factors and improve renal function and physical fitness, but the challenge lies in choosing the right exercise type tailored to patients’ condition. An electronic search of databases including PubMed, The Cochrane Library, EMBASE, Web of Science, VIP, WanFang, and CNKI was performed. The random effects model was used. Mean difference was employed as the effect size for continuous variables, with 95% confidence interval (CI) provided. A total of 36 RCTs were included in this study. Compared to conventional therapy (CT), the combination of three exercise therapies with CT resulted in notable benefits in enhancing six minutes walk test (6MWT) capacity, 24-h urinary protein quantity (24hUTP), systolic blood pressure (SBP), diastolic blood pressure (DBP). Resistance exercise therapy (RT) + CT were more effective than CT to reduce serum creatinine (Scr), body mass index (BMI), and hemoglobin A1c (HbA1c) and improve estimated glomerular filtration rate (eGFR). In terms of improving peak oxygen uptake (VO2 peak), only two exercise modalities were involved, aerobic exercise therapy (AT) and combined (Resistance-Aerobic) exercise therapy (CBT), both of which were more efficacious than CT. The efficacy ranking overall demonstrated clear benefits for RT in enhancing eGFR and 6MWT, decreasing Scr, BMI, SBP, DBP, and HbA1c, while AT was more suitable for boosting VO2 peak, and CBT had greater potential for reducing 24hUTP. Exercise therapy combined with CT offers significant advantages over CT in many cases, but no single exercise modality is universally effective for all indicators. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory disease that is debilitating, particularly in its more severe forms. Multiple systemic therapies are used in moderate-to-severe psoriasis, but the development of biological interventions has revolutionized its management and improved its outcomes. To compare the effectiveness and safety of the different biological interventions approved for use in moderate-to-severe plaque psoriasis. Multiple databases were searched for relevant articles and a prospectively planned network meta-analysis was conducted on randomized controlled trials that assessed biological treatments in moderate-to-severe psoriasis. The search yielded 84 trials that encompassed 39,798 patients. Infliximab 5 mg/kg had the highest probability of achieving 75% reduction on PASI scale in comparison to placebo (RR = 18.76, 95% CI [12.31; 28.57], high certainty), while Ixekizumab 80 mg and Brodalumab 210 mg had the highest probability at achieving PASI90 and PASI100 (37.81, [28.57; 50.03] and 81.04, [26.16; 251.01], respectively, with moderate certainty) On the other hand, Risankizumab 150 mg and Ustekinumab 90 mg were the only regimens with significantly less withdrawal rates due to adverse events (0.41, [0.18–0.96], and 0.57, [0.35–0.91], respectively with High certainty) compared to placebo. Anti-IL17 and Infliximab were among the most effective in ameliorating the symptoms of psoriasis, however, anti-IL17 were better at achieving full or almost full improvement on the PASI scale. Real life decision-making is not so clear-cut and should remain patient centered, taking into consideration factors such as safety, comorbidities, biologic naivety, dosing preferences and insurance considerations. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality. Methods: This network meta-analysis was registered with PROSPERO. We searched the PubMed, ClinicalTrials.gov. and Embase databases for studies published from inception to the 31st of March 2023. RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis (DMA) statistical analysis. Funnel maps, network meta-analysis (NMA), the surface under the cumulative ranking curve (SUCRA) to rank the different interventions and publication bias were generated by STATA 17.0 software. Results: We included eight randomized controlled trials (RCTs) involving a total of 1192 women with PE; two studies were of high quality and six were of moderate quality. Eight interventions were addressed in the NMA. In the DMA, we found that blood pressure in the Ketanserin group were significantly higher than those in the Nicardipine group. NMA showed that blood pressure in the Dihydralazine group was significantly higher than that in the Methyldopa, Labetalol, Nicardipine and Diltiazem groups. And the blood pressure in the Labetalol group was significantly lower than that in the Nicardipine group. SUCRA values showed that Diltiazem was more effective in lowering blood pressure than other drugs looked at in this study. Conclusion: According to the eight RCTs included in this study, Diltiazem was the most effective in reducing blood pressure in PE patients; Labetalol and Nicardipine also had good effects. Diltiazem is preferred for the treatment of patients with severe PE and high blood pressure. [ABSTRACT FROM AUTHOR]

Background: The lack of definitive scientific evidence sustains uncertainty about the efficacy of glucosamine and its combination therapies for knee osteoarthritis (KOA), contributing to an ongoing debate among clinical practice guidelines and healthcare practitioners. This systematic review and network meta-analysis (NMA) aimed to identify the most effective glucosamine combination therapy for KOA patients. Methods: Frequentist random-effects models were employed for this NMA, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated for primary outcomes. We incorporated an SMD value of 0.40 as a minimum clinically important difference (MCID) to interpret the pain outcome. Confidence in evidence was evaluated using CINeMA. Results: Thirty randomized controlled trials (RCTs) covering 5265 patients were included. Glucosamine with omega-3 (G + omega-3, SMD –2.59 [95% CI –4.42 to –0.75], moderate quality) and glucosamine with ibuprofen (G + ibuprofen, SMD –2.27 [95% CI –3.73 to –0.82], moderate quality) significantly reduced overall pain compared to placebo. Similarly, glucosamine + chondroitin sulfate + methylsulfonylmethane showed effectiveness in pain reduction (SMD –2.25 [95% CI –3.84 to –0.67], low-quality). None of the other interventions met the MCID threshold for overall pain reduction. Moreover, clustered ranking results showed that glucosamine with omega-3 interventions was more effective than others in reducing overall pain and adverse events. Conclusions: For KOA, combining glucosamine with omega-3 and ibuprofen effectively reduces pain and may lower NSAID side effects, improving treatment guidelines and decision-making for better patient care. [ABSTRACT FROM AUTHOR]

Obejective: To compare the effectiveness of endometrial receptivity and pregnancy outcomes of four common immunomodulatory therapies for patients with thin endometrium. Method: This systematic review and network meta-analysis using a literature search up to January 2024, to identify relevant trials comparing endometrial receptivity and pregnancy outcomes of human chorionic gonadotropin (hCG), platelet-rich plasma (PRP), infusion of granulocyte colony-stimulating factor (IG-CSF), and peripheral blood mononuclear cell (PBMC) for patients with thin endometrium. We used surface under the cumulative ranking (SUCRA) to ranked four common immunomodulatory therapies on endometrium thickness, implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR). RoB2 and ROBINS-I were used to assess the certainty of evidence. Results: The pooled results of 22 studies showed that hCG (mean difference [MD]: 3.05, 95% confidence interval [CI]: 1.46–4.64) and PRP (MD: 0.98, 95% CI: 0.20–1.76) significantly increase endometrium thickness. The hCG was the best among the IG-CSF (MD = −2.56, 95% CI = −4.30 to −0.82), PBMC (MD = −2.75, 95% CI = −5.49 to −0.01), and PRP (MD = −2.07, 95% CI = −3.84 to −0.30) in increasing endometrium thickness. However, IG-CSF and PRP significantly improved IR (IG-CSF: risk ratio (RR; IG-CSF: RR = 1.33, 95% CI = 1.06–1.67; PRP: RR = 1.63, 95% CI = 1.19–2.23), and LBR (IG-CSF: RR = 1.53, 95% CI = 1.16–2.02; PRP: RR = 1.59, 95% CI = 1.08–2.36). Conclusions: Available evidence reveals that hCG and subcutaneous or intrauterine CSF (SG-CSF) may be the best treatment options for current thin endometrium patients. However, future high-quality and large-scale studies are necessary to validate our findings. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and network meta-analysis was to compare the efficacy of different surgical treatments, including open and arthroscopic modified Broström procedures (MB), anatomical reconstructions, and suture tape augmentations (STA), for chronic lateral ankle instability (CLAI). We conducted a systematic search for comparative studies that included adult patients with CLAI who underwent open MB, arthroscopic MB, reconstruction with autografts or allografts, and STA. We used a random-effects model to present the NMA results, with mean differences and 95 % confidence intervals (CI) for continuous measures and relative ratios with 95 % CI for dichotomous variables. Surface under the cumulative ranking curve analysis (SUCRA) was used for treatment ranking. The results, based on surface under the cumulative ranking curve analysis, showed that arthroscopic MB likely improves functional outcomes the most as measured by change in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Anatomical graft reconstructions with allografts or autografts demonstrated greater reduction in anterior talar translation (ATT) and talar tilt angle (TTA). Arthroscopic MB and STA were associated with fewer complications. Arthroscopic MB may be associated with better functional outcomes, while anatomical reconstructions appear to provide greater improvements in stability for CLAI. Additionally, arthroscopic techniques seem to have lower complication risks compared to open procedures. These potential differences in outcomes and risks between techniques could help guide surgical decision-making. [ABSTRACT FROM AUTHOR]

Background: Chronic pruritus is the most prevalent and severe symptom of atopic dermatitis (AD). Objective: This network meta-analysis aims to assess the comparative efficacy of systemic targeted monotherapies in alleviating pruritus among adults and adolescents with moderate-to-severe AD. Methods: Data were collected from phase 3/4 randomized controlled trials (RCTs) published until 24 August 2024, focusing on targeted therapies for moderate-to-severe AD. The outcome measure was the proportion of patients achieving a ≥ 4-point improvement from baseline on the Pruritus Numerical Rating Scale (NRS). This analysis included both primary endpoints (week 12 or week 16) and secondary endpoints (weeks 2, 4, and 8). Results: Eleven reports comprising 16 studies with 8,462 participants were included. At all time points examined, targeted therapies demonstrated statistically significant efficacy over placebo, with upadacitinib 30 mg showing the highest response rate. The next most effective treatments at the primary endpoint were abrocitinib 200 mg, upadacitinib 15 mg, dupilumab 300 mg, and lebrikizumab 250 mg. Cumulative ranking probabilities at secondary endpoints varied based on time points. Conclusion: Targeted therapies, particularly upadacitinib 30 mg, showed significant advantages in managing moderate-to-severe AD pruritus. Further direct comparative trials are needed for conclusive evidence. [ABSTRACT FROM AUTHOR]

Background: The occurrence of acne in patients treated with Janus kinase (JAK) inhibitors for skin diseases is a potential issue, which may reduce treatment adherence. Purpose: To systematically analyzes randomized clinical trials (RCTs) of JAK inhibitors in dermatological indications for the risk of acne as an adverse event. Methods: A meta-analysis of odds ratios (ORs) for acne incidence was conducted. Data were quantitatively synthesized using random-effects meta-analysis. Surface under the cumulative ranking curve (SUCRA) values representing the relative ranking probabilities of treatments were obtained. Analyses were performed using R statistical software version 4.4.0. Results: A total of 11,396 patients were included from 24 studies. The incidence of acne for JAK inhibitors was ranked according to the SUCRA as follows: JAK1 inhibitors > TYK2 inhibitors > combined JAK1 and JAK2 inhibitors > combined JAK1 and TYK2 inhibitors > JAK3 + TEC inhibitors > pan-JAK inhibitors. ORs were higher for longer durations of drug use and larger dosages. Subgroup analyses by disease indication revealed increased ORs for psoriasis (5.52 [95% CI, 1.39–21.88]), vitiligo (4.15 [95% CI, 1.27–13.58]), alopecia areata (3.86 [95% CI, 1.58–9.42]), and atopic dermatitis (2.82 [95% CI, 1.75–4.54]). The use of JAK inhibitors in patients with systemic lupus erythematosus (SLE) may not significantly increase the incidence of acne. Conclusions: There are higher rates of acne following treatment with JAK inhibitors for dermatologic indications, particularly with longer durations and larger dosages. Pan-JAK inhibitors exhibit the lowest incidence of acne. [ABSTRACT FROM AUTHOR]

Summary: Objective: The purpose of this study is to utilize network meta‐analysis (NMA) to synthesize relevant randomized controlled trials (RCTs) and evaluate the most effective intermittent fasting (IF) combined with exercise interventions for weight loss. Methods: This study searched five databases up until April 2024, obtaining RCTs that investigated the effects of intermittent fasting (IF) combined with exercise. The quality of the literature was assessed using the Cochrane tool, followed by a random‐effects statistical analysis of each intervention. Eventually, a NMA was conducted to compare the effectiveness of each intervention on weight loss, thereby determining their combined effectiveness on reducing weight. Results: A total of nine trials, comparing 12 interventions involving 570 participants, were included. All interventions significantly reduced body weight (BW) and fat mass (FM) compared to the control (CON) group. In terms of BW reduction, the alternate‐day fasting + moderate‐intensity continuous training (ADF + MICT) intervention had the highest surface under the cumulative ranking curve average (SUCRA) score 88.1(MD: −4.44,95% CI −5.95, −2.92). Furthermore, for improving FM, the ADF + MICT intervention also had the highest SUCRA score 92.7(MD: −3.65,95% CI −5.05, −2.25), making it the optimal intervention for improving FM. Conclusion: The NMA results indicate that all interventions are effective in reducing weight. Among them, ADF + MICT is the most effective strategy for reducing BW, and it is also the best approach for improving FM. [ABSTRACT FROM AUTHOR]

A promising approach for managing root caries is the use of cross‐linking agents to stabilize collagen. However, despite testing various natural and synthetic agents in vitro, their efficacy remains uncertain. The aim of this review was to examine which cross‐linking agent performs better in reducing root caries lesion depth and the release of hydroxyproline, which is a marker of collagen degradation. Studies evaluating the impact of cross‐linking agents on dentin were included, while studies performed on enamel surface/cell cultures and studies evaluating collagenase inhibitors were excluded, among others. A comprehensive search covered eight databases, and study quality was assessed using the QUINN Tool for in vitro dental studies. Synthesis of the results was done using a Bayesian network meta‐analysis to compare agents. Fifty studies involving 31 cross‐linking agents were included for qualitative synthesis. The network meta‐analysis for lesion depth involved 284 samples across 36 comparisons and ranked cross‐linking agents in terms of their caries lesion depth‐reducing effect (from best to worst): naringin > quercetin > riboflavin > proanthocyanidins > hesperidin > glutaraldehyde > cranberry > grape seed extract > untreated controls. Only naringin, quercetin, proanthocyanidins, and glutaraldehyde showed statistically significant efficacy over untreated controls. Cranberry extract excelled in reducing hydroxyproline release, followed by proanthocyanidins. In conclusion, proanthocyanidins positively affected both outcomes, suggesting they are prime candidates for translational research. Clinical studies are now essential to evaluate their real‐world effectiveness against root caries. PROSPERO‐CRD42023404911. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and network meta‐analysis compared various antibiotic treatments with surgical treatment for acute appendicitis. Methods: We searched PubMed, Embase, Cochrane Library, and Wanfang databases for randomized controlled trials (RCTs) that met the prespecified inclusion criteria up to July 2023. The interventions included various antibiotics and surgery. The outcomes measured were initial treatment success, treatment success at 1‐year follow‐up, and treatment‐related complications. Meta‐analysis was conducted using R software with the gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the interventions. Results: Thirteen RCTs involving nine treatments (cefotaxime [CTX] + tinidazole [TNZ], CTX + metronidazole [MTZ], ampicillin [AMP] + gentamicin [GEN] + MTZ, amoxicillin/clavulanate [AMC] + GEN, meropenem [MEM] + MTZ, AMC, ertapenem [ETP] + MTZ, ETP, and surgery) were included in this network meta‐analysis. In head‐to‐head comparisons, no statistically significant difference was found between any two interventions for initial treatment success (p > 0.05). The SUCRA indicated that surgery ranked first (SUCRA, 66.5%) for initial treatment success. Surgery was associated with an increased treatment success rate at 1‐year follow‐up compared to AMC (OR = 0.01, 95% CrI = 0.00–0.14, p < 0.05), MEM + MTZ (OR = 0.06, 95% CrI = 0.00–0.42, p < 0.05), and AMP + GEN + MTZ (OR = 0.02, 95% CrI = 0.00–0.23, p < 0.05). No statistically significant differences were found between any two interventions regarding complications (p > 0.05). Conclusion: Our network meta‐analysis suggests that surgery ranks highest for initial treatment success and treatment success at 1‐year follow‐up. However, surgery may increase the complication rate. [ABSTRACT FROM AUTHOR]

To compare the effects of different exercise training on executive function (EF) in obese or overweight individuals. PubMed, Web of Science, SPORTDiscus, MEDLINE, and CINAHL. The included articles, in English, should have been published from January 2000 to February 2024. All included studies were randomized controlled trials (RCTs) of exercise intervention in overweight or obese populations. The primary outcomes are EFs, which encompass core functions (e.g., inhibitory control, working memory (WM), and cognitive flexibility (CF)) and higher-level functions (e.g., responding, planning, and problem-solving). Therefore, the primary outcomes should include at least one of the above indicators. Additionally, given the focus of many exercise intervention studies on academic performance (AP) in obese adolescents, a secondary outcome includes AP. This meta-analysis synthesizes findings from 20 RCTs published between 2010 and 2023, encompassing a total of 1183 overweight or obese participants. Interventions were categorized into seven types: control training (CT), aerobic exercise (AE), resistance training (RT), coordinated physical activity (CPA), prolonged time of exercise (PTE), high-intensity interval training (HIIT), and AE combined with RT (mix mode, MIX). The surface under the cumulative ranking curve (SUCRA) results demonstrated the preferable effects of various interventions on EF improvement. SUCRA values indicate that CPA performs best in improving the accuracy and reaction speed of CF, as well as the reaction speed of inhibitory control in children and adolescents. AE shows significant effects in enhancing AP in this population. Additionally, PTE excels in improving CF and inhibitory control in middle-aged and older adults. Through subgroup analysis based on age and intervention duration, we found AE exhibited a significant effect on interventions for the 0–17 age group (SMD = 0.84, 95%CI = 0.31~1.38, p = 0.002) and interventions lasting 8–16 weeks showed significant improvement in EFs (SMD = 0.53, 95%CI = 0.00~1.05, p = 0.048). There was also a significant difference between CPA intervention and CT (SMD = 1.12, 95%CI = 0.45~1.80, p = 0.001) in children and adolescents. Additionally, PTE showed significant effects for middle-aged adults aged 17–59 (SMD = 0.93, 95%CI = 0.11~1.96, p < 0.027). Conclusions: This NMA found that CPA and AE have significant benefits for CF, inhibitory control, and AP in children and adolescents. Furthermore, PTE improves EFs in adults and older adults. Combining the findings of this study with previous related research, we recommend that OW/OB begin by interrupting prolonged sedentary behavior and increasing fragmented physical activity, gradually incorporating AE, RT, and CPA (such as jump rope). [ABSTRACT FROM AUTHOR]

Background: This study sought to determine the optimal treatment strategy and timing for cholecystectomy in managing gallbladder diseases during pregnancy. It evaluated the effectiveness of conservative management (CM), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC) in pregnancy and compared cholecystectomy outcomes across three trimesters. Methods: Studies comparing CM, LC, and OC or evaluating cholecystectomy outcomes across trimesters were included in a literature search until February 2024. Studies included were required to have at least 10 cases per treatment group and perform statistical comparisons. Two Bayesian network meta-analyses (NMAs) were conducted, and surface under cumulative ranking area (SUCRA) values, risk ratio (RR), mean difference (MD), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Results: Our study included 17 studies with 63,523 pregnant patients. The first NMA included data from 12 studies involving 29,052 pregnant women, revealing that LC had the lowest risk for preterm delivery, significantly lower than CM (RR: 0.23, 95% CrI: 0.07–0.55). LC also had a significantly reduced risk of fetal complications (RR: 0.42, 95% CrI: 0.16–0.57) and maternal complications (RR: 0.44, 95% CrI: 0.15–0.50) compared to OC. LC was associated with a significantly shorter length of stay than OC (MD: −2.77, 95% CrI: −8.37 to −2.87). The second NMA analyzed data from five population-based studies with 34,471 pregnant patients, finding no significant differences in preterm delivery and abortion rates across the three trimesters following cholecystectomy. Cholecystectomy performed in the third trimester significantly increased the risk of maternal complications, with relative risks compared to first (RR: 0.48, 95% CrI: 0.22–1.00) and second trimesters (RR: 0.42, 95% CrI: 0.21–0.93). Conclusions: LC is deemed the optimal treatment for gallbladder diseases during pregnancy. While cholecystectomy is safe to be performed across all trimesters, careful deliberation is recommended during the third trimester due to an increased risk of maternal complications. [ABSTRACT FROM AUTHOR]

Purpose: A network meta-analysis was utilized to compare the rehabilitative effectiveness of different exercise interventions on motor function in cerebral palsy(CP) patients. Methods: Computer searches were conducted across 9 databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase, and others, to identify randomized controlled trials focusing on different exercise interventions aimed at enhancing motor function in CP patients. The search spanned from the inception of the databases to January 31, 2024. Results: 20 articles, encompassing 570 patients and evaluating three types of exercise interventions, were included in the analysis. Results showed that aerobic training, resistance training, and mixed training exhibited superior outcomes compared to the control group, as evidenced by improvements in Gross Motor Function Measure scores, muscle strength, gait speed, and 10-Meter Walk Test scores (P < 0.05). Furthermore, the network meta-analysis revealed that resistance training ranked highest in enhancing gross motor function and gait speed among CP patients, while mixed training was deemed most effective in improving muscle strength and 10-Meter Walk Test scores. Conclusion: Exercise interventions have been shown to significantly improve motor function in CP patients. Among these, resistance training and mixed training stand out for their effectiveness in enhancing walking capabilities. Resistance training is specifically aimed at improving gross motor function, while mixed training focuses on increasing muscle strength. [ABSTRACT FROM AUTHOR]

Introduction: Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. Methods: A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2–3 months and 6 months post-surgery. Results: Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2–3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2–3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2–3 months post-VATS compared to PVB, ICNB, or TEA. Conclusions: PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients. Methods: We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 h), opioid consumption within 24 h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness. Results: Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg having a lower adverse drug reaction (ADR) incidence. Conclusions: Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300 mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC. Trial Registration: PROSPERO CRD42024522185. [ABSTRACT FROM AUTHOR]

Dopaminergic antipsychotics for schizophrenia have modest effects on symptoms and can cause important side effects. KarXT is an investigational drug for schizophrenia with a novel mechanism targeting muscarinic receptors that may limit these side effects. We conducted a systematic review and Bayesian random-effects network meta-analyses of short-term RCTs (3–8 weeks) that enrolled adults with schizophrenia. We compared KarXT to aripiprazole, risperidone, and olanzapine. We sought evidence for symptoms (Positive and Negative Symptoms Scale [PANSS]), weight gain, and all-cause discontinuation. We included 33 trials with 7193 participants. For total, positive, and negative symptoms, KarXT and the three antipsychotics were significantly more efficacious than placebo (mean difference [MD] vs placebo range for total symptoms: −10.67 to −8.05; positive symptoms: −3.46 to −2.53; negative symptoms: −1.99 to −1.44) but not significantly different from each other. KarXT was ranked as least likely to lead to weight gain. This was significant versus risperidone (−2.06 kg; 95 % CrI: −3.28, −0.87) and olanzapine (−2.86 kg; 95 % CrI: −3.97, −1.82). However, KarXT was ranked highest for all-cause discontinuation. This was significant versus risperidone (RR: 0.64; 95 % CrI: 0.46, 0.89) and olanzapine (RR: 0.6; 95 % CrI: 0.44, 0.83). KarXT and commonly used antipsychotics were more efficacious than placebo at reducing symptoms, but there were no clear differences in short-term efficacy among the active interventions. KarXT was less likely to cause weight gain, an important outcome for those with schizophrenia; short-term data do not permit evaluation of the risk for tardive dyskinesia. Long-term data are needed. [ABSTRACT FROM AUTHOR]

Background: Influenza vaccines are available to help protect persons aged ≥65 years, who experience thousands of influenza hospitalizations annually. Because some influenza vaccines may work better than others, we sought to assess benefit of high‐dose (HD), adjuvanted (ADJ), and recombinant (RIV) influenza vaccines ("enhanced influenza vaccines") compared with standard‐dose unadjuvanted influenza vaccines (SD) and with one another for prevention of influenza‐associated hospitalizations among persons aged ≥65 years. Methods: We searched MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library to identify randomized or observational studies published between January 1990 and October 2023 and reporting relative vaccine effectiveness (rVE) of HD, ADJ, or RIV for prevention of influenza‐associated hospitalizations among adults aged ≥65 years. We extracted study data, assessed risk of bias, and conducted random‐effects network meta‐analysis and meta‐regression. Results: We identified 32 studies with 90 rVE estimates from five randomized and 27 observational studies (71,459,918 vaccinated participants). rVE estimates varied across studies and influenza seasons. Pooled rVE from randomized studies was 20% (95% CI −54 to 59) and 25% (95% CI −19 to 53) for ADJ and HD compared with SD, respectively; rVE was 6% (95% CI −109 to 58) for HD compared with ADJ; these differences were not statistically significant. In observational studies, ADJ, HD, and RIV conferred modestly increased protection compared with SD (rVE ranging from 10% to 19%), with no significant differences between HD, ADJ, and RIV. With enhanced vaccines combined, rVE versus SD was 18% (95% CI 3 to 32) from randomized and 11% (95% CI 8 to 14) from observational evidence. Meta‐regression of observational studies suggested that those requiring laboratory confirmation of influenza reported greater benefit of enhanced vaccines. Conclusions: HD, ADJ, and RIV provided stronger protection than SD against influenza hospitalizations among older adults. No differences in benefit were observed in comparisons of enhanced influenza vaccines with one another. See related articles by Andrew and McGeer. [ABSTRACT FROM AUTHOR]

The combinations of BRAF inhibitor-based targeted therapies with immune checkpoint inhibitors currently represent less common therapeutic approaches in advanced melanoma. The aim of this study was to assess the safety and efficacy of currently available melanoma treatments by conducting a systematic review and network meta-analysis. Four databases were systematically searched for randomized clinical studies that included patients with advanced/metastatic melanoma receiving chemotherapy, immune checkpoint inhibitors, BRAF/MEK inhibitor therapy, or combinations thereof. The primary endpoints were treatment-related adverse events (TRAE), serious adverse events (SAE) of grade ≥ 3 adverse events, therapy discontinuation, progression-free survival (PFS), as well as objective response rate (ORR) and complete response rate (CRR). A total of 63 articles were eligible for our systematic review; 59 of them were included in the statistical analysis. A separate subgroup analysis was conducted to evaluate the efficacy outcomes, specifically in BRAF-positive patients. Triple combination therapy or triple therapy (inhibiting BRAF, MEK and PD1/PDL1 axis) showed significantly longer progression-free survival compared to BRAF + MEK combination therapies (HR = 0.76; 95% CI 0.64–0.9), but similar objective and complete response rates in BRAF-mutated melanoma. This safety analysis suggests that triple therapy is not inferior to combined immune checkpoint inhibitors (ICI) and BRAF/MEK therapies in terms of serious adverse events and therapy discontinuation rates. However, monotherapies and BRAF/MEK combinations showed notable advantage over triple therapy in terms of treatment-related adverse events. Combination strategies including BRAF/MEK-targeted therapies with ICI therapies are effective first-line options for advanced, BRAF-mutant melanoma; however, they are associated with more frequent side effects. Therefore, future RCTs are required to evaluate and identify high-risk subpopulations where triple therapy therapies should be considered. [ABSTRACT FROM AUTHOR]

Objective: To investigate and compare the effects of basic preconditioning regimens Bu/Cy, Cy/TBI and Flu/Bu for the treatment of patients in allogeneic hematopoietic stem cell transplantation. Methods: It comprised exploring the published literature in the databases of PubMed, EMBASE, Cochrane Library, and Web of Science, using suitable keywords pertaining to various basic pretreatments Bu/Cy, Cy/TBI, and Flu/Bu, prior to allogeneic hematopoietic stem cell transplantation, and then extracting the searched outcome indicators of Overall Survival (OS) and survival (herein represented as OS and survival). Further, the results were estimated with meta-analysis using R, where the incidence of GVHD was reported in odds ratio (OR) with its 95% confidence interval (95%CI). Results and Discussion: A total of 14 papers were included in this study, including 1436 cases were treated with Bu/Cy, 1816 cases with Cy/TBI, and 549 cases with Flu/Bu in the preconditioning regimen. After OS was the outcome pooled, compared with Flu/Bu in the preconditioning group, the results (Cy/TBI HR = 1.12 (95% Cl:1.04,1.61), Bu/Cy HR = 1.24 (95% Cl. 1.13,2.06)) showed that Flu/Bu preconditioning regimen significantly improved the overall survival rate of allogeneic HSCT patients. With the incidence of GVHD as the outcome summary, compared with Flu/Bu in the pretreatment group, the results (Cy/TBI HR = 1.24 (95% Cl:1.12, 1.82), Bu/Cy HR = 1.14 (95% Cl. 1.03, 2.12)) indicated that Flu/Bu in the pretreatment regimen group also significantly reduced the incidence of GVHD after allogeneic HSCT. Conclusion: Patients who received the basal preconditioning regimen Flu/Bu before allogeneic hematopoietic stem cell transplantation had the lowest hazard ratio for overall survival (OS) development. This indicates that the use of the basal preconditioning regimen Flu/Bu for the treatment of patients was the most effective, although the quality of the studies included needs to be confirmed by high-quality randomized controlled trials. [ABSTRACT FROM AUTHOR]

Objective: To ascertain whether psychotherapies combined with medication are more efficacious than those without medication and determine which combinations yield the best results. Methods: We conducted a network meta-analysis of randomised controlled trials (RCTs) comparing behavioural activation (BA), psychoanalytic/psychodynamic psychotherapy (DYN), interpersonal psychotherapy (IPT), individual face-to-face cognitive behavioural therapy (CBT (ftf)), group cognitive behavioural therapy (gCBT), and computerised or internet cognitive behavioural therapy (iCBT) with each other, or with treatment-as-usual (TAU) and wait list control (WLC) among adults formally diagnosed with depression. The psychotherapy arms were categorised as either psychotherapy alone or psychotherapy combined with medication (+ p). Treatment efficacy was assessed based on depression severity. We used a random-effects model to conduct a pairwise meta-analysis. Results: A total of 100 RCTs with 9,873 participants were included. The most common treatment was CBT (ftf) alone. All treatment arms were compared with TAU. Most psychotherapies combined with medication were superior to psychotherapy alone. In the subgroup analyses according to the baseline severity of depression, most psychotherapies combined with medication were more effective than psychotherapy alone in moderate-to-severe depression, whereas in mild depression, such differences were not observed. Among psychotherapies with medication, gCBT + p was significantly more effective than TAU and other psychotherapies in both the main and subgroup analyses. Conclusion: The efficacy of depression treatment varied depending on the severity of the depressive condition. Notably, gCBT + p was identified as the most effective approach for treating adult depression. [ABSTRACT FROM AUTHOR]

In 1925, the American entomologist Walter Sidney Abbott proposed an equation for assessing efficacy, and it is still widely used today for analysing controlled experiments in crop protection and phytomedicine. Typically, this equation is applied to each experimental unit and the efficacy estimates thus obtained are then used in analysis of variance and least squares regression procedures. However, particularly regarding the common assumptions of homogeneity of variance and normality, this approach is often inaccurate. In this tutorial paper, we therefore revisit Abbott's equation and outline an alternative route to analysis via generalized linear mixed models that can satisfactorily deal with these distributional issues. Nine examples from entomology, weed science and phytopathology, each with a different focus and methodological peculiarity, are used to illustrate the framework. [ABSTRACT FROM AUTHOR]

Context: Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Chinese patent medicines (CPMs) are widely used in clinical practice to treat DPN. Objective: This study aims to summarize the latest evidence on the harms and benefits of CPMs as adjunctive therapy for DPN. Materials and methods: We conducted searches for randomized controlled trials (RCTs) evaluating CPMs in conjunction with mecobalamin (Mec) or alpha-lipoic acid (αLA) across eight databases up to July 2024. The surface under the cumulative ranking area (SUCRA) was utilized to assess the clinical efficacy rate (CER), the peroneal motor nerve conduction velocity (pMNCV), the peroneal sensory nerve conduction velocity (pSNCV), the median motor nerve conduction velocity (mMNCV), and the median sensory nerve conduction velocity (mSNCV). Results: The search yielded 128 eligible studies with 31 CPMs with Mec and 39 eligible studies with 17 CPMs with αLA. SUCRA rankings indicated that, when combined with Mec, Mailuoning liquid (lMLN) was the most effective regimen for CER, Honghua injection (iHH) for pMNCV, Maixuekang capsule (cMXK) for pSNCV, Dengzhanxixin injection (iDZXX) for mMNCV, and Tongxinluo capsule (cTXL) for mSNCV. Combined with αLA, Danhong injection (iDH) showed the highest efficacy for CER, pSNCV, and mSNCV, while Xueshuantong injection (iXShT) was the most effective for pMNCV and mMNCV. Conclusion: This network meta-analysis confirms the efficacy and safety of 37 CPMs combined with Mec or αLA for treating DPN. However, given the potential risk of bias and the very low certainty of the evidence, these recommendations should be adopted with caution. [ABSTRACT FROM AUTHOR]

Context: Chinese medicine injections (CMIs) are widely used as adjuvant therapy for cervical cancer in China. However, the effectiveness of different types of CMIs remains uncertain. Objective: To assess the effectiveness and safety of CMIs when used in conjunction with radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), particularly in combination with cisplatin (DDP), docetaxel plus cisplatin (DP), and paclitaxel plus cisplatin (TP). Materials and methods: Randomized controlled trials (RCTs) were searched in databases including CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library, Embase, and Web of Science from inception to September 2023. We calculated the risk ratio with a 95% confidence interval and the surface under the cumulative ranking area curve (SUCRA) for the clinical efficacy rate (CER), the efficacy rate by Karnofsky Performance Status (KPS), and the rates of leukopenia reduction (LRR) and gastrointestinal reactions (GRR). Results: Forty-seven RCTs were included, including nine CMI types: Aidi, Fufangkushen, Huangqi, Kangai (KA), Kanglaite (KLT), Renshenduotang, Shenqifuzheng (SQFZ), Shenmai (SM), and Yadanzi. KLT and KA were likely optimal choices with radiotherapy for CER and KPS, respectively. KA and KLT were optimal choices with RT + DDP for CER and GRR, respectively. KLT was the likely optimal choice with RT + DP for CER and KA for both KPS and GRR. SM and SQFZ were the likely optimal choices with RT + TP for CER and LRR, respectively. Conclusions: The optimal recommendation depends on whether CMIs are used with radiotherapy or concurrent chemoradiotherapy. More high-quality RCTs are needed to confirm further and update the existing evidence. [ABSTRACT FROM AUTHOR]

Objective: Eczema is the most burdensome skin condition worldwide and topical anti‐inflammatory treatments are commonly used to control symptoms. The relative effectiveness and safety of different topical anti‐inflammatory treatments is uncertain. Design: Network meta‐analysis performed within a Cochrane systematic review to compare and statistically rank efficacy and safety of topical anti‐inflammatory eczema treatments. Data Sources: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to June 2023. Eligibility Criteria for Selected Trials: Included trials were within‐participant or between‐participant randomised controlled trials. Participants had eczema that was not clinically infected and was not contact dermatitis, seborrheic eczema or hand eczema. Interventions were topical anti‐inflammatory treatments but not complementary treatments, antibiotics alone, wet wraps, phototherapy or systemic treatments. Comparators were no treatment/vehicle or another topical anti‐inflammatory. Results: We identified 291 trials (45,846 participants), mainly in high‐income countries. Most were industry‐funded with median 3 weeks treatment duration. Risk of bias assessed using the Cochrane Risk of Bias 2.0 tool was high in 89% of trials, mainly due to risk of selective reporting. Network meta‐analysis of binary outcomes ranked potent and/or very potent topical steroids, tacrolimus 0.1% and ruxolitinib 1.5% among the most effective treatments for improving patient‐reported symptoms (40 trials, all low confidence) and clinician‐reported signs (32 trials, all moderate confidence). For investigator global assessment, the Janus kinas inhibitors ruxolitinib 1.5%, delgocitinib 0.5% or 0.25%, very potent/potent topical steroids and tacrolimus 0.1% were ranked as most effective (140 trials, all moderate confidence). Continuous outcome data were mixed. Local application site reactions were most common with tacrolimus 0.1% (moderate confidence) and crisaborole 2% (high confidence) and least common with topical steroids (moderate confidence). Skin thinning was not increased with short‐term use of any topical steroid potency (low confidence) but skin thinning was reported in 6/2044 (0.3%) participants treated with longer‐term (6–60 months) topical steroids. Conclusion: Potent topical steroids, Janus kinase inhibitors and tacrolimus 0.1% were consistently ranked as among the most effective topical anti‐inflammatory treatments for eczema. [ABSTRACT FROM AUTHOR]

Objective: The optimal low‐dose antiplatelet agents in patients with coronary heart disease (CHD) had not been determined. The objective of this study was to compare the impact of different low‐dose antiplatelet agents on cardiovascular outcomes and bleeding risks in patients with CHD. Methods: We searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, VIP, WanFang Data, and China Biology Medicine. Randomized controlled trials (RCTs) enrolling patients with CHD treated with different low‐dose platelet aggregation inhibitors were included. The revised Cochrane Risk of Bias Tool for Randomized Trials Risk was used to assess risk of bias in RCTs. A Bayesian random network meta‐analysis (NMA) was conducted, with odds ratios (OR) and 95% confidence intervals (CI) as effect estimates in R 4.2.2 software and Stata 15.0. The quality of evidence was assessed using the Confidence in NMA framework. Results: Sixteen RCTs involving 6350 patients were included. All participants were treated with a recommended dose of aspirin plus a low or standard dose of P2Y12 receptor antagonist. Low‐level evidence indicated the risk of major adverse cardiovascular events (MACE) was similar among low doses of prasugrel, ticagrelor, standard doses of prasugrel, ticagrelor, and clopidogrel. Low‐ to moderate‐level evidence suggested there was no difference in bleeding risk among low dose of prasugrel, ticagrelor, clopidogrel compared to standard dose of prasugrel, ticagrelor, and clopidogrel. NMA showed that low dose of prasugrel had the highest probability of being the best intervention in terms of MACE, myocardial infarction, and bleeding events leading to discontinuation. Conclusion: Based on low‐level evidence, low dose of prasugrel combined with standard dose of aspirin can be recommended for patients with CHD, low dose of ticagrelor was similar in terms of MACE and bleeding compared with standard dose of P2Y12 receptor antagonist. The systematic review was registered in PROSPERO with the registration number CRD42023438376. [ABSTRACT FROM AUTHOR]

Background and Aims Approximately 40% of patients with steroid-refractory acute severe ulcerative colitis [SR ASUC] require colectomies. Advanced therapies may reduce the short-term colectomy rates in patients with SR ASUC. However, comparative clinical studies evaluating the effectiveness of these rescue therapies are lacking. Therefore, we conducted a network meta-analysis to study the effectiveness of rescue therapies for SR ASUC. Methods Six randomised, controlled trials and 15 cohort studies, including 2004 patients, were analysed. Rescue drugs included tofacitinib, infliximab with a 5 or 10 mg/kg induction dose at 0, 2, and 6 weeks [IFX and IFX10, respectively], IFX with an accelerated regimen of three 5-mg/kg induction doses timed according to clinical need [accelerated IFX], tacrolimus, ciclosporin [CyA], ustekinumab, and adalimumab. Treatments were compared with a placebo. Results Tofacitinib odds ratio [OR]: 0.09 (95% confidence interval [CI]: 0.02–0.52]), accelerated IFX (OR: 0.16 [95% CI: 0.03–0.94]), IFX (OR: 0.2 [95% CI: 0.07–0.58]), and tacrolimus (OR: 0.24 [95% CI: 0.06–0.96]) significantly reduced the short-term colectomy rates compared with placebo. IFX10 and CyA tended to prevent colectomies. However, ustekinumab and adalimumab did not significantly affect the colectomy rates. Conclusion This is the first network meta-analysis to investigate the efficacy of advanced therapies in reducing short-term colectomy rates in patients with SR ASUC. Tofacitinib, accelerated IFX, standard IFX, and tacrolimus significantly reduced the colectomy rates in SR ASUC patients compared with placebo. Thus, advanced therapies should be considered for rescue therapies in patients with SR ASUC. [ABSTRACT FROM AUTHOR]

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

Oral cancer became a very common condition. WHO estimates that there are 4 cases of lip and oral cavity cancer for every 100,000 people worldwide. The early diagnosis of cancers is currently a top focus in the health sector. Recent systematic reviews and meta-analyses have identified promising biomarkers for early detection in several original research investigations. However, it is still unclear the quality of these evidence and which biomarker performs the best in terms of early detection. Therefore, the objective was, to map the methodological and reporting quality of available oral squamous cell carcinoma (OSCC) or head/neck squamous cell carcinoma (HNSCC) systematic reviews and meta-analysis. Secondly, to evaluate diagnostic accuracy of salivary biomarkers for common craniofacial cancers and to compare the diagnostic value of different salivary biomarkers. PubMed, Scopus, Web of Science, Embase and Cochrane Library electronic databases were used to map the methodological and reporting quality of the systematic reviews and meta-analysis conducted on the HNSCC, OSCC using the AMSTAR-2 checklist. The inclusion criteria were systematic reviews and meta-analysis published in the topic of HNSCC and OSCC biomarkers. Exclusion criteria were no animal studies; original primary studies, due to limitation of competency in other languages articles with language other than English were excluded. The sensitivity and specificity were calculated for salivary biomarkers and ranked according to network meta-analysis principles. A total of N = 5893 patients were included from four meta-analysis studies. All together, these included n = 37 primary studies. n = 94 biomarkers were pooled from these four meta-analyses and categorised into the stages at which they were detected (I-IV). In OSCC, Chemerin and MMP-9 displayed the highest sensitivity, registering 0.94 (95% CI 0.78, 1.00) and a balanced accuracy of 0.93. Phytosphingosine closely followed, with a sensitivity of 0.91 (95% CI 0.68, 0.99) and a balanced accuracy of 0.87. For HNSCC, the top three biomarkers are Actin, IL-1β Singleplex, and IL-8 ELISA. Actin leads with a sensitivity of 0.91 (95% CI 0.68–0.99), a specificity of 0.67, and an overall accuracy of 0.79. Subsequently, IL-1β Singleplex exhibits a sensitivity of 0.62 (95% CI 0.30–0.88), a specificity of 0.89, and an accuracy of 0.75, followed by IL-8 ELISA with a sensitivity of 0.81 (95% CI 0.54–0.97), a specificity of 0.59, and an accuracy of 0.70. In conclusion, there was highest sensitivity for MMP-9 and chemerin salivary biomarkers. There is need of further more studies to identify biomarkers for HNSCC and OSCC. • Methodological and reporting quality of systematic reviews and meta-analysis was more than 50% based on AMSTAR-2 assessment. • UPLC-MS (31.79%) was the most used method to detect the salivary biomarkers followed by RT-qPCR (11.26%). • Chemerin & MMP-9 show top sensitivity in OSCC followed by Phytosphingosine. • Top 3 biomarkers for HNSCC are Actin, IL-1β Singleplex and IL-8 ELISA. • Top biomarkers in early OSCC I-II: chemerin, MMP-9, Phytosphingosine, Pipecolinic acid. [ABSTRACT FROM AUTHOR]

This American Gastroenterological Association (AGA) living guideline is intended to support practitioners in the pharmacological management of moderate-to-severe ulcerative colitis (UC). A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to prioritize clinical questions, identify patient-centered outcomes, conduct an evidence synthesis, and develop recommendations on the pharmacological management of moderate-to-severe UC. The AGA guideline panel made 14 recommendations. In adult outpatients with moderate-to-severe UC, the AGA recommends the use of infliximab, golimumab, vedolizumab, tofacitinib, upadacitinib, ustekinumab, ozanimod, etrasimod, risankizumab, and guselkumab, and suggests the use of adalimumab, filgotinib, and mirikizumab over no treatment. In patients who are naïve to advanced therapies, the AGA suggests using a higher-efficacy medication (eg, infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, and guselkumab) or an intermediate-efficacy medication (eg, golimumab, ustekinumab, tofacitinib, filgotinib, and mirikizumab) rather than a lower-efficacy medication (eg, adalimumab). In patients who have previously been exposed to 1 or more advanced therapies, particularly tumor necrosis factor (TNF)-α antagonists, the AGA suggests using a higher-efficacy medication (eg, tofacitinib, upadacitinib, and ustekinumab) or an intermediate-efficacy medication (eg, filgotinib, mirikizumab, risankizumab, and guselkumab) rather than a lower-efficacy medication (eg, adalimumab, vedolizumab, ozanimod, and etrasimod). In adult outpatients with moderate-to-severe UC, the AGA suggests against using thiopurine monotherapy for induction of remission, but suggests using thiopurine monotherapy over no treatment for maintenance of (typically corticosteroid-induced) remission. The AGA suggests against using methotrexate monotherapy, for induction or maintenance of remission. In adult outpatients with moderate-to-severe UC, the AGA suggests the use of infliximab, adalimumab, and golimumab in combination with an immunomodulator over corresponding monotherapy. However, the AGA makes no recommendation in favor of, or against, the use of non-TNF antagonist biologics in combination with an immunomodulator over non-TNF biologic alone. In patients with UC who are in corticosteroid-free clinical remission for at least 6 months on combination therapy of TNF antagonists and an immunomodulator, the AGA suggests against withdrawal of TNF antagonists, but makes no recommendation in favor of, or against, withdrawing immunomodulators. In adult outpatients with moderate-to-severe UC, who have failed 5-aminosalicylates, and have escalated to therapy with immunomodulators or advanced therapies, the AGA suggests stopping 5-aminosalicylates. Finally, in adult outpatients with moderate-severe UC, the AGA suggests early use of advanced therapies and/or immunomodulator therapy, rather than gradual step-up after failure of 5-aminosalicylates. The panel also proposed key implementation considerations for optimal use of these medications and identified several knowledge gaps and areas for future research. This guideline provides a comprehensive, patient-centered approach to the pharmacological management of patients with moderate-to-severe UC. [ABSTRACT FROM AUTHOR]

Background: The prevention of locoregional recurrence (LRR) is crucial in breast cancer, as it translates directly into reduced breast cancer–related death. Breast cancer is subclassified into distinct intrinsic biological subtypes with varying clinical outcomes. Aims: To perform a systematic review and network meta-analysis (NMA) to determine the rate of LRR by breast cancer molecular subtype. Methods: A NMA was performed as per PRISMA-NMA guidelines. Molecular subtypes were classified by St Gallen expert consensus statement (2013). Analysis was performed using R and Shiny. Results: Five studies were included including 6731 patients whose molecular subtypes were available. Overall, 47.3% (3182/6731) were Luminal A (LABC: estrogen receptor (ER) + /human epidermal growth factor receptor-2 (HER2) − /progesterone receptor (PR) + or Ki-67 < 20%), 25.5% (1719/6731) were Luminal B (LBBC: ER + /HER2 − /PR − or Ki-67 ≥ 20%), 11.2% (753/6731) were Luminal B-HER2 + (LBBC-HER2: ER + /HER2 +), 6.9% (466/6731) were HER2 + (HER2 ER − /HER2 +), and finally 9.1% (611/6731) were triple-negative breast cancer (TNBC: ER − /HER2 −). The median follow-up was 74.0 months and the overall LRR rate was 4.0% (271/6731). The LRR was 1.7% for LABC (55/3182), 5.1% for LBBC (88/1719), 6.0% for LBBC-HER2 (45/753), 6.0% for HER2 (28/466), and 7.9% for TNBC (48/611). At NMA, patients with TNBC (odds ratio (OR) 3.73, 95% confidence interval (CI) 1.80–7.74), HER2 (OR 3.24, 95% CI 1.50–6.99), LBBC-HER2 (OR 2.38, 95% CI 1.09–5.20), and LBBC (OR 2.20, 95% CI 1.07–4.50) were significantly more likely to develop LRR compared to LABC. Conclusion: TNBC and HER2 subtypes are associated with the highest risk of LRR. Multidisciplinary team discussions should consider these findings to optimize locoregional control following breast cancer surgery. [ABSTRACT FROM AUTHOR]

Objective: Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the efficacy and safety of simple analgesics for the treatment of episodic tension-type headache (ETTH) in adults. Methods: We searched the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature database and International Clinical Trials Registry Platform databases for eligible randomized clinical trials reporting the efficacy and/or safety of simple analgesics. A Bayesian NMA was performed to compare relative efficacy and safety. The surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. PROSPERO registration number: CRD42018090554. Results: We highlighted six studies including 3507 patients. For the 2h pain-free rate, the SUCRA ranking was ibuprofen > diclofenac-K > ketoprofen > acetaminophen > naproxen > placebo. All drugs except naproxen reported a higher 2h pain-free rate than placebo, with a risk ratio (RR) of 2.86 (95% credible interval, CrI: 1.62-5.42) for ibuprofen and 2.61 (1.53-4.88) for diclofenac-K. For adverse events rate, the SUCRA ranking was: metamizol > diclofenac-K > ibuprofen > lumiracoxib > placebo > aspirin > acetaminophen > naproxen > ketoprofen. The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen. Moreover, all drugs were superior to placebo in the global assessment of efficacy. In particular, the RR of lumiracoxib was 2.47 (1.57-4.57). Global heterogeneity I 2 between the studies was low. Conclusions: Simple analgesics are considered more effective and safe as a placebo for ETTH in adults. Our results suggest that ibuprofen and diclofenac-K may be the two best treatment options for patients with ETTH from a comprehensive point of view (both high-quality evidence). [ABSTRACT FROM AUTHOR]

Expanding the systemic treatment options for patients with psoriasis, deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor is approved in the United States, European Union, China, Japan, Taiwan, Korea, and other countries for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. Evidence suggests the comparative efficacy of systemic therapies may be different in Asian versus White patients. This systematic review and network meta‐analysis (NMA) evaluated the clinical efficacy associated with deucravacitinib and other biologic or non‐biologic systemic treatments for moderate to severe plaque psoriasis in Asian populations. Electronic databases were searched to identify randomized trials of the interventions of interest. Multinomial random effects models adjusting for baseline placebo risk were used to estimate Psoriasis Area and Severity Index (PASI) responses at weeks 10–16. Of 8596 studies identified, 20 were included in the NMA. The estimated PASI 75 and 90 (95% credible interval) response rates for deucravacitinib were estimated to be 66% (49%–80%) and 40% (24%–58%) in Asian populations, notably higher than placebo (6% [4%–9%] and 1% [0.8–2%]) and apremilast (24% [12%–40%] and 9% [4%–20%]). No statistically significant difference was observed in PASI 75 and 90 responses between deucravacitinib and adalimumab, certolizumab pegol, infliximab, ustekinumab, and tildrakizumab. Deucravacitinib demonstrated robust efficacy in the Asian population, with PASI 75 and 90 responses comparable to some biologics. Deucravacitinib provides a convenient oral therapy with efficacy similar to several biologic therapies. [ABSTRACT FROM AUTHOR]

Introduction: This study used network meta-analysis (NMA) to inform and compare the number needed to treat (NNT), number needed to harm (NNH), and cost per improved outcome (CPIO) associated with more recently approved treatments for anti-acetylcholine receptor antibody-positive (anti-AChR Ab+) generalized myasthenia gravis (gMG). Methods: Clinical trials of neonatal Fc receptor (FcRn) inhibitors, efgartigimod intravenous (IV) and rozanolixizumab, and complement inhibitors, ravulizumab and zilucoplan, versus placebo (with background conventional treatment) were included in the primary NMA to compare efficacy and safety outcomes. The outputs from the NMAs were used to estimate NNT and NNH of each treatment versus placebo. CPIO (2024 USD) was estimated for a ≥ 3- or ≥ 5-point reduction from baseline in Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis-Activities of Daily Living (MG-ADL) scores. Sensitivity analyses were performed adding efgartigimod PH20 subcutaneous (SC) and eculizumab to the NMA. Results: Efgartigimod IV had the lowest NNT versus placebo for achieving a ≥ 3- and ≥ 5-point reduction in QMG, as well as a ≥ 5-point reduction in MG-ADL, whereas rozanolixizumab had the lowest NNT for a ≥ 3-point reduction in MG-ADL. The NNH versus placebo was similar across comparator treatments. Efgartigimod IV had the lowest CPIO among all treatments for all assessed efficacy outcomes. Sensitivity analyses yielded results consistent with primary analysis and indicated that efgartigimod PH20 SC had comparable NNT and CPIO values to efgartigimod IV, whereas eculizumab had comparable NNT and higher CPIO values compared to other complement inhibitors. Conclusions: FcRn inhibitors and complement inhibitors assessed in this study all demonstrated clinical benefit in terms of NNT as well as an acceptable safety profile in terms of NNH. Within the limitations of this meta-analysis, efgartigimod was associated with a favorable benefit–risk profile as well as a better economic value compared to ravulizumab, rozanolixizumab, and zilucoplan as treatments for anti-AChR Ab+ gMG. [ABSTRACT FROM AUTHOR]

Introduction: A systematic literature review and network meta-analysis was conducted on azilsartan medoxomil (AZL-M) versus other antihypertensive drugs' efficacy in hypertensive patients. Methods: The search utilized English platforms, from January 2000 until December 2023, resulting in 10,380 articles being screened. Screening criteria included hypertension (mild or moderate); first-line treatment and washout periods; studies (monotherapy) with AZL-M, angiotensin type II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor neprilysin inhibitor (ARNIs), beta-blockers, calcium channel blockers (CCBs), and diuretics, either as intervention or comparator; and antihypertension efficacy as an outcome measure. Study design was randomized clinical trials. Efficacy variables included absolute office systolic and diastolic blood pressure (BP) reductions. A total of 21 publications provided adequate data for analysis, of which 20 studies reported both systolic and diastolic BP and one study reported only the diastolic BP. Results: In 21 studies on systolic BP, against the common comparator placebo, the differences in systolic BP were significantly in favor of AZL-M, amlodipine, candesartan, irbesartan, nebivolol, nifedipine, olmesartan, sacubitril valsartan, telmisartan, and valsartan. The surface under the cumulative ranking curve (SUCRA) ranking shows that AZL-M 80 mg had the highest ranking, with a possibility of 93% being the best in all other included treatments. In 20 studies on diastolic BP, against the common comparator placebo, the differences in diastolic BP were significantly in favor of AZL-M, amlodipine, bisoprolol, nebivolol, olmesartan, sacubitril valsartan, telmisartan, and valsartan. The SUCRA ranking shows that AZL-M 80 mg had the highest ranking, with a possibility of 90% being the best in all other included treatments. Conclusion: AZL-M at 40 mg and 80 mg shows favorable efficacy compared to other anti-hypertensives, and the 80 mg dosage seemed to be the most efficacious of all the included treatments in reducing both office systolic and diastolic BP in patients with mild-to-moderate hypertension. [ABSTRACT FROM AUTHOR]

Background: The optimal strategy for using hydroxychloroquine to prevent coronavirus disease 2019 (COVID-19) in patients, either before or after exposure, remains unclear. We evaluated the safety and efficacy of different doses and treatment durations of hydroxychloroquine for COVID-19 prevention. Method: Databases including PubMed, Web of Science, Cochrane Library, EMBASE, Medline, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing different doses of hydroxychloroquine for COVID-19 prevention, from their inception to February 2024. Results: A total of 20 RCTs involving 12,372 patients were included. Meta-analysis results showed no significant difference between the hydroxychloroquine and control groups in reducing the incidence of syndrome coronavirus type 2 (SARS-CoV-2) positivity (OR = 0.83, 95% CI = 0.67, 1.03). However, the subgroup receiving a daily dose of 200–400 mg (OR = 0.62, 95% CI = 0.51, 0.75) and a treatment duration of 5–8 weeks (OR = 0.52, 95% CI = 0.31, 0.88) showed statistically significant reductions in SARS-CoV-2 positivity. According to the surface under the cumulative ranking curve (SUCRA), the most effective intervention was a 200–400 mg dose for 5–8 weeks. Conclusions: A hydroxychloroquine dose of 200–400 mg for a duration of 5–8 weeks may moderately reduce the risk of COVID-19 with a relatively low risk of adverse events. [ABSTRACT FROM AUTHOR]