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Background: Low back pain (LBP) is a common musculoskeletal disorder, and respiratory exercise is considered a nonsurgical management method. Therefore, this systematic review and meta-analysis aims to estimate the results of randomized controlled trials on the effect of respiratory training in reducing LBP and its dose relationship. Methods: The present study was conducted from January 2020 to January 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (2020). Relevant studies were searched in multiple databases including PubMed, Web of Science, the Cochrane Library, EBSCO, Scopus, ScienceDirect, Wan Fang and China Knowledge Network, ClinicalTrials.gov, and Google Scholar, using a combination of MeSH/Emtree terms and free-text words. The heterogeneity of the studies was assessed using the I2 statistic. Results: A total of 14 publications were included in the meta-analysis, with a total sample size of 698 individuals, aged 60–80 years. Respiratory exercise was effective in relieving LBP (standardized mean difference = −0.87, P <.00001) and improving physical disability (standardized mean difference = −0.79, P <.00001). The type of breathing and the total duration of breathing exercises were found to be the source of heterogeneity in this study by subgroup analysis. Subgroup analysis revealed that the most significant effect sizes of breathing resistance exercise to reduce LBP and the most significant effect sizes of breathing relaxation techniques to alleviate physical disability were performed 3 to 5 times per week and period >4 weeks. Respiratory exercise reducing LBP and improving functional disability was most effective when the total duration of the intervention was >500 minutes. Funnel plots showed that the results of the 2 overall studies were reliable without publication bias. Conclusions: Respiratory exercise can effectively reduce LBP and improve physical disability. Therefore, these exercises can be regarded as a part of a LBP management plan. We recommend an exercise program with 30 to 50 minutes, 3 to 5 times per week, and >4 weeks of breathing resistance exercise program as the most effective for treating LBP. [ABSTRACT FROM AUTHOR]

Precise protein supplementation strategies for muscle improvement are still lacking. The timing or type of protein supplementation has been debated as a window of opportunity to improve muscle mass, strength, and physical performance. We conducted a network meta-analysis of randomized controlled trials with protein supplements and resistance training. PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases were searched until May 1, 2023. We included 116 eligible trials with 4,711 participants that reported on 11 timing and 14 types of protein supplementation. Compared with placebo, protein supplementation after exercise (mean difference [MD]: 0.54 kg [95% confidence intervals 0.10, 0.99] for fat-free mass, MD: 0.34 kg [95% confidence intervals 0.10, 0.58] for skeletal muscle mass) and at night (MD: 2.85 kg [0.49, 5.22] for handgrip strength, MD: 12.12 kg [3.26, 20.99] for leg press strength) was most effective in improving muscle mass and strength, respectively (moderate certainty). Milk proteins (milk, whey protein, yogurt, casein, and bovine colostrum), red meat, and mixed protein were effective for gains in both muscle mass and strength (moderate certainty). No timing or type of protein showed a significant enhancement in physical performance (timed up-to-go test, 6-min walk test, and gait speed). Pre/postexercise and Night are key recommended times of protein intake to increase muscle mass and strength, respectively. Milk proteins are the preferred types of protein supplements for improving muscle mass and strength. Future randomized controlled trials that directly compare the effects of protein timing or types are needed. This trial was registered at International Prospective Register of Systematic Reviews as CRD42022358766. [ABSTRACT FROM AUTHOR]

An increase in visceral fat is associated with an increase in insulin resistance, so reducing body fat mass through exercise may help alleviate type 2 diabetes mellitus (T2DM). The current meta-analysis evaluated the effect of changes in body fat via an intervention of regular exercise on hemoglobin A1c (HbA1c) in patients with T2DM. The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, an overall duration of intervention ≥12 weeks, and reporting HbA1c and body fat mass. The mean differences (MDs) were defined as the MD between the exercise group and the control group, and the MDs in HbA1c (in percentage) and body fat mass (in kilograms) were calculated. All MDs in HbA1c were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the MD in the body fat mass (in kilograms) and the MD in HbA1c. Twenty studies (1,134 subjects) were analyzed. The pooled MD in HbA1c (in percentage) decreased significantly (−0.4; 95% confidence interval [−0.5, −0.3]) but contained significant heterogeneity (Q = 52.7, p <.01; I2 = 41.6%). A meta-regression analysis showed that a decrease in the MD in body fat mass was significantly associated with a decrease in the MD in HbA1c (R2 = 80.0%) and heterogeneity decreased (Q = 27.3, p =.61; I2 = 11.9%), and a reduction in body fat mass of 1 kg was estimated to decrease the HbA1c (%) by approximately 0.2. The current study suggested that a decrease in HbA1c due to regular exercise depends on a reduction in body fat mass in patients with T2DM. [ABSTRACT FROM AUTHOR]

Objectives: To explore the immediate and retention effect of real-time tibial acceleration feedback on running biomechanics during gait retraining. Methods: Five electronic databases were searched to identify relevant studies published before May 2022. The included studies were evaluated for methodological quality and bias risk, and data were extracted. A meta-analysis was conducted on the primary outcomes, including peak tibial acceleration (PTA) and vertical ground reaction force. Subgroup analysis was performed by gender, feedback criterion, mode, dosage, fading, retention period, and running environment to evaluate the source of heterogeneity. Qualitative analysis was performed to describe other variables. Results: Fourteen studies (174 participants) were eligible. Meta-analysis showed that real-time tibial acceleration feedback reduced PTA (P < .01, P < .01), vertical impact peak (P = .004, P < .01), vertical average loading rate (P < .01, P < .01), and vertical instantaneous loading rate (P < .01, P < .01) after feedback and during retention period (5 min-12 mo). Subgroup analysis showed that the immediate effect of vertical impact peak was more noticeable with mixed gender (P = .005) and fading feedback (P = .005) conditions, and the retention effect of PTA was more noticeable with high feedback dosage (P < .01) and fading feedback (P < .01) conditions. Conclusions: Real-time tibial acceleration feedback can reduce PTA and vertical ground reaction force during gait retraining, and for periods of 5 minutes to 12 months when the feedback is removed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures; however, the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel. This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS: Computer searches of CNKI, WanFang, VIP, CBM, PubMed, Embase, Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022. The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China. The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria, respectively. The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria. The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software for inclusion metrics. Outcome metrics included operative time, intraoperative bleeding, fluoroscopy time, fluoroscopy frequency, number of holes drilled, Majeed postoperative function score, the excellent and good rates of Matta fracture reduction, the excellent and good rates of Gras screw position, fracture healing time and complications. RESULTS: (1) A total of 13 publications were included, 2 were randomized controlled trials both referring to randomized methods, 11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale, 1 scored 8, 9 scored 7; and 1 scored 6; the quality of literature was good. A total of 748 patients were included, including 430 in the robot-assisted group and 318 in the freehand group. (2) The results of the metaanalysis showed that the operative time (MD=-28.30, 95%CI:-40.20 to -16.40), intraoperative bleeding (MD=-6.36, 95%CI:-10.06 to -2.66), intraoperative fluoroscopy time (MD=-12.13, 95%CI:-19.54 to -4.72), intraoperative fluoroscopy frequency (MD=-17.39, 95%CI:-29.00 to -5.78), number of intraoperative needle drillings (SMD=-9.50, 95%CI:-14.27 to -4.73) and the excellent and good rates of Gras screw position (OR=8.65, 95% Cl:3.26-22.92) in the robot-assisted group were significantly better than those in the freehand group (P<0.05). (3) In the robot-assisted group, the overall postoperative complication rate was significantly reduced (OR=0.10, 95% Cl: 0.02-0.48, P < 0.05). (4) No significant difference was detected in fracture healing time (MD=-0.08, 95%CI:-0.21,0.06), the excellent and good rates of Matta fracture repositioning rate (OR=2.06, 95%Cl: 0.97-4.39), and Majeed functional score (MD=0.91, 95%CI: -0.31-2.13) between both groups (P>0.05). CONCLUSION: Compared with freehand sacroiliac joint nailing, robotic assistance shortens the operative time, reduces intraoperative bleeding, decreases radiation damage to patients and medical staff, improves the excellent and good rate of screw position, and reduces the overall incidence of postoperative complications in patients, but there was no significant improvement in fracture reduction quality, fracture healing time, and postoperative function. In the future, more large-sample, multicenter, and high-quality randomized controlled trials are still needed to verify. [ABSTRACT FROM AUTHOR]

OBJECTIVE: There is no consensus on which sit-up strategy to adopt in knee osteoarthritis patients of different ages. Therefore, this study evaluated the biomechanical characteristics of sit-ups in knee osteoarthritis patients of different ages compared with healthy individuals by meta-analysis system and analyzed the sit-up movement patterns of patients of different ages to provide a reference for improving the sit-up function of patients. METHODS: By March 2023, observational studies of biomechanical characteristics of sitting up in patients with knee osteoarthritis and healthy population were retrieved on PubMed, Web of Science and CNKI. Subjects were required to be patients over 50 years of age with knee osteoarthritis who had KellgrenLawrence severity grading ≥I on knee imaging and who had regular knee pain. Subjects were analyzed by age (50-60 years vs. over 60 years) and severity (mild to moderate patients vs. severe patients) subgroups according to inclusion and exclusion criteria. Quality assessment was performed using the modified Down and black scale. Stata 16.0 software was used to perform subgroup analysis to determine the biomechanical characteristics of sitting up in patients with knee osteoarthritis of different ages and severities. RESULTS: A total of 14 randomized controlled trials (824 subjects) were included in the meta-analysis. The mean quality score of all included literature was 76.2, with a range of 66.7 to 86.7, all of which were of medium to high quality and representative. The included studies were of moderate to high quality and representative. Meta-analysis results found that (1) compared to healthy individuals, patients with knee osteoarthritis had longer total sitting up time (SMD=0.92, 95%CI:0.76-1.09), P < 0.001) and longer extension phase time (SMD=0.46, 95%CI:0.18-0.74, P=0.001). Compared to mild to moderate patients, the total duration increased more significantly in severe patients (P < 0.001) and the duration of the extension phase increased more significantly in patients over 60 years of age than in patients 50-60 years of age (P=0.001). (2) Compared to healthy individuals, patients with knee osteoarthritis had greater sitting-up trunk flexion motion range (SMD=0.64, 95%CI:0.37-0.91, P < 0.001); knee flexion motion range (SMD=-0.47, 95%CI: -0.70 to -0.24, P < 0.001) and ankle dorsiflexion motion range (SMD=-0.32, 95%CI:-0.56 to -0.08, P=0.01) were smaller. And knee flexion motion range decreased more significantly in patients over 60 years of age than in patients 50-60 years of age (P < 0.001). (3) The peak hip flexion moment (SMD=-0.57, 95%CI:-0.83 to -0.31, P < 0.001) and peak knee extension moment (SMD=-0.83, 95%CI:-1.08 to -0.59, P < 0.001) were smaller in patients with knee osteoarthritis. CONCLUSION: (1) Patients with knee osteoarthritis over the age of 60 years have a longer sit-up cushion and extension phase than patients aged 50 to 60 years. The increase in total sit-up duration was also more pronounced in patients with higher severity grades. The increased length of sitting up in patients with advanced age and knee osteoarthritis severity may increase the duration of cartilage loading, exacerbate knee pain symptoms, and increase the difficulty of sitting up in this population. (2) Patients with knee osteoarthritis exhibit limited knee and ankle flexion motion range. Knee mobility is more limited in patients over 60 years of age. (3) Patients with knee osteoarthritis have reduced peak hip flexion and knee extension moments, which may be a compensatory strategy for pain relief. [ABSTRACT FROM AUTHOR]

Background: Hormone therapy, which is widely prescribed for prostate cancer, might induce cognitive impairment and affect the autonomy of elderly patients. However, previous studies provided conflicting results. The aim of this systematic review and meta‐analysis was to synthesize the longitudinal impact of hormone therapy on objective (cognitive tests) and subjective (questionnaires) cognition. Methods: A search was performed of the PubMed, Web of Science, and PsycINFO databases. Studies that longitudinally assessed cognition in patients undergoing androgen‐deprivation therapy and new‐generation hormone therapy were considered. To perform a meta‐analysis, available scores were aggregated and classified into six objective domains and one subjective domain. Weighted mean effect sizes were computed using a random effect model. Results: Twenty studies were included in the systematic review (1440 patients), and 15 could be included in the meta‐analysis (1093 patients). In the systematic review, 20%–50% of patients had objective cognitive impairment before treatment initiation. The meta‐analysis revealed a decline in subjective cognition (g = −0.44; p =.03) with androgen‐deprivation therapy and new‐generation hormone therapy. All other effect sizes were small (from g = −0.02 to g = 0.18), and none of them indicated a significant decline in objective cognition. Significant heterogeneity was observed in all domains of objective cognition. Conclusions: This synthesis presents the first meta‐analytic evidence of the negative impact of androgen‐deprivation therapy and new‐generation hormone therapy on subjective cognition. In contrast, there was no conclusive evidence of a decline in objective cognition. The high heterogeneity underscores the need for homogeneous cognitive research on prostate cancer. Plain Language Summary: There is no consensus on the cognitive impairment induced by hormone therapy for prostate cancer, despite the implications for patients' care and daily life.This synthesis of published studies demonstrated an increase in perceived cognitive difficulties but did not prove a decline in cognitive performance during treatment. This systematic review and meta‐analysis demonstrates that hormone therapy for prostate cancer has an impact on perceived cognitive impairment. Few studies have assessed the impact of new‐generation hormone therapy on objective cognition, and there was no conclusive evidence of objective decline, regardless of the treatment generation. [ABSTRACT FROM AUTHOR]

Many studies have analyzed the association between family cohesion and depression, but there are different views and the results are inconsistent. It is necessary to use meta-analysis to explore the association between family cohesion and depression and its influencing factors. Chinese database (China National Knowledge Infrastructure) and English databases (ERIC, MEDLINE, Web of Science Core Collection, Elsevier SD, PsycINFO, PsycArticles, and ProQuest dissertations and theses) were searched for articles published by November 2023. Measurements of family cohesion and depression, study design, age, gender, cultural background, and sampling year were analyzed as moderators. Meta-analysis was performed using the random effects model in CMA3.0 software. A total of 71 studies (90,023 participants) were included in this study. The meta-analysis revealed a significant negative correlation between family cohesion and depression (r = −0.31, 95 % CI [−0.35, −0.27]). The association was moderated by measurements of family cohesion and depression, design type, and cultural background, but not by age, gender, or sampling year. The sample size included in this study is relatively small in European and African cultures, making it challenging to analyze cultural differences in the study results at present comprehensively. The findings contribute to the ongoing debate between Social Support Theory and The Circumplex Model, showing that individuals with lower family cohesion tend to experience higher levels of depression. • This meta-analysis found a high correlation between family cohesion and depression. • Measurement tools, cultural background, and design type can moderate this association. • This study clarified the debate on Social Support Theory and the Circumplex Model. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is an immune-mediated and multi-systemic disease which may affect the nervous system, causing neuropsychiatric SLE (NPSLE). Recent neuroimaging studies have examined brain functional alterations in SLE. However, discrepant findings were reported. This meta-analysis aims to identify consistent resting-state functional abnormalities in SLE. PubMed and Web of Science were searched to identify candidate resting-state functional MRI studies assessing SLE. A voxel-based meta-analysis was performed using the anisotropic effect-size version of the seed-based d mapping (AES-SDM). The abnormal intrinsic functional patterns extracted from SDM were mapped onto the brain functional network atlas to determine brain abnormalities at a network level. Twelve studies evaluating fifteen datasets were included in this meta-analysis, comprising 572 SLE patients and 436 healthy controls (HCs). Compared with HCs, SLE patients showed increased brain activity in the bilateral hippocampus and right superior temporal gyrus, and decreased brain activity in the left superior frontal gyrus, left middle temporal gyrus, bilateral thalamus, left inferior frontal gyrus and right cerebellum. Mapping the abnormal patterns to the network atlas revealed the default mode network and the limbic system as core neural systems commonly affected in SLE. The number of included studies is relatively small, with heterogeneous analytic methods and a risk of publication bias. Brain functional alterations in SLE are predominantly found in the default mode network and the limbic system. These findings uncovered a consistent pattern of resting-state functional network abnormalities in SLE which may serve as a potential objective neuroimaging biomarker. • This study is the first meta-analysis to investigate the resting-state functional alterations in SLE. • SLE-related brain abnormalities are predominantly found in the default mode network and the limbic system. • Resting-state fMRI may be an objective neuroimaging biomarker for identifying brain abnormalities in SLE. [ABSTRACT FROM AUTHOR]

Patients with major depression often suffer from excessive interpersonal sensitivity, although it is not typically measured in antidepressant clinical trials. Preliminary evidence suggests selective serotonin reuptake inhibitors have the capacity to reduce interpersonal sensitivity. This was a pooled analysis of data from 1709 patients in three randomized, double-blind, placebo-controlled trials of fluoxetine and paroxetine for acute major depressive disorder. Depressive symptoms were assessed with the Hamilton Depression Rating Scale. A factor from the Symptom Checklist was used to assess interpersonal sensitivity. Our outcome of interest was change from baseline scores at the last assessment (up to 8 or 12 weeks, depending on the trial). Both medications produced significantly greater reductions in interpersonal sensitivity relative to placebo. The effect of medication remained significant after controlling for depression improvement, which explained 18.5% of the variation in interpersonal sensitivity improvement among those treated with active medication. The effect of medication on depressive symptoms, relative to placebo, was not influenced by baseline interpersonal sensitivity. The outcome measured interpersonal sensitivity over the last week, and the results do not necessarily reflect changes in long-standing, trait-like patterns of interpersonal sensitivity. Only two medications were studied. Selective serotonin reuptake inhibitors are effective at treating interpersonal sensitivity in acutely depressed patients. This appears to be a unique drug effect that is not only the result of depression improvement. Future clinical trials might benefit from assessing interpersonal sensitivity more routinely. • Paroxetine and fluoxetine reduced interpersonal sensitivity more than placebo. • This effect could not be fully explained by concurrent depression improvement. • Baseline interpersonal sensitivity did not moderate the depression treatment effect. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the diagnostic value of ML techniques based on sMRI or/and fMRI for ADHD. We conducted a comprehensive search (from database creation date to March 2024) for relevant English articles on sMRI or/and fMRI-based ML techniques for diagnosing ADHD. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), summary receiver operating characteristic (SROC) curve and area under the curve (AUC) were calculated to assess the diagnostic value of sMRI or/and fMRI-based ML techniques. The I2 test was used to assess heterogeneity and the source of heterogeneity was investigated by performing a meta-regression analysis. Publication bias was assessed using the Deeks funnel plot asymmetry test. Forty-three studies were included in the systematic review, 27 of which were included in our meta-analysis. The pooled sensitivity and specificity of sMRI or/and fMRI-based ML techniques for the diagnosis of ADHD were 0.74 (95 % CI 0.65–0.81) and 0.75 (95 % CI 0.67–0.81), respectively. SROC curve showed that AUC was 0.81 (95 % CI 0.77–0.84). Based on these findings, the sMRI or/and fMRI-based ML techniques have relatively good diagnostic value for ADHD. Our meta-analysis specifically focused on ML techniques based on sMRI or/and fMRI studies. Since EEG-based ML techniques are also used for diagnosing ADHD, further systematic analyses are necessary to explore ML methods based on multimodal medical data. sMRI or/and fMRI-based ML technique is a promising objective diagnostic method for ADHD. • sMRI/fMRI-based ML: Promising ADHD objective diagnosis. • Meta-analysis confirms sMRI/fMRI ML's good ADHD diagnostic value. • ML complements behavioral assessments; together, they enhance ADHD diagnosis and treatment. [ABSTRACT FROM AUTHOR]

ObjectivesMethodResultsConclusions\nKey PointsSupervisee nondisclosure (SND), a prevalent phenomenon in clinical supervision, hinders the learning process in supervision and may ultimately harm clients. The purpose of this study was to explore the relationship between supervisee nondisclosure and supervisee characteristics, supervisor characteristics, supervisory relationship, and supervision outcome.A comprehensive search following PRISMA guidelines was performed to collect studies that met the inclusion criteria. A meta-analysis was conducted with 61 articles (213 effect sizes, 12,376 participants).A low-to-moderate relationship was found between SND and supervisee characteristics. A moderate relationship was found for SND and supervisor characteristics. A moderate-to-high relationship was found for SND and supervisory relationship. Supervisee role conflict/ambiguity, supervisor multicultural competence/orientation, and supervisory working alliance showed the highest effect sizes in relationship to SND. Finally, a moderate relationship was found between SND and supervision outcome, demonstrating that SND was related to lower supervision satisfaction, perceived competence, and self-efficacy.Our findings demonstrate the importance of attending to nondisclosures in supervision. Supervisors should seek to create a collaborative and culturally sensitive relationship that can help the supervisee feel safe in providing information.What is already known about this topic: During clinical supervision, supervisees often withhold information from their supervisors.Concealment of perceived clinical errors or negative reactions to the supervisor may limit the learning opportunities of the supervisee, and affect their capability to provide quality services.Nondisclosure in supervision is related to the supervisee’s characteristics (e.g. attachment), the supervisor’s characteristics (e.g. supervisory style), supervisory relationship (e.g. supervisory alliance), and supervision outcome (e.g. self-efficacy).During clinical supervision, supervisees often withhold information from their supervisors.Concealment of perceived clinical errors or negative reactions to the supervisor may limit the learning opportunities of the supervisee, and affect their capability to provide quality services.Nondisclosure in supervision is related to the supervisee’s characteristics (e.g. attachment), the supervisor’s characteristics (e.g. supervisory style), supervisory relationship (e.g. supervisory alliance), and supervision outcome (e.g. self-efficacy).What this topic adds: This research is the first to conduct a comprehensive meta-analysis of supervisee nondisclosure including all supervision related variables that have been studied over the past 27 years. This meta-analysis enables an exhaustive coverage of the current literature on nondisclosures in supervision.Although nondisclosures are affected by supervisee characteristics, this connection may not necessarily be strong. Rather, variables pertaining to the supervisor or the supervisory relationship, such as the quality of the working relationship or supervisor multicultural competence/orientation, may contribute more to SND.Synthesis of individual studies show that nondisclosures may negatively impact supervision outcomes such as supervision satisfaction and supervisee competence. This calls for the importance of attending to SND.  This research is the first to conduct a comprehensive meta-analysis of supervisee nondisclosure including all supervision related variables that have been studied over the past 27 years. This meta-analysis enables an exhaustive coverage of the current literature on nondisclosures in supervision.Although nondisclosures are affected by supervisee characteristics, this connection may not necessarily be strong. Rather, variables pertaining to the supervisor or the supervisory relationship, such as the quality of the working relationship or supervisor multicultural competence/orientation, may contribute more to SND.Synthesis of individual studies show that nondisclosures may negatively impact supervision outcomes such as supervision satisfaction and supervisee competence. This calls for the importance of attending to SND.   [ABSTRACT FROM AUTHOR]

The prognostic factors of ICI-including combined therapy in patients with metastatic renal cell carcinoma were analyzed by systematic review. We searched Web of Science, Cochrane, PubMed, CNKI, Wanfang and other databases for randomized controlled trials and clinical trials of combination therapy including ICIs in the treatment of metastatic renal cell carcinoma. The search time was from the establishment of the database to September 2023. Data were extracted and evaluated with RevMan 5.4 software. Six studies were included, including 4723 patients. The results showed that ① in terms of progression-free survival, the factors of age < 65 years old, male sex, Canada and Western Europe, nephrectomy, different IMDC class, number of organs with metastases and PD-L1 expression ≥ 1% significantly prolonged PFS in patients with metastatic cancer treated by combination therapy including ICIs; ② in terms of overall survival rate, the factors of age < 65 years old, female sex, nephrectomy, different IMDC class and PD-L1 expression ≥ 1% significantly prolonged the OS of patients with metastatic cancer treated by combination therapy including ICIs. Age, sex, region, nephrectomy, different IMDC class, number of organs with metastases and PD-L1 expression are independent factors influencing the efficacy of combination therapy including ICIs in the treatment of metastatic renal cell carcinoma. Systematic evaluation of baseline indicators of patients with metastatic renal cell carcinoma to predict clinical benefits can effectively improve the benefit rate of patients. [ABSTRACT FROM AUTHOR]

Purpose: Vitamins and polyunsaturated fatty acids (PUFAs) have been studied extensively as safe and manageable nutrient interventions for mild cognitive impairment (MCI). The purpose of the current meta-analysis was to examine the effects of vitamins and PUFAs on cognition and to compare the effects of single and multiple nutrient subgroups in patients with MCI. Methods: Randomized controlled trials (RCTs) written in English and Chinese were retrieved from eight databases, namely, PubMed, CENTRAL, Embase, CINAHL, Web of Science, SinoMed, CNKI, and Wanfang Data, from their respective dates of inception until 16 July 2023. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool 2.0. Meta-analyses were performed to determine the standardized mean differences (SMDs) in global cognitive function, memory function, attention, visuospatial skills, executive function, and processing speed between the supplement and control groups using 95% confidence intervals (CI) and I2. Prospero registration number: CRD42021292360. Results: Sixteen RCTs that studied different types of vitamins and PUFAs were included. The meta-analysis revealed that vitamins affected global cognitive function (SMD = 0.58, 95% CI = [0.20, 0.96], P = 0.003), memory function (SMD = 2.55, 95% CI = [1.01, 4.09], P = 0.001), and attention (SMD = 3.14, 95% CI = [1.00, 5.28], P = 0.004) in patients with MCI, and PUFAs showed effects on memory function (SMD = 0.65, 95% CI = [0.32, 0.99], P < 0.001) and attention (SMD = 2.98, 95% CI = [2.11, 3.84], P < 0.001). Single vitamin B (folic acid [FA]: SMD = 1.21, 95% CI = [0.87, 1.55]) supplementation may be more effective than multiple nutrients (FA and vitamin B12: SMD = 0.71, 95% CI = [0.41, 1.01]; and FA combined with docosahexaenoic acid [DHA]: SMD = 0.58, 95% CI = [0.34, 0.83]) in global cognitive function. Conclusions: FA, vitamin B6, vitamin B12, and vitamin D may improve global cognitive function, memory function, and attention in patients with MCI. Eicosapentaenoic acid (EPA) and DHA may improve memory function and attention. We also noted that FA may exert a greater effect than a vitamin B combination (FA and vitamin B12) or the combination of FA and DHA. However, because of the low evidence-based intensity, further trials are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

The use of opportunistic computed tomography (CT) image-based biomarkers may be a low-cost strategy for screening older individuals at high risk for osteoporotic fractures and populations that are not sufficiently targeted. This review aimed to assess the discriminative ability of image-based biomarkers derived from existing clinical routine CT scans for hip, vertebral, and major osteoporotic fracture prediction. A systematic search in PubMed MEDLINE, Embase, Cochrane, and Web of Science was conducted from the earliest indexing date until July 2023. The evaluation of study quality was carried out using a modified Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. The primary outcome of interest was the area under the curve (AUC) and its corresponding 95% confidence intervals (CIs) obtained for four main categories of biomarkers: areal bone mineral density (BMD), image attenuation, volumetric BMD, and finite element (FE)-derived biomarkers. The meta-analyses were performed using random effects models. Sixty-one studies were included in this review, among which 35 were synthesized in a meta-analysis and the remaining articles were qualitatively synthesized. In comparison to the pooled AUC of areal BMD (0.73 [95% CI 0.71–0.75]), the pooled AUC values for predicting osteoporotic fractures for FE-derived parameters (0.77 [95% CI 0.72–0.81]; p < 0.01) and volumetric BMD (0.76 [95% CI 0.71–0.81]; p < 0.01) were significantly higher, but there was no significant difference with the pooled AUC for image attenuation (0.73 [95% CI 0.66–0.79]; p = 0.93). Compared to areal BMD, volumetric BMD and FE-derived parameters may provide a significant improvement in the discrimination of osteoporotic fractures using opportunistic CT assessments. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The transporter associated with antigen processing 2 (TAP2) gene is implicated in the MHO class I antigen processing and immune regulation. TAP2 rs4148876 polymorphism as a risk factor for cervical cancer (CC) risk has been investigated in many studies; however, with inconclusive results. A trial sequential meta-analysis was performed for a thorough evaluation of the relationship between TAP2 rs4148876 gene polymorphism and cc risk. EVIDENCE ACQUISITION: Medline (PubMed), EMBASE (Excerpta-Medica) and Google Scholar were used as sources for the selection of relevant articles about TAP2 rs4148876 gene polymorphism and CC risk. The significance of association between TAP2 rs4148876 and CC risk was determined using odds ratios (ORs) and 95% confidence intervals (CIs) estimation. Statistical I2 tests and sensitivity analyses were performed to detect inter study heterogeneity and test the statistical stability of the overall estimate association. Egger's test was used to detect the publication bias among included studies. EVIDENCE SYNTHESIS: The pooled analysis indicated significant risk for homozygous mutant (MM vs. WW: P=0.001; OR=3.744, 95% CI=1.972-7.106) and recessive (MM vs. WW+WM: P=0.001; OR=3.899, 95% CI=2.065-7.361) genetic models with CC. However, there was no association of allelic (M vs. W: P=0.544 OR =1.355, 95% CI = 0.507-3.623), heterozygous (MW vs. WW: P=0.730; 0R=0.857, 95% CI=0.357-2.059) and dominant (MM+MW vs. WW: P=0.563; OR=1.321, 95% CI=0.514- 3.395) models with CC risk. The study showed no publication bias. CONCLUSIONS: Our results indicate a positive association of TAP2 rs414884 genetic variant with CC. This is the first step in establishing an effective risk prediction for CC, which may help us better identify and prevent the occurrence of CC. However, exhaustive prospective epide- miological studies are warranted to confirm TAP2 rs414884 polymorphism as a risk factor in the etiology of CC. [ABSTRACT FROM AUTHOR]

BACKGROUND: CCND1 gene encoding the cyclin D1 protein is critically implicated in the regulation of cell cycle and genetic alterations in the CCND1 gene are thought to increase susceptibility for cancer development by altering the pathways of cellular transition and proliferation. In particular, the association of G870A polymorphism in the CCND1 gene with the pathogenesis of colorectal cancer (CRC) has been evaluated in many studies. However, the results have been inconclusive among the Asian population. In this trial sequential meta-analysis, we attempt for a precise evaluation of the relationship between CCND1 G870A gene polymorphism with CRC risk, specifically in the Asian population. METHODS: Medline (PubMed), EMBASE (Excerpta-Medica) and Google Scholar were employed for the selection of relevant studies. The significance of association between CCND1 G870A gene polymorphism with CRC risk was determined by estimation of the Odds Ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The pooled analysis indicated no significant relationships between the allelic (A vs. G: P=0.274 OR=1.093, 95% CI=0.932-1.281), heterozygous (AG vs. GG: P=0.724; OR=1.029, 95% CI=0.876-1.209), homozygous mutant (AA vs. GG: P=0.363; OR=1.159, 95% CI=0.843- 1.595), dominant (AA + AG vs. GG: P=0.423; OR=1.101, 95% CI=0.871-1.391) and recessive (AA vs. GG+ AG: P=0.262; OR=1.126, 95% CI=0.9150-1.384) genetic models and the susceptibility for CRC. Moreover, the study showed no publication bias. CONCLUSIONS: While our meta-analysis indicates that the CCND1 G870A genetic variant may not be a risk factor for CRC development in the Asian population, larger prospective-epidemiological studies evaluating the roles of CCND1 G870A polymorphism in the etiology of CRC are required to confirm the present findings. [ABSTRACT FROM AUTHOR]

Background and aims: The frequent occurrence of extreme rainfall events results in soils experiencing drying–rewetting (DRW) cycles. Such rewetting can lead to a surge in soil CO2 emissions; however, the main regulatory factors involved in this priming effect are unclear. Methods: In this study, we conducted a meta-analysis using data extracted from 43 published papers, to determine the direct regulatory factors involved in the priming effect of soil CO2. Results: The results indicated that the priming effect of rewetting on soil CO2 emissions was influenced by ecosystem type, soil properties, climatic factors, and the number of DRW cycles. The priming effect was the highest in cropland but the lowest in grassland when taking flux values observed before rewetting as the control group. It was also greater in acidic soils (pH < 6.5) and soils with a high clay fraction (clay ≥ 30%) than in other soils. The effect size (lnRR) of soil CO2 emissions was exponentially related to the mean annual precipitation (MAP), and decreased with increases in MAP. In DRW experiments, the priming effect of the first rewetting on soil CO2 emissions was the largest, an effect that gradually decreased with the number of DRW cycles, before disappearing completely. Most importantly, soil moisture influenced the peak time and the pulse time of the priming effect: the greater the change in soil moisture, the longer the peak time duration; the higher the maximum soil moisture content after rewetting, the longer the pulse time duration; and the lower the initial soil moisture content, the bigger the priming effect. Conclusion: Generally, physical mechanisms, especially soil moisture, directly regulate the CO2 priming effect during DRW cycles. Thus, this study provides a theoretical basis for assessing and predicting the impact of future precipitation changes on soil carbon cycling. Future studies should also carefully monitor any changes in soil microorganisms in response to changes in soil moisture during DRW cycles, because these appear to be significantly involved in CO2 release from soils. [ABSTRACT FROM AUTHOR]

Aims: No tillage (No-till, NT), a form of conservation agricultural management, can improve food security and alleviate world climate change by influencing crop yield and soil organic carbon (SOC), but the effects of NT on crop yields and SOC and the major factors which influence these effects remain poorly understood. Methods: We conducted a global meta-analysis using 5230 paired observations from 446 studies to evaluate the effects of NT on upland crop yield and SOC and to explore the associated influencing factors. Results: Generally, NT decreased upland crop yields by 5% (P < 0.05) and increased SOC sequestration by 9.9% (P < 0.05). Specifically, wheat and maize yields decreased by 7.7% and 2.3%, respectively. Our analyses indicate that NT combined with crop residue return and crop rotation reduced the negative effect of NT on crop yield from 5% to 2.44% and increased SOC up to 12.77%. The effects of NT on yield and SOC varied depending on the regulating factors. No-till increased yields in relatively arid areas, but reduced yields in more humid areas, whereas SOC is more likely to increase in humid regions. Soil organic carbon sequestration increased with temperature, but yield losses also increased in warmer regions. Conclusions: Our study suggests that NT combined with crop residue return and crop rotation could enhance SOC sequestration under moist and warm conditions without compromising crop yield. It may also improve soil quality and help alleviate global food security and climate change. [ABSTRACT FROM AUTHOR]

Whilst the practitioner field around current student communications has developed in recent years, most published research still focuses either on prospective students, theoretical benefits of student communications or usage of individual channels of communication. This paper contributes to policy and practice by providing the first UK-wide look at current students' communications preferences and behaviours through a meta-analysis of 17 student communications surveys (total students surveyed 20,134). Results show that students expect their universities to utilise a range of channels (including email, social media and student portals) – i.e. an integrated marketing theory approach. Most students feel that they receive the right level of information; however, overall satisfaction with communications has decreased in recent years. This paper provides recommendations for practice, as well as a template to improve consistency in future institutional student communications evaluations. [ABSTRACT FROM AUTHOR]

Background and purpose: The benefit and safety of intravenous thrombolysis before endovascular thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion (BAO) remains unclear. This article aims to investigate the clinical outcomes and safety of endovascular thrombectomy with versus without intravenous thrombolysis in acute BAO stroke patients. Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases to identify relevant literature pertaining to patients with acute BAO who underwent endovascular thrombectomy alone or intravenous thrombolysis bridging with endovascular thrombectomy (bridging therapy), until January 10, 2024. The primary outcome was functional independence, defined as a score of 0–2 on the modified Rankin Scale at 90 days. The safety outcome was mortality at 90 days and symptomatic intracranial hemorrhage within 48 h. Effect sizes were computed as risk ratio (RR) with random-effect models. This study was registered in PROSPERO (CRD42023462293). Results: A total of 528 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded. Finally, 2 RCTs and 10 cohort studies met the inclusion criteria. The findings revealed that the endovascular thrombectomy alone group had a lower rate of functional independence compared to the bridging therapy group (29% vs 38%; RR 0.78, 95% CI 0.68–0.88, p < 0.001), lower independent ambulation (39% vs 45%; RR 0.89, 95% CI 0.82–0.98, p = 0.01), and higher mortality (36% vs 28%, RR 1.22, 95% CI 1.08–1.37, p = 0.001). However, no differences were detected in symptomatic intracranial hemorrhage between the two groups (6% vs 4%; RR 1.12, 95% CI 0.74–1.71, p = 0.58). Conclusion: Intravenous thrombolysis plus endovascular thrombectomy seemed to led to better functional independence, independent ambulation, and lower risk of mortality without increasing the incidence of intracranial hemorrhage compared to endovascular thrombectomy alone. However, given the non-randomized nature of this study, further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin is a well-established practice after a minor stroke or transient ischemic attack (TIA). However, ticagrelor plus aspirin may be an alternative. Aims: We systematically searched PubMed, Embase, and Cochrane Central from inception to January 2024. We included randomized controlled trials (RCTs) enrolling adults with acute minor stroke or TIA within 72 hours of the onset of the symptoms. Results: A total of 8 RCTs were included in our meta-analysis. Ticagrelor plus aspirin (RR, 0.70; 95% CrI 0.52, 0.91) and clopidogrel plus aspirin (RR, 0.79; 95% CrI 0.64, 0.98) were superior to aspirin in preventing stroke recurrence in overall analysis. Excluding studies with dual antiplatelet up to 90 days, ticagrelor plus aspirin was the only strategy that maintained superiority compared with aspirin regarding stroke recurrence (RR, 0.70; 95% CrI 0.51, 0.95) and ischemic stroke (RR, 0.68; 95% CrI 0.47, 0.94). There was no significant difference between treatment groups regarding hemorrhagic stroke, functional disability, and mortality. Conclusions: DAPTs were superior to aspirin in preventing recurrence or ischemic stroke. Although no significant difference was observed between DAPTs, ticagrelor plus aspirin may be related to worse major bleeding results, including intracranial bleeding. Ticagrelor plus aspirin is a considerable option for patients after a minor stroke or TIA. [ABSTRACT FROM AUTHOR]

Background: Early neurological deterioration, a common complication in patients with intracerebral hemorrhage, is associated with poor outcomes. Despite the fact that the prevalence and predictors of early neurological impairment are widely addressed, few studies have consolidated these findings. This study aimed to systematically investigate the prevalence and predictors of early neurological deterioration. Methods: The PubMed, Embase, Cochrane Library, CIHNAL, and Web of Science databases were systematically searched for relevant studies from the inception to December 2023. The data were extracted using a predefined worksheet. Quality assessment was conducted using the Newcastle–Ottawa Scale. Two reviewers independently performed the study selection, data extraction, and quality appraisal. The pooled effect size and 95% confidence intervals were calculated using the STATA 17.0 software package. Results: In total, 32 studies and 5,014 patients were included in this meta-analysis. The prevalence of early neurological deterioration was 23% (95% CI 21–26%, p < 0.01). The initial NIHSS score (OR = 1.24, 95% CI 1.17, 1.30, p < 0.01), hematoma volume (OR = 1.07, 95% CI 1.06, 1.09, p < 0.01), intraventricular hemorrhage (OR = 3.50, 95% CI 1.64, 7.47, p < 0.01), intraventricular extension (OR = 3.95, 95% CI 1.96, 7.99, p < 0.01), hematoma expansion (OR = 9.77, 95% CI 4.43, 17.40, p < 0.01), and computed tomographic angiography spot sign (OR = 5.77, 95% CI 1.53, 20.23, p = 0.01) were predictors of early neurological deterioration. The funnel plot and Egger's test revealed significant publication bias (p < 0.001). Conclusions: This meta-analysis revealed a pooled prevalence of early neurological deterioration of 23% in patients with intracerebral hemorrhage. The initial NIHSS score, hematoma volume, intraventricular hemorrhage, intraventricular expansion, hematoma expansion, and spot sign enhanced the probability of early neurological deterioration. These findings provide healthcare providers with an evidence-based basis for detecting and managing early neurological deterioration in patients with intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Cancer-related fatigue (CRF) is unrelenting. As neither rest nor sleep ameliorates cognitive, emotional, and physical symptoms, quality of life is diminished. This study examines resistance training (RT) effectiveness on CRF in cancer survivors. The secondary aims were to identify the dose-response relationship of RT frequency, intensity, and volume on CRF in different cancer survivor populations. Systematic searches via numerous databases for RCTs were performed in June 2022. Patient-reported outcome measures (PROM), were analysed, pre-to-post intervention, using a random-effects model. The Physiotherapy Evidence Database (PEDro) scale informed methodological quality assessment. Eight studies were included (cancer survivors: breast (BCS) = 5; endometrial (ECS) = 1; prostate (PCS) = 2). Overall, RT interventions ≥ 6 weeks elicited large significant reductions in CRF for FACIT-F (SMD = 0.932, p = <0.001) and moderate significant reductions in CRF for PFS-R (SMD = −0.622, p = 0.004). Main findings indicate that RT ameliorates CRF, especially in BCS; however, individualised approaches should be advocated. Supervised training elicited the greatest positive outcomes, thus should be a pivotal part of the cancer rehabilitation pathway. Future studies should be adequately powered, undertake discrete analyses of different cancer types, and investigate chronic RT effects. Cancer-related fatigue (CRF) is debilitating and distressing, leading to reduced quality of life and function in cancer survivors. Considerable heterogeneity exists in disease histology and clinical patient presentation. Individualised resistance training (RT) is an effective, safe, and accessible intervention to mitigat:e fatigue levels, thus aid function, most notably in breast cancer survivors [ABSTRACT FROM AUTHOR]

Background: This study compared the cost-effectiveness of open (ODP), laparoscopic (LDP), and robotic (RDP) distal pancreatectomy (DP). Methods: Studies reporting the costs of DP were included in a literature search until August 2023. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Cluster analysis was performed to examine the similarity and classification of DP approaches into homogeneous clusters. A decision model-based cost–utility analysis was conducted for the cost-effectiveness analysis of DP strategies. Results: Twenty-six studies with 29,164 patients were included in the analysis. Among the three groups, LDP had the lowest overall costs, while ODP had the highest overall costs (LDP vs. ODP: MD − 3521.36, 95% CrI − 6172.91 to − 1228.59). RDP had the highest procedural costs (ODP vs. RDP: MD − 4311.15, 95% CrI − 6005.40 to − 2599.16; LDP vs. RDP: MD − 3772.25, 95% CrI − 4989.50 to − 2535.16), but incurred the lowest hospitalization costs. Both LDP (MD − 3663.82, 95% CrI − 6906.52 to − 747.69) and RDP (MD − 6678.42, 95% CrI − 11,434.30 to − 2972.89) had significantly reduced hospitalization costs compared to ODP. LDP and RDP demonstrated a superior profile regarding costs–morbidity, costs–mortality, costs–efficacy, and costs–utility compared to ODP. Compared to ODP, LDP and RDP cost $3110 and $817 less per patient, resulting in 0.03 and 0.05 additional quality-adjusted life years (QALYs), respectively, with positive incremental net monetary benefit (NMB). RDP costs $2293 more than LDP with a negative incremental NMB but generates 0.02 additional QALYs with improved postoperative morbidity and spleen preservation. Probabilistic sensitivity analysis suggests that LDP and RDP are more cost-effective options compared to ODP at various willingness-to-pay thresholds. Conclusion: LDP and RDP are more cost-effective than ODP, with LDP exhibiting better cost savings and RDP demonstrating superior surgical outcomes and improved QALYs. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and meta-analyze the efficacy and safety of salvage endoscopy for residual or recurrence of colorectal tumors after endoscopic resection. Methods: Multiple databases including PubMed, EMBASE and the Cochrane Library were searched to screen for eligible studies and perform data extraction and pooled analysis. Results: Sixteen studies on salvage endoscopy for residual or recurrent colorectal cancer after endoscopic resection were included, covering approximately 994 patients. The results of the meta-analysis demonstrated that salvage endoscopic therapy for residual or recurrent colorectal tumors following endoscopic resection achieved an en bloc resection rate of 92% (95% CI 0.85–0.97; I2 = 91%) and an R0 resection rate of 82% (95% CI 0.75–0.87; I2 = 78%). The rates of intraoperative or postoperative bleeding and perforation were 10%/1% and 5%/2%, and the recurrence rate was 2%. Conclusions: Salvage endoscopic resection is an effective and safe treatment strategy for residual or recurrent colorectal tumors after endoscopic resection. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic repair of duodenal atresia (LRDA) remains a technically challenging procedure and its benefits ambiguous. To assess the safety and efficacy of LRDA, we performed a systematic review of techniques and material for LRDA and a meta-analysis comparing outcomes with open repair (OR). Methods: Comprehensive search of EMBASSE, PubMed and Cochrane was performed from 2000 to 2023. Studies comparing LRDA with OR were identified and outcomes extracted included operative time, time to enteral feeds, length of hospitalisation, anastomotic leaks and stricture and total complications. χ2 was used to assess associations between complications and conversions rates of different LRDA approaches (laparoscopic technique, suturing technique). Comprehensive meta-analysis was used for Meta-analysis. Results: Twelve studies were identified and 1731 patients were enrolled in the study (398 [LRDA] and 1325 [OR]). Total rate of complications and conversion for LRDA was 15.58% and 18.84%, respectively. Complication rates were not significantly affected by operative technique and suturing technique. Conversion rates were not significantly affected operative technique; using a combination of interrupted and running suturing was significantly higher than using running or interrupted (χ2 = 7.45, p < 0.05). Anastomotic leaks, strictures and total complications were equivocal between LRDA and OR (OR 1.672, 95% CI 0.796–3.514; OR 2.010, 95% CI 0.758–5.333; OR 1.172, 95% CI 0.195–7.03). Operative time was significantly greater for LRDA (SDM 1.035, 95% CI 0.574–1.495, p < 0.001). Time to initial and full enteral feeds and length of hospitalisation were shorter in the LRDA group (SDM − 0.493, 95% CI − 2.166 to 1.752, p = 0.466; SDM − 0.207, 95% CI − 1.807 to 0.822, p = 0.019; SDM − 0.111, 95% CI − 1.101 to 0.880, p = 0.466, respectively). Conclusions: LRDA showed equivalent complication rates compared to OR with an additional benefit of quicker establishment of feeds. There was no significant difference in complication and conversion rates between laparoscopic techniques. Despite a longer operative time, LRDA provides a safe minimal access approach for neonates after this consistent implementation of the technique in the past decade. [ABSTRACT FROM AUTHOR]

Background: Studies have evaluated the efficacy of endoscopic incisional therapy (EIT) for benign anastomotic strictures. We performed a systematic review and meta-analysis to evaluate stricture recurrence after EIT following esophagectomy or gastrectomy. Methods: A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel–Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test. Results: A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13–0.92, p = 0.03; I2 = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17–0.59, p = 0.0003; I2 = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12–3.28, p = 0.58; I2 = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41–73.11, p = 0.006) among patients undergoing EIT compared to dilation. Conclusion: Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures. [ABSTRACT FROM AUTHOR]

Background: The surgical management of hiatal hernia remains controversial. We aimed to compare outcomes of mesh versus no mesh and fundoplication versus no fundoplication in symptomatic patients; surgery versus observation in asymptomatic patients; and redo hernia repair versus conversion to Roux-en-Y reconstruction in recurrent hiatal hernia. Methods: We searched PubMed, Embase, CINAHL, Cochrane Library and the ClinicalTrials.gov databases between 2000 and 2022 for randomized controlled trials (RCTs), observational studies, and case series (asymptomatic and recurrent hernias). Screening was performed by two trained independent reviewers. Pooled analyses were performed on comparative data. Risk of bias was assessed using the Cochrane Risk of Bias tool and Newcastle Ottawa Scale for randomized and non-randomized studies, respectively. Results: We included 45 studies from 5152 retrieved records. Only six RCTs had low risk of bias. Mesh was associated with a lower recurrence risk (RR = 0.50, 95%CI 0.28, 0.88; I2 = 57%) in observational studies but not RCTs (RR = 0.98, 95%CI 0.47, 2.02; I2 = 34%), and higher total early dysphagia based on five observational studies (RR = 1.44, 95%CI 1.10, 1.89; I2 = 40%) but was not statistically significant in RCTs (RR = 3.00, 95%CI 0.64, 14.16). There was no difference in complications, reintervention, heartburn, reflux, or quality of life. There were no appropriate studies comparing surgery to observation in asymptomatic patients. Fundoplication resulted in higher early dysphagia in both observational studies and RCTs ([RR = 2.08, 95%CI 1.16, 3.76] and [RR = 20.58, 95%CI 1.34, 316.69]) but lower reflux in RCTs (RR = 0.31, 95%CI 0.17, 0.56, I2 = 0%). Conversion to Roux-en-Y was associated with a lower reintervention risk after 30 days compared to redo surgery. Conclusions: The evidence for optimal management of symptomatic and recurrent hiatal hernia remains controversial, underpinned by studies with a high risk of bias. Shared decision making between surgeon and patient is essential for optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). Methods: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. Results: The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. Conclusions: Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise. [ABSTRACT FROM AUTHOR]

Background: The most effective injective treatment approach for sacroiliac joint (SIJ) pain remains unclear. Aim of this study was to quantify the safety and effectiveness of the available injective strategies to address SIJ pain. Methods: A systematic review and meta-analysis of the literature was conducted on PubMed, Scopus, and Embase databases from inception until January 2023. Inclusion criteria were studies written in English, comparative and non-comparative studies regardless of the minimum follow-up, and case series on SIJ injections. Safety and efficacy of the different injection therapies for the SIJ were quantified. A meta-analysis was conducted on the available data of the documented injective therapies. The "Checklist for Measuring Quality" by Downs and Black was used to assess the risk of bias and the quality of papers. Results: The literature search retrieved 43 papers (2431 patients): 16 retrospective case series, 2 retrospective comparative studies, 17 prospective case series, 3 prospective comparative studies, and 5 randomized controlled trials. Of the selected studies, 63% examined the effect of steroid injections, 16% of PRP injections, while 21% reported other heterogeneous treatments. The failure rate was 26% in steroid injections and 14% in PRP injections. The meta-analysis showed a statistically significant reduction in pain with the VAS score for both steroids and PRP: steroids improvement at mid-term 3.4 points (p < 0.05), at long-term 3.0 (p < 0.05), PRP improvement at mid-term 2.2 (p = 0.007), at long-term 2.3 points of the VAS pain scale (p = 0.02). Conclusions: Steroids are the most documented injective approach, with studies showing an overall safety and effectiveness. Still, the high number of failures underlined by some studies suggest the need for alternative procedures. Early PRP data showed promise, but the limitations of the current literature do not allow to clearly define the most suitable injective approach, and further studies are needed to identify the best injective treatment for SIJ patients. [ABSTRACT FROM AUTHOR]

Backgroud: Granulocyte colony-stimulating factor (G-CSF) is widely used for the primary prophylaxis of febrile neutropenia (FN). Two types of G-CSF are available in Japan, namely G-CSF chemically bound to polyethylene glycol (PEG G-CSF), which provides long-lasting effects with a single dose, and non-polyethylene glycol-bound G-CSF (non-PEG G-CSF), which must be sequentially administrated for several days. Methods: This current study investigated the utility of these treatments for the primary prophylaxis of FN through a systematic review of the literature. A detailed literature search for related studies was performed using PubMed, Ichushi-Web, and the Cochrane Library. Data were independently extracted and assessed by two reviewers. A qualitative analysis or meta-analysis was conducted to evaluate six outcomes. Results: Through the first and second screenings, 23 and 18 articles were extracted for qualitative synthesis and meta-analysis, respectively. The incidence of FN was significantly lower in the PEG G-CSF group than in the non-PEG G-CSF group with a strong quality/certainty of evidence. The differences in other outcomes, such as overall survival, infection-related mortality, the duration of neutropenia (less than 500/μL), quality of life, and pain, were not apparent. Conclusions: A single dose of PEG G-CSF is strongly recommended over multiple-dose non-PEG G-CSF therapy for the primary prophylaxis of FN. [ABSTRACT FROM AUTHOR]

Objectives: Third generation lasers with longer wavelengths (>1900 nm) have been introduced, in recent years, for the treatment of varicose veins. The possible advantage of the new generation lasers is that they allow complete damage to the vein wall using a lower Power in Watts (W: J/sec) and a lower linear energy density (LEED: J/cm). The aim of this work is to evaluate the results present in the literature regarding efficacy and safeness of the new generation lasers for the treatment of varicose veins. Methods: Published articles were searched on PubMed database and on Cochrane Library, entering the keywords "1940 nm or 1920 nm laser AND varicose veins laser thermoablation (EVLA)." The primary endpoint of the study was to value rate of occlusion and adverse events at the short term follow-up. The search yielded a total of 14 studies. In the end, only six studies were judge eligibility. Results: The studies were heterogenous in their documentation, EVLA, duplex ultrasound protocol and result reporting. A total of 540 limbs of 377 patients were treated with endovenous laser ablation (EVLA) with laser 1920–1940 nm. The treated veins had a mean diameter of 0.74 ± 0.17 cm and a mean length of 27.87 ± 20.63 cm. The pooled estimates of immediate occlusion rate was of 99.8% (95% CI: 97.9% to 100.0) with high heterogeneity (I2 = 60%; 95% PI: 89.7% to 100%), while at short-term follow-up was of 98.2% (95% CI: 94.0% to 100.0%) with higher heterogeneity (I2:79%; 95% PI: 77.1% to 100.0%). EHIT occurred in 7 cases (pooled estimate: 0.7%). The other adverse events rate reported were 1% of hyperpigmentation, 2.8% of neurological complications, 0.6% thrombophlebitis and 1.9% of bruising/hematoma. The pooled mean estimates of LEED was equal to 38.2 J/cm (95% CI: 26.3 to 50.1 J/cm) although with a very large heterogeneity (I2 = 100%). Conclusions: The overall success rate of EVLA was high. The analysis of these studies suggests that using lower parameters (Power and linear administered energy) may have no effect on the treatment success rate. Short-term results demonstrate comparable occlusion rates respect the second-generation lasers. Instead, data suggest a low complication rates. Short-term results demonstrate comparable complications rates respect the second-generation lasers (1300-1470 nm). Randomized studies with longer follow-up are required to evaluate the EVLA 1900 nm procedure further. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decade, numerous studies have described the types of pathogens and their antibiotic resistance patterns in patients with burn injuries in China; however, the findings have generally been inconsistent. We conducted a literature search and meta-analysis to summarize the infection spectra and antimicrobial resistance patterns in patients with burn injuries. Methods: We searched the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical Literature, Wanfang, and Weipu databases for relevant articles published between January 2010 and December 2023. The DerSimonian–Laird random-effects model was used to estimate the proportions and 95% confidence intervals (CIs) of pathogens among Chinese patients with burn injuries. Meta-regression analyses were performed to explore differences in the proportions of pathogens among different subgroups and their resistance patterns. This study was registered with PROSPERO (CRD42024514386). Results: The database searches yielded 2017 records; after removing duplicates and conducting initial screening, 219 articles underwent full-text screening. Ultimately, 60 studies comprising a total of 62,819 isolated strains reported the proportions of pathogens in patients with burn injuries and were included in this meta-analysis. Meta-analyses were conducted on 18 types of pathogens. The most common pathogens causing infections in Chinese patients with burn injuries were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus epidermidis. Similar results were observed in the subgroup analysis focusing on wound infections. Since 2015, there has been a significant decrease in the proportion of Pseudomonas aeruginosa (R2 = 4.89%) and a significant increase in the proportion of Klebsiella pneumoniae (R2 = 9.60%). In terms of antibiotic resistance, there has been a significant decrease in the resistance of Staphylococcus aureus to multiple antibiotics and an increasing trend in the resistance of Klebsiella pneumoniae. Conclusions: We systematically summarized the epidemiological characteristics and antibiotic resistance patterns of pathogens among individuals suffering from burns in China, thus providing guidance for controlling wound infections and promoting optimal empirical antimicrobial therapy. The observed high levels of antibiotic resistance underscore the need for ongoing monitoring of antibiotic usage trends. [ABSTRACT FROM AUTHOR]

Systems designed with persuasive software features can influence users to adopt attitudes and/or behaviours that contribute to better health outcomes. Studies on Coronary Heart Disease (CHD) interventions have shown how they can be used to support lifestyle changes. Meta-analytic reviews of randomised controlled trials (RCTs) are needed to appraise, summarise, and show their effects on health. To this end, we investigated the effectiveness of digital health interventions (DHI) designed for CHD and examined the impact of persuasive features in the DHIs. We performed a systematic search using three academic databases for scientific papers on CHD and digital interventions from 2010 to 2020, yielding 1556 papers. The systematic review and meta-analysis included 12 RCTs after screening. Our findings show that digital health interventions had an impact on diastolic blood pressure, systolic blood pressure, low-density lipoprotein, high-density lipoprotein, total cholesterol, glycated haemoglobin, glucose, triglyceride, heart rate, and depression but not body mass index. We present effective interventions and insights into persuasive software features that were associated with effective DHIs. More research is needed to investigate the effectiveness of persuasive features in other contexts and other factors that can impact the effectiveness of DHIs. [ABSTRACT FROM AUTHOR]

Phubbing—i.e. excluding and ignoring others through smartphone use—is a pervasive phenomenon. Yet, a comprehensive understanding of its consequences is still lacking. This systematic meta-analytic review aimed to (1) synthesize the associations between being phubbed and emotional and cognitive, social, and behavioural well-being, (2) test the strength of these associations, and (3) investigate moderating influences. Literature searches according to PRISMA-guidelines yielded k = 83 included studies. Random-effects meta-analyses were conducted for 24 of 72 extracted consequences. Subgroup analyses were performed for phubbees' relationship to interlocutors, age group, and study design. The overall sample was N = 53,916 with a mean age of 19.68 years. Being phubbed was moderately to strongly (e.g. $\hat{{\rm \rho }}$ ρ ˆ =.23–.75) associated with various adverse consequences (e.g. depression, relationship dissatisfaction, derogation of interlocutors, smartphone addiction). Effects were larger for adolescents than for adults. The findings are in line with existing theoretical assumptions (e.g. the temporal need-threat model of ostracism) corroborating that phubbing is a detrimental experience. Thus, phubbing appears to be a public health issue which should be addressed through suitable interventions in order to enhance healthy human-human and human-technology interactions. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is often diagnosed in advanced stages. Following sorafenib, lenvatinib (LENV) has been approved as a first‐line treatment option for unresectable HCC. In the past few years, at least 9 large‐scale cohort studies have examined the efficacy and safety of LENV compared to atezolizumab plus bevacizumab (ATE/BEV) in unresectable HCC, but there is currently no direct meta‐analysis conducted for a comprehensive consolidation. To provide the most updated meta‐analysis of the clinical efficacy and safety of ATE/BEV versus LENV for patients with unresectable HCC. Our studies comparing the efficacy and safety of ATE/BEV and LENV in unresectable HCC were systematically searched in PubMed, Embase, and Web of Science from inception to February 2023. Outcomes measured were overall survival (OS), progression‐free survival (PFS), mortality, complete response (CR), partial response (PR), objective response rate (ORR), disease control rate (DCR), progressive disease (PD), stable disease (SD), and adverse events (AEs). Seven eligible studies involving 4428 patients (1569 in the ATE/BEV group and 2859 in the LENV group) were included in the narrative synthesis. All baseline characteristics were similar between the 2 groups except for Child‐Pugh class B. Ultimately, our meta‐analysis showed that the LENV group had longer OS and PFS than the ATE/BEV group. Moreover, patients on LENV were more likely to achieve SD, whereas those on ATE/BEV were more likely to achieve PR. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this systemic review and meta-analysis was to explore the association between halitosis and periodontitis in observational studies. Materials and methods: A systematic search covered PubMed, Web of Science, Embase, Scopus, and Cochrane Library until August 18, 2023. Nine observational studies (585 cases, 1591 controls) were analyzed using Stata 17, with odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses considered halitosis assessment methods. Results: The review found a positive association between halitosis and periodontitis. Significant differences were observed with organoleptic test (OR = 4.05, 95% CI: 1.76, 9.30, p < 0.01) and volatile sulfur compound readings (OR = 4.52, 95% CI: 1.89, 10.83, p < 0.01). Conclusions: A positive association was observed between halitosis and periodontitis, supported by significant differences in both organoleptic and volatile sulfur compound readings. However, conclusive findings are limited by statistical heterogeneity, emphasizing the need for additional research. Clinical relevance: Understanding the halitosis and periodontitis association is clinically significant, informing potential interventions for improved oral health. Further research is vital to refine understanding and guide effective clinical strategies, acknowledging the limitations in current findings. [ABSTRACT FROM AUTHOR]

The influence of metabolic syndrome (MetS) on long-term prognosis of patients with myocardial infarction (MI), the most severe type of coronary artery disease, remains not fully determined. This systematic review and meta-analysis were conducted to investigate the association between MetS and long-term clinical outcomes of patients with MI. A systematic search of Medline, Web of Science, and Embase databases from inception to June 25, 2023, was conducted to obtain eligible studies. Only studies with follow-up duration for at least one year were considered. A random-effects model was utilized to pool the results, accounting for heterogeneity. Ten observational studies were included, which included 33 197 patients with MI. Among them, 17 244 (51.9%) were with MetS at baseline. During a follow-up duration of 12 to 48 months (mean: 22.5 months), patients with MetS were associated with higher incidence of major adverse cardiovascular events [risk ratio (RR): 1.35. 95% confidence interval (CI): 1.19 to 1.54, p<0.001; I2=64%] and all-cause deaths (RR: 1.34, 95% CI: 1.18 to 1.52, p<0.001; I2=23%), as compared to those without MetS at baseline. Subgroup analyses showed that the results were not significantly affected by study characteristics such as study country, design, type of MI, mean age of the patients, treatment with percutaneous coronary intervention, follow-up durations, or study quality scores (p for subgroup difference all>0.05). In patients with MI, MetS may be a risk factor of poor long-term prognosis. [ABSTRACT FROM AUTHOR]

Background Down syndrome (DS) is the most prevalent chromosomal disorder, being the leading cause of intellectual disability. The increased life expectancy of individuals with DS has led to a shift in the incidence of non-communicable chronic diseases, resulting in new concerns, particularly cardiovascular disease (CVD) and Alzheimer's disease. This study aimed to analyse the blood lipid profile of a large DS cohort to establish a baseline for evaluating health risk parameters. Methods A comprehensive literature search was conducted on PubMed and Virtual Health Library databases to identify original articles published before July 2022. Selected studies were included in the meta-analysis. Results Fifteen studies reporting serum lipid levels in individuals with DS were incorporated into the analysis. The meta-analysis used the means and standard deviations extracted from the selected studies. The analysis encompassed 671 participants in the DS group and 898 euploid controls. The results indicated significant differences in total cholesterol [C] (mean difference [MD]: −3.34; CI: 95%: −4.94 to −1.73; P < 0.0001), HDL-C (MD: −3.39; CI: 95%: −6.72 to −0.06; P = 0.05) and triglycerides (MD: 21.48; CI: 95%: 9.32 to 33.65; P = 0.0005) levels between individuals with DS and their control counterparts. Conclusions Individuals with DS have less favourable blood lipid concentrations than their controls, particularly HDL-C, triglycerides, and total-C, even when grouped by age. These findings underscore the importance of closer monitoring of lipid profiles in people with DS and the necessity for specific cut-offs for this population, considering the risk for ischemic heart and Alzheimer's diseases. [ABSTRACT FROM AUTHOR]

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression. [ABSTRACT FROM AUTHOR]

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist. Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted. One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257–0.643; vs. active controls, g = 0.192–0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI). MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy. [ABSTRACT FROM AUTHOR]

Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [−0.20 −0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach. [ABSTRACT FROM AUTHOR]

High variability of influenza vaccine efficacy requires the identification of modulators of immunisation that may be targeted as adjuvants in health psychology interventions. Psychosocial and behavioural variables such as psychological stress, greater negative and lower positive affectivity, poor sleep, loneliness, and lack of social support, have been associated with abnormal immune and inflammatory responses and negative health outcomes, yet their effects in modulating vaccine efficacy are yet to be fully understood. We conducted an updated systematic review of longitudinal and experimental studies examining the effects of such variables in predicting immune response to influenza vaccine. PubMed, Medline, PsycINFO, CINAHL and Scopus were searched up to November 2022. Twenty-five studies met the inclusion criteria for qualitative synthesis and 16 provided data for meta-analysis. Low positive and high negative affect were associated with low antibodies and weak cell-mediated immunity following vaccination in qualitative synthesis. Literature on sleep disturbance, loneliness and social support was limited and yielded inconsistent results. Psychological stress was associated with poorer antibody response in meta-analysis. In conclusion, findings from this review suggest a need for further longitudinal and experimental studies on these factors to support their inclusion as target variables in vaccine adjuvant interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening disease. Despite being considered the gold standard treatment scheme, inhaled nitric oxide (iNO) is not readily available in settings with limited resources. Therefore, in recent years, research on related drugs is being actively pursued. Herein, we aimed to use random-effects network meta-analysis to evaluate the efficacy and associated mortality of different PPHN therapies. DATA SOURCES: We electronically searched the PubMed, Embase, and Cochrane Library for data up to January 27, 2023. STUDY SELECTION: Randomized controlled trials involving neonates with PPHN assessing efficacy and mortality of various treatments. DATA EXTRACTION: Details of study population, treatments, and outcomes were extracted. DATA SYNTHESIS: Direct pairwise comparisons and a network meta-analysis was performed under random effects. The ranking probability was further assessed based on the surface under the cumulative ranking curve (SUCRA). We analyzed 23 randomized clinical trials involving 902 newborns with PPHN. Sixteen different treatment strategies were compared with each other and conventional therapy (CON). A median concentration of 10-20 parts per million (ppm) iNO (MNO) coupled with sildenafil orally administered at a dose of 1-3 mg/kg/dose every 6-8 hours (OSID) demonstrated the best efficacy (MNO + OSID vs. CON: odds ratio [OR] = 27.53, 95% CI, 2.36-321.75; SUCRA = 0.818, ranking first; moderate quality). OSID combined with milrinone administered IV also performed well in terms of efficacy (OSID + milrinone vs. CON: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.811, ranking second; low quality) and mortality reduction (CON vs. OSID + milrinone: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.786, ranking last; low quality). CONCLUSIONS: MNO + OSID is the most effective PPHN treatment. If iNO is not available, OSID + milrinone is preferred. [ABSTRACT FROM AUTHOR]

Purpose: A consensus has not been reached on the value of quality of life (QoL) as a prognostic factor for survival in gastrointestinal cancer. This meta-analysis aimed to investigate the association between functioning scales of the EORTC QoL Questionnaire Core 30 (QLQ-C30) and the overall survival (OS) in patients with gastrointestinal cancer. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Embase databases, until February 7, 2023. The studies included were those that investigated the association between baseline QoL measured by the functioning scales of EORTC QLQ-C30 and OS in patients with gastrointestinal cancer. The prognostic capacity of QoL was calculated by pooling the adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: Twenty-four studies' analyses reported by 22 eligible articles involving 11,609 patients were included. When compared with good parameters of QoL, poor global QoL (HR 1.81; 95% CI 1.53–2.13), physical functioning (HR 1.51; 95% CI 1.31–1.74), social functioning (HR 1.67; 95% CI 1.30–2.15), and role functioning scale (HR 1.42; 95% CI 1.20–1.29) were significantly associated with decreased OS. For each 10-point increase in QLQ-C30 parameters, the pooled HR of OS was 0.87 (95% CI 0.83–0.92) for global QoL, 0.87 (95% CI 0.83–0.92) for physical functioning, and 0.93 (95% CI 0.88–0.97) for role functioning. However, each 10-point increase in social, emotional, or cognitive functioning scale did not significantly predict OS. Conclusions: Baseline health-related QoL defined by the physical functioning or global QoL scale of EORTC QLQ-C30 significantly predicts OS in patients with gastrointestinal cancer. [ABSTRACT FROM AUTHOR]

Long-course neoadjuvant chemoradiotherapy (NCRT), followed by surgery after an interval of 6–8 weeks, represents standard of care for patients with locally advanced rectal cancer (LARC). Increasing this interval may improve rates of complete pathological response (pCR) and tumour downstaging. We performed a meta-analysis comparing standard (SI, within 8 weeks) versus longer (LI, after 8 weeks) interval from NCRT to surgery. PubMed, Embase, and Cochrane databases were searched up to 31 August 2022. Randomized controlled trials (RCTs) comparing SI with LI after NCRT for LARC were included. The primary endpoint was pCR rate. Secondary endpoints included rates of R0 resection, circumferential resection margin positivity (+CRM), TME completeness, lymph node yield (LNY), operative duration, tumour downstaging (TD), sphincter preservation, mortality, postoperative complications, surgical site infection (SSI) and anastomotic leak (AL). Random effects models were used to calculate pooled effect size estimates. Four RCTs encompassing 867 patients were included. There were 539 males (62.1%). LI was associated with a higher pCR rate (OR 0.61, 95%CI ​= ​0.39–0.95, p ​= ​0.03), and more TD (OR 0.60, 95%CI ​= ​0.37–0.97, p ​= ​0.04) compared to SI. However, there was no difference in rates of R0 resection (p ​= ​0.87), +CRM (p ​= ​0.66), sphincter preservation (p ​= ​0.26), incomplete TME (p ​= ​0.49), LNY (p ​= ​0.55), SSI (p ​= ​0.33), AL (p ​= ​0.20), operative duration (p ​= ​0.07), mortality (p ​= ​0.89) or any surgical complication (p ​= ​0.91). A LI to surgery after NCRT for LARC increases pCR and TD rates. Local recurrence or survival were not assessed due to unavailable data. We recommend deferring TME until after an interval of 8 weeks following completion of NCRT. • >8 weeks from NCRT to surgery for LARC improves pCR and tumour downstaging rates • No differences found in R0, +CRM, anastomotic leak, complications or mortality • Rates of recurrence or survival could not be assessed • These findings are robust as they are derived from randomized data [ABSTRACT FROM AUTHOR]

Purpose: Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care. Methods: A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention. Results: Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen's d = 0.1, 95% CI = − 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen's d = − 1.9, 95% CI = − 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294–303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference. Conclusions: CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings. [ABSTRACT FROM AUTHOR]

Purpose: Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. Method: The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. Results: The estimated prevalence was 0.10 (95%CI: 0.8–0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. Conclusions: There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women. [ABSTRACT FROM AUTHOR]

Background: Women with polycystic ovary syndrome (PCO) suffer from psychological difficulties like bipolar disorder. Various studies in the literature report several prevalence rates of bipolar disorder in women with PCO, while there is no systematic review in this field. So, we designed this systematic review and meta-analysis to estimate the pooled prevalence and odds of bipolar disorder in women with PCO disease. Method: PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and references of the references, conference abstracts were comprehensively searched by two independent researchers. The search was done on May 1st, 2023. Results: A literature search revealed 438 records, 35 full texts were evaluated, and finally, 11 studies remained for systematic review. Totally, 73,102 women with PCO and 340,724 controls were evaluated. Among cases, 1471 had bipolar diagnosis vs. 4321 controls. The prevalence of bipolar disorder in women with PCO ranged between 0 and 27%, and the pooled prevalence was estimated as 4% (95% CI, 2–5%; I2, 99.3%, p < 0.001). The odds of bipolar disorder in women with PCO ranged between 0.98 and 8.78, and the pooled estimate was 2.06 (95% CI, 1.61–2.63) (I2, 85.6%; p < 0.001). Conclusions: This systematic review and meta-analysis show that the pooled prevalence of bipolar disorder in women with PCO is 4%, and women with PCO are at a 2-fold higher risk of bipolar disorder. [ABSTRACT FROM AUTHOR]