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Introduction: Screening trials and meta-analyses emphasize the ratio of cancer death rates in screening and control arms. However, this measure is diluted by the inclusion of deaths from cancers that only became detectable after the end of active screening. Methods: We review traditional analysis of cancer screening trials and show that ratio estimates are inevitably biased to the null, because follow-up (FU) must continue beyond the end of the screening period and thus includes cases only becoming detectable after screening ends. But because such cases are expected to occur in equal numbers in the two arms, calculation of the difference between the number of cancer deaths in the screening and control arms avoids this dilutional bias. This difference can be set against the number of invitations to screening; we illustrate by reanalyzing data from all trials of tomography screening of lung cancer (LC) using this measure. Results: In nine trials of LC screening from 2000 to 2013, a total of 94,441 high-risk patients were invited to be in screening or control groups, with high participation rates (average 95%). In the older trials comparing computed tomography to chest X-ray, 88,285 invitations averted 83 deaths (1068 per death averted (DA)). In the six more recent trials with no screening in the control group, 69,976 invitations averted 121 deaths (577 invitations per DA). Discussion: Screens per DA is an undiluted measure of screening's effect and it is unperturbed by the arbitrary duration of FU. This estimate can be useful for program planning and informed consent. [ABSTRACT FROM AUTHOR]

The development of reading networks across different languages and cultures provides an important window to address gene‐culture interactions in brain functionality development. Previous meta‐analyses have explored the neural correlates of reading in different languages with diverse orthographic transparencies. However, it remains unknown whether the neural topographic relationship of different languages varies when taking development into account. To address this issue, we conducted meta‐analyses of neuroimaging studies with approaches of activation likelihood estimation and seed‐based effect size mapping and focused on two highly contrasting languages, Chinese and English. The meta‐analyses covered 61 studies of Chinese reading and 64 studies of English reading by native speakers. The brain reading networks of child and adult readers were further separately analyzed and compared to explore the developmental effects. The results revealed that the commonalities and differences in reading networks for Chinese and English were inconsistent between children and adults. In addition, the reading networks converged with development, and the effects of writing systems on brain function organizations were more salient in the initial stages of reading. An interesting finding was that the left inferior parietal lobule demonstrated increased effect sizes in adults compared with children in both Chinese and English reading, indicating a common developmental feature of reading mechanisms across the two languages. These findings provide new insights into the functional evolution and cultural modulation of brain reading networks. Research Highlights: Meta‐analyses with approaches of activation likelihood estimation and seed‐based effect size mapping were performed to evaluate the developmental characteristics of brain reading networks.The engagement of universal and language‐specific reading networks was different between children and adults, and the reading networks converged with increased reading experience.Overall the middle/inferior occipital and inferior/middle frontal gyrus were specific to Chinese and the middle temporal, right inferior frontal gyrus were specific to English.The left inferior parietal lobule was engaged more in adults than children in Chinese and English reading, demonstrating a common developmental feature of reading mechanisms. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent evidence regarding the accuracy of GNAS mutations identification forthe diagnosis of FD/MAS. This study was performed to estimate the prevalence and diagnostic accuracy of GNAS mutations detection and to preliminarily investigate the genotype-phenotype correlation in FD patients. Methods: Five electronic databases were searched from 1995 to 2024 using search terms related to GNAS and fibrous dysplasia. Observational studies of FD patients undergoing GNAS mutation detection in FD were included. Results: A total of 878 FD patients were included. The pooled prevalence of GNAS mutations in FD based on the random effects model was 74% (95% CI = 64%-83%). Regarding diagnostic accuracy, a sensitivity of 0.83 (95% CI, 0.65-0.96), specificity of 0.99 (95% CI, 0.98-1.00) and the area under the receiver operating characteristic curve of 98.38% were found. Additionally, meta-analysis and Fisher's test showed the GNAS mutation types were significantly associated with FD types (OR = 3.51, 95% CI = 1.05 to 11.72; p < 0.05). Conclusion: A high detection rate of GNAS mutations occurred in FD, and its detection is reliable for diagnosing FD. Additionally, GNAS mutation type was types were significantly associated with FD type. [ABSTRACT FROM AUTHOR]

Purpose: This updated umbrella review aimed to evaluate the evidence regarding the associations between dietary factors and the risks of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify relevant studies. The quality of the included meta-analyses was evaluated using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). For each association, the number of cases, random effects pooled effect size, 95% confidence intervals (CIs), heterogeneity, 95% prediction interval (PrI), small-study effect, and excess significance bias were recalculated to determine the evidence level. Results: We identified 33 meta-analyses describing 58 dietary factors associated with ESCC and 29 meta-analyses describing 38 dietary factors associated with EAC. There was convincing evidence regarding the association of 2 dietary factors (areca nut and high alcohol) with the risk of ESCC. There was highly suggestive evidence regarding the association of only 1 dietary factor (healthy pattern) with the risk of ESCC. There was suggestive evidence regarding the association of 11 dietary factors with the risk of ESCC, including fruit, citrus fruit, vegetables, pickled vegetables, maté tea, moderate alcohol, hot beverages and foods, hot tea, salt, folate, and vitamin B6. There was convincing evidence regarding the association of one dietary factor (vitamin B6) with the risk of EAC. There was suggestive evidence regarding the association of 4 dietary factors with the risk of EAC, including processed meat, dietary fibre, carbohydrate, and vitamin B12. The convincing evidence regarding the associations between dietary factors and the risks of ESCC and EAC remained robust in sensitivity analyses. Conclusions: This umbrella review highlighted convincing evidence regarding the associations of areca nut and high alcohol with a higher risk of ESCC. Additionally, an association between vitamin B6 and a decreased risk of EAC was observed. Further research is needed to examine the dietary factors with weak evidence regarding their associations with ESCC and EAC. [ABSTRACT FROM AUTHOR]

Research spanning 33 years establishes a robust link between government employees' Public Service Motivation (PSM) and job satisfaction (JS). Recent studies explore how national culture influences this connection across diverse cultural clusters. However, the complexity of national culture necessitates a closer examination of its dimensions within each country. Drawing from 53 studies spanning 16 regions (1990–2022), our findings demonstrate that the PSM-JS relationship tends to be more pronounced in Eastern groups than in Western counterparts, but with substantive variations. Consequently, power distance, uncertainty avoidance, and masculinity emerge as key cultural predictors. We offer nuanced insights into the role of cultural dimensions in shaping PSM and its sub-dimensions. Additionally, we present a list detailing the estimated strengths of the PSM-JS link in various countries, providing valuable insights for practitioners and future research endeavors. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to review and summarize the association between preoperative magnetic resonance imaging (MRI) and surgical outcomes in women with newly diagnosed invasive breast cancer from published randomized controlled trials (RCT). Materials and Methods: Two independent researchers conducted a systematic review through a comprehensive search of electronic databases, including PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science. If there was disagreement between the two reviewers, a third reviewer assessed the manuscript to determine whether it should be included for data extraction. The quality of the papers was assessed using the risk of bias tool, and the evidence was analyzed using GRADE. Meta-analyses using a fixed-effects model were used to estimate the pooled risk ratio (RR) and 95% confidence interval (CI). Results: Initially, 21 studies were identified, 15 of which were observational comparative studies. A total of five RCTs were included, and they suggested that preoperative MRI significantly reduced the rate of immediate breast-conserving surgery and increased the risk for mastectomy. Conclusions: From the RCT perspective, preoperative MRI for newly diagnosed invasive breast cancer did not improve surgical outcomes and may increase the risk of mastectomy. [ABSTRACT FROM AUTHOR]

Micronutrients are clinically important in managing COVID-19, and numerous studies have been conducted, but inconsistent findings exist. To explore the association between micronutrients and COVID-19. PubMed, Web of Science, Embase, Cochrane Library and Scopus for study search on July 30, 2022 and October 15, 2022. Literature selection, data extraction and quality assessment were performed in a double-blinded, group discussion format. Meta-analysis with overlapping associations were reconsolidated using random effects models, and narrative evidence was performed in tabular presentations. 57 reviews and 57 latest original studies were included. 21 reviews and 53 original studies were of moderate to high quality. Vitamin D, vitamin B, zinc, selenium, and ferritin levels differed between patients and healthy people. Vitamin D and zinc deficiencies increased COVID-19 infection by 0.97-fold/0.39-fold and 1.53-fold. Vitamin D deficiency increased severity 0.86-fold, while low vitamin B and selenium levels reduced severity. Vitamin D and calcium deficiencies increased ICU admission by 1.09 and 4.09-fold. Vitamin D deficiency increased mechanical ventilation by 0.4-fold. Vitamin D, zinc, and calcium deficiencies increased COVID-19 mortality by 0.53-fold, 0.46-fold, and 5.99-fold, respectively. The associations between vitamin D, zinc, and calcium deficiencies and adverse evolution of COVID-19 were positive, while the association between vitamin C and COVID-19 was insignificant. REGISTRATION: PROSPERO CRD42022353953. [ABSTRACT FROM AUTHOR]

Objective: To determine if librarian collaboration was associated with improved database search quality, search reproducibility, and systematic review reporting in otolaryngology systematic reviews and meta-analyses. Methods: In this retrospective cross-sectional study, PubMed was queried for systematic reviews and meta-analyses published in otolaryngology journals in 2010, 2015, and 2021. Two researchers independently extracted data. Two librarians independently rated search strategy reproducibility and quality for each article. The main outcomes include association of librarian involvement with study reporting quality, search quality, and publication metrics in otolaryngology systematic reviews and meta-analyses. Categorical data were compared with Chi-Squared tests or Fisher's Exact tests. Continuous variables were compared via Mann Whitney U Tests for two groups, and Kruskal-Wallis Tests for three or more groups. Results: Of 559 articles retrieved, 505 were analyzed. More studies indicated librarian involvement in 2021 (n=72, 20.7%) compared to 2015 (n=14, 10.4%) and 2010 (n=2, 9.0%) (p=0.04). 2021 studies showed improvements in properly using a reporting tool (p<0.001), number of databases queried (p<0.001), describing date of database searches (p<0.001), and including a flow diagram (p<0.001). Librarian involvement was associated with using reporting tools (p<0.001), increased number of databases queried (p<0.001), describing date of database search (p=0.002), mentioning search peer reviewer (p=0.02), and reproducibility of search strategies (p<0.001). For search strategy quality, librarian involvement was associated with greater use of "Boolean & proximity operators" (p=0.004), "subject headings" (p<0.001), "text word searching" (p<0.001), and "spelling/syntax/line numbers" (p<0.001). Studies with librarian involvement were associated with publication in journals with higher impact factors for 2015 (p=0.003) and 2021 (p<0.001). Conclusion: Librarian involvement was associated with improved reporting quality and search strategy quality. Our study supports the inclusion of librarians in review teams, and journal editing and peer reviewing teams. [ABSTRACT FROM AUTHOR]

Research syntheses that evaluate bilingual program effectiveness have grown exponentially since the 1980s. Contradictory to earlier anti-bilingual findings, these research syntheses, including statistical meta-analyses, have converged on findings supporting L1 teaching. This study examines the methodological soundness of eight statistical meta-analyses to provide methodology validation to this convergence conclusion. It examines the extent to which important methodological assumptions and conditions meta-analysis builds on are adequately considered and addressed. This examination lends some methodological support to the certainty of L1 teaching's positive impact. However, it also reveals some concerns, particularly regarding the source of primary studies that these meta-analyses include, consideration of primary studies' heterogeneity and meta-analyses' reporting gaps. Based on these findings, I recommend updating research about bilingual program effectiveness, giving greater attention to heterogeneity and developing reporting standards for future meta-analyses. [ABSTRACT FROM AUTHOR]

Introduction: This umbrella review aimed to investigate the evidence of an effect of dietary intake of total protein, animal and plant protein on blood pressure (BP), and hypertension (PROSPERO: CRD42018082395). Methods: PubMed, Embase and Cochrane Database were systematically searched for systematic reviews (SRs) of prospective studies with or without meta-analysis published between 05/2007 and 10/2022. The methodological quality and outcome-specific certainty of evidence were assessed by the AMSTAR 2 and NutriGrade tools, followed by an assessment of the overall certainty of evidence. SRs investigating specific protein sources are described in this review, but not included in the assessment of the overall certainty of evidence. Results: Sixteen SRs were considered eligible for the umbrella review. Ten of the SRs investigated total protein intake, six animal protein, six plant protein and four animal vs. plant protein. The majority of the SRs reported no associations or effects of total, animal and plant protein on BP (all "possible" evidence), whereby the uncertainty regarding the effects on BP was particularly high for plant protein. Two SRs addressing milk-derived protein showed a reduction in BP; in contrast, SRs investigating soy protein found no effect on BP. The outcome-specific certainty of evidence of the SRs was mostly rated as low. Discussion/conclusion: This umbrella review showed uncertainties whether there are any effects on BP from the intake of total protein, or animal or plant proteins, specifically. Based on data from two SRs with milk protein, it cannot be excluded that certain types of protein could favourably influence BP. [ABSTRACT FROM AUTHOR]

Key digested message This article explores the role of intuition in judgement and decision-making in assessment and selection and proposes that the shift towards statistically-driven approaches has led to the dismissal of intuition with negative consequences. [ABSTRACT FROM AUTHOR]

Purpose: Acute kidney injury (AKI) associated with COVID‐19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID‐19 on the progression and clinical outcomes of patients with AKI. Methods: Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing‐risk and multi‐state models, have revealed insights into AKI progression dynamics associated with PCR‐confirmed COVID‐19 acquisition and death. Meta‐analyses of case fatality ratios among patients with AKI were also conducted. Results: The overall case‐fatality ratio was 0.33 [95% CI (0.20–0.36)]; higher in COVID‐19 positive (COVID+) patients 0.52 [95% CI (0.46–0.58)] than in their negative (COVID‐) counterparts 0.16 [95% CI (0.12–0.20)]. In AKI Stage‐3 patients, that was 0.71 [95% CI (0.64–0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25–0.44)] in the COVID‐ group and 28% died within 14 days. Among patients diagnosed with AKI Stage‐1 within 24 h, the probability of progression to AKI Stage‐3 on day 7 post admission was 0.22 [95% CI (0.17–0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID‐ patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage‐3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)]. Conclusion: These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage‐3 patients, significantly exacerbated by COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Objective: Summarize the conclusions of the systematic review/meta-analysis of the clinical efficacy of acupuncture for stroke hemiplegia, and evaluate its methodological quality and the quality of evidence. Methods: Two researchers searched and extracted 8 databases for systematic reviews (SRs)/meta-analyses (MAs), and independently assessed the methodological quality, risk of bias, reporting quality, and quality of evidence of SRs/MAs included in randomized controlled trials (RCTs). Tools used included the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The search time is from database building to July 2023. Results: A total of 11 SRs/MAs were included, including 2 English literature and 9 Chinese literature, with all study sites in China. AMSTAR-2 evaluation results showed that the methodological quality of 11 articles was rated as very low quality; Based on the ROBIS evaluation results, the SRs/MAs was assessed as a high risk of bias; According to the results of the PRISMA checklist evaluation, most of the SRs/MAs reports are relatively complete; according to GRADE system, 42 outcomes were extracted from the included SRs/MAs for evaluation, of which 1 was rated as high-quality evidence, 14 as moderate-quality evidence, 14 as low-quality evidence, and 13 as very low-quality evidence. Conclusion: The available evidence indicates that acupuncture has certain clinical efficacy in the treatment of stroke hemiplegia. However, there are still some limitations to this study, such as the lower quality of SRs/MAs methodologies and evidence included, and more high-quality studies are needed to verify them. [ABSTRACT FROM AUTHOR]

Background: The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach is used to assess the certainty of evidence in systematic reviews and meta‐analyses. Methods: We describe how the GRADE approach is used in systematic reviews and meta‐analyses, including key points and examples. This overview is aimed at clinicians and researchers who are, or plan to be, involved in the development or assessment of systematic reviews with meta‐analyses using GRADE. Results: We outline how the certainty of evidence is assessed, how the evidence is summarized using GRADE evidence profiles or summary of findings tables, how the results are communicated, and we discuss challenges, advantages, and disadvantages with using GRADE. Conclusions: This overview aims to provide an overview of how GRADE is used in systematic reviews and meta‐analyses, and may be used by systematic review developers, methodologists, and evidence end‐users. [ABSTRACT FROM AUTHOR]

Context: Currently, clinical practice guidelines (CPGs) recommend the prescription of metformin as a first-line treatment for patients with type 2 diabetes. However, a systematic review and network meta-analysis of randomized clinical trials published in 2022 question the role of metformin as a first-line treatment. The objective of this work was to assess the impact of scientific evidence on the prescription choice. Methods: A randomized experimental study with four arms (1.1.1.1), using clinical vignettes, was conducted in June 2023 at the Faculty of Medicine of Lyon, France, involving 160 general medicine interns present at the faculty for a teaching day. The clinical vignettes all described the same context. Nine antidiabetic medications were presented with their efficacy and safety profiles. The question focused on the choice of first-line treatment and the reasons behind it. The four arms of the study were constituted as follows: two control arms with the names of pharmacological classes (one with benefits and adverse effects (AEs), the other without AEs); two intervention arms without the names of pharmacological classes (one with benefits and AEs, the other without AEs). Results: In all groups, the choice of treatments was strictly limited to the following three pharmacological classes: SGLT2 inhibitors (ISGLT2), GLP1 receptor agonists (AGLP1), and Biguanides (metformin). In the control arm with AEs, the prescription intentions were 10%, 30%, and 60%, respectively. In the control arm without AEs, they were 44.2%, 16.3%, and 39.5%, respectively. In the intervention arm with AEs, the prescription intentions were 48.7%, 51.3%, and 0%, respectively. In the intervention arm without AEs, they were 68.4%, 28.9%, and 2.6%, respectively. There was a significant difference only for ISGLT2 and metformin, with and without mention of AEs. Conclusion: These results suggest that the therapeutic reasoning of interns in general practice is not primarily based on EBM data, but probably on their own knowledge, mainly derived from CPGs. [ABSTRACT FROM AUTHOR]

BackgroundComplications related to diabetic foot ulcers (DFU) due to diabetes are increasing. One of the factors influencing the management and treatment of complications related to DFU is the vitamin D serum levels of patients. Therefore, we sought to comprehensively review meta-analyses from randomized controlled trials and observational studies examining the link between serum vitamin D levels and DFU outcomes in diabetic patients.MethodsWe searched PubMed, Scopus, and ISI Web of Science until September 2024 and extracted the required data from related articles according to Inclusion criteria. The certainty of the evidence and the quality of conduct of the published meta-analyses were rated using the ASMTAR 2 tools, respectively.ResultA total of 8 meta-analyses studies that met inclusion criteria were included. Based on the obtained results, it has been noted that individuals with DFU exhibit serum vitamin D levels significantly lower, ranging from −7.14 (5.44, 8.83) to −0.93 (95% CI: 0.17, 1.68) ng/ml, compared to those with diabetes but without DFU. Furthermore, individuals exhibiting severe vitamin D deficiency are found to be at least 1.82 times more susceptible to developing DFU. Conversely, administering varying doses of vitamin D supplementation has been shown to positively affect the size and number of ulcers in DFU patients.ConclusionThis study suggests a potential link between lower levels of vitamin D in the blood and the risk of DFU, hinting at the benefits of vitamin D supplementation in improving outcomes associated with DFU. However, caution is warranted due to the potential bias present in the included studies.

ObjectiveThe study attempted to evaluate the meta-analyses (MAs) of the acupuncture treatment of diabetic peripheral neuropathy (DPN) to provide a basis for clinical decision-making.MethodsEight databases, such as PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, CQVIP, and CBM, were searched from database creation to December 22, 2023. The MAs of DPN treatment using acupuncture or acupuncture combined with conventional Western medicine were included. AMSTAR-2 and PRISMA 2020 helped evaluate the methodological and reporting quality of the included studies. The GRADE methodology helped assess the evidence quality of outcome indicators. Evidence mapping was performed to display evaluation results.ResultsA total of 18 MAs involving 23,240 DPN patients were included. Based on the methodological quality evaluation, four MAs were of “moderate” quality, seven had a quality grade of “low,” and another seven were of “critically low” quality. The evidence quality evaluation showed that among studies of acupuncture vs. conventional Western medicine, four had an evidence quality of “moderate,” 18 had an evidence quality of “low,” and 17 had an evidence quality of “critically low” and that among studies of acupuncture + conventional Western medicine vs. conventional Western medicine, 12 had an evidence quality of “moderate,” 29 had an evidence quality of “low,” and 33 had an evidence quality of “critically low.” Compared with conventional Western medicine, simple acupuncture and acupuncture + conventional Western medicine significantly improved total effective rate (TER) and nerve conduction velocity (NCV).ConclusionAcupuncture treatment of DPN significantly improves TER and NCV with proven safety. However, the MAs of the acupuncture treatment of DPN must strictly refer to relevant standards and specifications regarding methodological and reporting quality, along with the design, execution, and reporting of primary randomized controlled trials (RCTs).

Abstract The study conducted a review of the parasitological profile of vegetables from 2001 to 2021, considering the type, consumption, and cultivation, globally. The databases searched included MEDLINE, SciELO, Web of Science, Science Direct, and Scopus using the terms "Detection OR Prevalence OR Incidence OR occurrence OR contamination AND vegetable OR fruit AND Helminth OR egg OR Parasite OR cysts OR protozoa". A total of 16,600 articles were found, 117 of which were reviewed. Of the 391,291 samples, 3.85% (15,095) were contaminated by parasites. Among those positive, 30.10% (4,543/15,095) contained enteroparasites commonly of human origin and 58.78% (8,873/15,095) came from markets. Few articles mentioned the cultivation type, but among those, conventional cultivation showed more contamination (42.34%; 224/529). Herbaceous vegetables were the most contaminated (56.84%; 8,580/15,095. Ascaris lumbricoides was found in 10.16% (1,535/15,095) of the samples. Lettuce was the most contaminated (20.43%; 3,084/15,095).

Introduction: Mosquito-borne diseases represent a global public health concern and are responsible for over 700 000 deaths globally every year. Additionally, many mosquito species have undergone a dramatic global expansion due to various factors, including climate change, and forecasts indicate that mosquito populations will persist in dispersing beyond their present geographic range, namely in temperate climates. The research literature on this topic has grown in recent years, including some systematic evidence synthesis. However, to provide a comprehensive overview of this growing literature needed for policy action, a summary of this evidence, including existing systematic reviews, is required. This study aims to undertake an umbrella review that explores the impacts of climate change on the emergence and reemergence of diseases transmitted by mosquitoes in temperate zones and the publication of the protocol is a fundamental step to ensure the credibility, transparency and reproducibility of this research. Methods and Analysis: Studies published in scientific journals indexed by PubMed, EMBASE, Cochrane Library, Epistemonikos, and Web of Science Core Collection to be included in this umbrella review will meet the following criteria: the topic of study (climate change and mosquito-borne diseases), regions (temperate zones), study designs (systematic reviews and meta-analysis), language (any) and date (since inception until December 31st, 2023). Titles and abstracts from selected articles will be evaluated by two authors independently and any discrepancy will be resolved through consensus or, if not possible, through a third author. The data will be extracted, and the risk of bias will be evaluated. The quality of the methodology of the included reviews will be assessed using AMSTAR 2. A narrative synthesis will examine the included systematic reviews. The quality of evidence for all outcomes will be judged using the Grading of Recommendations Assessment, Development and Evaluation working group methodology.

Introduction: Continuous glucose monitoring (CGM) has shown favorable outcomes in patients with type 2 diabetes (T2D) who are on insulin therapy. However, the efficacy of CGM in managing glucose levels in noninsulin-treated people with T2D remains controversial. Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing CGM to self-monitoring of blood glucose (SMBG) in people with T2D not using insulin. We computed weighted mean differences (WMDs) and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R version 4.2.3. Results: We included six RCTs comprising 407 noninsulin-treated people with T2D of whom 228 were randomized to CGM. Diabetes duration ranged from 5.4 to 13.9 years. The mean age was 57.9 years and the mean body mass index was 30.8 kg/m2. Four trials used real-time CGM (rt-CGM) and two intermittent scanning CGM (is-CGM). Compared with SMBG, CGM significantly reduced the glycated hemoglobin level (WMD −0.31%; 95% CI −0.42 to −0.21; I2 = 0%), glucose level (WMD −11.16 mg/dL; 95% CI −19.94 to −2.39; I2 = 0%), time in hypoglycemia level 2 (WMD −0.28%; 95% CI −0.52 to −0.03; I2 = 91%), glucose time >180 mg/dL (WMD −7.75%; 95% CI −12.04 to −3.45; I2 = 0%), and the standard deviation of glucose variation (WMD −4.00 mg/dL; 95% CI −6.86 to −1.14; I2 = 0%). CGM also increased time in range (WMD 8.63%; 95% CI 4.54–12.71; I2 = 0%) and treatment satisfaction (SMD 0.79; 95% CI 0.54–1.05; I2 = 0%). Conclusion: In this meta-analysis, rt-CGM and is-CGM were associated with improvement in glycemic control in people with T2D not using insulin when compared to SMBG. [ABSTRACT FROM AUTHOR]

Background: Clinicians and healthcare policymakers have been drenched with a deluge of overlapping meta-analyses (MAs), and the necessity for comprehensive and clearly defined evidence of Janus kinase inhibitors (JKIs) in atopic dermatitis (AD) is urgent. Methods: Six databases were searched for MAs published until October 2023. Qualitative description of MAs was mainly used, and Investigator's Global Assessment response (IGA response), the 75% improvement in Eczema Area and Severity Index (the EASI75), peak pruritus Numerical rating score (PP-NRS), and adverse effects were cited to describe the efficacy and safety of JKIs. The methodological quality of the included MAs was assessed by A Measurement Tool to Assess Systematic Reviews II (AMSTAR II), and the quality of evidence was evaluated by the grading of recommendations, assessment, development, and evaluation (GRADE). Results: Sixteen MAs were pooled in this review, of which five studies appraised JKIs, five appraised systemic JKIs, five papers assessed abrocitinib only, and one assessed baricitinib. Two studies were of "high" methodological quality and 14 MAs were of "moderate" quality. Eleven MAs integrated the results of JKIs and reported that JKIs provide faster onset of IGA response (RR=2.83, 95% CI [2.25, 3.56], highquality evidence). Similarly, 10 MAs showed that JAK inhibitors weremore effective in improving the EASI75 (RR=2.84, 95% CI [2.2, 3.67], high-quality evidence). Results from 12 MAs showed JKIs were active in reducing the PP-NRS (SMD= -0.49, 95% CI [-0.67, -0.32]). All MAs affirmed JKIs added no adverse effects leading to discontinuation and serious adverse events (P<0.05). However, 200mg of abrocitinib had a higher risk of acne (RR=4.34, 95% CI [1.61, 11.71), herpes zoster (RR=1.64, 95% CI [0.42, 6.39]), headache (RR=1.76, 95% CI [1.03, 3]), and nausea (RR=7.81, 95% CI [3.84, 15.87]). Upadacitinib was known to increase acne (RR=6.23, 95% CI [4.08, 9.49]), nasopharyngitis (RR=1.36, 95% CI [1.03, 1.8]) and blood creatine phosphokinase (blood CPK) (RR=2.41, 95% CI [1.47, 3.95]). Baricitinib at 2mg was associated with increased blood CPK (RR=2.25, 95% CI [1.1, 2.97]). Conclusion: Compared to placebo or dupilumab, the administration of JKIs can ameliorate IGA response more effectively, improve the EASI75, and relieve pruritus without severe adverse effect, while accompanied by more acne, nasopharyngitis, headache, and digestive disturbances. The curative effect of 200 mg of abrocitinib is significant and more caution should be given in patients with gastrointestinal dysfunction, herpes zoster, and those who are acne-prone. Baricitinib and upadacitinib should be avoided in populations at high risk for cardiovascular events. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the differences between radiofrequency ablation and partial nephrectomy in patients with early-stage renal cell carcinoma, and to provide evidence-based medical evidence for the choice of surgery for patients with early-stage renal cell carcinoma. Methods: According to the search strategy recommended by the Cochrane Collaboration, Chinese databases such as CNKI, VIP Chinese Science and Technology Periodicals Database (VIP), and Wanfang Full-text Database were searched with Chinese search terms. And PubMed and MEDLINE as databases for English literature retrieval. Retrieve the relevant literature on renal cell carcinoma surgical methods published before May 2022, and further screen radiofrequency ablation and partial nephrectomy in patients with renal cell carcinoma The relevant literature on the application is analyzed. RevMan5.3 software was used for heterogeneity test and combined statistical analysis, sensitivity analysis, and subgroup analysis. Analysis, and draw forest plot, using Stata software Begger quantitative assessment of publication bias. Results: A total of 11 articles were involved, including 2958 patients. According to the Jadad scale, 2 articles were of low quality, and the remaining 9 articles were of high quality. Results of this study demonstrates the advantages of radiofrequency ablation in early-stage renal cell carcinoma. The results of thismeta-analysis showed that compared with partial nephrectomy, there was significant difference in the 5-year overall survival rate between radiofrequency ablation and partial nephrectomy and there was a statistically significant difference between the two surgical methods in the 5-year relapse free survival rate of early renal cell carcinoma. Conclusion: 1. Compared with partial nephrectomy, the 5-year relapse-free survival rate, the 5-year cancer specific survival rate and the overall 5-year survival rate were higher in the radiofrequency ablation group. 2. Compared with partial nephrectomy, there was no significant difference in the postoperative local tumor recurrence rate of radiofrequency ablation. 3. Compared with partial resection, radiofrequency ablation is more beneficial to patients with renal cell carcinoma. [ABSTRACT FROM AUTHOR]

Simple Summary: BioCholine Powder can improve domestic ruminants' (sheep, goats, calves, and cows) productive performance. The objective of this study was to review published data and evaluate the effects of dietary polyherbal supplementation in lambs, ewes, dairy goats, and cows on productive performance and blood serum metabolites through a meta-analysis and by a comparison of the estimated net energy for maintenance (NEm) and gain (NEg) in lambs, which was expressed as a percentage of change in the polyherbal mixture regarding their control using a Chi-squared test. BioCholine supplementation improved small ruminants' daily gain and milk production and modified some blood metabolites. The results confirm that including BioCholine Powder in ruminant diets shows nutraceutical effects that outweigh those of phosphatidylcholine bypass and that benefits in growth, milk production, and health can therefore be expected with its dietary inclusion. BioCholine Powder is a polyherbal feed additive composed of Achyrantes aspera, Trachyspermum ammi, Azadirachta indica, and Citrullus colocynthis. The objective of this study was to analyze published results that support the hypothesis that the polyherbal product BioCholine Powder has rumen bypass choline metabolites through a meta-analysis and effect size analysis (ES). Using Scopus, Web of Science, ScienceDirect, PubMed, and university dissertation databases, a systematic search was conducted for experiments published in scientific documents that evaluated the effects of BioCholine supplementation on the variables of interest. The analyzed data were extracted from twenty-one publications (fifteen scientific articles, three abstracts, and three graduate dissertations available in institutional libraries). The studies included lamb growing–finishing, lactating ewes and goats, calves, and dairy cows. The effects of BioCholine were analyzed using random effects statistical models to compare the weighted mean difference (WMD) between BioCholine-supplemented ruminants and controls (no BioCholine). Heterogeneity was explored, and three subgroup analyses were performed for doses [(4 (or 5 g/d), 8 (10 g/d)], supplementation in gestating and lactating ewes (pre- and postpartum supplementation), and blood metabolites by species and physiological state (lactating goats, calves, lambs, ewes). Supplementation with BioCholine in sheep increased the average daily lamb gain (p < 0.05), final body weight (p < 0.01), and daily milk yield (p < 0.05) without effects on intake or feed conversion. Milk yield was improved in small ruminants with BioCholine prepartum supplementation (p < 0.10). BioCholine supplementation decreased blood urea (p < 0.01) and increased levels of the liver enzymes alanine transaminase (ALT; p < 0.10) and albumin (p < 0.001). BioCholine doses over 8 g/d increased blood glucose, albumin (p < 0.10), cholesterol, total protein, and globulin (p < 0.05). The ES values of BioCholine in retained energy over the control in growing lambs were +7.15% NEm (p < 0.10) and +9.25% NEg (p < 0.10). In conclusion, adding BioCholine Powder to domestic ruminants' diets improves productive performance, blood metabolite indicators of protein metabolism, and liver health, showing its nutraceutical properties where phosphatidylcholine prevails as an alternative that can meet the choline requirements in ruminants. [ABSTRACT FROM AUTHOR]

Balancing stroke prevention and risk of bleeding in patients with atrial fibrillation (AF) is challenging. Direct oral anticoagulants (DOACs) are by now considered standard of care for treating patients with AF in international guidelines. Our objective was to assess the safety of long-term intake of DOACs in older adults with AF. We included RCTs in elderly (≥ 65 years) patients with AF. A systematic search in MEDLINE and EMBASE was performed on 19 April 2022. For determination of risk of bias, the RoB 2 tool was applied. We pooled outcomes using random-effects meta-analyses. The quality of evidence was assessed using GRADE. Eleven RCTs with a total of 63,374 patients were identified. Two RCTs compared apixaban with either warfarin or aspirin, four edoxaban with either placebo, aspirin, or vitamin K antagonists (VKAs), two dabigatran with warfarin and three rivaroxaban with warfarin. DOACs probably reduce mortality in elderly patients with AF (HR 0.89 95%CI 0.77 to 1.02). Low-dose DOACs likely reduce bleeding compared to VKAs (HR ranged from 0.47 to 1.01). For high-dose DOACS the risk of bleeding varied widely (HR ranged from 0.80 to 1.40). We found that low-dose DOACs probably decrease mortality in AF patients. Moreover, apixaban and probably edoxaban are associated with fewer major or clinically relevant bleeding (MCRB) events compared to VKAs. For dabigatran and rivaroxaban, the risk of MCRB varies depending on dose. Moreover, subgroup analyses indicate that in the very old (≥ 85) the risk for MCRB events might be increased when using DOACs. Registration: PROSPERO: CRD42020187876. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) represent a substantial challenge within the healthcare landscape, thereby necessitating efficacious therapeutic strategies. Exercise has been investigated as a prospective intervention to bolster the management of VLUs. The objective of this comprehensive review is to systematically scrutinize and appraise the extant body of evidence pertaining to the impact of exercise on the treatment of patients diagnosed with VLUs. A comprehensive literature search was executed across multiple databases, encompassing PubMed, the Cochrane Library, Web of Science, Embase, and Google Scholar. The methodological rigour was evaluated utilizing the Assessment of Multiple Systematic Reviews 2 (AMSTAR‐2) instrument, while the quality of the evidence was appraised via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system. The relative efficacy of exercise interventions on outcomes related to VLUs, including rates of wound healing, total range of motion in the ankle joint, and adherence rates, was synthesized. Data were consolidated employing fixed‐effects models, and the impact of exercise on these outcomes was visually represented through the use of forest plots. The methodological foundation of this investigation comprised four systematic reviews and meta‐analyses, each characterized by an intermediate level of methodological rigour and evidence quality. Subsequent analyses revealed that exercise interventions exert a multifaceted and favourable impact on the therapeutic landscape of VLUs. These interventions distinctly contribute to the enhancement of wound healing rates (risk difference 0.17, 95% confidence interval [CI]: 0.06–0.28) and the extension of ankle range of motion (mean difference [MD] 6.10, 95% CI: 4.61–7.59). Furthermore, Pooled adherence rate was 0.70 (95% CI: 0.20–2.45) with no significant heterogeneity. In conclusion, although existing evidence supports the positive impact of exercise training on VLUs, higher‐quality research is still needed to deepen our understanding of its effects and provide more specific guidance for clinical practice. [ABSTRACT FROM AUTHOR]

BackgroundCOVID-19-induced pneumonia has become a persistent health concern, with severe cases posing a significant threat to patient lives. However, the potential of artificial intelligence (AI) in assisting physicians in predicting the prognosis of severe COVID-19 patients remains unclear.MethodsTo obtain relevant studies, two researchers conducted a comprehensive search of the PubMed, Web of Science, and Embase databases, including all studies published up to October 31, 2023, that utilized AI to predict mortality rates in severe COVID-19 patients. The PROBAST 2019 tool was employed to assess the potential bias in the included studies, and Stata 16 was used for meta-analysis, publication bias assessment, and sensitivity analysis.ResultsA total of 19 studies, comprising 26 models, were included in the analysis. Among them, the models that incorporated both clinical and radiological data demonstrated the highest performance. These models achieved an overall sensitivity of 0.81 (0.64–0.91), specificity of 0.77 (0.71–0.82), and an overall area under the curve (AUC) of 0.88 (0.85–0.90). Subgroup analysis revealed notable findings. Studies conducted in developed countries exhibited significantly higher predictive specificity for both radiological and combined models (p

Objective: To determine if librarian collaboration was associated with improved database search quality, search reproducibility, and systematic review reporting in otolaryngology systematic reviews and meta-analyses. Methods: In this retrospective cross-sectional study, PubMed was queried for systematic reviews and meta-analyses published in otolaryngology journals in 2010, 2015, and 2021. Two researchers independently extracted data. Two librarians independently rated search strategy reproducibility and quality for each article. The main outcomes include association of librarian involvement with study reporting quality, search quality, and publication metrics in otolaryngology systematic reviews and meta-analyses. Categorical data were compared with Chi-Squared tests or Fisher’s Exact tests. Continuous variables were compared via Mann Whitney U Tests for two groups, and Kruskal-Wallis Tests for three or more groups. Results: Of 559 articles retrieved, 505 were analyzed. More studies indicated librarian involvement in 2021 (n=72, 20.7%) compared to 2015 (n=14, 10.4%) and 2010 (n=2, 9.0%) (p=0.04). 2021 studies showed improvements in properly using a reporting tool (p

Background: Septic shock is associated with systemic inflammatory response, hemodynamic instability, impaired sympathetic control, and the development of multiorgan dysfunction that requires vasopressor or inotropic support. The regulation of immune function in sepsis is complex and varies over time. However, activating Beta-2 receptors and blocking Beta-1 receptors reduces the proinflammatory response by influencing cytokine production. Evidence that supports the concomitant use of ultra short beta-blockers with inotropes and vasopressors in patients with septic shock is still limited. This study aimed to evaluate the use of ultra short beta-blockers and its impact on the ICU related outcomes such as mortality, length of stay, heart rate control, shock resolution, and vasopressors/inotropes requirements. Methods: A systematic review and meta-analysis of randomized controlled trials including critically ill patients with septic shock who received inotropes and vasopressors. Patients who received either epinephrine or norepinephrine without beta-blockers “control group” were compared to patients who received ultra short beta-blockers concomitantly with either epinephrine or norepinephrine “Intervention group”. MEDLINE and Embase databases were utilized to systematically search for studies investigating the use of ultra short beta-blockers in critically ill patients on either epinephrine or norepinephrine from inception to October 10, 2023. The primary outcome was the 28-day mortality. While, length of stay, heart rate control, and inotropes/ vasopressors requirements were considered secondary outcomes. Results: Among 47 potentially relevant studies, nine were included in the analysis. The 28-day mortality risk was lower in patients with septic shock who used ultra short beta-blockers concomitantly with either epinephrine or norepinephrine compared with the control group (RR (95%CI): 0.69 (0.53, 0.89), I2=26%; P=0.24). In addition, heart rate was statistically significantly lower with a standardized mean difference (SMD) of -22.39 (95% CI: -24.71, –20.06) among the beta-blockers group than the control group. The SMD for hospital length of stay and the inotropes requirement were not statistically different between the two groups (SMD (95%CI): -0.57 (-2.77, 1.64), and SMD (95%CI): 0.08 (-0.02, 0.19), respectively). Conclusion: The use of ultra short beta-blockers concomitantly with either epinephrine or norepinephrine in critically ill patients with septic shock was associated with better heart rate control and survival benefits without increment in the inotropes and vasopressors requirement.

Abstract Background Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate. Methods We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers. Results The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger’s test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = −3.04, P = 0.0024). Conclusion A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples.

Abstract Background Breast cancer (BC) is the most frequent malignancy in the world. Chemotherapy (CT) is a common treatment for BC but is accompanied by toxicity and side effects. Shenqi Fuzheng Injection (SFI) is an adjuvant therapy with promising results in improving efficacy and reducing toxicity in clinical studies. This overview of systematic reviews and meta-analysis (SRs/MAs) aimed to summarize the benefits and evaluate the quality of evidence supporting SFI adjuvant as CT for BC. Methods A systematic search for SRs/MAs of randomized controlled trials (RCTs) on SFI treatment for BC was performed by searching PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to October 1, 2022. The quality of SRs/MAs was evaluated using AMSTAR-2, PRISMA 2020, ROBIS, and GRADE by two reviewers. The corrected covered area (CCA) was used to quantify the degree of duplication of the original SRs/MAs. Finally, quantitative analysis of RCTs was conducted using RevMan 5.4 software. This study was registered with PROSPERO, CRD42022377290. Results Six SRs/MAs including 61 RCTs with 5593 patients were included in this study. Studies were published between 2015 and 2019, the original RCTs ranged from 7–49, with sample sizes ranging from 336–1989. The quantitative meta-analysis found that adjuvant CT of SFI improved the clinical response rate (RR=1.37, 95% CI=1.28, 1.46; P

Background: Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or "meta-reviews" (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. Methods: In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. Results: During the MR process, the following challenges were encountered: (1) if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2) many SRs/MAs reviewed the same primary-level studies; (3) many SRs/MAs failed to disclose effect modifier analyses; (4) source populations varied; (5) physical activity exposures were nonstandardized; and (6) dose–response effects or effect modification of the physical activity exposure could not be identified. Conclusions: Using examples from the PAGAC Scientific Report, we provide (1) a high-level introduction to MRs; (2) recommended steps in conducting a MR; (3) challenges that can be encountered; and (4) guidance in addressing these challenges. [ABSTRACT FROM AUTHOR]

Summary: Background: Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta‐analysis on foods, drinks and diets in constipation. Aims: To investigate the effect of foods, drinks and diets on response to treatment, stool output, gut transit time, symptoms, quality of life, adverse events and compliance in adults with chronic constipation via a systematic review and meta‐analysis. Methods: Studies were identified using electronic databases (12th July 2023). Intervention trials (randomised controlled trials [RCTs], non‐randomised, uncontrolled) were included. Risk of bias was assessed using Cochrane 2.0 (RCTs) or JBI Critical Appraisal (uncontrolled trials). Data from RCTs only were synthesised using risk ratios (RRs), mean differences (MDs), standardised mean differences (95% CI) using random‐effects. Results: We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high‐mineral water (n = 4), prunes (n = 2), rye bread (n = 2), mango, fig, cereal, oat bran, yoghurt, water supplementation, prune juice, high‐fibre diet, no‐fibre diet (n = 1). Fruits resulted in higher stool frequency than psyllium (MD: +0.36 bowel movements [BM]/week, [0.25–0.48], n = 232), kiwifruits in particular (MD: +0.36 BM/week, [0.24–0.48], n = 192); there was no difference for prunes compared with psyllium. Rye bread resulted in higher stool frequency than white bread (MD: +0.43 BM/week, [0.03–0.83], n = 48). High‐mineral water resulted in higher response to treatment than low‐mineral water (RR: 1.47, [1.20–1.81], n = 539). Conclusions: Fruits and rye bread may improve certain constipation‐related outcomes. There is a scarcity of evidence on foods, drinks and diets in constipation and further RCTs are needed. [ABSTRACT FROM AUTHOR]

Background: Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate. Methods: We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers. Results: The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger's test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = −3.04, P = 0.0024). Conclusion: A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples. [ABSTRACT FROM AUTHOR]

Associations between fruit and vegetable (FV) consumption and mental health are suggested, largely from observational studies. This systematic review aimed to identify and summarise all published controlled intervention studies investigating the effects of FV consumption on mental health in adults. Four academic databases (Medline, PsycINFO, PubMed, Web of Science) were searched on 16 September 2022, over all years, for studies that used an intervention design; included FV consumption; included an appropriate non-FV-consumption control; used a validated measure of mental health and were conducted in healthy adults or adults with solely a depressive or anxiety-related condition. Study details were tabulated and combined using meta-analyses. Risk of bias was assessed using the domains of the Cochrane Collaboration. Six studies, enrolling 691 healthy adults and reporting on one or more mental health outcomes, were found. Meta-analyses found small and imprecise effects of FV consumption for: psychological well-being (4 studies, 289 participants) standardised mean difference (SMD) = 0·07 (95 % CI −0·17, 0·30), P = 0·58, I2 = 0 %; depressive symptomology (3 studies, 271 participants) SMD = –0·15 (95 % CI −0·40, 0·10), P = 0·23, I2 = 47 % and anxiety-related symptomology (4 studies, 298 participants) SMD = –0·15 (95 % CI −0·39, 0·08), P = 0·20, I2 = 71 %. Some benefit for psychological well-being was found in change-from-baseline data: SMD = 0·28 (95 % CI 0·05, 0·52), P = 0·02, I2 = 0 %. Risk of bias was high in many studies. Limitations include the consideration only of published studies and stem from the studies found. Given the few, limited studies available and the small size of effects, stronger evidence is needed before recommending FV consumption for mental health. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is the most frequent malignancy in the world. Chemotherapy (CT) is a common treatment for BC but is accompanied by toxicity and side effects. Shenqi Fuzheng Injection (SFI) is an adjuvant therapy with promising results in improving efficacy and reducing toxicity in clinical studies. This overview of systematic reviews and meta-analysis (SRs/MAs) aimed to summarize the benefits and evaluate the quality of evidence supporting SFI adjuvant as CT for BC. Methods: A systematic search for SRs/MAs of randomized controlled trials (RCTs) on SFI treatment for BC was performed by searching PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to October 1, 2022. The quality of SRs/MAs was evaluated using AMSTAR-2, PRISMA 2020, ROBIS, and GRADE by two reviewers. The corrected covered area (CCA) was used to quantify the degree of duplication of the original SRs/MAs. Finally, quantitative analysis of RCTs was conducted using RevMan 5.4 software. This study was registered with PROSPERO, CRD42022377290. Results: Six SRs/MAs including 61 RCTs with 5593 patients were included in this study. Studies were published between 2015 and 2019, the original RCTs ranged from 7–49, with sample sizes ranging from 336–1989. The quantitative meta-analysis found that adjuvant CT of SFI improved the clinical response rate (RR=1.37, 95% CI=1.28, 1.46; P<0.00001) and the KPS score (RR=1.66, 95% CI 1.54, 1.79, P<0.00001) of patients with BC. In terms of immune function, CD3+ (SMD=1.51, 95% CI 0.91, 2.10; P<0.00001), CD4+ (SMD=1.87, 95% CI 1.18, 2.56; P<0.00001), CD4+/CD8+ (SMD=0.86, 95% CI 0.48, 1.23; P<0.00001), and NK cell levels (SMD=0.94, 95% CI 0.63, 1.24; P<0.00001) in the adjuvant CT group SFI were better than those with CT alone. Adverse reactions following SFI adjuvant CT showed reduced incidence of leukopenia (RR=0.53, 95% CI 0.46, 0.62; P<0.00001) and gastrointestinal reactions (RR=0.48, 95% CI 0.39, 0.58; P<0.00001). However, the GRADE results showed 'very low' to 'moderate' evidence for the 42 outcomes, without high-quality evidence supporting them, limited mainly by deficiencies in the design of RCTs (42/42, 100.00%), inconsistency (19/42, 45.24%), publication bias (41/42, 97.62%), and inaccuracy (3/42, 7.14%). The unsatisfactory results of AMSTAR-2, PRISMA 2020, and ROBIS were limited to lack of registration of study protocols, explanation of inclusion basis of RCTs, description of funding sources for the included studies, incomplete search strategy and screening process, addressing heterogeneity and sensitivity, and reporting potential conflicts of interest. Conclusion: Adjuvant CT with SFI for BC had better benefits and a lower risk of adverse events. The methodology and quality of the evidence are generally low, highlighting a need of greater attention during study implementation. More objective and high-quality studies are needed to verify the efficacy of adjuvant CT with SFI in clinical decision-making for BC. [ABSTRACT FROM AUTHOR]

Various studies have shown that eye cues trigger a sense of being monitored, leading to behavioral changes, such as increases in prosocial behaviors, decreases in antisocial behaviors, stricter standards of moral judgment, and so on. However, studies have increasingly failed to replicate the watching eyes effect, and previous meta-analyses showed inconsistent results. One potential explanation for the inconsistency of the watching eyes effect is the existence of moderating variables; however, there is a lack of meta-analyses that include moderator analyses. The present study collected 91 articles with 216 effect sizes related to the watching eyes effect, and divided data types into measures of "proportion who did" (i.e., number of participants performing a specified behavior) and "degree of behavior" (i.e., the mean level of a specified behavior) to perform two respective meta-analyses. The results showed that eye cues significantly affected people's behaviors, with a small but significant effect size (log odds ratio = 0.231, Hedges' g = 0.117). The cultural type (i.e., Eastern vs. Western) had a marginally significant moderating effect on "degree of behavior". Publication status, gender ratio, age, dependent variable behavior, stimulus type, eyes presentation time, and experiment type had no significant moderating effects. Finally, the mechanism, influencing factors, and future prospects of the watching eyes effect were discussed. [ABSTRACT FROM AUTHOR]

Recently, several meta‐analyses (MAs) have focused on the health effects of resveratrol. However, the methodological and reporting quality of these MAs has not yet been fully evaluated so far. Therefore, the present study evaluated the quality of these MAs through a methodological systematic review. Systematic searches were conducted in PubMed, Embase, Web of Science, and Cochrane Library from inception until May 20, 2022, and PubMed was used to update the search until September 6, 2023. The methodological and reporting quality of the selected MAs was evaluated using AMSTAR‐2 and PRISMA 2009. Fifty‐one MAs published during 2013–2023 were included. In each review, the number of primary studies ranged from 3 to 37, and the number of participants ranged from 50 to 2114. Among the first‐listed primary outcomes, only 23 (45.10%) were "positive." As for the methodological quality, most MAs (44, 86.27%) on resveratrol were rated critically low. Inadequate reporting of the included MAs mainly involved items 2 ("Structured summary"), 5 ("Protocol and registration"), 8 ("Search"), 9 ("Study selection"), 10 ("Data collection process"), 12 ("Risk of bias in individual studies"), and 24 ("Summary of evidence") based on the PRISMA 2009. Additionally, journal's impact factor, number of authors, and funding support were positively associated with the overall methodological quality but were not statistically significant (p > 0.05). Future MAs on resveratrol require better design, implementation, and reporting by following the Cochrane Handbook, AMSTAR‐2, and PRISMA. [ABSTRACT FROM AUTHOR]

Objectives: To compare LISA with INSURE technique for surfactant administration in preterm with gestational age (GA) < 36 weeks with RDS in respect to the incidence of pneumothorax, bronchopulmonary dysplasia (BPD), need for mechanical ventilation (MV), regional cerebral oxygen saturation (rSO2), peri-intraventricular hemorrhage (PIVH) and mortality. Methods: A systematic search in PubMed, Embase, Lilacs, CINAHL, SciELO databases, Brazilian Registry of Randomized Clinical Trials (ReBEC), Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. RCTs evaluating the effects of the LISA technique versus INSURE in preterm infants with gestational age < 36 weeks and that had as outcomes evaluation of the rates of pneumothorax, BPD, need for MV, rSO2, PIVH, and mortality were included in the metaanalysis. Random effects and hazard ratio models were used to combine all study results. Inter-study heterogeneity was assessed using Cochrane Q statistics and Higgin's I2 statistics. Results: Sixteen RCTs published between 2012 and 2020 met the inclusion criteria, a total of 1,944 preterms. Eleven studies showed a shorter duration of MV and CPAP in the LISA group than in INSURE group. Two studies evaluated rSO2 and suggested that LISA and INSURE transiently affect brain autoregulation during surfactant administration. INSURE group had a higher risk for MV in the first 72 h of life, pneumothorax, PIVH and mortality in comparison to the LISA group. Conclusion: This systematic review and meta-analyses provided evidence for the benefits of the LISA technique in the treatment of RDS, decreasing CPAP time, need for MV, BPD, pneumothorax, PIVH, and mortality when compared to INSURE. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the characteristics of overlapping meta-analyses based on randomized controlled trials (RCTs) which reported PD-1/PD-L1 inhibitors in non-small cell cancer (NSCLC). Methods: Meta-analyses were identified from English and Chinese databases until January 1, 2022. Differences in characteristics of overlapping meta-analyses that conducted in China and other countries were compared to assess their publication propensity. The corrected covered area (CCA) and coverage of relevant RCTs were analyzed for subtopics according to detailed intervention types. The waste and redundancy of evidence were assessed in the case of PD-1/PD-L1 inhibitor monotherapy for second-line treatment for NSCLC. Results: Fifty-nine meta-analyses published in English and 17 meta-analyses published in Chinese reporting 26 RCTs were identified. Fifty-three (69.74%) meta-analyses were conducted in China. The overlapping meta-analyses in China were more likely to be from hospitals, supported by government funding, integrate first and second-line therapies. Five of the six subtopics had overlapping meta-analyses according to specific types of interventions. The CCA of overlapping meta-analyses ranged from 33.33 to 63.19%, and the coverage of relevant RCTs ranged from 63.64 to 100%. All the conclusions of overlapping meta-analyses have been consistent in the subtopic of PD-1/PD-L1 inhibitor monotherapy for second-line treatment since 2017. Conclusion: Overlapping meta-analyses of PD-1/PD-L1 inhibitors in NSCLC hints that meta-analyses under this topic probably exist serious redundancy. Future research should focus on prospective registration of protocols for systematic reviews/meta-analyses, scientific designed PICO, and cumulative meta-analysis to reduce redundant and wasted studies. Journals should strengthen the requirement for reviewing previously published evidence in manuscript review. [ABSTRACT FROM AUTHOR]

Background: Acupuncture therapy is believed to have therapeutic potential for patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of acupuncture treatment for CIPN. Methods: We conducted a comprehensive search in eight electronic databases for SRs/MAs that included RCTs on acupuncture treatment for CIPN. Two separate researchers independently evaluated the methodological quality, reporting quality, and evidence quality of the SRs/MAs that were included in the study. Additionally, we examined the extent of overlap among the included RCTs by calculating the corrected covered area (CCA). Furthermore, we assessed the dependability of the effect sizes by conducting excess significance tests. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Furthermore, we also conducted an analysis of the acupuncture points used in RCTs. Results: This umbrella review includes 9 SRs/MAs, and their methodological quality, risk of bias, reporting quality, and evidence quality were all deemed unsatisfactory. Out of the 9 SRs/MAs, 28 RCTs were included, with a total CCA of 25.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that CIPN patients can benefit from acupuncture therapy, as indicated by effectiveness in measures including BPI-SF, VAS, FACT-NTX, NRS, SCV, and NCI-CTCAE. Egger's test and sensitivity analysis demonstrate the reliability and stability of this conclusion. The commonly used acupuncture points in the current RCTs include ST36, LI11, LI4, LR3, and SP6. Conclusion: Based on the existing evidence, acupuncture is effective and safe for patients with CIPN, as it can significantly improve effective rate, pain symptoms, quality of life, and nerve conduction velocity. However, given the low quality of current evidence, we should be cautious in interpreting this conclusion. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the potential relationship between serum vaspin levels and gestational diabetes mellitus (GDM). The PubMed, EBSCO, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) database were searched for articles published before December 2022. The publication language was restricted to English and Chinese. A meta-analysis was conducted by combining all studies that met the inclusion and exclusion criteria. Twenty-two studies (1990 women with GDM and 1597 pregnant women without GDM) were ultimately included in this meta-analysis. The meta-analysis showed that the serum vaspin levels are significantly higher in GDM compared with the controls (standardized mean difference: 0.720, 95% confidence interval: 0.440–1.000, Z = 5.041, P < 0.001). Subgroup analyses by stage of pregnancy and body mass index showed results similar to the overall outcome. No publication bias was identified, and the sensitivity analysis confirmed the robustness of the final result. Our results show that the serum vaspin levels are significantly higher in GDM. These findings suggest that high vaspin concentration is closely related to GDM and the serum vaspin levels might be a potential biomarker to indicate risk of GDM, more randomized control trials comparing the expression levels of vaspin between early and standard diagnosis of GDM are needed to strengthen our findings. [ABSTRACT FROM AUTHOR]

Background: Gut microbiome dysbiosis has been implicated in various gastrointestinal and extra-gastrointestinal diseases, but evidence on the efficacy and safety of fecal microbiota transplantation (FMT) for therapeutic indications remains unclear. Methods: The gutMDisorder database was used to summarize the associations between gut microbiome dysbiosis and diseases. We performed an umbrella review of published meta-analyses to determine the evidence synthesis on the efficacy and safety of FMT in treating various diseases. Our study was registered in PROSPERO (CRD42022301226). Results: Gut microbiome dysbiosis was associated with 117 gastrointestinal and extra-gastrointestinal. Colorectal cancer was associated with 92 dysbiosis. Dysbiosis involving Firmicutes (phylum) was associated with 34 diseases. We identified 62 published meta-analyses of FMT. FMT was found to be effective for 13 diseases, with a 95.56% cure rate (95% CI: 93.88-97.05%) for recurrent Chloridoids difficile infection (rCDI). Evidence was high quality for rCDI and moderate to high quality for ulcerative colitis and Crohn's disease but low to very low quality for other diseases. Conclusion: Gut microbiome dysbiosis may be implicated in numerous diseases. Substantial evidence suggests FMT improves clinical outcomes for certain indications, but evidence quality varies greatly depending on the specific indication, route of administration, frequency of instillation, fecal preparation, and donor type. This variability should inform clinical, policy, and implementation decisions regarding FMT. [ABSTRACT FROM AUTHOR]

Aim: We aimed to assess the beneficial and harmful effects of perioperative pain treatment with ketamine in patients undergoing spinal surgery. Methods: We searched Medline, Embase, and CENTRAL from inception until 15 February 2023 for randomised clinical trials comparing ketamine with placebo or no intervention in patients undergoing spinal surgery. The primary outcomes were cumulative opioid consumption at 24 h postoperatively and serious adverse events. We adhered to recommendations of the Cochrane Collaboration and performed meta‐analysis, Trial Sequential Analysis (TSA) to assess the risks of random errors, risk of bias assessment to evaluate the risks of systematic errors, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We included a total of 28 randomised clinical trials enrolling 2110 participants providing data for our pre‐defined outcomes. Twenty‐three trials enrolled adult participants and 5 trials enrolled paediatric participants. Three trials were at low risk of bias. Meta‐analysis and TSA of trials including adults showed that ketamine versus placebo or no intervention seemed to reduce the cumulative 24‐h opioid consumption (mean difference −17.57 mg; TSA‐adjusted 95% confidence interval, −24.22 to −10.92; p <.01; low certainty of evidence), and there was no evidence of a difference of ketamine versus placebo or no intervention on the risk of serious adverse events (risk ratio 2.16; 96.7% confidence interval, 0.35 to 13.17; p =.36; very low certainty of evidence). Conclusion: In adults undergoing spinal surgery, ketamine may reduce cumulative 24‐h opioid consumption. Ketamine may increase the occurrence of serious adverse events, but the evidence was very uncertain. [ABSTRACT FROM AUTHOR]

BackgroundObservational studies have shown that micronutrients can affect the occurrence of frailty. However, it is not clear whether there is a causal relationship between the two. This study aimed to explore the causal relationship between circulating micronutrient levels and frailty risk using a two-sample Mendelian randomization (TSMR) approach.MethodsWe gathered and screened instrumental variables (IVs) for six circulating micronutrients, including vitamin B12, vitamin B6, folate, vitamin C, vitamin D, and vitamin E, from published genome-wide association studies (GWAS) and the IEU OpenGWAS open database. Summary statistics for frailty were obtained from a GWAS meta-analysis, including the UK Biobank and TwinGene (N = 175,226). We performed two independent TSMR analyses and a meta-analysis based on the two independent MR estimates to assess the causal relationship between circulating micronutrientn and frailty.ResultsOur study found, no causal relationship between genetically predicted vitamin D (β = −0.059, p = 0.35), vitamin B6 (β = 0.006, p = 0.80), vitamin E (β = −0.011, p = 0.79), vitamin C (β = −0.044, p = 0.06), vitamin B12 (β = −0.027, p = 0.37), and folate (β = 0.029, p = 0.17), with frailty.ConclusionThis study showed that these six micronutrients did not reduce the risk of developing frailty. However, we think it is necessary further to investigate the relationship and mechanisms between micronutrients and frailty using methods such as randomized controlled trials.

Abstract Background It has been reported that metformin use may reduce the risk of thyroid cancer, but existing studies have generated inconsistent results. The purpose of this study was to investigate such association between metformin use and the risk of thyroid cancer. Methods Studies of metformin use for the risk of thyroid cancer were searched in Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Database, Wanfang Data, and Chinese Scientific Journals Database (VIP) from the establishment date to December 2022. Newcastle–Ottawa scale is adopted for assessing the methodological quality of included studies, and the inter-study heterogeneity was assessed by using the I-squared statistic. Combined odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated through either fixed-effects or random-effects model according to the heterogeneity. Besides, subgroup analyses, sensitivity analyses and test for publication bias were conducted. Results Five studies involving 1,713,528 participants were enrolled in the qualitative and quantitative synthesis. The result of the meta-analyses showed that metformin use was associated with a statistically significant lower risk of thyroid cancer (pooled OR = 0.68, 95% CI = 0.50–0.91, P = 0.011). Moreover, in the subgroup analysis, we found that the use of metformin may also aid in the prevention of thyroid cancer in Eastern population (pooled OR = 0.55, 95% CI = 0.35–0.88, P = 0.012) rather than Western population (pooled OR = 0.89, 95% CI = 0.52–1.54, P = 0.685). Sensitivity analysis suggested the results of this meta-analyses were relatively stable. No publication bias was detected. Conclusion Metformin use is beneficial for reducing the risk of thyroid cancer. For further investigation, more well-designed studies are still needed to elucidate the association between metformin use and the risk of thyroid cancer.

Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.

Abstract Background The search for quantitative trait loci (QTL) affecting traits of interest in mammals is frequently limited to autosomes, with the X chromosome excluded because of its hemizygosity in males. This study aimed to assess the importance of the X chromosome in the genetic determinism of 11 complex traits related to milk production, milk composition, mastitis resistance, fertility, and stature in 236,496 cows from three major French dairy breeds (Holstein, Montbéliarde, and Normande) and three breeds of regional importance (Abondance, Tarentaise, and Vosgienne). Results Estimates of the proportions of heritability due to autosomes and X chromosome (h²X) were consistent among breeds. On average over the 11 traits, h²X=0.008 and the X chromosome explained ~ 3.5% of total genetic variance. GWAS was performed within-breed at the sequence level (~ 200,000 genetic variants) and then combined in a meta-analysis. QTL were identified for most breeds and traits analyzed, with the exception of Tarentaise and Vosgienne and two fertility traits. Overall, 3, 74, 59, and 71 QTL were identified in Abondance, Montbéliarde, Normande, and Holstein, respectively, and most were associated with the most-heritable traits (milk traits and stature). The meta-analyses, which assessed a total of 157 QTL for the different traits, highlighted new QTL and refined the positions of some QTL found in the within-breed analyses. Altogether, our analyses identified a number of functional candidate genes, with the most notable being GPC3, MBNL3, HS6ST2, and DMD for dairy traits; TMEM164, ACSL4, ENOX2, HTR2C, AMOT, and IRAK1 for udder health; MAMLD1 and COL4A6 for fertility; and NRK, ESX1, GPR50, GPC3, and GPC4 for stature. Conclusions This study demonstrates the importance of the X chromosome in the genetic determinism of complex traits in dairy cattle and highlights new functional candidate genes and variants for these traits. These results could potentially be extended to other species as many X-linked genes are shared among mammals.