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Xu M, Chen S, Liu X, Luo Y, Wang D, Lu H, Jiang M, Chen X. Best evidence for rehabilitation management of urinary incontinence in patients with bladder cancer following orthotopic neobladder reconstruction. Asia Pac J Oncol Nurs 2025; 12:100647. [PMID: 39896758 PMCID: PMC11782885 DOI: 10.1016/j.apjon.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 12/19/2024] [Indexed: 02/04/2025] Open
Abstract
Objective This study aims to establish the best evidence for the rehabilitation management of urinary incontinence (UI) in patients with orthotopic neobladder (ONB) following radical cystectomy (RC) for bladder cancer, providing a theoretical foundation for clinical practice. Methods A systematic search was conducted across evidence-based databases, guideline networks, and professional association websites to identify relevant literature on rehabilitation management for patients with ONB after bladder cancer surgery. Studies published in both English and Chinese, up to May 8, 2024, were included. Trained researchers assessed the quality of the literature and summarized the evidence. Results Fourteen documents were included, consisting of eight guidelines, two clinical decision documents, and four expert consensus reports. A total of 43 pieces of evidence were identified, covering seven key areas: preoperative UI assessment and counseling, preventive measures, UI assessment and diagnosis, conservative treatments, selection and use of nursing equipment, evaluation of effectiveness, and follow-up care. Conclusions The best evidence for UI rehabilitation management after ONB for bladder cancer can help standardize patient care and clinical practices. Healthcare providers should adapt this evidence to their local healthcare settings, cultural contexts, barriers, and patient preferences. Systematic review registration This study was conducted following the evidence summary reporting specifications of the Fudan University Center for Evidence-Based Nursing (Registration No. ES20244165).
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Affiliation(s)
- Man Xu
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shuhong Chen
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xiyuan Liu
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yuyi Luo
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Di Wang
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Huiming Lu
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Mengxiao Jiang
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xiaoping Chen
- Urology Department, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
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Hong M, Yu W, Gao Y, Pei B, Chen J, Lou Y. Pelvic floor muscle training for the prevention and management of low anterior resection syndrome in patients with rectal cancer: An evidence-based summary. Asia Pac J Oncol Nurs 2025; 12:100620. [PMID: 39712512 PMCID: PMC11658566 DOI: 10.1016/j.apjon.2024.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 11/09/2024] [Accepted: 11/11/2024] [Indexed: 12/24/2024] Open
Abstract
Objective This study aims to summarize the best available evidence on the effectiveness of pelvic floor muscle training (PFMT) in preventing and managing low anterior resection syndrome (LARS) among patients with rectal cancer, with the goal of enhancing quality of care. Methods A systematic search was conducted across databases, including BMJ Best Practice, UpToDate, WHO, GIN, UK NICE, NGC, SIGN, RNAO, NCCN, JBI Library, Cochrane Library, CINAHL, Web of Science, Embase, OVID, PubMed, Chinese Wanfang, CNKI, SinoMed, and VIP, covering publications from inception through June 30, 2024. We targeted clinical decisions, guidelines, evidence summaries, expert consensus statements, systematic reviews, and randomized controlled trials related to PFMT for LARS in patients with rectal cancer. Two independent reviewers assessed the quality of the literature and extracted key findings. Results A total of 15 articles were included, yielding 21 pieces of evidence across six core areas: multidisciplinary management, bowel function risk screening and assessment, the purpose and target population for PFMT, pre-exercise instructions, exercise regimens, and exercise feedback. Conclusions The summarized 21 recommendations provide guidance for integrating PFMT into care plans for patients with rectal cancer and LARS. However, given that evidence originates from diverse clinical settings, considerations such as the local health care environment should be evaluated before implementation. Future research should focus on optimizing PFMT regimens to improve bowel function outcomes in patients with rectal cancer, refining exercise protocols, and gathering further data to enhance clinical application. Systematic review registration Registered with the Fudan University Centre for Evidence-Based Nursing, registration number ES20245385.
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Affiliation(s)
- Meirong Hong
- School of Nursing, Hangzhou Normal University, Hangzhou, China
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Yu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yating Gao
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bei Pei
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ji Chen
- Nursing Department, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yan Lou
- School of Nursing, Hangzhou Normal University, Hangzhou, China
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Bardach A, Brizuela M, Berrueta M, Ciapponi A, Sambade JM, Ballivian J, Ortega V, Castellana N, Comandé D, Parker EPK, Kampmann B, Stegelmann K, Xiong X, Stergachis A, Munoz FM, Buekens P, Mazzoni A. Umbrella review of the safety of Chikungunya vaccine platforms used in other vaccines. Hum Vaccin Immunother 2025; 21:2463191. [PMID: 39932481 DOI: 10.1080/21645515.2025.2463191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 01/20/2025] [Accepted: 02/02/2025] [Indexed: 02/14/2025] Open
Abstract
Chikungunya virus (CHIKV), transmitted through Aedes mosquitoes, is a significant global health concern. Various vaccine platforms have been explored to combat CHIKV, including formalin inactivation, live-attenuated strains, virus-like particles (VLPs), viral vectors, and mRNA technologies. This umbrella review synthesizes evidence on the safety profiles of vaccine platforms used in Chikungunya vaccines that have been applied in other vaccines, focusing on adverse events of special interest (AESI) in pregnant persons, children, and adolescents. A comprehensive overview of systematic reviews (SRs) was conducted. Results: Seven systematic reviews were included and complemented with primary studies. Vaccines like influenza, human papillomavirus (HPV), and COVID-19, which share platforms with Chikungunya vaccines, showed no significant increase in AESI. Moderate-to high-quality SRs supported favorable safety profiles. Vaccines sharing platforms with Chikungunya vaccines generally exhibit acceptable safety profiles in pregnant persons, children, and adolescents.
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Affiliation(s)
- Ariel Bardach
- Center for Research in Epidemiology and Public Health (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Martin Brizuela
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Mabel Berrueta
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Juan M Sambade
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Jamile Ballivian
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vanesa Ortega
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Noelia Castellana
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Daniel Comandé
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Edward P K Parker
- The Vaccine Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Beate Kampmann
- Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, London, UK
- Charite Centre for Global Health, Charité, Universitätsmedizin, Vaccine Centre, Berlin, Germany
| | - Katharina Stegelmann
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Andy Stergachis
- Schools of Pharmacy and Public Health, University of Washington, Seattle, USA
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Agustina Mazzoni
- Department of Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Vargas Campos CA, García-Pérez S, Figuerola J, Martínez-de la Puente J, Polo I, Rodríguez-de-Fonseca B, Fernández-Álvarez S, Galván Fraile V, Martín-Rey M, Lacasaña M, Bermúdez-Tamayo C. Comprehensive analysis of West Nile Virus transmission: Environmental, ecological, and individual factors. An umbrella review. One Health 2025; 20:100984. [PMID: 40040921 PMCID: PMC11876902 DOI: 10.1016/j.onehlt.2025.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 01/24/2025] [Accepted: 01/30/2025] [Indexed: 03/06/2025] Open
Abstract
Background West Nile Virus (WNV) exemplifies the complexities of managing vector-borne diseases, expanding globally due to human activities and ecological changes. Originating from Africa and transmitted by Culex mosquitoes, WNV is now reported across multiple continents. The aim of this study was to identify the environmental, ecological, and individual factors influencing WNV transmission. Methods An umbrella review was conducted. Comprehensive searches were performed in PubMed, Scopus, Web of Science, Embase, and LILACS. Inclusion criteria were reviews involving WNV transmission agents (reservoirs, vectors, hosts) and associative analyses between environmental, ecological, or individual factors and WNV transmission. Data extraction and quality appraisal were performed using templates and the AMSTAR 2 tool. Results From 404 retrieved studies, 23 systematic reviews and meta-analyses were included. Almost 70 % were low or critically low quality. The co-occurrence network highlighted emerging research on climate change and environmental factors. Temperature, precipitation, and land use significantly influence WNV transmission. Warmer temperatures enhance mosquito populations and viral replication, while extreme weather events like droughts increase mosquito-human contact. Climate change significantly contributes to WNV dynamics by altering temperature and precipitation patterns, enhancing vector proliferation, and extending transmission seasons. Ecological factors such as higher avian diversity, vegetation indexes, and distribution of mosquito species can impact WNV transmission significantly. Education and income levels influence preventive behaviors and infection risk, with lower socioeconomic status linked to higher WNV risk. Certain occupational groups are also at elevated risk of WNV infection. Conclusion Environmental factors like temperature and precipitation critically affect WNV transmission by influencing mosquito behavior and avian reservoir dynamics. Socio-economic status and education levels significantly impact individual preventive behaviors and infection risk. Multifactorial influences on infection risk make necessary integrated surveillance systems and public health strategies. Longitudinal studies with One Health approaches are necessary to better understand WNV dynamics and reduce WNV transmission.
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Affiliation(s)
- Carlos Adrián Vargas Campos
- Universidad Complutense de Madrid, Physics, Physics of the Earth and Astrophysics, Ciudad Universitaria, ZIP code 28040 Madrid, Spain
- Universidad de Granada, Av. Del Hospicio, 1, 18012 Granada, Spain
| | - Selene García-Pérez
- Unit of Preventive Medicine and Public Health, Puerto Real University Hospital, Calle Romería, 7, 11510, Puerto Real, Cádiz, Spain
- Andalusian School of Public Health EASP, Cta. del Observatorio, 4, Beiro, 18011 Granada, Spain
| | - Jordi Figuerola
- Department of Conservation Biology and Global Change, Estación Biológica de Doñana (EBD), CSIC, Avda. Américo Vespucio 26, 41092 Sevilla, Spain
- Ciber de Epidemiología y Salud Pública, CIBERESP, Av. Monforte de Lemos, 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Josué Martínez-de la Puente
- Department of Conservation Biology and Global Change, Estación Biológica de Doñana (EBD), CSIC, Avda. Américo Vespucio 26, 41092 Sevilla, Spain
- Ciber de Epidemiología y Salud Pública, CIBERESP, Av. Monforte de Lemos, 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Irene Polo
- Universidad Complutense de Madrid, Physics, Physics of the Earth and Astrophysics, Ciudad Universitaria, ZIP code 28040 Madrid, Spain
| | - Belén Rodríguez-de-Fonseca
- Universidad de Granada, Av. Del Hospicio, 1, 18012 Granada, Spain
- Geosciences Institute IGEO-CSIC, Madrid, Spain
| | - Sofía Fernández-Álvarez
- Universidad Complutense de Madrid, Physics, Physics of the Earth and Astrophysics, Ciudad Universitaria, ZIP code 28040 Madrid, Spain
| | - Víctor Galván Fraile
- Universidad Complutense de Madrid, Physics, Physics of the Earth and Astrophysics, Ciudad Universitaria, ZIP code 28040 Madrid, Spain
| | - Marta Martín-Rey
- Universidad Complutense de Madrid, Physics, Physics of the Earth and Astrophysics, Ciudad Universitaria, ZIP code 28040 Madrid, Spain
| | - Marina Lacasaña
- Andalusian School of Public Health EASP, Cta. del Observatorio, 4, Beiro, 18011 Granada, Spain
- Ciber de Epidemiología y Salud Pública, CIBERESP, Av. Monforte de Lemos, 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avda. de Madrid, 15, Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
| | - Clara Bermúdez-Tamayo
- Andalusian School of Public Health EASP, Cta. del Observatorio, 4, Beiro, 18011 Granada, Spain
- Ciber de Epidemiología y Salud Pública, CIBERESP, Av. Monforte de Lemos, 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avda. de Madrid, 15, Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
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Ameyaw DS, Manuh T, Oppong SA, Nyan CP. PROTOCOL: Gender-Responsive Macro-Level Policies and Women's Economic Empowerment in Sub-Saharan Africa: An Evidence and Gap Map. CAMPBELL SYSTEMATIC REVIEWS 2025; 21:e70035. [PMID: 40124217 PMCID: PMC11929552 DOI: 10.1002/cl2.70035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 11/04/2024] [Accepted: 02/28/2025] [Indexed: 03/25/2025]
Abstract
This Evidence and Gap Map (EGM) protocol aims to identify, map, and provide an overview of the existing evidence and gaps on gender-responsive macro-level policies and women's economic empowerment in sub-Saharan Africa. Specifically, the EGM will: (1) identify which evidence clusters present opportunities for evidence synthesis and (2) identify the evidence gaps that require additional studies, research, and evaluations.
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Affiliation(s)
| | - Takyiwaa Manuh
- International Centre for Evaluation and DevelopmentTemaAccraGhana
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Rodriguez L, Lyons J, Maloy A, O'Brien A. PROTOCOL: Bereavement Interventions for Children and Adolescents: An Evidence and Gap Map of Primary Studies and Systematic Reviews. CAMPBELL SYSTEMATIC REVIEWS 2025; 21:e70027. [PMID: 40124216 PMCID: PMC11929544 DOI: 10.1002/cl2.70027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 01/28/2025] [Accepted: 02/10/2025] [Indexed: 03/25/2025]
Abstract
This is the protocol for a Campbell evidence and gap map. The objectives are as follows: (1) To identify and map all existing primary studies and systematic reviews (published and unpublished) on bereavement interventions/programmes for children and adolescents to create a live, searchable and publicly available EGM; (2) Provide a comprehensive descriptive overview of psychosocial outcomes targeted by bereavement interventions for children and adolescents; (3) Determine the characteristics of bereavement interventions targeted at children and adolescents, including age, location, duration, delivery, underlying theories, evaluation and target death.
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Affiliation(s)
- Leonor Rodriguez
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - James Lyons
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - Amy Maloy
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - Ailsa O'Brien
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
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Siqin L, Jia S, Shiming H, Xiaoli Y, Yan P, Congcai G, Zucai X. Pre-pregnancy fertility guidance for women of childbearing age with epilepsy: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2025; 8:100276. [PMID: 39835206 PMCID: PMC11743865 DOI: 10.1016/j.ijnsa.2024.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 11/25/2024] [Accepted: 12/02/2024] [Indexed: 01/22/2025] Open
Abstract
Background Epilepsy is one of the most common neurological conditions affecting women of reproductive age. Epilepsy management during pregnancy is a clinical conundrum, requiring a balance between seizure control and risk minimization for women with epilepsy, as well as for their fetuses. Objective In this review, we aimed to systematically search, evaluate, and summarize relevant evidence on perinatal fertility guidance for women with epilepsy to provide a basis for medical staff to offer comprehensive fertility counseling. Methods Systematic searches were conducted for system evaluations, expert consensus, guidelines, and evidence summarizing best clinical practices and clinical decision-making in fertility guidance for women with epilepsy. The search encompassed resources from the National Institute of Health and Clinical Optimization in the United Kingdom, the National Guidelines Network in the United States, the International Guidelines Collaboration Network, Registered Nurses' Association of Ontario guidelines in Canada, the Scottish Interhospital Guidelines Network, the International Anti-Epilepsy Alliance, the Royal College of Obstetricians and Gynecologists in the United Kingdom, the American Association of Obstetricians and Gynecologists, Chinese Anti Epilepsy Association, PubMed, UpToDate, BMJ Best Clinical Practice, Web of Science, Embase, JBI Evidence Based Health Care Center, Cochrane Library Database, and China National Knowledge Infrastructure databases or websites from inception to July 31st 2023. Two researchers with evidence-based nursing backgrounds independently completed literature screening and quality evaluation while extracting and summarizing evidence based on themes. Results A total of 11 articles were ultimately included, comprising one clinical decision, six guidelines, two expert consensus statements, one meta-analysis, and one evidence summary. In these articles, authors collectively addressed five themes: pre-pregnancy consultation and preparation, pregnancy management, delivery management, postpartum and newborn care, and selection of contraceptive measures. Conclusion We have synthesized the most compelling evidence regarding reproductive counseling for women with epilepsy across the preconception, pregnancy, labor and delivery, and postpartum periods. This serves as a foundation for healthcare professionals to implement effective reproductive counseling practices. In clinical practice, medical personnel should consider the patient's clinical context, individual circumstances, and preferences when devising treatment and care plans. This will facilitate the implementation of scientifically-sound management strategies for women with epilepsy to enhance maternal and infant outcomes.
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Affiliation(s)
- Liu Siqin
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
| | - Song Jia
- School of Nursing, Zunyi Medical University, Guizhou, , 56300, China
| | - Huang Shiming
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
| | - Yuan Xiaoli
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
| | - Peng Yan
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
| | - Gu Congcai
- School of Nursing, Zunyi Medical University, Guizhou, , 56300, China
| | - Xu Zucai
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Guizhou, , 56300, China
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Norouzzadeh M, Hasan Rashedi M, Azizi MH, Teymoori F, Maghsoomi Z, Shidfar F. Efficacy and safety of Hibiscus sabdariffa in cardiometabolic health: An overview of reviews and updated dose-response meta-analysis. Complement Ther Med 2025; 89:103135. [PMID: 39870328 DOI: 10.1016/j.ctim.2025.103135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/14/2025] [Accepted: 01/20/2025] [Indexed: 01/29/2025] Open
Abstract
BACKGROUND Conventional treatments for cardiometabolic diseases face limitations related to cost, efficacy, and side effects. Hibiscus sabdariffa (HS) is a common food product and a potential alternative. However, previous studies have shown inconsistent results and lacked assessments of result certainty, intervention safety, and subgroup analysis credibility. This study evaluated the efficacy and safety of HS on blood pressure (BP), lipid profiles, glycemic control, anthropometric parameters, inflammatory markers, oxidative stress indicators, and liver enzymes. METHODS To conduct this umbrella review, a systematic search of eligible meta-analyses was performed up to May 2024. The random-effects model was used to synthesize results from individual trials. Quality, certainty, and credibility of evidence were evaluated using the Cochrane Risk of Bias tool, AMSTAR-II, GRADE, and ICEMAN frameworks. RESULTS Data from 26 randomized controlled trials involving 1797 participants revealed that HS dose-dependently reduced systolic and diastolic BP compared to placebo and other teas. Although no significant differences were found between HS and antihypertensive drugs, HS showed moderate credibility for therapeutic BP reduction (> 10 mmHg), especially in individuals over 50 years, in trials lasting over four weeks, and in those with a low risk of bias. HS also reduced total cholesterol, LDL-C, fasting blood glucose, and increased HDL-C. A minor, clinically insignificant increase in aspartate aminotransferase was observed without elevating adverse event risks. CONCLUSIONS HS showed BP-lowering effects comparable to antihypertensive drugs and beneficial impacts on lipid and glycemic profiles. Although HS is generally considered safe, long-term and therapeutic dosing safety requires careful monitoring.
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Affiliation(s)
- Mostafa Norouzzadeh
- Institute for Studies in Medicine History, Persian and Complementary Medicine, Iran University of Medical Science, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran; Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Minoo Hasan Rashedi
- Institute for Studies in Medicine History, Persian and Complementary Medicine, Iran University of Medical Science, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran; Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hesam Azizi
- Institute for Studies in Medicine History, Persian and Complementary Medicine, Iran University of Medical Science, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Teymoori
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Maghsoomi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farzad Shidfar
- Institute for Studies in Medicine History, Persian and Complementary Medicine, Iran University of Medical Science, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
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Yi Y, Ma F, Jiao Y, Zhang R, Yi Y, Ma Y. Comparative efficacy of acupuncture therapies in premature ovarian failure: A systematic review and network meta-analysis. Complement Ther Med 2025; 89:103141. [PMID: 39922292 DOI: 10.1016/j.ctim.2025.103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/12/2025] [Accepted: 01/31/2025] [Indexed: 02/10/2025] Open
Abstract
OBJECTIVES Premature ovarian failure (POF) is becoming more common and has a major negative impact on women's mental and physical well-being. The use of acupuncture therapies to treat POF has gained popularity. However, the optimal treatment remains uncertain. This study aimed to systematically review the literature and conduct a network meta-analysis (NMA) to compare the efficacy of different acupuncture and related therapies and identify methodologic weaknesses in previous studies. DESIGN We systematically searched six databases from their inception to April 2024 for randomized controlled trials (RCTs) of acupuncture therapies for POF. We assessed methodological quality and risk of bias using the RoB 2.0 tool. The NMA was conducted using R and STATA software based on frequency theory, focusing on overall effectiveness rates and hormone levels. Additionally, we critically reviewed methodological limitations and potential biases in the studies included. RESULTS Thirty-seven eligible studies involving 2419 patients were included in this NMA. The NMA results indicated that moxibustion_catgut implantation at acupoint (MB_CIA) (P-score = 0.88; pooled mean difference (95 % CI): 22.07 (1.61-302.48)) showed the highest improvement in overall effectiveness, while warming acupuncture (WA) (0.95; -27.56 (-45.35 to -9.78)) improved follicle-stimulating hormone (FSH) levels best. WA_MB (0.85; -9.35 (-15.08 to -3.62)) and WA (P-score = 0.77) were most effective for luteinizing hormone (LH) and estradiol (E2) levels, respectively. Confidence in evidence ranged from moderate to very low, with low overall confidence. Key methodologic weaknesses included insufficient allocation concealment, lack of blinding, and small sample sizes. CONCLUSIONS Acupuncture therapies may effectively improve POF. MB_CIA, WA, and WA_MB seem to be the most effective. However, severe methodological constraints, such as insufficient randomization and a lack of blinding, may reduce trust in these results. To offer robust evidence, high-quality RCTs must overcome these limitations. SYSTEMATIC REVIEW REGISTRATION [PROSPERO], identifier [CRD42024550180].
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Affiliation(s)
- Yonghang Yi
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
| | - Fengjun Ma
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
| | - Yang Jiao
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
| | - Rongqi Zhang
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
| | - Yunhao Yi
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
| | - Yuxia Ma
- Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
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10
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Yeh ML, Hsu CC, Lin M, Lin CJ, Lin JG. Effects of acupuncture-related intervention on chemotherapy-induced peripheral neuropathy and quality of life: An umbrella review. Complement Ther Med 2025; 89:103131. [PMID: 39900253 DOI: 10.1016/j.ctim.2025.103131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/05/2025] [Accepted: 01/17/2025] [Indexed: 02/05/2025] Open
Abstract
BACKGROUND Numerous studies have explored the role of acupuncture-related treatments in alleviating chemotherapy-induced peripheral neuropathy (CIPN) and improving the quality of life for patients with cancer, resulting in mixed findings. This umbrella review aimed to synthesize existing systematic reviews (SRs) to deliver an updated assessment of the certainty of evidence concerning the effects of acupuncture-related treatments on CIPN and quality of life among a diverse group of patients with cancer. METHODS This umbrella review considered eligible SRs published on one of nine electronic databases between inception and August 2024. It included adult patients with cancer of any stage who were undergoing chemotherapy. Interventions encompassed acupuncture, either alone or with electrical stimulation or moxibustion, and transcutaneous electrical acupoint/nerve stimulation (TEAS). The outcomes analyzed were changes in CIPN, nerve conduction velocity (NCV), and quality of life. RESULTS The outcomes were evaluated using data obtained from 14 SRs that demonstrated moderate to high methodological and reporting quality. The findings showed that acupuncture (either alone or combined with electrical stimulation) and TEAS effectively alleviated CIPN symptoms, reduced CIPN pain, improved NCV, and enhanced quality of life. CONCLUSION The findings of this umbrella review indicate that these benefits were usually noticeable by the second week of treatment, persisted until the sixth week, and then gradually declined. Sensory nerve recovery occurred more rapidly than motor nerve recovery, often within 1.5 weeks. Although acupuncture combined with moxibustion or acupressure also enhanced patient outcomes, there was insufficient information available for further study analysis.
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Affiliation(s)
- Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing & Health Sciences, Taipei Medical University Research Center of Cochrane Taiwan, 365 Minte Road, Taipei, Taiwan; Taipei Medical University Research Center of Cochrane Taiwan
| | - Chin-Che Hsu
- Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan
| | - Matthew Lin
- School of Nursing, National Taipei University of Nursing & Health Sciences, 365 Minte Road, Taipei, Taiwan
| | - Chuan-Ju Lin
- Hsinchu Cathay General Hospital, No. 678, Section 2, Zhonghua Road, Hsinchu, Taiwan; National Taipei University of Nursing and Health Sciences.
| | - Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, Taiwan.
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11
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Srichawla BS, Kaur T, Singh H. Corticosteroids in posterior reversible encephalopathy syndrome: Friend or foe? A systematic review. World J Clin Cases 2025; 13:98768. [DOI: 10.12998/wjcc.v13.i12.98768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 10/24/2024] [Accepted: 12/17/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a complex neurological disorder characterized by symptoms such as headaches, seizures, confusion, and visual disturbances. The pathophysiology of PRES involves endothelial dysfunction, disrupted cerebral autoregulation, and resulting vasogenic edema. Hypertension and other factors that alter cerebral autoregulation are critical in its development. Corticosteroids, widely used for their anti-inflammatory and immunosuppressive properties, play a controversial role in PRES.
AIM To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature. Specifically, it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES. By synthesizing case reports and series, this review aims to provide a comprehensive understanding of the mechanisms, clinical presentations, and management strategies associated with corticosteroid-related PRES.
METHODS The review was carried out according to the PRISMA guidelines. The databases searched included Science Direct, PubMed, and Hinari. The search strategy encompassed terms related to corticosteroids and PRES. Studies were included if they were peer-reviewed articles examining corticosteroids in PRES, excluding non-English publications, reviews, and editorials. Data on patient demographics, clinical characteristics, imaging findings, corticosteroid regimens, and outcomes were extracted. The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.
RESULTS A total of 56 cases of PRES (66.1% women, 33.9% men) potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified. Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years, with seizures, headaches, hypertension, and visual disturbances being common clinical sequelae. Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes. High-dose or prolonged corticosteroid therapy was a significant risk factor. On the contrary, in the treatment cases, corticosteroids were associated with positive outcomes, including resolution of vasogenic edema and stabilization of symptoms, particularly in patients with underlying inflammatory or autoimmune diseases.
CONCLUSION Corticosteroids have a dual role in PRES, capable of both inducing and treating the condition. The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating. Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation. Corticosteroids may aid in the management of PRES: (1) Enhancing endothelial stability; (2) Anti-inflammatory properties; and (3) Improving blood-brain barrier integrity. Mechanisms which may reduce or mitigate vasogenic edema formation.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Taranjit Kaur
- Department of Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, MS 39401, United States
| | - Harsimran Singh
- Department of Medicine, University of California Berkeley, Berkeley, CA 94720, United States
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12
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Iwamoto K, Pines K, Lochala C, Long D, Hess P, Sargent B. Systematic Review to Inform the Developmental Coordination Disorder Clinical Practice Guideline Update: Physical Therapy Intervention. Pediatr Phys Ther 2025; 37:194-208. [PMID: 39918921 DOI: 10.1097/pep.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
PURPOSE Systematically review current evidence on physical therapy (PT) intervention for developmental coordination disorder (DCD) to inform the update to the 2020 DCD Clinical Practice Guideline (CPG). METHODS Eight databases were searched for qualitative studies, randomized controlled trials (RCTs) and systematic reviews (SRs) that informed PT management of DCD. Risk of bias and certainty of evidence were assessed. RESULTS Sixteen studies were included. Three SRs, 3 RCTs, and 1 qualitative study supported task-oriented interventions, the first-choice intervention recommended by the 2020 DCD CPG. One SR and 7 RCTs supported supplemental activities, including a meta-analysis of 2 studies on active video gaming. One qualitative study informed how physical therapists adapt motor learning strategies for children with DCD. CONCLUSION Newer evidence reaffirms 3 of the 5 recommendations on intervention of the 2020 DCD CPG and adds low to very low-quality evidence on new evidence-informed supplemental activities.
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Affiliation(s)
- Kai Iwamoto
- Children's Hospital Los Angeles, Division of Pediatric Rehabilitation Medicine, Los Angeles, California (Drs Iwamoto and Pines); University of Southern California, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles, California (Drs Iwamoto, Pines, Lochala, Long, and Sargent); and Children's Hospital Los Angeles, Patient Care Services Education and Research, Los Angeles, California (Ms Hess)
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13
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D'Antoni AV, Kamel N, Tubbs RS, McCartan MG, Strobel LW, Bubb KC. Psychometric Properties of the Critical Appraisal Tool for Anatomical Meta-Analysis. Clin Anat 2025; 38:355-361. [PMID: 39844509 DOI: 10.1002/ca.24263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/10/2025] [Accepted: 01/10/2025] [Indexed: 01/24/2025]
Abstract
The hallmark of evidence-based anatomy (EBA) is the anatomical meta-analysis (AMA). The Critical Appraisal Tool for Anatomical Meta-Analysis (CATAM) was recently published to enable users to appraise AMAs quickly and effectively. The tool is valuable for students and clinicians who need to judge the quality of AMAs, which informs clinical decision making and results in better patient care. Subjective measures of the tool's face and content validity have been established, but establishing its reliability provides a more objective measure of the instrument's dependability. This study investigated the interrater reliability (IRR) of the CATAM between novice and expert raters. Three graduate students and three professors (two anatomists and one pharmacist) read the original CATAM paper, and then had a post hoc meeting to discuss scoring with the tool. Three recent AMAs (published between 2017 and 2022) were randomly chosen from PubMed, and all six raters scored the papers blindly. The intraclass correlation coefficient (ICC) statistic was used to calculate the interrater reliability (IRR) between all scores, and then the ICCs between novice and expert scores were compared. Cronbach's alpha (internal consistency) of the CATAM was also calculated (SPSS 25, Armonk, NY). ICC for AMA-1 was 0.999 (95% CI, 0.997-0.999), p = 0.000, and alpha was 0.999. ICC for AMA-2 was 0.994 (95% CI, 0.988-0.998), p = 0.000, and alpha was 0.994. ICC for AMA-3 was 0.998 (95% CI, 0.995-0.999), p = 0.000, and alpha was 0.998. ANOVA showed no significant differences (p > 0.05) in mean ICCs between raters. The CATAM is a robust tool with excellent IRR (ICC > 0.990) and internal consistency (alpha > 0.990). No significant difference in ICC scores between novices and experts suggests the tool does not require prior expert knowledge to be effective. Now that the reliability of the CATAM is established, it can be more widely adopted by students and physicians worldwide to evaluate the quality of AMAs. The CATAM offers widespread applicability, and can be adopted in medical education, journal clubs, and clinical seminars to critically evaluate AMAs.
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Affiliation(s)
- Anthony V D'Antoni
- Physician Assistant Program, University of Mount Saint Vincent, Riverdale, New York, USA
| | - Nancy Kamel
- Physician Assistant Program, University of Mount Saint Vincent, Riverdale, New York, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Morgan G McCartan
- Physician Assistant Program, University of Mount Saint Vincent, Riverdale, New York, USA
| | - Laine W Strobel
- Physician Assistant Program, University of Mount Saint Vincent, Riverdale, New York, USA
| | - Kathleen C Bubb
- Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Yasmin F, Moeed A, Iqbal K, Ali A, Kumar A, Basit J, Hamza M, Dani SS, Kalra A. Clinical and hemodynamic outcomes of self-expanding and balloon-expandable valves for valve-in-valve transcatheter aortic valve implantation (ViV-TAVI): An updated systematic review and meta-analysis. IJC HEART & VASCULATURE 2025; 57:101627. [PMID: 40092565 PMCID: PMC11907471 DOI: 10.1016/j.ijcha.2025.101627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 01/20/2025] [Accepted: 02/02/2025] [Indexed: 03/19/2025]
Abstract
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a feasible alternative to reoperative surgery in patients with degenerated surgical bio-prosthesis. However, data regarding the choice of valve type in ViV-TAVI remain inconclusive. This meta-analysis compares the procedural and clinical outcomes of self-expanding (SE) vs. balloon-expandable (BE) valves in ViV-TAVI. MEDLINE and Scopus were queried to identify studies reporting outcomes of ViV-TAVI by SE/BE valve type or comparing outcomes between SE or BE valves for ViV-TAVI. The primary outcome was incidence of all-cause mortality at 30 days. Data were presented as incidence of outcomes, analyzed via random effects model using inverse variance method with 95 % confidence intervals. Further incidence rates of primary and secondary outcomes were presented as subgroups of BE and SE, with comparison in incidence rates between the subgroups made using p-interaction of proportions. 27 studies with 13,182 patients (SE: 7346; BE: 5836) were included. There were no significant differences between the BE vs. SE valves in 30-day mortality (BE 4 % vs. SE 3 %, p = 0.44), 1-year mortality (BE 12 % vs. SE 10 %, p = 0.60), and moderate-to-severe AR at 1 year (BE 1 % vs. SE 3 %, p = 0.36). However, patients with SE valves had higher rates of new permanent pacemaker insertion (BE 4 % vs. SE 9 %, p = 0.0019). There were no significant differences in the incidence of 30-day safety outcomes, including stroke, AKI, coronary obstruction, major bleeding, and major vascular complications. Both BE and SE valve types showed comparable mortality and safety outcomes in ViV-TAVI, except pacemaker insertion, which was higher in SE compared with BE valves.
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Affiliation(s)
- Farah Yasmin
- Yale University School of Medicine, New Haven CT 06511, USA
| | - Abdul Moeed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Kinza Iqbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abraish Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ashish Kumar
- Cleveland Clinic Akron General, Akron General Avenue, Akron Ohio, OH 44307, USA
| | - Jawad Basit
- Rawalpindi Medical College, Rawalpindi, Karachi, Pakistan
| | | | - Sourbha S Dani
- Department of Cardiology, Beth Israel Lahey Health, Burlington, MA 01805, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN 47905, USA
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Poon ET, Li H, Kong APS, Little JP. Efficacy of high-intensity interval training in individuals with type 2 diabetes mellitus: An umbrella review of systematic reviews and meta-analyses. Diabetes Obes Metab 2025; 27:1719-1734. [PMID: 39910758 PMCID: PMC11885077 DOI: 10.1111/dom.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/03/2025] [Accepted: 01/20/2025] [Indexed: 02/07/2025]
Abstract
High-intensity interval training (HIIT) has gained attention as a potentially effective alternative to traditional exercise modalities for individuals with type 2 diabetes mellitus (T2DM). Previous studies have evaluated this exercise strategy with various regimens, comparator groups and outcomes, limiting the generalisability of findings. We performed a novel umbrella review to generate an up-to-date synthesis of the available evidence regarding the effect of HIIT on glycaemic control and other clinically relevant cardiometabolic health outcomes in individuals with T2DM, as compared with traditional moderate-intensity continuous training (MICT) and/or non-exercise control (CON). This umbrella review followed the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases were searched until August 2024. Systematic reviews with meta-analyses comparing HIIT with MICT and/or CON were included. Literature search, data extraction and methodological quality assessment (A MeaSurement Tool to Assess systematic Reviews 2 [AMSTAR-2]) were conducted independently by two reviewers. Ten systematic reviews with meta-analyses, encompassing 76 primary studies and 2954 unique participants, met the inclusion criteria. The data indicated that HIIT significantly improves glycosylated haemoglobin and cardiorespiratory fitness compared with CON (weighted mean difference [WMD]: -0.83% to -0.39% and 3.35-6.38 mL/kg/min) and MICT (WMD: -0.37% to -0.07% and 1.68-4.12 mL/kg/min) in individuals with T2DM. HIIT is also effective in improving other glycaemic parameters, including fasting blood glucose, fasting blood insulin and HOMA-IR. Improvement in body composition, lipid profiles and blood pressure has also been observed following HIIT. Most systematic reviews received moderate to low AMSTAR-2 score. This umbrella review supports HIIT as an efficacious exercise strategy for improving glycaemic control and certain relevant cardiometabolic health outcomes in individuals with T2DM. Our findings offer a comprehensive basis that may potentially contribute to informing physical activity recommendations for incorporating HIIT into T2DM management strategies.
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Affiliation(s)
- Eric Tsz‐Chun Poon
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongHong KongChina
| | - Hong‐Yat Li
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongHong KongChina
| | - Alice P. S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong KongPrince of Wales HospitalHong KongChina
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong KongPrince of Wales HospitalHong KongChina
| | - Jonathan P. Little
- School of Health and Exercise SciencesUniversity of British ColumbiaKelownaBritish ColumbiaCanada
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Beigrezaei S, Raeisi-Dehkordi H, Hernández Vargas JA, Amiri M, Artola Arita V, van der Schouw YT, Salehi-Abargouei A, Muka T, Chatelan A, Franco OH. Non-Sugar-Sweetened Beverages and Risk of Chronic Diseases: An Umbrella Review of Meta-analyses of Prospective Cohort Studies. Nutr Rev 2025; 83:663-674. [PMID: 39325512 PMCID: PMC11894252 DOI: 10.1093/nutrit/nuae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
CONTEXT Several effects of non-sugar-sweetened beverage (NSSBs) intake on health outcomes have been reported; however, the evidence on the association between NSSBs intake and chronic diseases and mortality risk is still inconclusive. OBJECTIVE This umbrella review aimed to summarize the evidence on the association between NSSBs intake and the risk of chronic diseases and mortality. DATA SOURCES Embase, ISI Web of Science, Cochrane Central, and PubMed were searched up to September 2023 for relevant meta-analyses of observational prospective cohort studies. DATA EXTRACTION Two groups of researchers independently extracted study data and assessed the risk of bias for meta-analyses and primary studies. DATA ANALYSIS Six meta-analyses, reporting 74 summary hazard ratios (HRs) for different outcomes obtained from 50 primary studies, were included. The summary HRs, 95% CIs, and certainty of evidence on the association of NSSBs intake with risk of chronic diseases and mortality were as follows: all-cause mortality (per 355 mL/d: 1.06 [1.01 to 1.10]; moderate certainty); stroke (per 250 mL/d: 1.09 [1.04 to 1.13]; high certainty); coronary heart disease (CHD) (per 250 mL/d: 1.06 [1.02 to 1.11]; high certainty); hypertension (HTN) (high vs low intake: 1.14 [1.09 to 1.18]; moderate certainty); type 2 diabetes (T2D) (high vs low intake: 1.16 [1.08 to 1.26]; low certainty); metabolic syndrome (MetS) (high vs low intake: 1.32 [1.22 to 1.43]; low certainty); colorectal cancer (high vs low intake: 0.78 [0.62 to 0.99]; moderate certainty); and leukemia (high vs low intake: 1.35 [1.03 to 1.77]; moderate certainty). For other outcomes, including the risk of cardiovascular and cancer mortality, chronic kidney diseases, breast cancer, prostate cancer, endometrial cancer, pancreatic cancer, multiple myeloma, and non-Hodgkin lymphoma, no association was found. CONCLUSION This study provides further evidence that NSSBs are associated with increased risk of all-cause mortality, stroke, CHD, HTN, T2D, MetS, and leukemia. Moreover, a higher intake of NSSBs was associated with a lower risk of colorectal cancer. However, it should be noted that the magnitudes of the associations are not large. Further studies are needed to clarify the long-term effects of different NSSBs intakes on health. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42023429981.
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Affiliation(s)
- Sara Beigrezaei
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Hamidreza Raeisi-Dehkordi
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Juliana Alexandra Hernández Vargas
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Mojgan Amiri
- Department of Epidemiology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Vicente Artola Arita
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Amin Salehi-Abargouei
- Research Center for Food Hygiene and Safety, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, 89151-73160 Yazd, Iran
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, 89151-73160 Yazd, Iran
| | | | - Angeline Chatelan
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1227 Carouge, Geneva, Switzerland
| | - Oscar H Franco
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
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Deblois S, Bergeron N, Vu TTM, Paquin-Lanthier G, Nauche B, Pomp A. The Prevention and Treatment of Postoperative Delirium in the Elderly: A Narrative Systematic Review of Reviews. J Patient Saf 2025; 21:174-192. [PMID: 39907462 DOI: 10.1097/pts.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 12/27/2024] [Indexed: 02/06/2025]
Abstract
OBJECTIVES Postoperative delirium (POD) is a common complication after major surgeries, posing significant challenges to patient recovery and outcomes, particularly among the elderly. A narrative systematic review was conducted to assess the clinical effectiveness and safety of interventions aimed at preventing and treating POD. METHODS A review of the literature from 2017 to September 29, 2023, was conducted using MEDLINE, EMBASE, and CINAHL. Systematic reviews, with or without meta-analyses, as well as practice guidelines, were included. Participants were adults, ≥60 years. The methodological quality of included reviews was appraised using AMSTAR 2. RESULTS After the search strategy identified 2295 references, 36 review studies were selected. Multicomponent interventions, incorporating both pharmacological and nonpharmacological approaches, demonstrate promise, particularly in hip fracture patients. Notably, dexmedetomidine emerges as a potential preventive measure, showing a notable reduction in delirium incidence following cardiac surgery. While several pharmacological interventions show potential, evidence remains inconclusive, necessitating further investigation. Similarly, varying anesthesia type and monitoring methods has mixed outcomes on delirium prevention. Despite methodological variations and quality appraisal limitations, this review underscores the importance of multicomponent interventions and the potential efficacy of dexmedetomidine in mitigating POD. Integration of evidence-based protocols into clinical practice is advocated to improve patient outcomes. However, the complex interplay between intervention components calls for further research to optimize delirium management strategies. CONCLUSIONS The strength of evidence associated with multicomponent interventions and dexmedetomidine use should require a genuine commitment from health care institutions to support their integration into efficient strategies to prevent and treat POD. Ongoing research is vital to uncover their full potential and refine clinical protocols, ultimately enhancing patient care outcomes.
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Affiliation(s)
- Simon Deblois
- Health Technology Assessment Unit, Centre hospitalier de l'Université de Montréal (CHUM)
| | | | | | | | | | - Alfons Pomp
- Health Technology Assessment Unit, Centre hospitalier de l'Université de Montréal (CHUM)
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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18
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Pagano D, Toniutto P, Burra P, Gruttadauria S, Vella R, Martini S, Morelli MC, Svegliati-Baroni G, Marrone G, Ponziani FR, Caraceni P, Angeli P, Calvaruso V, Giannelli V. Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review. Dig Liver Dis 2025; 57:819-826. [PMID: 39645428 DOI: 10.1016/j.dld.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 11/08/2024] [Accepted: 11/14/2024] [Indexed: 12/09/2024]
Abstract
Hypoalbuminemia is a risk factor for mortality in patients with end-stage liver disease (ESLD) and in those undergoing orthotopic liver transplantation (OLT), since it represents a biomarker of post-operative delayed functional recovery of the graft. Despite albumin infusion during and after OLT is frequently adopted in recipients with hypoalbuminemia, it remains unclear whether this procedure could improve post OLT clinical outcomes. Observational studies indicated that treatment with albumin after OLT might be beneficial in reducing ascites and acute kidney injury (AKI) development. However, considering potential complications and the cost of albumin therapy, the decision to use albumin after OLT should be based on careful consideration of patient's individual needs and risks. In addition, the threshold plasma value of albumin below which it could be clinically useful to infuse albumin has not been clearly defined. This systematic review, prepared in accordance with the PRISMA 2020 guidelines, aimed to assess the efficacy of albumin infusion in patients undergoing OLT, in the prevention or treatment of ascites, AKI, and ischemia reperfusion syndrome, as well as its potential impact on patient survival. Furthermore, this review aimed to illustrate the pathophysiological bases justifying the use of albumin infusion in a subset of patients receiving OLT.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, University of Udine 33100, Udine, Italy.
| | - Patrizia Burra
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova 35122, Padova, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; University of Catania, Catania, Italy
| | - Roberta Vella
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; Department of Precision Medicine in the Medical, Surgical and Critical Care Area University of Palermo, Palermo, Italy
| | - Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Cristina Morelli
- RCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy
| | | | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Romana Ponziani
- Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Semeiotics, IRCCS AOU Bologna, Bologna, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo 90127 Palermo, Italy
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Jamshidi M, Jones CMP, Langford AV, Patanwala AE, Liu C, Harris IA, Wale J, Horsley M, Adie S, Jenkin DE, Lin CWC. Comparative Effectiveness of Different Opioid Regimens, in Daily Dose or Treatment Duration, Prescribed at Surgical Discharge: a Systematic Review and Meta-Analysis. CNS Drugs 2025; 39:345-360. [PMID: 40057907 PMCID: PMC11909025 DOI: 10.1007/s40263-025-01165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Opioids are prescribed for postsurgical pain management, but a balance between achieving adequate pain control and minimising opioid-related harm is required. This study aimed to investigate the effectiveness of different opioid regimens, in daily dose or treatment duration, prescribed at surgical discharge. METHODS A systematic search of MEDLINE, EMBASE, CENTRAL, and ICTRP was performed from inception to 12 January 2025. Randomised controlled trials (RCTs) and non-RCTs comparing different daily doses or treatment durations of opioid analgesics were included. All surgeries were included, except those related to cancer treatment or palliative care. Eligible populations were adults (≥ 18 years) or individuals classified as adults according to the criteria of the respective studies. Data were extracted at immediate-term (≤ 3 days), short-term (> 3 to ≤ 7 days), medium-term (> 7 to ≤ 30 days), and long-term (> 30 days). Data from RCTs were pooled using a random-effects model. Risk of bias was assessed. Certainty of evidence from RCTs was evaluated with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The primary outcome was pain intensity. Adverse events were also measured. RESULTS A total of 8432 records were identified. In total, 12 RCTs with 7128 patients and 24 non-RCTs with 118,849 patients were included. Studies included orthopaedic, gynaecology and obstetric surgeries, ranging from minor to major procedures. Higher-doses of opioids were more effective than lower-doses in reducing immediate pain intensity (mean difference (MD) 4.36, 95% confidence interval (CI) 0.50-8.23, n = 364, three studies, I2 = 0%, high certainty). No difference in pain was found between higher-doses and lower-doses at other time points (moderate to high certainty). Longer-durations of opioid treatment showed no difference in pain at any time point (low to moderate certainty). More adverse events were reported with higher doses of opioids. CONCLUSIONS Higher-dose opioids provide a slight reduction in immediate post-discharge pain intensity but may lead to more adverse events. Longer durations of opioid treatment are probably not more effective in reducing pain than shorter treatment durations. Our findings suggest that clinicians may choose to prescribe lower doses of opioids or shorter durations of opioids without compromising pain control, even for major surgery.
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Affiliation(s)
- Masoud Jamshidi
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Level 10N, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Sydney, NSW, 2050, Australia.
| | - Caitlin M P Jones
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aili V Langford
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Asad E Patanwala
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chang Liu
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
- Department of Orthopaedic Surgery, School of Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ian A Harris
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research and School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Janney Wale
- Consumer Representative, Melbourne, Australia
| | - Mark Horsley
- Deputy Director of Neurosciences, Bone & Joint for the Sydney Local Health District, Sydney, Australia
| | - Sam Adie
- School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Sydney, Australia
- St George and Sutherland Centre for Clinical Orthopaedic Research, Sydney, Australia
| | - Deanne E Jenkin
- School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Sydney, Australia
- St George and Sutherland Centre for Clinical Orthopaedic Research, Sydney, Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Wen J, Hui SS, Chin EC, Yang Y, Sit CH. The Effectiveness of Mind-Body Exercise on Health-Related Quality of Life and Mental Health During and After Breast Cancer Treatment: An Umbrella Review of Meta-Analyses for Randomized Controlled Trials. Worldviews Evid Based Nurs 2025; 22:e70008. [PMID: 40090889 PMCID: PMC11911294 DOI: 10.1111/wvn.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 12/01/2024] [Accepted: 02/15/2025] [Indexed: 03/18/2025]
Abstract
BACKGROUND Previous studies regarding mind-body exercise among people with breast cancer mostly focused on one type of mind-body exercise and provided conflicting results. AIMS This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind-body exercises. METHODS We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind-body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2. RESULTS The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as "low" quality and 6 articles as "critically low" quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = -0.77, 95% Confidence Interval [-0.93, -0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind-body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality). LINKING EVIDENCE TO ACTION Mind-body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind-body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.
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Affiliation(s)
- Jingsi Wen
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Stanley Sai‐chuen Hui
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
- University of MacauTaipaMacau
| | - Edwin Chun‐Yip Chin
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Yijian Yang
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Cindy Hui‐ping Sit
- Department of Sports Science and Physical EducationThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
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21
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Peng G, Pan X, Ye Z, Yi X, Xie Q, Zhang X, Tong N. Nongenetic risk factors for thyroid cancer: an umbrella review of evidence. Endocrine 2025; 88:60-74. [PMID: 39745600 DOI: 10.1007/s12020-024-04155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/27/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND The incidence of thyroid cancer has increased annually, but the risk factors for thyroid cancer are still unclear. In this umbrella review, we aimed to identify associations between nongenetic risk factors and thyroid cancer incidence, and assess the quality and validity of the evidence. METHODS PubMed, Embase and the Cochrane Database of Systematic Reviews were searched to identify related meta-analyses or systematic reviews of epidemiological studies. We extracted the estimated summary effect and 95% confidence interval (CI) through fixed or random effects models of each meta-analysis. AMSTAR2 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used to evaluate the methodological quality of the included meta-analyses and the quality of evidence respectively. Further subgroup analyses by sex and sensitivity analyses were conducted. RESULTS We identified 53 articles with 112 associations, of which 69 had significant relationships with thyroid cancer risk, including factors related to iodine, nitrates, fish, vitamin D, tea, alcohol, smoke, body mass index (BMI), pesticides, X-ray, I131, oral contraceptives, flavonoids, reproductive factors and some medical conditions. However, most studies (65%) were categorized as "critically low" on the basis of AMSTAR2, and most evidence (86%) was of weak quality since the classification by GRADE was very low. Moreover, subgroup and sensitivity analyses revealed more risk factors in women than in men. CONCLUSION We found that several modifiable factors have essential effects in the primary prevention of thyroid cancer, but few high-quality studies exist. In the future, more well-conducted, especially prospective, studies are needed to confirm the results. TRIAL REGISTRATION The protocol for this review was registered in PROSPERO (CRD42022352841).
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Affiliation(s)
- Ge Peng
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Pan
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Ziwei Ye
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Xianyanling Yi
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingxing Xie
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyi Zhang
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, Laboratory of Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China.
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22
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Berthelsen C, Hansen CA. Content and Effect of Introduction Programmes to Increase Retention and Decrease Turnover of Newly Graduated Nurses in Hospitals: Umbrella Review. J Clin Nurs 2025; 34:1149-1169. [PMID: 39449556 PMCID: PMC11933529 DOI: 10.1111/jocn.17494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/26/2024]
Abstract
AIM The aim of this study is to combine and compare results from systematic reviews reporting the content and effect of programmes for the introduction of newly graduated nurses employed in hospital settings on increasing retention and decreasing turnover. DESIGN An umbrella review. METHODS The electronic databases of PubMed/MEDLINE, CINAHL and PhycInfo were searched in January 2023 for eligible systematic reviews. The search string consisted of keywords extracted from the PICOS inclusion criteria. The AMSTAR 2 instrument was used for critical appraisal of the methodological quality of the eligible systematic reviews. The process and results of the review were presented using a narrative description of the data. RESULTS Five systematic reviews, reporting 84 intervention studies evaluating nine types of introduction programmes from 2001 to 2018, were included in the umbrella review. All nine programme types were executed by nurses in a preceptor or mentor role and the content was directed towards training of the preceptor/mentor and introduction of the newly graduated nurses. The nine programmes showed overall positive effects on retention and turnover. CONCLUSIONS Mentorship and Preceptorship were the most frequently evaluated programmes in the included intervention studies of the five reviews. However, the lack of transparency of the reviews and the bias of the intervention studies within the reviews, made it difficult to conclude specific effects of the content of the nine programmes. REGISTRATION The protocol for the umbrella review is registered with Open Science Framework (https://OSF.IO/DXYS4). IMPACT A weak introduction to hospital employment of newly graduated nurses may decrease retention and increase turnover. Structured and personal introduction by a mentor can have an effect on the newly graduated nurses' intentions to stay in their hospital care position. REPORTING METHOD AMSTAR 2. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Connie Berthelsen
- Medical DepartmentZealand University Hospital KogeKøgeDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Carrinna Aviaja Hansen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Department of Orthopaedic SurgeryZealand University Hospital, KøgeKøgeDenmark
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23
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Li Y, Deng J, Ma X, Li W, Wang Z. Diagnostic accuracy of CT and PET/CT radiomics in predicting lymph node metastasis in non-small cell lung cancer. Eur Radiol 2025; 35:1966-1979. [PMID: 39223336 DOI: 10.1007/s00330-024-11036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/09/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This study evaluates the accuracy of radiomics in predicting lymph node metastasis in non-small cell lung cancer, which is crucial for patient management and prognosis. METHODS Adhering to PRISMA and AMSTAR guidelines, we systematically reviewed literature from March 2012 to December 2023 using databases including PubMed, Web of Science, and Embase. Radiomics studies utilizing computed tomography (CT) and positron emission tomography (PET)/CT imaging were included. The quality of studies was appraised with QUADAS-2 and RQS tools, and the TRIPOD checklist assessed model transparency. Sensitivity, specificity, and AUC values were synthesized to determine diagnostic performance, with subgroup and sensitivity analyses probing heterogeneity and a Fagan plot evaluating clinical applicability. RESULTS Our analysis incorporated 42 cohorts from 22 studies. CT-based radiomics demonstrated a sensitivity of 0.84 (95% CI: 0.79-0.88, p < 0.01) and specificity of 0.82 (95% CI: 0.75-0.87, p < 0.01), with an AUC of 0.90 (95% CI: 0.87-0.92), indicating no publication bias (p-value = 0.54 > 0.05). PET/CT radiomics showed a sensitivity of 0.82 (95% CI: 0.76-0.86, p < 0.01) and specificity of 0.86 (95% CI: 0.81-0.90, p < 0.01), with an AUC of 0.90 (95% CI: 0.87-0.93), with a slight publication bias (p-value = 0.03 < 0.05). Despite high clinical utility, subgroup analysis did not clarify heterogeneity sources, suggesting influences from possible factors like lymph node location and small subgroup sizes. CONCLUSIONS Radiomics models show accuracy in predicting lung cancer lymph node metastasis, yet further validation with larger, multi-center studies is necessary. CLINICAL RELEVANCE STATEMENT Radiomics models using CT and PET/CT imaging may improve the prediction of lung cancer lymph node metastasis, aiding personalized treatment strategies. RESEARCH REGISTRATION UNIQUE IDENTIFYING NUMBER (UIN) International Prospective Register of Systematic Reviews (PROSPERO), CRD42023494701. This study has been registered on the PROSPERO platform with a registration date of 18 December 2023. https://www.crd.york.ac.uk/prospero/ KEY POINTS: The study explores radiomics for lung cancer lymph node metastasis detection, impacting surgery and prognosis. Radiomics improves the accuracy of lymph node metastasis prediction in lung cancer. Radiomics can aid in the prediction of lymph node metastasis in lung cancer and personalized treatment.
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Affiliation(s)
- Yuepeng Li
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Junyue Deng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, China
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, China
| | - Zhoufeng Wang
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, China.
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
- The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, China.
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24
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Hendlmeier M, Fischer T, Drebenstedt C, Fuchs S, Norda H, Sirsch E. [Pain management in geriatric patients-methods paper for the S3 guideline "GeriPAIN"]. Schmerz 2025:10.1007/s00482-025-00875-9. [PMID: 40146348 DOI: 10.1007/s00482-025-00875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2025] [Indexed: 03/28/2025]
Abstract
Geriatric patients are characterized by an advanced age and typical geriatric multimorbidity. The prevalence of pain increases with age. In geriatric patients in particular, pain is one of the most frequently occurring characteristic complexes. In Germany, a trend has been observed that the prevalence and intensity of pain in older people has continued to increase in recent years. Pain management in this particularly vulnerable group poses major challenges for the patients themselves, their relatives and healthcare professionals. For this reason, the expiring S3 guideline on "Pain assessment in older people in full inpatient care for the elderly" will be taken up, updated and expanded to include pain therapy and extended to outpatient and acute inpatient care.
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Affiliation(s)
- Melina Hendlmeier
- Deutsche Schmerzgesellschaft e. V., Alt-Moabit 101b, 10559, Berlin, Deutschland
| | | | | | - Stephan Fuchs
- Institut für Allgemeinmedizin der Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Heike Norda
- UVSD SchmerzLOS e. V., Neumünster, Deutschland
| | - Erika Sirsch
- Universität Duisburg-Essen, Duisburg-Essen, Deutschland
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Fan G, Ma J, Wu Y, Wang J, Wang Y, Chen Y, Hu K, Tang T. Robotic versus open surgery for ureteroenteric stricture after radical cystectomy: a systematic review and meta-analysis. J Robot Surg 2025; 19:130. [PMID: 40148577 DOI: 10.1007/s11701-025-02295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025]
Abstract
Ureteroenteric stricture (UES) frequently occurs as a postoperative complication following radical cystectomy, potentially causing severe clinical issues. The aim of this study was to systematically review and meta-analyze to compare the clinical efficacy and safety of robot-assisted ureteroenteric reimplantation (RUER) versus open ureteroenteric reimplantation (OUER) in the treatment of UES. The research was comprehensively explored in the PubMed, Embase, Cochrane Library, and Web of Science databases, covering the timeframe from their inception up to January 17, 2025. The research included quality-evaluated observational studies that compared RUER with OUER for UES. The primary assessment metric was the rate of stenosis recurrence versus reconstruction success. This analysis covered four studies involving a total of 161 participants, with 39 in the OUER cohort and 122 in the RUER cohort. The findings indicated that the RUER cohort experienced a shorter hospital stay than the OUER cohort (RR = - 3.18, 95% CI [- 4.88, - 1.48], p < 0.05). However, there were no notable differences between the two cohorts in terms of stenosis recurrence, reconstruction success, surgical duration, blood loss, intraoperative complications, minor issues, or the incidence of severe complications. RUER has the advantage of shorter hospitalization time than conventional open surgery in the treatment of UES, and both perform comparably in terms of safety. Nevertheless, it is essential to recognize that larger-scale randomized controlled studies are needed to thoroughly validate the reliability of these findings.
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Affiliation(s)
- Gen Fan
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China
| | - Jiakai Ma
- Department of Urology/Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, 63700, Sichuan, China
| | - Yinyu Wu
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China
| | - Junji Wang
- Jintang First People'S Hospital/West China Hospital Sichuan University Jintang Hospital, Chengdou, 610000, Sichuan, China
| | - Yu Wang
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China
| | - Yushui Chen
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China
| | - Ke Hu
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China
| | - Tielong Tang
- Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China.
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Xie W, Wang Z, Liu X, Tan S. Robotic single site versus robotic multiport hysterectomy in endometrial cancer: a systematic review and meta-analysis. BMC Cancer 2025; 25:554. [PMID: 40148895 DOI: 10.1186/s12885-025-13968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 03/19/2025] [Indexed: 03/29/2025] Open
Abstract
OBJECTIVE This meta-analysis aims to compare the safety and efficacy of robotic single-site hysterectomy (RSSH) with robotic multiport hysterectomy (RMPH) in treating endometrial cancer. METHODS We conducted a comprehensive literature search across several databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, the Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Chinese Science and Technology Journal Full Text Database (VIP). The search covered literature from inception until October 17, 2024. The primary outcomes included intraoperative complications, postoperative complications, postoperative pain scores, and satisfaction with cosmetic outcomes. The secondary outcomes included operative time (min), estimated blood loss (ml), hemoglobin drop, blood transfusion, conversion, postoperative hospital stay, lymph nodes harvested, sentinel lymph node identification, recurrence, and mortality during follow-up. Data analysis was performed using random-effects or fixed-effects models, calculating combined risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI). RESULTS Five studies describing a total of 448 patients were retained and included for this meta-analysis. No significant differences were found between RSSH and RMPH regarding intraoperative complications, postoperative complications, and postoperative pain scores. There were also no differences in terms of operation time, estimated blood loss, hemoglobin drop, blood transfusion, conversion, postoperative hospital stay, lymph nodes harvested, and sentinel lymph node identification. CONCLUSION This systematic review and meta-analysis provides evidence that RSSH is effective and safe for the treatment of endometrial cancer, as it is generally equivalent to RMPH regarding perioperative outcomes.
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Affiliation(s)
- Weimin Xie
- Department of Gynecology, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hunan Province, No. 31 Guanghui Road, Zhengxiang District, Hengyang City, 421000, China
| | - Zhangyi Wang
- Nursing Department, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hunan Province, Hengyang, 421000, China
| | - Xiaohang Liu
- Department of Gynecology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikouaq , Hainan, 570100, China
| | - Songhong Tan
- Department of Gynecology, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hunan Province, No. 31 Guanghui Road, Zhengxiang District, Hengyang City, 421000, China.
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27
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Ugalde-Resano R, Gamboa-Loira B, Mérida-Ortega Á, Rincón-Rubio A, Flores-Collado G, Piña-Pozas M, López-Carrillo L. Biological concentrations of DDT metabolites and breast cancer risk: an updated systematic review and meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2025; 40:225-236. [PMID: 39643980 DOI: 10.1515/reveh-2024-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 11/14/2024] [Indexed: 12/09/2024]
Abstract
The question of whether dichlorodiphenyltrichloroethane (DDT) exposure is related to breast cancer (BC) remains unanswered, possibly due to methodological constraints in the studies that have been performed. We aimed to update and synthesize the available epidemiological evidence on the relationship of p,p'-DDT, o,p'-DDT and p,p'-dichlorodiphenyldichloroethylene (p,p'- DDE) biological concentrations with female BC, focusing in methodological characteristics not addressed in previous reviews. We conducted an overview of reviews and a systematic review and meta-analysis. We used six databases and one search engine to identify meta-analyses based on systematic reviews, pooled analyses, and individual studies published from January 2000 to December 2021. For the overview of reviews, we assessed meta-analyses' risk of bias and carried out a narrative synthesis. For the meta-analysis, we estimated summary association measures with fixed or random effects models for each compound stratifying for characteristics of interest. We estimated a positive summary association between p,p'- DDT biological concentrations and BC in prospective studies (nested case control) with >10 years of follow-up (sOR=1.41; 95 %CI: 1.06-1.88). Among retrospective studies (hospital or population-based case-control), BC was positively related with p,p'-DDE biological concentrations (sOR=1.15; 95 %CI: 1.02-1.30), and with p,p'-DDT in women with mean serum concentrations>100 ng/g (sOR=1.33; 95 %CI: 1.25-1.41). Moreover, we detected a positive association between o,p'-DDT and BC (sOR=2.24; 95 %CI: 2.15-2.34). Our results support a positive relationship between DDT exposure and BC, and are useful to reinforce its worldwide prohibition, since this pesticide is still used in some countries, has long persistence in the human body and disseminates to other geographic areas.
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28
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Abate BB, Tusa BS, Sendekie AK, Araya FG, Bizuayehu MA, Walle GT, Kitaw TA, Tilahun BD, Alamaw AW, Zemariam AB, Kassaw A, Kassie AM, Yilak G, Bizuneh FK, Dachew B. Non-exclusive breastfeeding is associated with pneumonia and asthma in under-five children: an umbrella review of systematic review and meta-analysis. Int Breastfeed J 2025; 20:18. [PMID: 40134007 DOI: 10.1186/s13006-025-00712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 03/16/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND Despite numerous reviews examining the impact of exclusive breastfeeding on preventing childhood pneumonia and asthma, a comprehensive and up-to-date synthesis is lacking. This umbrella review aims to consolidate the current evidence on the link between non-exclusive breastfeeding and the risk of pneumonia and asthma in under-five children. METHODS A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar to identify systematic review and meta-analysis (SRM) studies evaluating the effect of exclusive breastfeeding on preventing childhood pneumonia and asthma globally. The latest search was conducted on January 25/2025. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews Two (AMSTAR-2) tool. A weighted inverse variance random-effects model was employed to generate pooled estimates. Summary effect estimates were expressed using odds ratios (OR) with 95% confidence intervals (CI). We evaluated the quality of evidence for each association using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, categorising it as convincing (class I), highly suggestive (class II), suggestive (class III), and weak (class IV). RESULTS Twelve SRMs, including 270 primary studies with over ten million participants, were analysed. The random-effects model revealed a highly suggestive association between non-exclusive breastfeeding and an increase in the risk of pneumonia (OR 2.34; 95% CI 1.89, 2.78, GRADE: highly suggestive). Similarly, there was highly suggestive evidence that non-exclusive breastfeeding was associated with a 29% higher risk of childhood asthma (OR 1.21; 95% CI 1.07, 1.34, GRADE: highly suggestive). CONCLUSION Our results highlighted that non-exclusive breastfeeding is associated with an increased risk of pneumonia and asthma in under-five children. These findings emphasise the critical role of exclusive breastfeeding in reducing the risk of respiratory health issues, highlighting the need for policies and initiatives that promote breastfeeding as a key strategy for improving children's health outcomes.
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Affiliation(s)
- Biruk Beletew Abate
- School of Population Health, Curtin University, Perth, WA, Australia.
- College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Biruk Shalmeno Tusa
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Pharmacy, Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | | | | | - Getachew Tesfaw Walle
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Befkad Derese Tilahun
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | | | - Alemu Birara Zemariam
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Amare Kassaw
- Department of Nursing, College of Health Science, Debre Tabor University, Debra Tabor, Ethiopia
| | | | - Gizachew Yilak
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | | | - Berihun Dachew
- School of Population Health, Curtin University, Perth, WA, Australia
- enAble Institute, Curtin University, Perth, WA, Australia
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Vousden N, Geddes-Barton D, Hanley SJ, Roberts N, Knight M. Interventions to reduce inequalities for pregnant women living with disadvantage in high-income countries: an umbrella review. BMC Public Health 2025; 25:1140. [PMID: 40133955 DOI: 10.1186/s12889-025-22283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 03/11/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND Women facing multiple disadvantage such as financial poverty, poor mental health or domestic abuse, may experience inequalities in health prior to and during pregnancy, as well as into early motherhood. This can have lifelong intergenerational impacts. The primary aim of this overview was to identify the breadth and efficacy of interventions that work across health and social care to reduce inequalities in maternal or child health. The second aim was to explore their relevance to women with lived experience. METHODS An overview of systematic reviews and meta-analyses from high-income countries that aim to reduce inequalities for women with social disadvantage during pregnancy was performed. Searches were conducted in eight electronic databases up to August 2023 and supplemented with grey literature searches. We included any individual, hospital, or community level activities specific to women during the pre-conception, antenatal or postpartum period up to one year after. The protocol was registered. Two workshops with women with lived experience of disadvantage explored the relevance of identified interventions, and gaps in evidence, in relation to their experiences. RESULTS A total of 36 reviews, including 734 primary studies, were included in the narrative synthesis. The majority of reviews included studies undertaken in North America and were of critically low or low quality. Interventions were grouped into 11 categories. The majority of interventions were aimed at single social exposures and targeted individual behavior during pregnancy and the postnatal period. Some at risk populations were excluded from all reviews. There was potential benefit of home-based interventions, psychosocial interventions, models of maternity care and interdisciplinary programs of care for some population groups, across a range of maternal and child health outcomes. Our lived experience group felt these interventions had potential to meet their shared needs for advocacy, support and information, but they should also consider culture, past trauma and factors underpinning pregnancy such as housing and finances. CONCLUSIONS Further high-quality research is required to demonstrate efficacy and cost-effectiveness of potentially effective interventions in the European health systems. Additional research gaps include interventions prior to pregnancy, culture informed care and upstream determinants of health (PROSPERO: CRD42023455502).
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Affiliation(s)
- Nicola Vousden
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Dorothea Geddes-Barton
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Stephanie J Hanley
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Brucchi F, Filisetti C, Luconi E, Fugazzola P, Cattaneo D, Ansaloni L, Zuccotti G, Ferraro S, Danelli P, Pelizzo G. Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials. World J Emerg Surg 2025; 20:25. [PMID: 40133910 DOI: 10.1186/s13017-025-00584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 01/30/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis. METHODS A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths. RESULTS Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = - 0.03; 95% CI - 0.11; 0.06, p = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = - 0.05; 95% CI - 0.13; - 0.04; p = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant - 0.01 (IC - 0.17; 0.16; p value: 0.93). There is no statistical difference in terms of efficacy at 1 year, between NOM and OM (combined RD = - 0.06; 95% CI - 0.21; 0.09), p = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = - 19.90 h; 95% CI - 29.27; - 10.53, p < .0001). CONCLUSIONS This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.
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Affiliation(s)
| | - Claudia Filisetti
- Pediatric Surgery Department, Buzzi Children's Hospital, 20154, Milan, Italy
| | - Ester Luconi
- Department Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Paola Fugazzola
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, Italy.
| | - Dario Cattaneo
- Department of Infectious Diseases, ASST Fatebenefratelli University Hospital, Milan, Italy
| | - Luca Ansaloni
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics Buzzi Children 's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Simona Ferraro
- Department of Pediatrics Buzzi Children 's Hospital, 20154, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
- Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
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Moré JS, Serbena DR, Camargo LGGD, Clemente PA, Santos FSD, Bonini JS. How the COVID-19 pandemic affected routine child vaccination: an integrative review. EINSTEIN-SAO PAULO 2025; 23:eRW1119. [PMID: 40136151 DOI: 10.31744/einstein_journal/2025rw1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 10/04/2024] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND Child immunization plays a critical role in preventing numerous diseases. However, the COVID-19) pandemic has profoundly disrupted healthcare systems globally, including routine child vaccination programs. OBJECTIVE To provide an overview of the reduction in vaccine coverage among infants and children during the pandemic and analyze the potential impacts of decreased child immunization during this period. METHODS A comprehensive search was conducted using the MeSH terms "Child," "Vaccination", and "COVID-19," along with their synonyms. Systematic reviews published between March 11, 2020, and June 1, 2023, in Portuguese or English were included. Databases searched included PubMed, BVS (Biblioteca Virtual em Saúde), Embase, and Scopus. Two blinded independent reviewers performed the selection process, with conflicts resolved by a third reviewer. The AMSTAR-II tool was used to assess the methodological quality of the included studies. RESULTS Of the 1,534 eligible articles, only 13 addressed the pandemic's impact on children's vaccination coverage. Most studies involved multiple countries and reported a significant decrease in children's vaccination coverage due to the COVID-19 pandemic. CONCLUSION The findings were heterogeneous but consistently highlighted the substantial impact of the COVID-19 pandemic on routine vaccination coverage in most countries. Further research is needed to explore the epidemiological consequences of disruptions to vaccination schedules, potentially guiding public policies and raising awareness about the importance of adhering to health protection programs.
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Affiliation(s)
- Julia Stoeterau Moré
- Laboratório de Neurociências e Comportamento, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Daniel Rodrigo Serbena
- Laboratório de Neurociências e Comportamento, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | | | - Pedro Augusto Clemente
- Laboratório de Neurociências e Comportamento, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | | | - Juliana Sartori Bonini
- Laboratório de Neurociências e Comportamento, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
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Zhao W, Kong L, Wang X, Liu Q, Wang Y, Wang J. Efficacy and safety of Chinese patent medicines for allergic rhinitis based on 2020 Chinese Pharmacopoeia: a protocol for systematic review and meta-analysis of randomized controlled trials. Syst Rev 2025; 14:69. [PMID: 40128915 PMCID: PMC11934513 DOI: 10.1186/s13643-024-02748-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 12/20/2024] [Indexed: 03/26/2025] Open
Abstract
BACKGROUND Allergic Rhinitis (AR) is a prevalent chronic respiratory condition with limited long-term relief from Western medications. Interest in Traditional Chinese Patent Medicines (TCPMs) as a complementary approach is growing, but research on their efficacy and safety is lacking. We aim to evaluate the efficacy and safety of TCPMs listed in the 2020 Chinese Pharmacopoeia (ChP 2020) that are indicated for treating AR. METHODS We will search PubMed, Embase, Web of Science, Cochrane Library, and four Chinese databases to retrieve randomized controlled trials investigating specific TCPMs (Biyankang tablets, Tongqiao Biyan Granules, Tongqiao Biyan Tablets, Tongqiao Biyan Capsules, Xinqin Granules, Xinqin Tablets, Xinyi Biyan Pills) for AR. Primary outcomes are Total Nasal Symptom Scores (TNSS) and Total Ocular Symptom Scores (TOSS). Secondary outcomes include quality of life, relapse rates, nasal function, biomarkers, and adverse events. No languages and publication data limitations. Meta-analysis will be performed using RevMan 5.4 with random effects model. Publication bias are set to be assessed using funnel plots and Egger's test, and adjusted with the trim and fill method. Meta-regression will investigate factors influencing outcomes for AR. Study quality will be assessed using the Cochrane Risk of Bias 2.0 tool, and the Grading of Recommendations Assessment, Development, and Evaluation approach will be used to evaluate the quality of evidence. DISCUSSION Despite the limitations of conventional AR medications, TCPMs show potential benefits in immune modulation and symptom relief. This review will focus on TCPMs listed in ChP 2020 to comprehensively evaluate their safety and efficacy for AR. Unlike existing reviews, this study emphasizes rigorous standards of TCPMs, aiming to provide a more reliable evidence base. Although a network meta-analysis would be ideal, a traditional meta-analysis will be conducted due to limited data. Future research should focus on direct comparative studies and utilize AI techniques for understanding mechanisms and enhancing personalized treatments. This review aims to bridge gaps in the current literature and potentially improve clinical guidelines and patient outcomes in AR management. SYSTEMATIC REVIEW REGISTRATION INPLASY202450121.
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Affiliation(s)
- Weibo Zhao
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
- Institute for TCM-X, Department of Automation, Tsinghua University, Beijing, China
| | - Lingyao Kong
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xuehui Wang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qingyuan Liu
- Institute for TCM-X, Department of Automation, Tsinghua University, Beijing, China
| | - Yaqi Wang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ji Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China.
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Getahun H, Apte RS. Therapeutic interventions for chronic central serous chorioretinopathy: a comprehensive assessment of systematic reviews. Int J Retina Vitreous 2025; 11:34. [PMID: 40122856 PMCID: PMC11931883 DOI: 10.1186/s40942-025-00660-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Accepted: 03/13/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND A variety of different treatments have been proposed to effectively treat chronic central serous chorioretinopathy but there remains uncertainty regarding the efficacy of a number of treatment options. We aim to evaluate the efficacy of several therapeutic options for chronic central serous chorioretinopathy including photodynamic therapy, conventional laser photocoagulation, subthreshold micropulse laser, selective retina therapy, vascular endothelial growth factor (VEGF) antagonists, and mineralocorticoid receptor antagonists. METHODS Pubmed, Embase, and Cochrane databases were searched for systematic reviews and meta-analyses evaluating treatment modalities for chronic central serous chorioretinopathy. Primary outcome measures included improvement in best corrected visual acuity (BCVA) and resolution of subretinal fluid (SRF). Conclusions regarding the efficacy of each modality were summarized and compared to findings of several key randomized controlled trials. RESULTS Ten systematic reviews and meta-analyses that incorporated 58 unique randomized controlled trials and observational studies were identified. Treatments that were shown to improve BCVA and promote SRF resolution included half-fluence and half-dose photodynamic therapy, conventional laser therapy, and subthreshold micropulse laser therapy. Evidence regarding selective retina therapy was limited and inconclusive. VEGF antagonists were not effective in the absence of choroidal neovascularization and mineralocorticoid receptor antagonists were not effective. CONCLUSION The most effective therapeutic option for chronic central serous chorioretinopathy is half-dose or half-fluence photodynamic therapy, however, conventional laser therapy is an acceptable alternative in cases when photodynamic therapy is unavailable and when fluid leakage sites are not subfoveal or juxtafoveal. Subthreshold micropulse laser is less effective but can be considered when other options are unavailable.
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Affiliation(s)
- Henok Getahun
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rajendra S Apte
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Wiecha S, Cieśliński I, Wiśniowski P, Cieśliński M, Pawliczek W, Posadzki P, Prill R, Zając J, Płaszewski M. Physical Therapies for Delayed-Onset Muscle Soreness: An Umbrella and Mapping Systematic Review with Meta-meta-analysis. Sports Med 2025:10.1007/s40279-025-02187-5. [PMID: 40120073 DOI: 10.1007/s40279-025-02187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND Delayed-onset muscle soreness commonly arises from intense and unaccustomed physical exercise, leading to reduced muscle strength, increased pain and inflammation. A number of systematic reviews evaluating physiotherapeutic treatments for delayed-onset muscle soreness have been published since the 1990s. However, these systematic reviews frequently yield conflicting findings, further impeding clinical practice. OBJECTIVES The primary aim of this study was to summarise the effectiveness of physiotherapy interventions in alleviating delayed-onset muscle soreness through an umbrella review. Additionally, we evaluated the risk of bias in systematic reviews, synthesised their findings, and categorised the evidence strength to provide practical insights for clinicians and researchers. METHODS An umbrella review with a meta-meta-analysis was conducted. MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro and Epistemonikos were searched from 1998 to February 2024. Systematic reviews of randomised controlled trials of any treatments used post-exercise by physiotherapists to reduce delayed-onset muscle soreness in healthy adults, regardless of their physical activity, were eligible. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to evaluate the methodological quality of the included systematic reviews. Corrected covered areas were calculated to address the overlap of primary trials in the included systematic reviews. An evidence map was created to categorise and visualise the effects of interventions using a multi-dimensional approach, based on the effect size and strength of evidence (Class I-V), i.e. the number of cases, Hedges' g, p-value, heterogeneity, Egger's test and excess of significance bias test. RESULTS Twenty-nine systematic reviews with 863 unique randomised controlled trials, addressing 24 distinct physiotherapeutic treatments, met the inclusion criteria. Seventeen systematic reviews were of critically low methodological quality, with only two rated as high quality. The evidence map suggests significant effects in pain reduction immediately post-exercise for contrast therapy (Class II), cooling therapy and cryostimulation (Class IV); 24 h: massage therapy (Class III) and cooling therapy, contrast therapy, electrical stimulation, cryostimulation, phototherapy, heat therapy (Class IV); 48 h: compression, contrast therapy, kinesiotaping and cryostimulation (Class III) and cooling therapy, massage, phototherapy, heat therapy (Class IV); 72 h: kinesiotaping (Class III) and contrast therapy, cooling therapy, massage, phototherapy, vibration (Class IV); 96 h: compression, phototherapy, and contrast therapy (Class IV). The effect sizes (Hedges' g) ranged from 0.36 (95% confidence interval 0.46, 3.18) for cooling therapy to 1.82 (95% confidence interval 0.46, 3.18) for heat therapy indicating small and large effects, respectively. CONCLUSIONS There is a large body of evidence from predominantly low-quality systematic reviews of randomised controlled trials evaluating the effectiveness of physiotherapeutic treatments for delayed-onset muscle soreness. There is some strong evidence to support the effectiveness of cooling therapy, cryostimulation, contrast therapy, massage, phototherapy and kinesiotaping at various follow-up intervals, whereas evidence for stretching, exercises and electrical stimulation is weak. Uncertainties, heterogeneity and weaknesses of the available evidence partially limit the applicability and generalisability of the findings. CLINICAL TRIAL REGISTRATION PROSPERO registration number CRD42024485501 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024485501 ).
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Affiliation(s)
- Szczepan Wiecha
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507, Warsaw, Poland.
| | - Igor Cieśliński
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, Warsaw, Poland
| | - Paweł Wiśniowski
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, Warsaw, Poland
| | - Maciej Cieśliński
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, Warsaw, Poland
| | - Wojciech Pawliczek
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, Warsaw, Poland
| | - Paweł Posadzki
- Faculty of Rehabilitation, University of Physical Culture, Kraków, Poland
- Kleijnen Systematic Reviews Ltd., York, UK
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg a.d.H., Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Joanna Zając
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Płaszewski
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education, Warsaw, Poland
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De Pieri M, Sabe M, Rochas V, Poglia G, Bartolomei J, Kirschner M, Kaiser S. Resting-state EEG and MEG gamma frequencies in schizophrenia: a systematic review and exploratory power-spectrum metanalysis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2025; 11:48. [PMID: 40128239 PMCID: PMC11933325 DOI: 10.1038/s41537-025-00596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 03/05/2025] [Indexed: 03/26/2025]
Abstract
The hypoactivity of parvalbumin-containing interneurons (PV-interneurons) is a pathogenetic mechanism of schizophrenia according to the glutamatergic theory, and PV-interneurons are necessary for the generation of EEG/MEG gamma-frequencies (30-100 Hz). The present study aims to a literature synthesis on resting-state gamma-frequency changes in patients with schizophrenia vs healthy controls, and to examine the relationship between these changes and severity of symptoms. A protocol was enregistered in PROSPERO and a systematic search was conducted in PubMed, PsycINFO and Cochrane Database of Systematic Reviews, following PRISMA guidelines. An exploratory metanalysis was realized. Out of 1391 records, 43 were included for a qualitative synthesis (N = 2133 [11-185], females 37.4%, age 33.9 ± 9.2). Results on power spectra were heterogeneous: in 12 studies gamma power was increased, involving the whole brain (N = 3), multiple regions (N = 6) or only frontal (N = 1), central (n = 1) and temporal (N = 1) areas; in 3 studies gamma power was reduced, involving multiple areas (N = 2) or the right temporal region (N = 1); one study revealed mixed results and 13 studies showed no differences. The meta-analysis on 4 studies (N = 211) showed non-significant differences between patients and controls and a large heterogeneity. The functional connectivity picture consists of sparse patterns of decreases and/or increases, widespread to multiple regions. Relationships emerged between gamma power and connectivity and severity of psychotic and cognitive symptoms. Theta-gamma coupling was increased in patients, with limited evidence for other changes in phase-amplitude coupling. Resting-state gamma-frequencies alterations in schizophrenia were inconsistent across studies; the heterogeneity of patients and methods could partially explain this outcome.
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Affiliation(s)
- Marco De Pieri
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland.
| | - Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Rochas
- Functional Brain Mapping Laboratory, Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Greta Poglia
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - Javier Bartolomei
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Zhou X, Yang N, Xu W, Li X, Spiliopoulou A, Theodoratou E. Associations of genetic factors with vascular diabetes complications: an umbrella review. J Glob Health 2025; 15:04081. [PMID: 40116328 PMCID: PMC11927039 DOI: 10.7189/jogh.15.04081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2025] Open
Abstract
Background To comprehensively assess evidence from published systematic review and meta-analyses (SRMAs) on the genetics of vascular diabetes complications. Methods A systematic literature search conducted in Medline and Embase identified 63 non-overlapping SRMAs. We re-conducted meta-analyses to compare diabetes with and without complications using multiple genetic models; evaluated associations using Venice criteria and Bayesian false-discovery probability (BFDP); and graded as highly credible, credible, and not credible. We also contrasted highly credible and credible associations to recent genome-wide association studies (GWASs). Results Highly credible evidence was discovered for single nucleotide polymorphisms (SNPs) rs1024611 at MCP-1 gene and SNP rs3025039 at VEGF gene with diabetic retinopathy (DR) in type 2 diabetes; SNP rs2268388 at ACACB gene, insertion/deletion (Ins/Del) variant at ACE gene, SNP rs1801133 at MTHFR gene, and SNP rs7903146 at TCF7L2 gene with diabetic kidney disease (DKD) in type 2 diabetes; and SNP rs4880 at SOD2 gene with diabetic peripheral neuropathy (DPN) in type 1 diabetes. Combining type 1 and 2 diabetes, highly credible evidence was discovered for insertion/deletion variant at ACE gene, SNP rs759853 at AKR1B1 gene, SNP rs1044498 at ENPP1 gene and DKD, and SNP rs1617640 at EPO gene for the combined endpoint of DR and DKD. None of these associations was directly replicated in the latest GWASs for DR and DKD, however, another SNP, rs55853916 at TCF7L2 gene had been detected as a GWAS hit for DKD. Conclusions This umbrella review rigorously assessed evidence on the genetics of vascular diabetes complications, complemented findings in recent GWASs and yielded insight into the optimal selection of genetic models for the design of GWASs on vascular diabetes complications. Mechanistic or bioinformatic studies are warranted to further assess the role of these genes in the pathology of vascular diabetes complications and their potential as drug targets. Registration PROSPERO: CRD42022384423.
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Affiliation(s)
- Xuan Zhou
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Nan Yang
- Department of Big Data in Health Science School of Public Health, and Centre of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Xu
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Xue Li
- Department of Big Data in Health Science School of Public Health, and Centre of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Athina Spiliopoulou
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Evropi Theodoratou
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Wang Z, Zhu S, Zhu J, Jiang Z, Ren Y. Comparison of P2Y12 inhibitors and aspirin in secondary prevention of coronary events: a meta-analysis of RCTs. BMC Cardiovasc Disord 2025; 25:207. [PMID: 40119267 PMCID: PMC11927196 DOI: 10.1186/s12872-025-04668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 03/13/2025] [Indexed: 03/24/2025] Open
Abstract
OBJECTIVE This systematic review and meta-analysis compared the efficacy and safety of P2Y12 inhibitors versus aspirin monotherapy for secondary prevention in patients with coronary heart disease (CAD), providing evidence for clinical decision-making. METHODS Following the PRISMA and AMSTAR2 guidelines, a comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing P2Y12 inhibitors and aspirin monotherapy in CAD patients. The inclusion criteria focused on RCTs comparing P2Y12 inhibitors (clopidogrel, ticagrelor, and prasugrel) with aspirin. Studies that were non-randomized, did not focus on monotherapies with these agents, involved patients under 18 years old, or included non-CAD patients were excluded. The primary outcomes included myocardial infarction (MI) and stroke, while secondary outcomes comprised gastrointestinal complications, major bleeding, and mortality. The Cochrane Risk of Bias tool was used to assess the risk of bias. A random-effects model was applied to calculate risk ratios (RR) with 95% confidence intervals (CI), and sensitivity analyses were conducted to evaluate the robustness of the findings. RESULTS A total of 31,956 patients were included in the meta-analysis. P2Y12 inhibitors significantly reduced the risk of myocardial infarction (RR: 0.77, 95% CI: 0.67 to 0.89, I² = 0%, P < 0.001) and hemorrhagic stroke risk (RR: 0.53, 95% CI: 0.30 to 0.92, I² = 20.2%, P = 0.025). No statistically significant difference was observed in major bleeding (RR: 0.96, 95% CI: 0.71 to 1.30, I² = 63.8%, P = 0.814) or all-cause mortality (RR: 0.99, 95% CI: 0.85 to 1.15, I² = 30.3%, P = 0.877). Heterogeneity was assessed, and sensitivity analysis confirmed the robustness of the primary findings. CONCLUSIONS Compared with aspirin, P2Y12 inhibitors reduce risk of myocardial infarction and hemorrhagic stroke in the secondary prevention of CAD. However, there is no significant differences in major bleeding or all-cause mortality. Further research, including subgroup analyses and studies in diverse populations, is needed to validate these findings and explore genetic factors that may influence treatment outcomes.
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Affiliation(s)
- Zhitao Wang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Shanshan Zhu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jiajia Zhu
- Department of Operation Room, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Zhengli Jiang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
| | - Yu Ren
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
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Stevens A, Hersi M, Garritty C, Hartling L, Shea BJ, Stewart LA, Welch VA, Tricco AC. Rapid review method series: interim guidance for the reporting of rapid reviews. BMJ Evid Based Med 2025; 30:118-123. [PMID: 39038926 DOI: 10.1136/bmjebm-2024-112899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Abstract
Rapid reviews (RRs) are produced using abbreviated methods compared with standard systematic reviews (SR) to expedite the process for decision-making. This paper provides interim guidance to support the complete reporting of RRs. Recommendations emerged from a survey informed by empirical studies of RR reporting, in addition to collective experience. RR producers should use existing, robustly developed reporting guidelines as the foundation for writing RRs: notably Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020; reporting for SRs), but also preferred reporting items for overviews of reviews (PRIOR) items (reporting for overviews of SRs) where SRs are included in the RR. In addition, a minimum set of six items were identified for RRs: three items pertaining to methods and three addressing publication ethics. Authors should be reporting what a priori-defined iterative methods were used during conduct, what distinguishes their RR from an SR, and knowledge user (eg, policymaker) involvement in the process. Explicitly reporting deviations from standard SR methods, including omitted steps, is important. The inclusion of publication ethics items reflects the predominance of non-journal published RRs: reporting an authorship byline and corresponding author, acknowledging other contributors, and reporting the use of expert peer review. As various formats may be used when packaging and presenting information to decision-makers, it is practical to think of complete reporting as across a set of explicitly linked documents made available in an open-access journal or repository that is barrier-free. We encourage feedback from the RR community of the use of these items as we look to develop a consolidated list in the development of PRISMA-RR.
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Affiliation(s)
- Adrienne Stevens
- Centre for Immunization Programs, Infectious Diseases & Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mona Hersi
- Centre for Immunization Programs, Infectious Diseases & Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Chantelle Garritty
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Beverley J Shea
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Vivian Andrea Welch
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea C Tricco
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Park JM, Park HJ, Yoon SY, Kim YW, Shin JI, Lee SC. Effects of Robot-Assisted Therapy for Upper Limb Rehabilitation After Stroke: An Umbrella Review of Systematic Reviews. Stroke 2025. [PMID: 40115991 DOI: 10.1161/strokeaha.124.048183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 01/08/2025] [Accepted: 02/13/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Robotic rehabilitation, which provides a high-intensity, high-frequency therapy to improve neuroplasticity, is gaining traction. However, its effectiveness for upper extremity stroke rehabilitation remains uncertain. This study comprehensively reviewed meta-analyses on the effectiveness of upper extremity robot-assisted therapy in patients with stroke. METHODS We combined results from 396 randomized controlled trials (RCTs) in 16 meta-analyses and conducted a new meta-analysis using nonoverlapping RCTs and 6 additional RCTs published after 2024. Duplicate studies were removed, all data were from RCTs, and a random-effects model resolved heterogeneity. Effects were analyzed by comparing robot-assisted therapy with conventional therapy at the same dose and as an add-on to conventional therapy. RESULTS Compared with conventional therapy, the effect of robot-assisted therapy on the Fugl-Meyer assessment was summarized as a significant standardized mean difference (SMD) of 0.29 (95% CI, 0.14-0.44; number of individual RCTs reanalyzed, 100 RCTs), and the additional effect of robot-assisted therapy was an SMD of 0.42 (95% CI, 0.23-0.61; 16 RCTs). However, these Fugl-Meyer assessment improvements did not meet the minimum clinically important difference thresholds identified in previous studies: 12.4 for subacute and 3.5 for chronic stroke. For activities of daily living, only the additional effect was significant by SMD of 0.35 (95% CI, 0.17-0.54; 26 RCTs), muscle strength was significant by SMD of 0.46 (95% CI, 0.22-0.70; 31 RCTs), and spasticity was not significant by SMD of -0.25 (95% CI, -0.55 to 0.06; 25 RCTs). CONCLUSIONS Robot-assisted therapy shows statistically significant improvements in motor recovery as measured by the Fugl-Meyer assessment in patients with stroke, both at the same dose and as an add-on to conventional therapy; however, these improvements do not meet the minimum clinically important difference. These benefits are consistent across different stages of stroke recovery, different types of robotic devices, duration of intervention, and training sites. However, the heterogeneity of included studies in patient population, stroke severity, intervention protocol, and robot type limits generalizability. High-quality trials are needed to better define the value of robot-assisted therapy across various devices and strategies.
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Affiliation(s)
- Jong Mi Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (J.M.P., H.J.P., S.Y.Y., Y.W.K., S.C.L.)
| | - Hee Jae Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (J.M.P., H.J.P., S.Y.Y., Y.W.K., S.C.L.)
| | - Seo Yeon Yoon
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (J.M.P., H.J.P., S.Y.Y., Y.W.K., S.C.L.)
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (J.M.P., H.J.P., S.Y.Y., Y.W.K., S.C.L.)
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea (J.I.S.)
- The Center for Medical Education Training and Professional Development in Yonsei-Donggok Medical Education Institute, Seoul, Republic of Korea (J.I.S.)
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, South Korea (J.I.S.)
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (J.M.P., H.J.P., S.Y.Y., Y.W.K., S.C.L.)
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Jiang W, Zhou H, Xu G, Zhang M, Tung TH, Luo C. The association between air pollution and three types of diabetes: An umbrella review of systematic reviews and meta-analyses. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 294:118080. [PMID: 40118013 DOI: 10.1016/j.ecoenv.2025.118080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 03/12/2025] [Accepted: 03/17/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Despite numerous meta-analyses showing an association between air pollutants and diabetes, there is considerable heterogeneity between studies. OBJECTIVES This study aims to evaluate the cumulative evidence regarding the association between air pollution and type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) through systematic reviews and meta-analyses. METHODS Following the PRISMA 2020 guidance, a comprehensive review across three databases, including Web of Science, Embase, and PubMed, from inception to September 30, 2024. The quality of the included systematic reviews was assessed using the AMSTAR 2 tool. The research protocol has been registered in PROSPERO (CRD42024594953). RESULTS A total of 19 meta-analyses were identified in this review, including two articles investigating the impact of air pollution on T1DM, nine on T2DM, and ten on GDM. Due to limited data, no significant relationship between air pollution and T1DM was found. There is evidence that exposure to particulate matter (PM2.5 and PM10) may significantly increase the risk of T2DM. However, meta-analyses concerning GDM exhibit a less consistent association between air pollution and GDM risk, which varies by pollutant and duration of exposure. CONCLUSION Results suggest that exposure to air pollution may increase diabetes risk to some extent, particularly for T2DM. However, due to limited available studies, further prospective cohort studies are warranted to elucidate the role of air pollutants in diabetes, particularly for T1DM. Additionally, understanding potential mechanisms by which air pollution affects diabetes is crucial for future investigations.
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Affiliation(s)
- Weicong Jiang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China; Department of Financial Markets, Linhai Rural Commercial Bank, Linhai, China
| | - Huili Zhou
- Department of Nephrology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Guangbiao Xu
- Department of Nephrology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Meixian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China.
| | - Chengwen Luo
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China.
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Zhao Y, Huang Y, Wang Z, Song Y, Feng G. Evaluating surgical interventions for low-grade degenerative lumbar spondylolisthesis: a network meta-analysis of decompression alone, fusion, and dynamic stabilization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025:10.1007/s00586-025-08788-y. [PMID: 40108039 DOI: 10.1007/s00586-025-08788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 01/09/2025] [Accepted: 03/09/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVE This study aimed to investigate which of the decompression alone (DA), decompression with fusion (DF), and decompression with dynamic stabilization (DS) produced the most favorable outcome for patients with low-grade degenerative lumbar spondylolisthesis (LDLS). MATERIAL AND METHOD Pubmed, Embase, Cochrane, and Web of Science were searched for all studies published before October 1, 2023. A review and data analysis of all randomized controlled trials (RCTs) of three interventions was performed by Stata (version 17.0) and Review Manager (version 5.4). RESULT 21 RCT studies with 3192 patients were included in the network meta-analysis. DA was superior to DF (MD = -92.05, P < 0.05; MD = -295.57, P < 0.05; MD = -2.19, P < 0.05; RR = 0.54, P < 0.05, respectively) and DS (MD = -35.69, P < 0.05; MD = -100.7, P < 0.05; MD = -295.57, P < 0.05; MD = -2.19, P < 0.05; RR = 0.54, P < 0.05, respectively) in reducing operative time, intraoperative blood loss, length of hospital stay, and postoperative adverse events. DS was superior to DF in reducing operative time, intraoperative blood loss, and length of hospital stay (MD = -56.35, P < 0.05; MD = -194.84, P < 0.05; MD = -1.12, P < 0.05, respectively). DF was superior to DA in reducing reoperations (RR = 0.55, p < 0.05). DF was superior to DA (MD = -1.44, p < 0.05) and DS (MD = -0.41, p < 0.05) in controlling the progression of olisthesis. CONCLUSION DA was the most favorable treatment for LDLS, reducing operative time, bleeding, hospital stay, and postoperative complications. DF outperformed DA in reducing reoperation rates. Although DS showed benefits in operative time and bleeding compared to DF, it did not offer a significant advantage over DA.
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Grants
- No. 82260431, 81871772, 82172495 National Natural Science Foundation of China
- No. 82260431, 81871772, 82172495 National Natural Science Foundation of China
- No. 82260431, 81871772, 82172495 National Natural Science Foundation of China
- No. 82260431, 81871772, 82172495 National Natural Science Foundation of China
- No. 82260431, 81871772, 82172495 National Natural Science Foundation of China
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Affiliation(s)
- Yize Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhe Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Villanova V, Martinino A, Stanzani E, Pastena P, Lorenzon L, Giovinazzo F. Extended pelvic lymphadenectomy and rectal cancer: An umbrella review. Surg Oncol 2025; 60:102215. [PMID: 40147057 DOI: 10.1016/j.suronc.2025.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 03/10/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025]
Abstract
Extended pelvic lymph node dissection (EPLND) for rectal cancer is common in Asian countries to reduce local recurrence and improve survival. This umbrella review investigates the benefit of adding extended lymphadenectomy to the standard total mesorectal excision (TME) practice. We conducted a comprehensive search of PubMed, Scopus, and Web of Science to identify systematic reviews and meta-analyses examining the role of EPLND in rectal cancer surgery. Primary outcomes were local recurrence and overall survival; secondary outcomes included: operation time, blood loss, urinary dysfunction, and sexual dysfunction. Of the 953 articles screened, 12 met the inclusion criteria. The median follow-up time was 52 months. In terms of overall survival, 10 studies found no statistically significant difference in the EPLND group; only two showed a significant improvement in 5-year survival. Nine studies found no significant benefit of EPLND in preventing local recurrence, while two suggested benefits for patients with locally advanced cancer after neoadjuvant chemoradiotherapy. In most studies, operation time and blood loss were higher in the EPLND group. EPLND was associated with increased odds of urinary and sexual dysfunction, with four out of six studies reporting higher rates for both outcomes. Our analysis concludes that EPLND offers no additional benefit over TME alone in terms of local recurrence, overall survival, or secondary outcomes, including increased risks of urinary and sexual dysfunction, longer operation times, and greater blood loss.
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Affiliation(s)
- Valentina Villanova
- School of Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Emilia Stanzani
- School of Medicine, Università di Roma "La Sapienza", Rome, Italy
| | - Paola Pastena
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Hearth, Rome, Italy
| | - Francesco Giovinazzo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Hearth, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy; Department of Surgery Saint Camillus Hospital, Treviso, Italy.
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Bahrami LS, Rahnama I, Chambari M, Norouzy A, Karav S, Arabi SM, Sahebkar A. The Effects of Curcuminoids Supplementation on Serum Adipokines: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials. Phytother Res 2025. [PMID: 40109154 DOI: 10.1002/ptr.8471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 01/08/2025] [Accepted: 02/20/2025] [Indexed: 03/22/2025]
Abstract
This umbrella review of randomized clinical trials aims to provide a unique and detailed understanding of curcumin's effects on adipokines, adding a novel perspective to the existing body of research. We carried out a thorough search of international databases up to April 2024, including MEDLINE, SciVerse Scopus, and Clarivate Analytics Web of Science. A random-effects model was utilized to evaluate the impact of curcuminoid on adipokines. The umbrella review incorporated meta-analyses that examined the effects of curcuminoid supplementation on adipokines, presenting associated effect sizes (ES) and confidence intervals (CI). We applied the GRADE and AMSTAR (A Tool for Assessing the Risk of Bias in Systematic Reviews system) to assess the certainty of the evidence and the quality of the systematic reviews. Our analysis of one meta-analysis, including 14 RCTs plus 1 RCT not included in meta-analyses, revealed significant and impactful findings. We found a substantial increase in serum adiponectin levels with curcuminoid supplementation, indicating a positive effect (SMD: 0.9; 95% CI, 0.4 to 1.3, p < 0.001; I2 = 92.2%). However, we did not observe a significant impact on serum leptin. The GRADE assessment supports the effect of curcuminoids on adiponectin with moderate evidence, while the impact on leptin was supported by low evidence. Curcuminoid supplementation significantly increases serum adiponectin levels with moderate-quality evidence and has no significant impact on serum leptin. This provides evidence as to the safety and effectiveness of curcuminoids in enhancing adiponectin without adverse effects, reassuring the audience about their potential in adipokine research.
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Affiliation(s)
- Leila Sadat Bahrami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Iman Rahnama
- Binaloud Institute of Higher Education, Mashhad, Iran
| | - Mahla Chambari
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sercan Karav
- Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Seyyed Mostafa Arabi
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Wang D, Sun X, Sun W, Wang R, Pan H, Zhou W. Influence of surgical timing post-neoadjuvant chemotherapy on survival outcomes in breast cancer patients: A comprehensive systematic review and meta-analysis. Breast 2025; 81:104454. [PMID: 40120518 DOI: 10.1016/j.breast.2025.104454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 03/18/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Increasing evidence supports the use of neoadjuvant chemotherapy (NAC) prior to surgery for breast cancer. However, the optimal timing between NAC and surgery had yet to be fully elucidated. This meta-analysis aims to assess how the optimal interval time (OTT) between NAC and surgery affects outcomes in breast cancer, providing additional evidence for clinical practice and future research. METHODS PubMed, Web of Science and Cochrane Library databases in English were systematically searched for this systematic review. All included studies investigated the variations in surgical timing following NAC and their effects on breast cancer outcomes. The endpoints included the rate of pathological complete response (pCR), overall survival (OS), recurrence free survival (RFS), and disease-free survival (DFS). This study has been registered with PROSPERQ. RESULTS Eleven eligible studies were identified, encompassing a total of 10,834 cases, all of which received surgery post-NAC. All studies were retrospective in nature. Ultimately, compared to intervals within 4 weeks, patients who underwent surgery>8weeks post-NAC demonstrated a statistically significant worse OS (HR = 1.21, 95 % CI: 1.06-1.40, p = 0.333 for heterogeneity). No significant difference of OS was observed between patients with OTT of 4-8 weeks vs < 4 weeks. Notably, patients with an OTT of 4-8 weeks (HR = 1.18, 95 % CI: 1.10-1.26, I2 = 0.0 %, p = 0.931 for heterogeneity) and>8weeks (HR = 1.21, 95 % CI: 1.13-1.29, I2 = 36.2 %, p = 0.195 for heterogeneity) exhibited decreasing RFS, compared with those with OTTs of<4 weeks. DFS and pCR rates were similar in>8weeks vs < 4 weeks and 4-8weeks vs < 4 weeks. CONCLUSION Our systematic review and meta-analysis indicate that the optimal interval following NAC for breast cancer patients might be within four weeks, as delays exceeding eight weeks could be associated with poorer clinical outcomes. However, additional research is necessary to validate these preliminary findings.
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Affiliation(s)
- Dandan Wang
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xiaowei Sun
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Wen Sun
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Ruoxi Wang
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Hong Pan
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Wenbin Zhou
- Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
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Strieker S, Heinen F, Ziegler A, Schmucker C, Kopp I, Landgraf MN. First Evidence-Based Guideline for Interventions in FASD. Neuropediatrics 2025. [PMID: 40015329 DOI: 10.1055/a-2547-4610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Prenatal alcohol exposure causes disruptions in brain development. The resulting disorder, fetal alcohol spectrum disorder (FASD), cannot be cured, but interventions can help improve the daily functioning of affected children and adolescents and the quality of life for the entire family.The aim of the German guideline version 2024 is to provide validated and evidence-based recommendations on interventions for children and adolescents with FASD.We searched for international guidelines and performed a systematic literature review and a hand search to identify literature (published 2012-2022) on interventions for children (0-18 years) with FASD. The quality of the literature was assessed for predefined outcomes using the GRADE method (grading of recommendations, assessment, development, and evaluation). We established a multidisciplinary guideline group, consisting of 15 professional societies, a patient support group, and 10 additional experts in the field. The group agreed on recommendations for interventions based on the systematic review of the literature and formulated additional recommendations, based on clinical experience/expert evidence in a formal consensus process.No international guideline focusing on interventions for patients with FASD was found. Thirty-two publications (4 systematic reviews and 28 original articles) were evaluated. The analysis resulted in 21 evidence-based recommendations and 26 expert consensus, covering the following topics: neuropsychological functioning, adverse effects of therapy, complications/secondary conditions, quality of life, caregiver burden, knowledge of FASD, and coping and self-efficacy.The German guideline is the first internationally to provide evidence-based recommendations for interventions in children and adolescents with FASD.
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Affiliation(s)
- Sonja Strieker
- Department of Paediatric Neurology and Developmental Medicine, iSPZ Hauner MUC, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Department of Paediatric Neurology and Developmental Medicine, iSPZ Hauner MUC, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Annika Ziegler
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Centre, University of Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Centre, University of Freiburg, Germany
| | - Ina Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Berlin, Germany
| | - Mirjam N Landgraf
- Department of Paediatric Neurology and Developmental Medicine, iSPZ Hauner MUC, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Rozga M, Moloney L, Handu D. Dietitian-Provided Interventions for Adults with Cancer: An Umbrella Review of Systematic Reviews. Nutr Cancer 2025:1-15. [PMID: 40108878 DOI: 10.1080/01635581.2025.2480317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/07/2025] [Accepted: 03/10/2025] [Indexed: 03/22/2025]
Abstract
Malnutrition is common in adults with cancer and is associated with lower quality of life and higher risk of mortality. A comprehensive picture of dietitian efficacy in cancer care is needed to inform payers and policymakers about effective care options. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of dietitian interventions, compared to no intervention or usual care, on nutrition-related outcomes in adults with all types and stages of cancer. MEDLINE, CINAHL, Cochrane Database of SRs, Food Science Source, and SPORTSDiscus databases were searched for SRs and meta-analyses published from 2018 to September 2024. The GRADE method was used to rate evidence certainty. There were 2,087 articles identified in the search, 125 full texts were examined for eligibility, and seven SRs were included in this umbrella review, representing 25 randomized controlled trials and six observational studies. Interventions provided by dietitians may improve nutrition status, protein and energy intake, length of stay, and quality of life, but evidence certainty was low, primarily due to the risk of bias in primary studies, heterogeneity, and lack of precise effect size. Providing dietitian-led interventions for adults with cancer may improve a wide range of nutrition-related outcomes.
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Affiliation(s)
- M Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - L Moloney
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - D Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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Li Y, Quan X, Zhou C, Duan X, Nie M, Si H. Risk factors for metachronous periprosthetic joint infection in patients with multiple prosthetic joints: a systematic review and meta-analysis. J Orthop Surg Res 2025; 20:293. [PMID: 40102953 PMCID: PMC11921538 DOI: 10.1186/s13018-025-05694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 03/07/2025] [Indexed: 03/20/2025] Open
Abstract
OBJECT Although periprosthetic joint infection (PJI) can affect multiple joints simultaneously, most individuals with multiple joint involvement exhibit PJI in only one joint. Data regarding the metachronous PJI management for these patients are limited. This study aimed to explore the risk factors for metachronous PJI in patients with multiple prosthetic joints, thereby guiding and optimizing clinical practice. METHODS The MEDLINE, Web of Science, Cochrane Library, and EMBASE were searched for all clinical studies of metachronous PJI from inception until May 2024. The clinical studies on risk factors for metachronous PJI in patients with multiple prosthetic joints after experiencing a periprosthetic infection were collected, with two authors independently screening the literatures. Newcastle Ottawa scale was used as a quality assessment tool for the included studies, and the meta-analysis was conducted to evaluate the potential risk factors of metachronous PJI. RESULTS A total of 1,544 patients with PJI after multiple joint arthroplasties were reported in 9 studies, including 189 with metachronous PJI. The meta-analysis showed that methicillin-resistant staphylococcus aureus (MRSA; OR, 3.43; 95%CI, 1.71-6.88; p = 0.0005), rheumatoid arthritis (RA; OR, 2.38; 95%CI, 1.06-5.38; p = 0.04), history of steroid use (OR, 2.93; 95%CI, 1.58-5.43; p = 0.0007), and previous or ongoing non-periprosthetic infection (OR, 4.47; 95%CI, 1.45-13.82; p = 0.009) were identified as significant risk factors for metachronous PJI in patients with multiple prosthetic joints. However, there was no significant difference between the metachronous PJI group and non-metachronous group in terms of revision, age, diabetes, and gender. CONCLUSION Patients with MRSA, RA, history of steroid use, previous or ongoing non-periprosthetic infection are at significantly higher risk for metachronous PJI. Further research is needed to optimize management strategies for preventing metachronous PJI in patients with multiple prostheses after a single joint PJI.
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Affiliation(s)
- Yi Li
- Department of Orthopaedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, China
| | - Xiaolin Quan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Cheng Zhou
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xin Duan
- Department of Orthopaedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, China
| | - Mao Nie
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
| | - Haibo Si
- Department of Orthopaedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, China.
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Gartlehner G, Dobrescu A, Wagner G, Chapman A, Persad E, Nowak C, Klerings I, Neubauer C, Feyertag J, Gadinger A, Thaler K. Pharmacologic Treatment of Acute Attacks of Episodic Migraine: A Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med 2025. [PMID: 40096693 DOI: 10.7326/annals-24-02034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Migraine is common, affecting 15% of Americans. PURPOSE To compare benefits and harms of pharmacologic treatments for acute attacks of episodic migraine in adults and assess cost-effectiveness. DATA SOURCES Three electronic databases searched to October 2024, gray literature, and reference lists. STUDY SELECTION Two investigators independently selected English-language randomized trials. DATA EXTRACTION Single reviewer data extraction with second review. Dual independent risk of bias and certainty of evidence (COE) assessment. DATA SYNTHESIS Twenty-one head-to-head and 165 placebo-controlled trials were included in meta-analyses and network meta-analyses. Triptans were more effective than acetaminophen (low COE) and nonsteroidal anti-inflammatory drugs (NSAIDs) (high COE) for pain outcomes at 2 hours and pain freedom up to 48 hours. Triptan and acetaminophen combinations were more effective than acetaminophen alone (moderate COE) for pain outcomes at 2 hours and pain freedom up to 48 hours but not more than triptans alone (low COE). Triptan and NSAID combinations were more effective for pain outcomes at 2 hours and pain freedom up to 48 hours compared with acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE). Triptan regimens, however, often had a higher risk for adverse events. One study found triptans more cost-effective than ditans and gepants. LIMITATIONS Harms assessment was limited to randomized trials. Many comparisons lacked sufficient evidence to draw conclusions. CONCLUSION Triptans and combinations of triptans were more effective than NSAID and acetaminophen alone. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42023441146).
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Affiliation(s)
- Gerald Gartlehner
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria, and RTI International, Center for Public Health Methods, Research Triangle Park, North Carolina (G.G.)
| | - Andreea Dobrescu
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Gernot Wagner
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Andrea Chapman
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Emma Persad
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Claus Nowak
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Irma Klerings
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Camilla Neubauer
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
| | - Johanna Feyertag
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, and Karl Landsteiner University of Health Sciences, Krems, Austria (J.F., A.G.)
| | - Arianna Gadinger
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, and Karl Landsteiner University of Health Sciences, Krems, Austria (J.F., A.G.)
| | - Kylie Thaler
- Cochrane Austria, American College of Physicians Center for Evidence Reviews, Department for Evidence-based Medicine and Evaluation, University of Continuing Education Krems, Krems, Austria (A.D., G.W., A.C., E.P., C.Nowak, I.K., C.Neubauer, K.T.)
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Martuszewski A, Paluszkiewicz P, Poręba R, Gać P. Clinical Significance of Extracellular Volume of Myocardium (ECV) Assessed by Computed Tomography: A Systematic Review and Meta-Analysis. J Clin Med 2025; 14:2066. [PMID: 40142874 DOI: 10.3390/jcm14062066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/09/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Background/Objectives: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. Methods: A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using Cochrane Handbook formulas. Statistical analyses employed random-effects models (R version 4.4.2). Results: The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23-1.96; I2 = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. Conclusions: CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.
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Affiliation(s)
- Adrian Martuszewski
- Department of Environmental Health, Occupational Medicine and Epidemiology, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-345 Wrocław, Poland
- Department of Neurology, Specialist Hospital in Walbrzych, 58-309 Wałbrzych, Poland
| | - Patrycja Paluszkiewicz
- Department of Neurology, Specialist Hospital in Walbrzych, 58-309 Wałbrzych, Poland
- Department of Emergency Medical Service, Wroclaw Medical University, Bartla 5, 50-367 Wrocław, Poland
| | - Rafał Poręba
- Department of Biological Principles of Physical Activity, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Paweł Gać
- Department of Environmental Health, Occupational Medicine and Epidemiology, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-345 Wrocław, Poland
- Centre of Diagnostic Imaging, 4th Military Hospital, Weigla 5, 50-981 Wrocław, Poland
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50
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Liu Y, Chen X, Zou L. Boosting recovery before surgery: The impact of prehabilitation on upper gastrointestinal cancer patients - A quantitative comparative analysis. PLoS One 2025; 20:e0315734. [PMID: 40100884 PMCID: PMC11918424 DOI: 10.1371/journal.pone.0315734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 12/01/2024] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Emerging research presents divergent perspectives on the efficacy of prehabilitation for patients scheduled for surgery due to upper gastrointestinal (GI) cancers, capturing the attention of both the scientific community and surgical professionals. This quantitative comparative analysis seeks to assess the association of prehabilitation to ameliorate postoperative outcomes in individuals with upper GI cancers, thereby providing a comprehensive evaluation of its potential benefits within a surgical context. MATERIALS AND METHODS Medline, Embase, Cochrane Library and Web of Science were searched up to February 2024. Studies reporting the association between prehabilitation, and postoperative complications, readmissions or other outcomes of interest were included. Fixed or random effect models were used, and forest plots were applied to show the results of the quantitative comparative analysis. RESULTS A total of 198 studies were initially screened based on titles and abstracts, with 129 studies subsequently excluded. Overall, 69 full-text studies were identified, of which 12 studies were finally included for qualitative analysis in the quantitative comparative analysis after determining whether the inclusion and exclusion criteria were met. The pooled results indicated that prehabilitation significantly reduced the overall postoperative complication rates in patients with upper GI cancer undergoing surgical therapy with the pooled OR of 0.59 (95%CI: 0.39-0.88). Moreover, prehabilitation was also shown to be a protective factor of pulmonary complications (OR: 0.54, 95%CI: 0.36-0.80) and ICU readmissions (OR: 0.23, 95%CI: 0.06-0.89). CONCLUSION The correlation between prehabilitation and a reduction in overall postoperative complications, pulmonary complications, and ICU readmissions among patients with upper GI cancer is substantiated by significant data. This pivotal finding necessitates further empirical investigation to validate these initial results and ascertain the clinical efficacy of prehabilitation protocols, thereby informing future surgical practice strategies.
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Affiliation(s)
- Yuping Liu
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoli Chen
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
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