Cone-beam computed tomography (CBCT) assisted bronchoscopy shows prospective advantages in diagnosing peripheral pulmonary lesions (PPLs), but its diagnostic value and potential influencing factors remain unclear. What is the clinical value and optimal strategy of CBCT-assisted bronchoscopy in diagnosing PPLs? The references were searched from PubMed, EmBase, and Web of Science. Studies reporting diagnostic yield and potential influencing factors of CBCT-assisted bronchoscopy were included. The navigational success rate, diagnostic rate, complication rate, and potential influencing factors were pooled by random-effects model and meta-regression. A total of 1,441 patients with 1,540 lesions from 15 studies were included in our meta-analysis. The pooled navigational success rate (97.0% vs 81.6%; odds ratio [OR] 5.12) and diagnostic rate (78.5% vs 55.7%; OR 2.51) of the CBCT-assisted group were significantly higher than those without CBCT. The complication rate of CBCT-assisted bronchoscopy was 4.4% (95%CI: 0.02-0.07). Cone-beam CT combined with r-EBUS can achieve the highest diagnostic rate. Applying positive end-expiratory pressure could improve the diagnostic rate and reduce the complication rate (p < 0.05). Lesions located in the upper lobe could achieve a higher diagnostic rate and lesions located in the right lobes could get a lower complication rate (p < 0.05). Cone-beam CT combined with r-EBUS seems to be the effective and optimal approach to ameliorate the navigation success rate and diagnostic rate of diagnosing PPLs.Clinical trial registration: This study was registered in PROSPERO (Registration Number: CRD42022378992). URL: PROSPERO (york.ac.uk).

Diabetic nephropathy (DN) is a diabetes mellitus (DM)-induced complication that poses high morbidity and mortality risks. The Astragalus and Salvia miltiorrhiza couplet medicines (AS) are commonly employed in DN clinical treatment in China, but their clinical efficacy and potential pharmacological mechanisms are yet to be evaluated.

A meta-analysis of 15 studies involving 1,443 patients was conducted. Furthermore, network pharmacology predicted components and targets, which were verified by molecular docking and in vivo validation.

In our meta-analysis, AS notably elevated clinical outcomes and renal function among patients with DN. Meanwhile, when the treatment duration exceeds 12 weeks, AS demonstrated a significant reduction in fasting blood glucose levels, indicating a time-dependent effect. Moreover, based on network pharmacology results, AS likely enhanced clinical outcomes by interacting with vital signaling pathways, including PI3K/Akt, MAPK, and NF-kappa B. Molecular docking studies have confirmed that PTGS2, the key therapeutic target of AS, can be closely combined with bioactive components GLY, quercetin, apigenin, and daidzein. Additionally, in vivo experiments have corroborated that AS can ameliorate renal function, UACR, and biomarkers associated with iron metabolism, such as GPX4, PTGS2, FTH1, and FTL1.

Through rigorous experimental validation, our study demonstrates AS's significant clinical efficacy in managing DN. Specifically, AS has been shown to enhance renal function, ameliorate renal fibrosis, and positively influence iron metabolism. Despite these promising outcomes, future research with a larger sample size must be conducted to further substantiate these findings.

This study aimed to assess the associations between multidimensional sleep features and type 2 diabetes mellitus (T2DM).

We conducted a systematic search across the PubMed, Embase, Web of Science, and Scopus databases for observational studies examining the association between nighttime sleep duration, nighttime sleep quality, sleep chronotype, and daytime napping with type 2 diabetes mellitus (T2DM), up to October 1, 2024. If I2 < 50%, a combined analysis was performed based on a fixed-effects model, and vice versa, using a random-effects model.

Our analysis revealed that a nighttime sleep duration of less than 7 h (odds ratio [OR] = 1.18; 95% CI = 1.13, 1.23) or more than 8 h (OR = 1.13; 95% CI = 1.09, 1.18) significantly increased the risk of T2DM. Additionally, poor sleep quality (OR = 1.50; 95% CI = 1.30, 1.72) and evening chronotype (OR = 1.59; 95% CI = 1.18, 2.13) were associated with a notably greater risk of developing T2DM. Daytime napping lasting more than 30 min augments the risk of T2DM by 7-20%. Interactively, the incidence of T2DM was most significantly elevated among individuals with poor sleep quality and nighttime sleep duration of more than 8 h (OR = 2.15; 95% CI = 1.19, 3.91).

A U-shaped relationship was observed between sleep duration and type 2 diabetes mellitus (T2DM), with the lowest risk occurring at a sleep duration of 7 to 8 h. Additionally, poor sleep quality, evening chronotypes, and daytime napping exceeding 30 min emerged as potential risk factors for T2DM. These high-risk sleep characteristics interacted with one another, amplifying the overall risk of developing the disease.

This systematic review evaluated a total of 31 included human intervention studies that have assessed methods to improve quercetin bioavailability from different formulations and food matrices using urine or blood samples up to July 2024. The bioavailability of quercetin in humans was affected by several factors. 1) Chemical structure: Quercetin-3-O-oligoglucosides exhibited 2-fold higher bioavailability than quercetin-3-O-glucoside, 10-fold higher than quercetin-3-O-rutinoside and ∼ 20-fold higher than quercetin aglycone. 2) Modification of physicochemical properties: In comparison to quercetin aglycone, the quercetin-3-O-glucoside-γ-cyclodextrin inclusion complex showed a 10.8-fold increase in bioavailability, while the self-emulsifying fenugreek galactomannans and lecithin encapsulation, and lecithin phytosome, showed a 62- and 20.1-fold increase, respectively. 3) Food matrix effects: the addition of dietary fats and fibre increased bioavailability by ∼2-fold. This review summarises key factors that enhance quercetin bioavailability, contributing to the development of more effective and practical quercetin supplements or functional foods for better bioactivity of quercetin in humans.

Oral health care of older people in long-term care facilities is insufficient, stressing the need for clear evidence-based implementation strategies to improve oral care. In 2013, a systematic review was performed and new evidence was published. This study aimed to gain insights into implementation strategies used to promote or improve oral health care for older people in long-term care facilities, explore their effectiveness and uncover strategy content in behavioral change techniques, and report the differences between the current results and those of the 2013 study.

A systematic review of the literature according to PRISMA guidelines and meta-analyses of implementation strategies were performed. Cochrane Library, PubMed, and CINAHL databases were searched for papers published between 2011 and 2023. Strategies were identified using the Coding Manual for Behavioral Change Techniques. Meta-analyses of oral health outcomes ("plaque" and "denture plaque") were performed with random-effects models using R language for statistical computing.

16 studies were included in the current results; 20 studies were included in the 2013 findings. More high-quality studies (67 %) were included in this review than in 2013 (47 %). Dental care professionals were involved in 14 of the 16 studies. Fourteen of the 16 studies used and/ or combined five or more different implementation strategies: knowledge, intention, awareness, self-efficacy, attitude, and facilitation of behavior. Implementation positively affected the knowledge and attitudes of the nursing staff; however, the oral health of older people did not necessarily improve. In the 2013 review, more studies indicated combined oral health measurements were effective (71 %) than in the current review (20 %-33 %). Meta-analysis of four studies on dental plaque (0-3 scale) showed a significant, statistically small mean difference of -.21 (CI -.36; -.07, Cohen's d -.29) between the control and treatment group. Meta-analysis of three studies on denture plaque (0-4 scale), showed a significant, statistically large mean difference of -.76 (CI -1.48; -.05, Cohen's d -.88).

In this review, more implementation strategies and combinations were used to implement oral care in long-term care. Implementation strategies positively affected the knowledge and attitudes of nursing staff; however, the oral health of older people did not necessarily improve. Meta-analyses on plaque showed that oral care implementations are effective; for denture plaque, the effect size was large and thus may have more clinical value than for dental plaque.

Current guidelines advise against using embryos derived from mono-pronuclei (1PN) or non-pronuclei (0PN) zygotes for clinical purposes. Nevertheless, recent studies have demonstrated that 1PN and 0PN zygotes can lead to healthy births. This study aimed to investigate the pregnancy outcomes of 1PN and 0PN blastocysts.

PubMed, EMBASE, Web of Science and Cochrane databases were searched up to 14 March 2024. Eligible studies enrolled participants transferring 0PN or 1PN blastocysts, with two pronuclei (2PN) blastocysts used as the control. Clinical pregnancy rate, miscarriage rate and live birth rate were the main outcomes. The results were presented as odds ratios (OR) with 95 % confidence intervals (CI) using random-effect models with the Mantel-Haenszel method. Additionally, a stratified analysis was conducted based on the type of fertilization. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of the included studies.

In total, 270 articles were identified, with 16 ultimately included in the meta-analysis. In total, 57,835 cycles were analysed: 1071 cycles in the 1PN group, 2324 cycles in the 0PN group, and 54,440 cycles in the 2PN group. The results indicated that 1PN or 0PN blastocysts were associated with lower clinical pregnancy rates and live birth rates than 2PN blastocysts. Interestingly, there was no significant difference in live birth rate between 1PN blastocysts and 2PN blastocysts in patients undergoing intracytoplasmic sperm injection (ICSI), nor between 0PN blastocysts and 2PN blastocysts in patients undergoing in-vitro fertilization (IVF).

Careful consideration should be given to the utilization of 1PN and 0PN blastocysts, especially if an improved methodology of non-invasive assessment of fertilization is available. At the very least, 1PN blastocysts in patients undergoing ICSI and 0PN blastocysts in patients undergoing IVF represent viable fertility options for patients facing abnormal fertilization in clinical practice.

Resting-state functional magnetic resonance imaging (fMRI) studies have shown abnormal functional connectivity (FC) of the insula (INS) in patients with musculoskeletal pain (MSP). However, there is a lack of consistency in previous studies, which is an obstacle to understanding the underlying neuropathology of MSP.

Seven databases, including PubMed, Web of Science, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chongqing VIP, were systematically searched from inception to 15 May 2024. The meta-analysis of the aberrant INS-based FC in MSP patients was performed using the anisotropic effect-size signed differential mapping (AES-SDM).

A total of eleven neuroimaging studies with 276 patients and 253 HCs were included in the meta-analysis. The results indicate that MSP patients have increased FC between INS and the right median cingulate gyri, right inferior frontal gyrus, right paracentral lobule, and right supplementary motor area, and decreased FC between INS and the right posterior cingulate gyrus, left precuneus, and left angular gyrus. Heterogeneity and sensitivity analysis showed that most of the results of INS-based FC were highly reproducible and robust. Meta-regression analysis showed that revealed a negative association between the Visual Analog Scale (VAS) score and the reduction in FC between the INS and the left precuneus.

The meta-analysis reveals that patients with MSP show abnormal FC between the INS and multiple brain regions, which are involved in emotional, cognitive, sensory, visuospatial and motor regulation of pain. These findings provide important insights into the underlying neuropathological mechanisms of musculoskeletal disorders.

The incidence of persistent tracheocutaneous fistula (TCF) in children has dramatically increased with the increasing number of tracheostomies performed earlier in the paediatric population. Despite the various emerging techniques, two fundamental surgical approaches are primary closure and healing by secondary intention. We aim to compare the surgical outcomes between the two procedures.

PubMed, EMBASE and Scopus databases were searched from inception to 31 December 2023 with no restrictions on the setting or design of studies.

Data were pooled using a random effects model to assess the success and complication rates between the two surgical techniques.

A total of 26 studies were identified with a total of 1263 children. Persistent TCF was surgically treated with primary closure in 24 studies (n = 898), whereas healing by secondary intention was reported in 12 studies (n = 366). The success rate following primary closure and healing by secondary intention is 97.3% (95% CI: 95.7%-99.0%) and 94.0% (95% CI: 91.2%-96.7%), respectively. The pooled rate of complications following primary closure was 14.1% (95% CI: 8.9%-19.4%) and 8.4% (95% CI: 3.4%-13.3%) following healing by secondary intention.

Based on the pooled results, healing by secondary intention is a safer surgical option in children with persistent TCF.

Evidence suggests L-arginine may be effective at reducing pre-eclampsia and related outcomes. However, whether L-arginine can prevent or only treat pre-eclampsia, and thus the target population and timing of initiation, remains unknown.

To evaluate the effects of L-arginine and L-citrulline (precursor of L-arginine) on the prevention and treatment of pre-eclampsia.

MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were searched through 7 February 2024.

Trials administering L-arginine or L-citrulline to pregnant women, with the comparison group receiving placebo or standard care, were included.

Meta-analyses were conducted separately for prevention or treatment trials, using random-effects models.

Twenty randomised controlled trials (RCTs) (2028 women) and three non-randomised trials (189 women) were included. The risk of bias was 'high' in eight RCTs and showed 'some concerns' in 12. In prevention trials, L-arginine was associated with a reduced risk of pre-eclampsia (relative risk [RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low-certainty evidence, four trials) and severe pre-eclampsia (RR 0.23; 95% CI, 0.09, 0.55; low-certainty evidence, three trials). In treatment trials, L-arginine may reduce mean systolic blood pressure (MD -5.64 mmHg; 95% CI, -10.66, -0.62; very low-certainty evidence, three trials) and fetal growth restriction (RR 0.46; 95% CI, 0.26, 0.81; low-certainty evidence, two trials). Only one study (36 women) examined L-citrulline and reported no effect on pre-eclampsia or blood pressure.

L-arginine may be promising for pre-eclampsia prevention and treatment, but findings should be interpreted cautiously. More trials are needed to determine the optimal dose and time to commence supplementation and support clinical decision-making.

To systematically evaluate the efficacy of electrical stimulation (ES) in the treatment of patients with foot drop (FD) after stroke, and to compare the efficacy of different types of ES.

We searched 5 English database (PubMed, Web of Science, Embase, Cochrane Library and Scopus) and 4 Chinese databases (China National Knowledge Infrastructure (CNKI), SinoMed (CBM), VIP and Wanfang Data) from inception to June, 2024.

Traditional meta-analysis and network meta-analysis were performed using RevMan5.4 software and Stata 14.0 software respectively. A total of 37 RCTs were included, involving 2309 patients. The results of the traditional meta-analysis showed that compared with CRT, ES combined with CRT was effective in improving the range of motion (ROM) of ankle dorsiflexion in patients with FD after stroke and significantly improved the fugl-meyer assessment of lower extremity (FMA-LE) scores. For patients with FD with different disease duration, the subgroup analysis results showed that the ES improved the ROM of ankle dorsiflexion of patients in recovery phases (1-6 months) better than those in the acute phases (≤ 1 month) and sequelae phases (≥ 6 months), but the overall results of the three groups were not significantly different. The ES improved the lower limb motor function of patients in the recovery phases better than those in the acute phases, and the efficacy was not significant in patients in the sequelae phases (P > 0.05). The results of network meta-analysis showed that the best probability of improving the dorsiflexion angle of the ankle was electroacupuncture (EA) > transcranial direct current stimulation (tDCS) > transcutaneous electrical nerve stimulation (TENS) > functional electrical stimulation (FES) > neuromuscular electrical stimulation (NMES) > electromyographic biofeedback therapy (EMGBFT) > conventional rehabilitation therapy (CRT); the best probability of improving the dorsiflexion angle of the ankle was EA > EMGBFT > tDCS > FES > TENS > NMES > CRT.

The current evidence showed that the ES combined with CRT can effectively improve the ROM of ankle dorsiflexion and lower limb motor function in patients with FD after stroke, especially the patients in recovery phases. Among the different types of ES, EA had the best effect than other types of ES.

Polypoidal choroidal vasculopathy (PCV) is an aneurismal type of macular neovascularization that show similarities with age-related macular degeneration and diseases that are part of the pachychoroid disease spectrum. Exudative changes in PCV can be treated with intravitreal anti-vascular endothelial growth factor monotherapy; however, a combination therapy with photodynamic therapy may be required. In this systematic review and meta-analysis, we evaluated the efficacy of faricimab for PCV. We searched 12 literature databases for eligible studies. All study evaluation and data extraction were made by two authors in duplicate. Studies eligible for analysis were included for a qualitative and quantitative review. We identified seven studies with data from 150 eyes with PCV, five studies were of treatment-naïve eyes who were commenced in faricimab monotherapy, and two studies were of switch-over to faricimab from other anti-VEGF drugs. After faricimab loading dose in treatment-naïve eyes, the best-corrected visual acuity (BCVA) remained stable at -0.09 (95% CI: -0.20-0.03) logMAR, central retinal thickness (CRT) decreased -169 (95% CI: -311--27) μm, and 48.7 (95% CI: 32.5-65.0) % of eyes obtained polyp closure. In switch-over eyes, 57%-67% experienced fluid reduction and 21% were able to extend their treatment interval. In conclusion, faricimab monotherapy for PCV leads to acceptable clinical outcomes in terms of stable BCVA, reduction of CRT, and high incidence of polyp closure. Some cases may benefit from a switch to faricimab. However, long-term efficacy studies and controlled comparative studies are warranted.

Dry needling has been increasingly used as an adjunctive therapy for patellofemoral pain syndrome in clinical practice. This study aimed to summarize the available evidence about the effects of dry needling in managing patellofemoral pain syndrome.

Seven English-language databases and three Chinese-language databases were searched. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the PEDro scale and the Cochrane Risk of Bias Assessment Tool. The quality of evidence was evaluated using the GRADE approach.

A total of 12 studies were included, involving 624 participants. Dry needling significantly improved knee pain (MD = -0.86, 95%CI -1.17 to -0.55) and physical function (MD = 5.33, 95%CI 3.88 to 6.78) compared to comparative groups. When combined with exercise therapy, dry needling resulted in large reduction in knee pain(MD = -2.02, 95%CI -2.36 to -1.67) and small improvement in physical function (MD = 9.56, 95%CI 7.84 to 11.27) compared to exercise therapy alone. However, negligible or no additional benefits were observed when dry needling was added to extracorporeal shock wave therapy or multimodal interventions. Furthermore, dry needling showed no significant advantage over other trigger point therapies in terms of pain reduction and functional improvement.

Dry needling is effective in reducing pain and improving function for patients with patellofemoral pain syndrome, particularly when combined with exercise therapy. However, more high-quality studies are required to draw a definitive conclusion.

CRD42023490627 on PROSPERO.

To evaluate the characteristics, assessment methods and overall impact of pharmacist-led interventions on medication adherence (MA) and clinical outcomes in patients with co-morbid hypertension and diabetes.

A predetermined search in four scientific databases (Scopus, Cochrane, Medline, and CINAHL) and a search engine (Google Scholar) was conducted between October 2023 and February 2024. This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A screening was conducted which considered the article type (original article), written in the English language and based on the study's relevance while conference proceedings, reviews, and meta-analyses were excluded. Bibliometric indicators and VOSviewer were utilized to analyse and visualize keyword networks.

Out of the 420 studies initially identified, 12 of them involving 3512 patients were analysed in this review. The majority (11) reported a significant effect of pharmacist interventions on MA to prescribe medications. Pharmacist-led interventions, including remote and in-person education, special monitoring, and medication simplification, significantly improved MA and clinical outcomes in patients with hypertension and diabetes. The inclusion of patient education in a pharmacist-led multimodal intervention achieved a 100% success rate in improving MA.

For patients with hypertension and diabetes co-morbidity, integrating pharmacist education in multifaceted interventions is more effective in improving MA and clinical outcomes.

Antimicrobial drugs are used to treat bacterial pathogens that cause infections in humans and animals. Despite their importance, antimicrobial drugs exhibit inefficiency in treating infections if used irrationally without adherence to standard guidelines. Currently there is a lack of review literatures concerning antimicrobial resistance status in the southern sub Saharan African countries, hence the study is designed for and provides valuable insights into the status and comparison of antimicrobial resistance among foodborne bacteria in Zambia relative to other regions of the world, using systematic literature review and meta-analysis. For meta-analysis of bacterial and AMR prevalence and, generation of forest plots, functions from R packages were used and meta-regression analysis using the random effect model with the R functions "escalc" and "rma" from R "metafor" package was used to determine sample size on bacterial prevalence. A total of 434 articles were identified and downloaded after a systematic research. The study has implicated that the most common foodborne bacteria in the last five years in Zambia are salmonella spp., E. coli., and L. monocytogens. Based on the random effect model, the prevalence of bacterial pathogens across all studies in food samples was observed to be 11% and in human samples was 14%. The study found a significant increase in antimicrobial resistance (AMR) burden among foodborne pathogens in Zambia compared to other regions of the world over the past five years. This rise is attributed to the bacteria's ability to develop resistance mechanisms and easily spread between humans, animals, and the environment. Ineffective surveillance, inadequate management by stakeholders, and public unawareness have further exacerbated the problem, requiring effective policy implementations in the health sector.

Prostate cancer (PCa) significantly impacts patients' sexual functioning and quality of life. Patient-reported outcome measures (PROMs) are essential for accurately assessing these issues, yet a comprehensive evaluation of their psychometric properties in PCa patients is lacking.

This systematic review aimed to provide a comprehensive evaluation of all generic and specific PROMs used to assess sexual functioning in PCa patients and make recommendations the application of PROMs in this patient group.

Six electronic databases were searched from up to May 5, 2024. Studies reporting the development and/or validation of PROMs for PCa patients or generic instruments administered to this population were included. The COSMIN risk of bias checklist was adopted to assess the methodological quality and psychometric properties of included PROMs. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.

The main outcome was to identify the appropriate PROM that can be adopted and used for assessing sexual functioning in PCa patients in clinical setting.

A total of 10 PROMs were identified across 32 studies, primarily focusing on localized PCa patients after radical prostatectomy. The Expanded Prostate Cancer Index Composite (EPIC-26) was the most frequently evaluated and widely used PROM in clinical practice. EPIC-26 (Spanish, Italian, Chinese versions) and UCLA Prostate Cancer Index (UCLA-PCI) demonstrated better psychometric properties compared to other scales. However, no PROM met all COSMIN standards.

In a clinical setting, it is crucial to utilize well-validated PROMs with good psychometric properties to effectively identify patients with PCa experiencing sexual difficulties who may require additional support.

We applied strict inclusion criteria related to study design and study population, ensuring the assumption of transitivity and the consistency of the analysis.

Although EPIC-26 is a shortened version with strong psychometric properties, it may still be too lengthy for patients with significant health issues. Furthermore, the included PROMs do not address issues related to partner relationships, or the psychological impact of sexual dysfunction in sufficient detail. Future research should aim to develop and validate new PROMs that fill these gaps. These tools should be both psychometrically robust and practical for routine use, enabling real-time monitoring and improved care delivery.

The optimal surgical technique for managing Rathke's Cleft Cyst (RCC) remains unclear. Leaving the sellar defect open (marsupialisation) after transsphenoidal surgery facilitates ongoing drainage of cyst contents, but cannot be performed in the setting of an intraoperative cerebrospinal fluid (CSF) leak. The effects of intraoperative CSF leaks and sellar floor reconstruction on RCC recurrence require further investigation.

A systematic literature search was conducted for studies reporting RCC recurrence following transsphenoidal surgery, with data on intraoperative CSF leak rates and skull base reconstruction. Studies were classified based on surgical technique: cyst wall resection vs. fenestration, and open (no reconstruction) vs. closed (reconstructed) sellar floor.

Nineteen studies, comprising 1,076 patients, were included. The overall radiological RCC recurrence rate was 19.8% over a mean follow-up of 50.4 months. The recurrence rate in closed sella surgeries was significantly higher (32.1%) than in open sellar cases (14.0%) (OR 2.28, 95% CI: 1.41-3.67, p < 0.05). Intraoperative CSF leak occurred in 29.1% of cases. Patients with CSF leaks had a higher recurrence rate (23.4% vs. 12.9%), though meta-analysis demonstrated only a non-significant trend (OR 1.67, 95% CI: 0.95-2.96). Subgroup analysis revealed that intraoperative CSF leaks were significantly associated with increased recurrence after fenestration (38.5% vs. 18.4%, p = 0.03), and cyst wall resection (21.7% vs. 7.8%, p = 0.004). In the setting of an intraoperative CSF leak, there was a trend for lower recurrence when cyst wall resection was attempted (21.7% vs. 38.5%, p = 0.09).

Patients undergoing transsphenoidal surgery for RCC experience high rates of postoperative radiological recurrence. Cyst fenestration while maintaining an open sellar floor (marsupialisation into the sphenoid sinus) is associated with a significantly lower risk of recurrence at over 4 years follow-up. Intraoperative CSF leaks were less strongly associated with cyst recurrence, suggesting that watertight reconstruction, rather than the leak itself, is the primary driver of reaccumulation. When a closed sella is necessitated by intraoperative CSF leak, the addition of cyst wall resection may be associated with a lower rate of recurrence than fenestration alone but must be weighed against a higher risk of AVP-deficiency.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that significantly impacts patients' quality of life. Novel biological agents targeting the OX40 pathway have shown promise in refractory cases. We aimed to systematically evaluate the efficacy and safety of anti-OX40 therapies (amlitelimab, rocatinlimab, and telazorlimab) in moderate-to-severe AD. We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up to January 2025 for clinical trials comparing anti-OX40 therapies with placebo in patients with AD. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Five randomized clinical trials were included, comprising 1118 patients, of whom 857 (76.6%) received one of the anti-OX40 therapies. Both high-dose (mean difference [MD] = -17.33; 95% confidence interval [CI] = -23.79 to -10.87; P < 0.001) and low-dose (MD = -16.35; 95% CI = -27.42 to -5.28; P = 0.004) regimens significantly improved the SCORing AD, and multiple other outcomes also showed statistically significant improvements, including reductions in the mean Eczema Area and Severity Index score and body surface area affected by the disease. The incidence of any treatment-emergent adverse event was not statistically significant for either the high-dose group (risk ratio [RR] = 1.14; 95% CI = 0.82-1.59; P = 0.443) or the low-dose group (RR = 1.10; 95% CI = 0.84-1.45; P = 0.486). In conclusion, anti-OX40 therapies demonstrate clinically meaningful efficacy and an acceptable safety profile for moderate-to-severe AD, offering a potential alternative for patients with inadequate responses to current treatments. Further research is warranted to confirm these results and to refine optimal dosing strategies.

Active play emphasizes the enjoyment of physical activity, it is affordable and unconstrained. In contrast, skill-oriented physical education, a mainstream physical activity intervention, is more formalized. However, the comparative effects of these interventions on fundamental movement skills in preschool children remain a subject of debate.

Determine the effectiveness of active play and compare it with skill-oriented physical education on fundamental movement skills.

We searched four databases (MEDLINE, ERIC, Web of Science, and SPORTDiscus) from January 2004 to March 2024. Included studies assessed FMS in children aged 2-6 years, with active play interventions lasting ≥ 4 weeks. The effects of active play and skill-oriented physical education on total fundamental movement skills, locomotor skills, object control, and balance were calculated within random effects models (weighted SMD) in meta-analysis.

This systematic review included 23 studies involving 2201 preschool children, with 15 eligible for meta-analysis. The meta-analysis showed no significant differences in the effects of active play compared to skill-oriented physical education on total FMS, locomotor skills, object control, balance (p > 0.05). Subgroup analyses indicated that skill-oriented physical education marginally outperformed unstructured active play in total fundamental movement skills and locomotor skills (SMD=-1.0172, 95% CI -1.6748~ -0.3595, p = 0.0073; SMD=-1.6956, 95% CI -3.3511~ -0.0401, p = 0.0471).

Both structured active play and skill-oriented physical education are comparable effective in improving fundamental movement skills. However, unstructured active play is less effective. In resource-limited educational settings, structured active play may serve as a viable complement to partial skill-oriented physical education programming.

To determine the effectiveness of various interventions in reducing myopia progression in children. Literature databases were searched on December 2, 2023: PubMed, Embase, the Cochrane Central, Web of Science Core Collection, BIOSIS Previews, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI-Korean Journal Database, Preprint Citation Index, ProQuest™ Dissertations and Theses Citation Index and SciELO Citation Index. PRISMA guidelines and the Cochrane Handbook recommendations were followed. All unique interventions were analyzed individually in order to generate clinically applicable results. The main outcome was axial length progression. Secondary outcomes were incident corneal infiltrates, photophobia, development of an allergic response towards the intervention, visual acuity at near and distance and drop-out from allocated intervention/control. We identified 74 RCTs involving 12 154 participants aged 6-18 years. Network meta-analysis compared axial length after 1 year between 45 interventions and placebo or single-vision spectacles. The most effective interventions reported in weighted mean difference and 95% confidence interval were low-level red-light (-0.33 mm (-0.40, -0.25)), ortho-K with 5 mm treatment zone (-0.32 mm (-0.41, -0.24)), ortho-K with aspheric base curve (-0.29 mm (-0.37, -0.22)), atropine 1.0% (-0.28 mm (-0.30, -0.26)), combined atropine 0.01% and ortho-K (-0.24 mm (-0.37, -0.11)), spectacles with highly aspherical lenslets (-0.23 mm (-0.26, -0.19)), ortho-K with increased compression factor (-0.23 mm (-0.28, -0.17), atropine 0.05% (-0.21 mm (-0.30, -0.13)) and defocus incorporated multiple segments spectacles (-0.21 mm (-0.27, -0.15)). Photophobia and reduced near-visual acuity were reported for atropine, and lower adherence to treatment was found for atropine at 1.0%. There was no significant association between any interventions and corneal infiltrates or allergic reactions. Over 70% of the studies were conducted in Asian populations. This systematic review and network meta-analysis highlights the efficacy of various interventions, including orthokeratology lenses, atropine, highly aspherical lenslets and defocus incorporated multiple segments spectacles in slowing axial elongation in children. Low-level red-light therapy also slowed axial length progression, but further research is needed to assess the potential side effects. Future studies should include diverse populations and standardized methodologies to enhance the applicability and comparability of results.

Breast cancer is the most prevalent cancer in women worldwide. Despite it having an etiology that has fixed, genetic as well as modifiable, environmental risk factors, the narrative around breast cancer prevention emphasizes gendered interpretations of the etiology, such as "reproductive factors cause breast cancer" and women should change their behaviors to reduce their risk. Since migrant studies can distinguish environmental from genetic risk factors, we conducted a structured review of migrant studies and assessed prominent cancer website resources to determine evidence of gender bias between breast and prostate cancer.

We searched ten online databases for articles with migration as the exposure and breast cancer mortality and/or incidence as the outcome. We also searched using prostate cancer as the outcome to generate a comparison group. We developed rubrics to categorize the studies by study design (single, double, and time dimensional), convergence (a change in incidence or mortality for the migrant population), and concordance (consistency between results and author-attributed etiology). We used chi-square tests to test for differences by cancer type. We web-scraped four notable cancer websites to extract website layouts, risk factor information, and language describing breast cancer etiology and compared it to the content used for prostate cancer.

Of all 140 studies and 220 comparisons, breast (n = 131) outnumbered prostate cancer studies (n = 89; p-value = 0·005). For both cancers, studies that compared all three populations (the non-migrant, origin, and destination population outcomes) or measured length of stay demonstrated that cancer rates converged with migration. Most authors attributed breast cancer etiology to genetic and environmental factors. Yet, the migrant study results were inconsistent with public health messaging; all four websites framed breast cancer as more modifiable than prostate cancer.

Research efforts and public health messaging for breast cancer should consider gendered barriers to changing individual-level risk factors and develop more prevention strategies at the health systems level.

Cardiovascular disease is the leading cause of death globally. Non-malignant gynaecological diseases (NMGD) significantly affect patient health and well-being and may be associated with cardiovascular or cerebrovascular disease (C/CVD).

Seven databases were searched for relevant studies up to 21 April 2024. Observational studies reporting risk estimates and 95% CIs for the association between NMGD and C/CVD were included. Data were extracted by two independent reviewers. Random effects models were used to calculate summary relative risk (SRR) with 95% CI. Composite C/CVD outcome was defined as a combination of ischaemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease. The ROBINS-I tool defined study quality and risk of bias.

We screened 6639 studies, of which 59 were eligible for full-text review and 28 were included in our analysis, comprising a total of 3 271 242 individuals. The majority (53.5%) of the studies were scored as having a 'serious'/'critical' risk of bias. Overall, individuals with an NMGD had a significantly greater risk of composite C/CVD with low heterogeneity among contributing studies (SRR 1.28, 95% CI 1.20 to 1.37; n=16 studies, I2=65.3%), ischaemic heart disease (SRR 1.41, 95% CI 1.31 to 1.51; n=21 studies, I2=73.7%), and cerebrovascular disease (SRR 1.33, 95% CI 1.18 to 1.51; n=16 studies, I2=91.5%). In NMGD-specific analyses, the risk of C/CVD and its components was greater among those with a history of endometriosis or polycystic ovary syndrome.

We found an overall association between NMGD and C/CVD across all studies. However, estimates from individual studies varied substantially.

Clinicians and patients have been found to attribute musculoskeletal (MSK) pain to normal age-related changes seen on imaging, which can negatively impact patient outcomes and increase healthcare costs. While some studies have tested interventions to improve how MSK imaging findings are communicated, their impact has been limited. Applying a behavioural science framework has the potential to identify the rationale and target of these interventions to inform future intervention design-an analysis that has not yet been conducted. This study aims to identify the Behaviour Change Techniques (BCTs), the behavioural targets and the theoretical basis of interventions seeking to affect the communication of MSK imaging.

Scoping review using the Capability, Opportunity, Motivation - Behaviour (COM-B) model.

Searches of MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 9 February 2024.

We included studies that have developed or evaluated interventions which target the communication of MSK imaging findings. Interventions targeting both patients and clinicians were included. Experimental and quasi-experimental study designs were included, and studies that focused on serious or specific known causes of MSK pain were excluded.

Two independent authors extracted study participant data and intervention details. A theory of behaviour called the COM-B model was used to map the BCTs and behavioural components targeted by studies.

We identified 11 studies from 2486 studies in our electronic search. 11 different BCTs were identified across 11 studies. The most common techniques were framing/reframing (nine studies), adding objects to the environment (eight studies), incompatible beliefs (seven studies) and avoidance/reducing exposure to cues for the behaviour (four studies). Only two studies (feasibility studies) used behavioural theory to guide their intervention design. While one study showed a large effect, most interventions had little to no impact on pain, disability, or fear over time.

This review highlighted a lack of studies targeting clinician knowledge and the provision of high-quality patient resources about the nature of MSK pain, even though the broader literature identifies both as enablers of effective health communication. Additionally, the absence of a theory-informed design likely resulted in attempts to reassure patients about normal age-related imaging findings without providing an alternate, more coherent explanation for symptoms. Future interventions should focus on enhancing clinician psychological capability (knowledge) as well as clinician and patient reflective motivation (beliefs) to enable more helpful explanations of MSK symptoms. The key challenge for future interventions will be achieving these aims in a way that is effective, consistent and practical.

Open Science Framework (https://doi.org/10.17605/OSF.IO/ECYS8).

Accurate assessment of liver inflammation and fibrosis is of vital importance in the clinical management of patients with liver diseases. Our aim is to conduct a meta-analysis to evaluate the diagnostic accuracy of serum cytokeratin 18 (CK18) for staging of liver inflammation and fibrosis against a liver biopsy in adults.

We systematically searched articles from eight electronic databases. Two authors independently selected included studies, extracted data, and assessed quality. In our meta-analysis, we used the random-effects meta-analysis model. Publication bias, sensitivity analysis, heterogeneity analysis, and post-test probability were used in this meta study.

A total of 20 studies with 2235 patients were initially found by the search strategies. The pooled sensitivity, specificity, and area under the curve (AUC) of the summary receiver operating characteristic curve were 0.56, 0.81, and 0.810 for significant fibrosis; 0.64, 0.76, and 0.785 for advanced fibrosis; 0.53, 0.76, and 0.830 for cirrhosis; and 0.68, 0.73, and 0.786 for significant inflammation, respectively. High heterogeneity was observed in our meta-analysis because of factors such as the proportion of males, total number, and antigens of CK-18.

Serum CK18 had moderate diagnostic value (AUC > 0.7) in different stages of liver fibrosis and significant inflammation, offering a complementary approach to other non-invasive indicators such as serological biomarkers and imaging techniques. Future research should focus on elucidating the role of CK18 in the occurrence and progression of hepatitis and liver fibrosis, particularly in liver diseases with diverse etiologies.

Knee osteoarthritis (KOA) is a chronic, degenerative joint disease characterized by pain, stiffness, and functional impairment, significantly affecting mobility and quality of life. Traditional rehabilitation, mainly through in-person physiotherapy, is widely recommended for KOA management. However, access to these services is often limited due to geographic, financial, and mobility constraints. Telerehabilitation has emerged as an alternative, providing remote rehabilitation through digital platforms. Despite its increasing adoption, its effectiveness in improving key functional parameters such as pain, strength, and balance remains uncertain. While previous studies have focused primarily on pain relief and overall functional improvement, a broader assessment of its impact on mobility and fall prevention is needed.

This systematic review examines the effectiveness of telerehabilitation in improving pain, strength, and balance in adults with KOA compared with traditional rehabilitation or no intervention. In addition, it evaluates the impact of different telerehabilitation models, such as therapist-guided versus self-managed programs, and explores the feasibility of integrating telerehabilitation as an alternative in KOA management.

A systematic search of 4 databases (PubMed, PEDro, Cochrane, and Scopus) was conducted to identify randomized controlled trials (RCTs) published from May 2004 to May 2024. Inclusion criteria consisted of adults with KOA, evaluation of telerehabilitation either as a stand-alone intervention or in comparison to traditional rehabilitation or no intervention, and measurement of at least one primary outcome (pain, strength, or balance). A total of 2 independent reviewers assessed the risk of bias using validated tools. Due to variations in intervention programs and assessment methods, a narrative synthesis was performed instead of a meta-analysis. The review followed established guidelines, and data extraction was conducted using appropriate software.

A total of 6 RCTs (N=581 participants) met the inclusion criteria. The results indicate that telerehabilitation effectively reduces pain and improves strength and balance, although the extent of benefits varies. Some studies reported similar pain reductions between telerehabilitation and traditional rehabilitation, while others highlighted greater functional improvements in telerehabilitation groups. Therapist-guided telerehabilitation was associated with higher adherence rates and better functional outcomes compared with self-managed programs. The risk of bias assessment showed that most studies were of moderate to good quality, though common issues included selection bias, performance bias, and participant attrition.

Telerehabilitation is a promising alternative for KOA management, especially for individuals facing barriers to in-person therapy. It is effective in reducing pain and improving strength and balance, though its success depends on patient engagement, intervention delivery, and rehabilitation protocols. Therapist-guided programs yield better outcomes than self-managed approaches. Further research is needed to standardize intervention protocols, integrate emerging technologies, and evaluate cost-effectiveness to guide clinical practice and health care policies.

PROSPERO CRD42024564141; https://tinyurl.com/25ykvy7d.

This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.

To compare the efficacy of levobupivacaine versus bupivacaine for peribulbar block in ophthalmic surgery.

A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Publications in MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) that compared levobupivacaine and bupivacaine for peribulbar block in ophthalmic surgery were screened for eligibility from inception through December 22, 2023. Our analyses were summarized by calculating mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous variables, using either fixed-effects or random-effects meta-analysis based on the level of heterogeneity.

Eight randomized control trials enrolling 800 patients were identified in the English literature published between 1998 and 2023. There was no statistically significant difference in akinesia score at 2 minutes (MD = 0.17; p = 0.12) or 10 minutes postinjection (MD = 0.02; p = 0.89). Similarly, there was no statistically significant difference between the 2 groups in terms of time of onset of the anesthetic effect (MD = 0.38; p = 0.36), postoperative diplopia (OR = 0.62; p = 0.17), incidence of systemic hypotension (OR = 1.00; p = 1.00) or verbal pain scales during the block (MD = 0.04; p = 0.66), at the end of surgery (MD = -0.01; p = 0.94) or 4 hours postoperatively (MD = -0.00; p = 0.98).

As a result of conducting this meta-analysis, we conclude that there is no significant difference between levobupivacaine and bupivacaine in terms of akinesia score, time to onset of anesthetic effect, verbal pain scales, postoperative diplopia, or incidence of systemic hypotension.

Stem cells are specialised precursor cells that can replace aged or damaged cells and thereby maintain healthy tissue function. Stem cell therapy is increasingly used as a treatment for knee osteoarthritis, despite the lack of clarity around the mechanism by which stem cell therapy may slow down disease progression in osteoarthritis, and uncertainty regarding its benefits and harms.

To assess the benefits and harms of stem cell injections for people with osteoarthritis of the knee. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase on 15 September 2023, unrestricted by date or language of publication. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant trial protocols and ongoing trials.

We included randomised controlled trials (RCTs), or trials using quasi-randomised methods of participant allocation, comparing stem cell injection with placebo injection, no treatment or usual care, glucocorticoid injection, other injections, exercise, drug therapy, surgical interventions, and supplements and complementary therapies in people with knee osteoarthritis.

Two review authors selected studies for inclusion, extracted trial characteristics and outcome data, assessed risk of bias and assessed the certainty of evidence using the GRADE approach. The primary comparison was stem cell injection compared with placebo injection. The primary time point for pain, function and quality of life was three to six months, and the end of the trial period for participant-reported success, joint structure changes and adverse event outcomes. Major outcomes were pain, function, quality of life, global assessment of success, radiographic joint progression, withdrawals due to adverse events and serious adverse events.

We found 25 randomised trials (1341 participants) comparing stem cell injections with placebo injection (eight trials), no treatment or usual care (analgesia, weight loss and exercise) (two trials), glucocorticoid injection (one trial), hyaluronic acid injection (seven trials), platelet-rich plasma injections (two trials), oral acetaminophen (paracetamol) (one trial), non-steroidal anti-inflammatory drugs plus physical therapy plus hyaluronic acid injection (one trial) and stem cell injection plus intra-articular co-intervention versus co-intervention alone (three trials) in people with osteoarthritis of the knee. Trials were predominantly small, with sample sizes ranging from 6 to 252 participants, with only two trials having more than 100 participants. The average age of participants across trials ranged from 51 to 66 years, and symptom duration varied from one to 10 years. Placebo-controlled trials were largely free from bias, while most trials without a placebo control were susceptible to performance and detection biases. Here, we limit reporting to the main comparison, stem cell injection versus placebo injection. Compared with placebo injection, stem cell injection may slightly improve pain and function up to six months after treatment. Mean pain (0 to 10 scale, 0 no pain) was 4.5 out of 10 points with placebo injection and 1.2 points better (2.5 points better to 0 points better) with stem cell injection (I2 = 80%; 7 studies, 445 participants). Mean function (0 to 100 scale, 0 best function) was 46.3 points with placebo injection and 14.2 points better (25.3 points better to 3.1 points better) with stem cell injection (I2 = 82%; 7 studies, 432 participants). We are uncertain whether stem cell injections improve quality of life or increase the number of people who report treatment success compared to placebo injection, because the certainty of the evidence was very low. Mean quality of life was 45.3 points with placebo injection and 22.8 points better (18.0 points worse to 63.7 points better) with stem cell injection (I2 = 96%; 2 studies, 288 participants) at up to six months follow-up. At the end of follow-up, 89/168 participants (530 per 1000) in the placebo injection group reported treatment success compared with 126/180 participants (683 per 1000) in the stem cell injection group (risk ratio (RR) 1.29, 95% CI 1.10 to 1.53; I2 = 0%; 4 trials, 348 participants). We downgraded the evidence to low certainty for pain and function due to indirectness (as the source, method of preparation and dose of stem cells varied across studies), and suspected publication bias (up to three larger RCTs have been conducted but withdrawn prior to reporting of results). For quality of life and treatment success, we further downgraded the evidence to very low certainty due to imprecision in addition to indirectness and suspected publication bias. We are uncertain of the potential harms associated with stem cell injection, as there were very low event rates for serious adverse events. At the end of follow-up, 5/219 participants (23 per 1000) in the placebo injection group experienced serious adverse events compared with 4/242 participants (16 per 1000) in the stem cell injection group (RR 0.72, 95% CI 0.20 to 2.64; I2 = 0%; 7 trials, 461 participants) and there were no reported withdrawals due to adverse events. We downgraded the evidence to very low certainty due to indirectness, suspected publication bias and imprecision. Radiographic progression was not assessed in any of the included studies.

Compared with placebo injections and based upon low-certainty evidence, stem cell injections for people with knee osteoarthritis may slightly improve pain and function. We are uncertain of the effects of stem cell injections on quality of life or the number who report treatment success. Although the putative benefits of stem cell therapies for osteoarthritis include potential regenerative effects on damaged tissues, particularly articular cartilage, we remain uncertain of the effect of stem cell injections on structural progression in the knee (measured by radiographic appearance). There is also uncertainty regarding the safety of stem cell injections. Serious adverse events were infrequently reported, although all invasive joint procedures (including injections) carry a small risk of septic arthritis. The risk of other important harms, including potential concerns related to the use of a therapy with the theoretical capacity to promote cell growth, or to the use of allogeneic cells, remains unknown.

In some European countries, animal brucellosis is a concern that requires a comprehensive understanding of its distribution, hosts and transmission routes, particularly involving wild species, in which the disease is still neglected. This systematic review was designed to summarize the current knowledge on the epidemiology of brucellosis in wild boar and domestic pigs in Europe. A systematic search was conducted in four databases to identify relevant original research articles. Thirty-six articles were included. Brucellosis has been identified in 17 European countries and the most reported circulating Brucella species and biovar was Brucella suis biovar 2. Brucella suis biovar 1, Brucella suis biovar 3, Brucella melitensis biovar 3 and Brucella microti were also identified from molecular investigations. We highlight the diversity in the occurrence of this infection, with the presence of Brucella species with zoonotic potential, and emphasize the need for surveillance.

In today's fast-paced world, work-related stress is a prevalent problem, particularly among health care professionals in high-pressure environments such as emergency departments (EDs). This stress can lead to mental health disorders, such as depression and burnout, affecting job performance, patient care, and the quality of professional and private life. This systematic review aimed to investigate the prevalence of burnout, depression, and stress among ED nurses and physicians and the impact of these conditions on personal and professional quality of life (QoL).

The systematic literature search covered PubMed, PsycINFO, Embase, and grey literature databases. Articles were included if they were published in English or German by 31 January 2020, focused on ED physicians or nurses, and examined burnout, depression, or stress and its impact on professional or personal QoL. Quality assessment of the included studies was performed using a modified version of the Newcastle-Ottawa Scale.

The systematic search resulted in 893 articles, of which 11 met the inclusion criteria. All reviewed studies had a cross-sectional study design and were of low to moderate quality. Depression, burnout, and stress were prevalent among ED physicians, ranging from 15.5% to 19.3%, 18% to 71.4%, and 19.5% to 22.7%, respectively. These were associated with lower job satisfaction in ED physicians, while findings in ED nurses also showed a considerable rate of burnout with an inverse association with compassion satisfaction. Burnout and stress were significantly associated with intentions to quit emergency medicine in ED physicians, whereas no association was found for depression. In addition, burnout showed a negative relationship to work-life balance and QoL, while higher stress levels were associated with lower life satisfaction in ED physicians.

Our review underlines the high prevalence of stress, depression, and burnout among ED health care professionals and their potential negative impact on private and professional life, emphasizing the need for targeted support and interventions to enhance resilience, reduce stress, and prevent the onset or deterioration of mental health diseases. This, in turn, can contribute to maintaining and strengthening the already limited human resources in EDs, ensuring the quality of patient care, and strengthening health care systems.

Menopause, marked by a decline in estrogen, leads to disruptive vasomotor symptoms like hot flashes and night sweats, significantly affecting quality of life. This meta-analysis evaluated the efficacy and safety of fezolinetant and elinzanetant, two neurokinin 3 receptor antagonists, in managing vasomotor symptoms in postmenopausal women.

Data sources were identified by searches in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to September 2024. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with the risk of bias assessed using the version 2 of the Cochrane Risk of Bias Tool for Randomized Trials and evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model, and statistical analysis was performed using R version 4.4.1.

Ten studies involving 4663 patients were included in the analysis. Elinzanetant >100 mg and fezolinetant ≤45 mg were the most effective doses for reducing vasomotor symptom frequency and severity. Fezolinetant (MD = -1.38) and elinzanetant (MD = -2.04) achieved ≥50 % reductions in vasomotor symptom frequency, with a greater effect in the elinzanetant group. Additionally, elinzanetant improved menopause-specific quality of life. However, higher doses of both drugs were associated with increased adverse effects, with elinzanetant demonstrating a more favorable side-effect profile than fezolinetant.

Fezolinetant and elinzanetant are effective options for managing vasomotor symptoms. However, further research is needed to compare these treatments directly and evaluate their long-term safety profiles across different patient populations.

Insomnia affects at least one-third of the global population and is more common in women. Exercise has been reported to improve sleep quality and subsequent use of hypnotics. Therefore, we performed a meta-analysis to assess the effect of exercise on sleep quality in adult women.

This meta-analysis systematically assessed the effects of exercise on women's sleep quality using a random-effects model.

We searched seven databases for randomised controlled trials examining the effect of exercise on sleep quality in women. Inclusion criteria were women aged 18 or older with insomnia symptoms, exercise used as an intervention, and the Pittsburgh Sleep Quality Index or Insomnia Severity Index as outcome measures. We excluded studies using other treatments, those involving cancer patients or pregnant women, and those with unclear, unanalysable data. A random-effects model was used for meta-analysis, with outcomes expressed as the weighted mean difference and 95 % confidence interval. Risk of bias was assessed using Cochrane Handbook criteria.

The meta-analysis included 16 studies. The results indicated that exercise significantly reduced the Pittsburgh Sleep Quality Index total score. Exercise implemented for <12 weeks was more effective in improving sleep quality and daytime dysfunction, whilst interventions ≥12 weeks reduced the use of sleep medication.

Exercise training can significantly improve sleep quality in adult women, as measured by the Pittsburgh Sleep Quality Index. Therefore, exercise can be crucial in promoting health, especially as a non-pharmacological treatment. When more studies will be available in the future, it will be possible to further explore the impact of age, type of exercise, and time of exercise.

This systematic review and meta-analysis evaluated the incidence of serious adverse events (SAEs) in patients with Crohn's disease (CD) and ulcerative colitis (UC) treated with upadacitinib and examined secondary adverse events.

A comprehensive search of PubMed, Embase and Cochrane Library was conducted to identify randomized controlled trials (RCTs) comparing upadacitinib with placebo in adults with inflammatory bowel disease (IBD). The primary outcome was the incidence of SAEs, while secondary outcomes included specific adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.

Six RCTs, including 2611 patients, were analyzed. The incidence of SAEs did not significantly differ between upadacitinib (6.1%) and placebo (7%) (RR = 0.77; 95% CI: 0.50-1.20; p = 0.25). Secondary outcomes showed no significant differences in serious infections, hepatic disorders, nasopharyngitis or herpes zoster. However, neutropenia (RR = 5.63; 95% CI: 1.90-16.65; p = 0.0002) and creatine kinase elevation (RR = 2.34; 95% CI: 1.22-4.47; p = 0.01) were higher with upadacitinib, while anemia (RR = 0.36; 95% CI: 0.27-0.48; p < 0.00001) and arthralgia (RR = 0.47; 95% CI: 0.30-0.75; p = 0.001) were reduced.

Upadacitinib did not increase the overall risk of SAEs in IBD patients, with a notable reduction in anemia and arthralgia. However, the higher risks of neutropenia and CK elevation underscore the importance of monitoring. Further research is necessary to assess long-term safety, particularly regarding rare but serious events such as thromboembolism.

Solitary hepatocellular carcinoma measuring ≤3 cm represents approximately 30% of hepatocellular carcinoma cases, yet treatment guidelines lack robust evidence. This study compares oncologic outcomes after ablation, liver resection, and liver transplantation for solitary, small hepatocellular carcinoma.

We systematically searched databases up to 7 February 2022, for studies including adults with solitary hepatocellular carcinoma ≤3 cm treated by any ablation, liver resection, or liver transplantation. We excluded non-hepatocellular carcinoma cancers, recurrent/metastatic diseases, and alternative therapies. A frequentist network meta-analysis assessed 5-year overall survival and recurrence-free survival using only adjusted effect estimates while accounting for bias risk.

We identified 80 studies (4 randomized controlled trials, 72 retrospectives, and 4 prospective cohorts) with 28,211 patients. In the network meta-analysis for 5-year overall survival (26 studies), liver transplantation was associated with the lowest mortality hazard (hazard ratio, 0.47; 95% confidence interval, 0.31-0.73, referenced to liver resection), followed by liver resection (reference), whereas ablation had the greatest mortality hazard (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49, referenced to liver resection). For 5-year recurrence-free survival (19 studies), liver transplantation had the best outcome (hazard ratio, 0.36; 95% confidence interval, 0.20-0.63, referenced to liver transplantation), followed by liver resection (reference), with ablation showing the least favorable outcome (hazard ratio, 1.67; 95% confidence interval, 1.45-1.93, referenced to liver resection).

This network meta-analysis provides the evidence for comparing treatment modality outcomes for solitary, small (≤3 cm) hepatocellular carcinoma. LT emerges as the superior choice for achieving a better 5-year OS, followed by liver resection, then ablation. When feasible to preserve liver function, liver resection can be prioritized. Ablation with close surveillance should be reserved for individuals unfit for surgery.

Initial management for overactive bladder includes behavioral modification with avoidance of bladder irritants. However, in 2017, the International Consultation on Incontinence concluded that more research is needed to determine the precise role of these irritants in the treatment of overactive bladder.

The objectives were to identify, evaluate, and summarize peer-reviewed literature examining associations between 6 potential bladder irritants as proposed by the National Institute of Diabetes and Digestive and Kidney Diseases (alcohol; spicy foods; chocolate; artificial sweeteners; caffeinated, carbonated, and citrus beverages; and high-acid foods such as citrus and tomatoes) and OAB symptoms.

We performed a systematic literature search on MEDLINE, EMBASE, and SCOPUS. An adapted version of the patient-intervention-comparison-outcome framework was applied. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures assessment tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023466251).

We reviewed 51 unique articles exploring the effect of alcohol (n = 34); spicy foods (n = 1); chocolate (n = 3); artificial sweeteners (n = 5); caffeinated, carbonated, and citrus beverages (n = 27); and high-acid foods (n = 2). The considered outcomes included overactive bladder (n = 16), urgency incontinence (n = 19), urinary urgency (n = 15), frequency (n = 17), and nocturia (n = 17). Overall, observed associations were mixed and inconsistent. The risk of bias was moderate in 23 publications and low for the remaining publications.

This systematic review failed to identify consistent evidence of an association between any of these 6 potential bladder irritants and overactive bladder symptoms.

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.

The administration of crushed or chewed P2Y12 inhibitors (P2Y12i) allows faster platelet inhibition in patients presenting acute coronary syndrome (ACS). Whether this administration approach is safe needs further analysis. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing chewed/crushed to integral P2Y12i administration in patients with ACS. Major bleeding, minor bleeding, and major adverse cardiovascular events (MACE) were analyzed as binary outcomes. Platelet reactivity unit (PRU) was assessed as a continuous outcome to estimate the impact on platelet physiology. A subgroup analysis of P2Y12i administered was performed. Nine studies comprising 1091 patients with ACS were included, 77% were males. Overall, 87% presented with ST-segment elevation acute myocardial infarction. Six studies administered Ticagrelor, while 3 studies used Prasugrel. The absolute risk of bleeding, assessed by TIMI, was low in both intervention and control arms (0.36% vs. 0.95% for major bleedings and 3.3% vs. 4.4% for minor bleedings), and crushed/chewed administration did not increase the relative risk of bleeding events for TIMI major or minor bleedings (RR 0.51, 95% CI 0.09-2.77, p = 0.293; RR 0.76, 95% CI 0.24-2.43, p = 0.542) or MACE (RR 0.94, 95% CI 0.28-3.19, p = 0.902). PRU was significantly reduced within 1 h after administration in the crushed/chewed P2Y12i group (MD: -70.0%, 95% CI, -89.0 to -51.1%, p<0.01) while we did not observe a significant difference after 4 h (MD: -15.1%, 95% CI -34.2 to 4.0%, p = 0.12). The type of drug did not influence the relative risk of crushed/chewed P2Y12i on major or minor bleeding (pinteraction = 0.62 and pinteraction = 0.23, respectively). The crushed/chewed administration of P2Y12i in the setting of ACS was not associated with an increased risk of bleeding, suggesting the safety of this strategy.

Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.

Adverse childhood experiences (ACEs) significantly impact lifelong health and well-being. Despite extensive research, a comprehensive understanding of ACEs' multifaceted impacts continues to be challenging to achieve. This study synthesizes meta-analytic evidence to provide a comprehensive view of ACEs' effects, addressing various approaches to conceptualizing ACEs and their diverse outcomes. Employing an umbrella synthesis methodology, this review integrated findings from 99 meta-analyses involving 592 effect sizes. We examined ACEs through specificity, lumping, dimensional, and child maltreatment-centric approaches, assessing their impact across six domains: biological system dysregulation, neuropsychological impairments, physical health complications, mental health conditions, social and behavioral challenges, and criminal justice involvement. The findings reveal a small to moderate overall effect size of ACEs across outcome domains. Specific ACE approaches exhibited varying impact levels, with notable differences in effects on mental health, social/behavioral issues, and criminal justice involvement. When ACEs were aggregated without distinguishing between different types, but with consideration of their cumulative effects, adverse outcomes were significantly exacerbated. The child maltreatment-centric approach consistently demonstrated substantial effects across all evaluated domains. This review underscores the heterogeneity in ACEs' impacts, influenced by the type of ACE and specific outcomes considered. It highlights the necessity for comprehensive approaches to understanding, preventing, and mitigating the effects of ACEs. These insights are vital for developing targeted interventions and informing policy-making, emphasizing the complexity and varied nature of ACEs' influence on individual development and societal well-being.

To improve dental care for individuals with special needs, it is crucial to understand the effectiveness of endodontic treatments under general anaesthesia. This systematic review explores the feasibility, prognostic factors, and outcomes of root canal treatment and pulpotomy performed under general anaesthesia in adult and adolescent patients with special needs. A comprehensive search of Cochrane Library and MEDLINE databases was conducted until July 2024. The quality of evidence was assessed using the Newcastle-Ottawa scale (NOS). Among the 637 initially identified studies, 5 met the inclusion criteria. Treatment outcomes, radiographic findings, and clinical survival rates were evaluated. Root canal treatment success rates ranged from 81.5 to 90% over a minimum observation period of 12 months. Survival rates varied from 87.7% (9 year cumulative survival rate) to 89.8% (5 year survival rate). One study showed a lower failure risk in endodontic treatment under general anaesthesia compared to local anaesthesia. Another study found no significant difference in root canal treatment quality between general and local anaesthesia. Influencing factors identified by multivariate regression analyses included soft diet, periodontal status, oral hygiene status, pulp vitality, and length of root canal filling. Limited evidence suggests that endodontic treatment under general anaesthesia is feasible and can yield favourable outcomes in patients with special needs. However, the scarcity of studies and concerns about publication bias and methodological limitations emphasize the need for further research.

There is ongoing debate concerning the association of metformin with the risk of dementia in type 2 diabetes mellitus (T2DM). This study was conducted to evaluate the impact of metformin therapy on dementia in patients with T2DM.

PubMed, Embase, Cochrane Library, Web of Science and the ClinicalTrials.gov website were searched until 9 April 2024. Cohort studies investigating the effects of metformin therapy compared with other antidiabetic drugs or no therapy in T2DM were included. The hazard ratio (HR) and the 95% confidence interval (CI) were computed using the random effects model.

Twenty cohort studies (24 individual comparisons) involving 3 463 100 participants were identified. A meta-analysis revealed that people with T2DM who take metformin are linked to a lower incidence of all-cause dementia compared to non-user (n = 17, HR = 0.76, 95% CI = 0.65-0.91, p = 0.002, I2 = 98.9%) and sulfonylureas (n = 5, HR = 0.88, 95% CI = 0.85-0.90, p < 0.001, I2 = 9.7%), but not to thiazolidinedione (n = 2, HR = 0.53, 95% CI = 0.08-3.41, p = 0.503, I2 = 92.7%). Additionally, metformin showed favourable effects in non-specified T2DM (n = 19, HR = 0.75, 95% CI = 0.64-0.89), but not in newly diagnosed T2DM (n = 5, HR = 1.01, 95% CI = 0.81-1.27).

Metformin might correlate with a lower dementia incidence in people with T2DM. However, it is crucial to interpret these results with caution considering the high heterogeneity.

Background: Bats act as reservoirs for a variety of zoonotic viruses, sometimes leading to spillover into humans and potential risks of global transmission. Viral shedding from bats is an essential prerequisite to bat-to-human viral transmission and understanding the timing and intensity of viral shedding from bats is critical to mitigate spillover risks. However, there are limited investigations on bats' seasonal viral shedding patterns and their related risk factors. We conducted a comprehensive review of longitudinal studies on bat viruses with spillover potential to synthesize patterns of seasonal viral shedding and explore associated risk factors. Methods: We extracted data from 60 reviewed articles and obtained 1085 longitudinal sampling events. We analyzed viral shedding events using entropy values to quantitatively assess whether they occur in a consistent, pulsed pattern in a given season. Results: We found that clear seasonal shedding patterns were common in bats. Eight out of seventeen species-level analyses presented clear seasonal patterns. Viral shedding pulses often coincide with bats' life cycles, especially in weaning and parturition seasons. Juvenile bats with waning maternal antibodies, pregnant bats undergoing immunity changes, and hibernation periods with decreased immune responses could be potential risk factors influencing seasonal shedding patterns. Conclusion: Based on our findings, we recommend future longitudinal studies on bat viruses that combine direct viral testing and serological testing, prioritize longitudinal research following young bats throughout their developmental stages, and broaden the geographical range of longitudinal studies on bat viruses based on current surveillance reports. Our review identified critical periods with heightened viral shedding for some viruses in bat species, which would help promote efforts to minimize spillovers and prevent outbreaks.

Early detection of prostate cancer (PCa) is crucial for better patient outcomes. However, due to overdiagnosis with the current biopsy strategy, there is a need to improve and refine the biopsy strategy. The aim of this study was to thoroughly evaluate existing biopsy schemes for patients with suspicious lesions.

This study conducted a systematic review and network meta-analysis following PRISMA guidelines (from their start until 15 January 2025), evaluating 13 biopsy schemes for detecting PCa in MRI-positive (PIRADS/Likert score 2-5) patients. Data from PubMed, Embase, and Cochrane databases were examined to assess the efficacy of biopsy schemes in detecting clinically significant (csPCa) and clinically insignificant (ciPCa) prostate cancer. This study is registered with PROSPERO (CRD42024551971).

The analysis included 211 studies involving 74,113 individuals. When compared with the combination of systematic biopsy (SB, defined as <20 cores) and targeted biopsy (TB, defined as <6 cores) (SB+TB), ipsilateral SB with TB (ips-SB+TB) and saturation TB did not show statistically significant inferior detection rate of csPCa (ips-SB+TB: RR 0.95, 95% CrI 0.88, 1.02; saturation TB: RR 0.96, 95% CrI 0.91, 1.01). Meanwhile, there was no significant difference in csPCa detection rates for saturation SB+TB, SB+saturation TB compared to SB+TB (saturation SB+TB: RR 1.04, 95% CrI 0.98, 1.11; SB+saturation TB: RR 1.14, 95% CrI 0.999, 1.30). TB and SB alone detected significantly less csPCa than SB+TB (TB: RR 0.86, 95% CrI 0.84, 0.88; SB: RR 0.75, 95% CrI 0.73, 0.77). Saturation SB also did not show significant superiority in detecting csPCa. Additionally, saturation TB and ips-SB+TB also decrease the detection of ciPCa. (ips-SB+TB: RR 0.87, 95% CrI 0.72, 1.04; saturation TB: RR 0.76, 95% CrI 0.65, 0.88).

The network meta-analysis reveals that saturation SB+TB and SB+saturation TB have no significant difference in csPCa detection between them and SB+TB. Meanwhile, ips-SB+TB and saturation TB are effective biopsy strategies for MRI-positive PCa patients, offering a more targeted approach for detecting csPCa.

The National Natural Science Foundation of China (Grant number: 81500522) and Science & Technology Department of Sichuan Province (Grant number: 2020YFS0090, 2020YFS0046) and Cadre Health Research Project of Sichuan Province (Grant number: ZH2023-102).