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.

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.

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.

Recurrent disease after liver transplant is well recognized for many diseases. Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) are leading indications for liver transplant, and there is scarce knowledge about recurrence-related end outcomes such as retransplant and mortality. This project aims to assess the proportion of patients transplanted for MASH who develop recurrent disease and adverse clinical outcomes.

A systematic review and pooled proportions meta-analysis was performed by searching the following databases: MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Library. Inclusion criteria were studies discussing adult patients with liver transplants secondary to MASH or presumed MASH with recurrent disease-related outcomes. Outcomes were assessed in time frames from <6 mo to ≥5 y.

Of 5859 records, 40 were included (16 157 patients). Recurrent MASLD and MASH (28 studies each) occurred in frequencies of 35%-49% and 11%-24%, respectively. Fibrosis occurred in 4%-25% (13 studies). Recurrent disease-related cirrhosis (13 studies), graft failure (8 studies), and retransplant (9 studies) occurred in 0%-2%, 3%-9%, and 0%-1%, respectively. Recurrent disease-related hepatocellular carcinoma (1 study) and mortality (17 studies) both had a prevalence of 0%. Studies were of moderate or high quality using the Methodological Index for Non-Randomized Studies tool.

Recurrent MASLD and MASH after liver transplant occur frequently, but adverse clinical outcomes due to disease recurrence are infrequent, maybe due to insufficient data on long-term follow-up. Long-term outcomes after transplantation for MASLD appear favorable; however, identifying those more likely to have progressive recurrent disease leading to adverse clinical outcomes may allow for pre- and posttransplant interventions to improve outcomes further.

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.

Stillborn babies are those that are born with no signs of life at or after 28 weeks of gestation or weighing more than 1000 g. It is a public health problem that is overlooked in the global agenda. Individual studies have been conducted with different estimates across countries, making it difficult to understand the national stillbirth rate. Thus, this study aims to better understand stillbirth in Ethiopia and inform policy makers by producing pooled estimates.

A systematic review and meta-analysis were performed between 2013 and 2024 in accordance with the PRISMA guidelines. The outcomes of interest in the English language were exhaustively searched in different databases, such as PubMed/Medline, Science Direct, HINARI and Google Scholar. Data selection, extraction and quality assessment were performed by two authors independently. Zotero was used for study selection, whereas all the statistical analyses were performed with MEDCALC version 23.2.1 software.

Among a total of 1007 studies found in databases and manual citation searches, 35 studies were included in the analysis. The overall pooled stillbirth rate was 68 (95% confidence interval (CI) 52-85) per 1000 births in Ethiopia. Subgroup analysis revealed discrepancies in rates across regions, study years and settings. Subgroup analysis revealed that the pooled estimate of the stillbirth rate of recent studies (2021-2024) is 72 (95% CI, 48-100) per 1000 births, which is higher than the rate of earlier studies (2013-2020), with a rate of 63 (95% CI, 38-93) per 1000 births.

The pooled estimate of the stillbirth rate is high in Ethiopia compared with the global target stillbirth rate of 12 per 1000 births, which is set for 2030 and is also higher than African countries. The stillbirth rate has also increased over time in Ethiopia. This might be due to poor maternal health access and utilization, including a significant rate of iodine deficiency, among pregnant women in Ethiopia. The review informs policy makers and program implementers about the burden of stillbirth in Ethiopia. All health sector actors should adjust and improve the quality of maternal health services, with attention given to stillbirth to reach the global target.

Coastal erosion is a significant global threat to coastal communities, ecosystems, and infrastructure. Despite various global coastal management strategies and policies and the best efforts to combat coastal erosion, challenges persist. This study reviews global literature on coastal erosion management strategies, highlighting lessons learned and challenges encountered in implementation from past experiences. Findings indicate that global coastal erosion is increasing, with seawalls and hard engineering declining and nature-based solutions and ecological engineering being developed. However, balancing coastal protection with environmental and socioeconomic impacts remains a global challenge, as static coastal protections struggle to adapt to dynamic climate change scenarios. Thus, rising sea levels and other causes of coastal erosion should be prioritized alongside holistic coastal management approaches that consider recession, land use, infrastructure, community well-being, and resilience. This study underscores the need collaborative efforts among stakeholders to develop sustainable coastal protection solutions to address rising sea levels and coastal erosion.

This study aimed to perform a systematic meta-analysis to investigate how varying severities of tricuspid regurgitation (TR) affect mortality in patients with heart failure (HF). PubMed, Web of Science, Embase and the Cochrane Library were searched up to March 2024. Heterogeneity and sensitivity analyses as well as subgroup analyses were carried out using Stata (15.1). In total, 12 cohort studies involving 45 829 HF patients were included. The meta-analysis demonstrated that the TR group exhibited notably higher all-cause mortality [risk ratio (RR) = 1.15, 95% confidence interval (CI): 1.02-1.29, P < 0.05] and HF rehospitalization rate (RR = 1.24, 95% CI: 1.13-1.36, P < 0.001) than the non-TR group. Subgroup analysis by the severity of TR indicated that all-cause mortality (RR = 1.34, 95% CI: 1.10-1.63, P < 0.05), HF rehospitalization rate (RR = 1.30, 95% CI: 1.16-1.45, P < 0.001) and cardiovascular mortality (RR = 1.49, 95% CI: 1.04-2.15, P < 0.05) were notably higher in the moderate/severe TR group than in the non-TR/mild TR group. Subgroup analysis showed that ejection fraction, region, regression methods and publication year affected the results of both groups. Moderate and severe TR can increase the risk of all-cause mortality and HF rehospitalization rate. However, these results may be influenced by other factors. More studies on the prognosis of HF patients with different ejection fractions and regions are desired to further validate and improve our findings.

Endometriosis affects women of reproductive age. Increasing attention is being given to the characterization of comorbidities in endometriosis to enhance clinical phenotyping. Among these comorbidities, migraine has been reported to be significantly more common in individuals with endometriosis compared to the general population. However, the true epidemiological burden remains uncertain, and no conclusive evidence links specific subtypes of endometriosis to migraine.

Seven electronic databases were searched from inception until July 22nd, 2024, using combinations of relevant keywords. PROSPERO Registration CRD42023449492. Two independent reviewers screened the records according to inclusion/exclusion criteria and abstracted data. The risk of bias assessment was undertaken using the ROBINS-E tool. Random effects models were implemented to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between endometriosis and migraine. Fourteen studies were included in the qualitative synthesis, and 13 in the meta-analysis, accounting for a total of 331,655 individuals (32,489 with endometriosis vs. 299,166 controls). There was a serious risk of bias in the majority of the included studies, with 50% being at very high risk of bias. The risk of migraine was higher in individuals with endometriosis compared to those without (OR 2.25, 95%CI = 1.85-2.72; n = 13 studies; I2 = 81%). This association remained significant in the sensitivity analyses: (i) when excluding studies at very high or high risk of bias (OR 2.64; 95%CI = 1.62-4.31; n = 4 studies; I2 = 77%), (ii) when including only risk estimates adjusted for clinically relevant confounders (OR 2.35; 95%CI = 1.77-3.13; n = 6 studies; I2 = 88%), and (iii) when including only risk estimates adjusted for hormonal therapy (OR 1.95; 95%CI = 1.42-2.66; n = 3; I2 = 92%). Endometriosis was significantly associated with migraine without aura (OR 2.64, 95%CI 1.89-3.69; n = 3 studies; I2 = 0%), but not migraine with aura (OR 3.47, 95%CI = 0.53-22.89; n = 3, I2 = 73%).

This meta-analysis highlights the high prevalence of migraine in patients with endometriosis. However, due to observed high heterogeneity and risk of bias, caution is advised when interpreting and applying these findings in clinical practice. Future research should address these issues by limiting variations in diagnostic criteria, stratifying study populations, accounting for key confounders, and investigating potential underlying pathophysiological mechanisms to enhance understanding of the endometriosis-migraine relationship.

Chronic open-angle glaucoma (COAG) affecting over 70 million people globally, is one of the leading causes of irreversible blindness. To lower intraocular pressure (IOP) in COAG, common treatments include Selective Laser Trabeculoplasty (SLT) and Micropulse Laser Trabeculoplasty (MLT). This systematic review and meta-analysis evaluates the efficacy, safety, and clinical outcomes of both treatments in managing open-angle glaucoma. A systematic review and meta-analysis following PRISMA guidelines, with searches across MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2024. Five studies, including 462 eyes from COAG patients, met the inclusion criteria. Primary outcomes were the success rate (defined as ≥ 20% IOP reduction) and mean IOP reduction. Secondary outcomes included adverse events, medication use, and requirement for glaucoma surgery. No significant difference was observed between both treatments in success rates (OR = 0.91, 95% CI: 0.61-1.36, P = 0.64). Mean IOP reduction at 3-6 months (MD = 0.46 mmHg, 95% CI: -0.43-1.36, P = 0.31) and 6-12 months (MD = 0.72 mmHg, 95% CI: -0.22-1.65, P = 0.13) showed no significant differences. Medication requirements, post-laser IOP spikes, and requirement for further surgery were similar between both treatments (OR = 2.31, 95% CI: 0.75-7.15, P = 0.15). SLT and MLT are both effective and safe for COAG, showing no significant differences in efficacy or safety over one year. MLT's cooling cycles may reduce IOP spikes, but further studies are needed to confirm long-term outcomes. Clinicians can choose between treatments based on patient-specific preferences and needs.

Continuous kidney replacement therapy (CKRT) is an established treatment supporting kidney function in patients with severe acute kidney disease. Systemic heparin and regional citrate anticoagulation (RCA) are the main anticoagulation strategies to prevent dialysis filter loss due to clotting, a complication of all KRT, including CKRT. The present study aims to comprehensively compare two anticoagulation strategies by collecting available clinical and economic evidence for an adult population under CKRT through a systematic literature review and meta-analysis.

Randomized controlled trials, prospective/retrospective observational studies and economic analyses, involving systemic heparin or RCA, were searched through PubMed and Web of Science databases. Extracted data focused on clinical parameters, adverse events and cost items. Meta-analyses were conducted on data points with numeric outcomes to compare the two anticoagulation techniques. An evaluation of the quality of the evidence was also conducted using the GRADE system.

Seventy-two studies were eligible for this meta-analysis. Statistically significant differences between heparin and RCA were observed in ionized calcium levels (mmol/l; heparin 1.19, RCA 1.13), bleeding events (heparin 12.6%, RCA 2.4%), filter lifespan (hours; heparin 16.43, RCA 36.69), clotting issues (heparin 50.7%, RCA 21.3%), filter failure rate (heparin 67.7%, RCA 13.5%), hypocalcemia (heparin 0.1%, RCA 4.4%) and alkalosis (heparin 0.4%, RCA 6.6%) rates. Limitations include heterogeneity across studies, particularly for RCA, and potential biases, although the overall methodological quality ranged from moderate to low.

Based on the evidence presented, despite higher rates of hypocalcemia and alkalosis, RCA demonstrates advantages over heparin, including a reduction in bleeding events, prevention of filter clotting and improvement in filter lifespan. Additionally, the cost outcome demonstrated comparable statistics depending on the RCA protocol considered, which supports the potential cost-effectiveness of RCA. RCA provides clear clinical and potential organizational benefits and comparable cost statistics with a reasonable level of confidence in the evidence for the economic data.

There is a pressing requirement to formulate innovative approaches for addressing inadequate weight loss or recurrence in individuals following metabolic bariatric surgery (MBS). Glucagon-like peptide- 1 (GLP- 1) analogues such as liraglutide and semaglutide have been formulated for treating type 2 diabetes or managing obesity. In this systematic review and meta-analysis, we aimed to pool the results from all available studies on GLP- 1 agonists to assess the efficacy of these drugs in weight recurrence or suboptimal clinical response of patients who underwent MBS.

We searched PubMed, Scopus, and Web of Science from inception till October 2024 for articles that fulfil our eligibility to be included in the systematic review and meta-analysis investigating the use of GLP- 1 agonists in the management of weight recurrence or suboptimal clinical response in patients who underwent MBS. The search strategy was as follows: "Liraglutide" OR "Semaglutide" OR "Tirzepatide" OR "GLP- 1" OR "Glucagon like peptide" AND "Weight" AND "Bariatric" OR "Sleeve" OR "Banding" OR "Roux-en-Y bypass. We used the mean difference (MD) to compare between continuous variables at a confidence interval (CI) of 95%, and p-value of 0.05.

The use of GLP- 1 agonists (liraglutide, semaglutide, and tirzepatide) was associated with a statistically significant decrease in the weight of the included patients showing an overall MD = 8.07 kg (95%CI: 5.5, 10.64, p < 0.00001) and I2 = 44%, p = 0.04. Moreover, these drugs (liraglutide, and semaglutide) showed significantly reduced body mass index (BMI) after treatment with overall MD = 4.42 kg/m2 (95%CI: 3.42, 5.42, p < 0.00001), and I2 = 67%, p = 0.0005. Compared with control group, the use of GLP- 1 agonists was associated with reduced weight with MD = - 9.19% (95%CI: - 10.81, - 7.58, p < 0.00001) and I2 = 0%. However, no difference was observed between both groups regarding BMI change with MD = - 1.97% (95%CI: - 4.65, 0.71, p = 0.15).

GLP- 1 agonists such as liraglutide and semaglutide effectively lower body weight and BMI in patients who suffer from weight recurrence or suboptimal clinical response after undergoing MBS. However, future studies are still warranted to investigate the most appropriate protocols for management.

With climate change, abiotic and biotic stresses such as drought and herbivory are predicted to further diminish agricultural productivity. Soybean (Glycine max [L.] Merrill), a crop of global economic importance, is vulnerable to both. However, the interactive effects of drought and herbivory on soybeans haven't been explored, especially through the lens of physiological and phytohormonal changes. To address this, we conducted a meta-analysis from 114 published studies, further reduced to 31 after removing redundancy, with data on physiological (photosynthesis and stomatal conductance) and phytohormonal traits (jasmonic acid [JA] and salicylic acid [SA]) of soybeans under drought, herbivory, and their combination. With existing studies so far, we show that drought has negative impacts on soybean photosynthesis and stomatal conductance whereas herbivory has negative effects on photosynthesis but neutral effects on stomatal conductance. And the effects of drought and herbivory on phytohormones had opposite effects, with JA levels increasing. To our understanding, this is the first meta-analysis assimilating studies to understand the combined impacts of drought and herbivory on soybean physiological and phytohormonal changes. We also put forward potential questions and avenues for further research in expanding our understanding about the regulatory pathways and consequences of other abiotic and biotic stressors in agroecosystems.

Asymptomatic severe aortic stenosis (AS) poses a clinical challenge with variations in recommendations for management.

We sought to compare contemporary guidelines focusing on asymptomatic AS management and present a summary of contemporary studies on early intervention in these patients.

Systematic search of electronic databases was conducted with guidelines analyzed using a comparative matrix. A pooled random-effects meta-analysis of randomized controlled trial (RCT) data comparing intervention versus clinical surveillance in asymptomatic severe AS was also performed.

Four guidelines from ACC/AHA, ESC/EACTS, JCS/JSCS/JATS/JSVS, and NICE were included encompassing 108 recommendations. Consensus was found for intervention thresholds including left ventricular dysfunction and very severe AS while discrepancies existed in the utility of biomarkers, myocardial fibrosis, exercise stress testing and choice of intervention. Despite variation in study inclusion criteria, current RCTs on the management of asymptomatic AS indicated a significant reduction in rates of major adverse cardiovascular events when comparing early intervention to clinical surveillance (hazard ratio [HR] 0.52 [0.42, 0.63]), driven primarily by reductions in unplanned hospitalizations (HR 0.41 [0.32, 0.52]).

While there is broad consensus on classic indicators of severity such as left ventricular dysfunction as indication for intervention, guidelines diverge on other high-risk features warranting intervention. Early studies indicate the overall safety of early intervention, although further work is needed to identify whether it can reduce the risk of hard clinical endpoints. This underscores the need for further research and updated guidelines to clarify the optimal thresholds for intervention and harmonize treatment pathways for the growing number of patients with asymptomatic AS.

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.

Medication administration errors remain a persistent issue in the US healthcare system, impacting patient safety and leading to worsened outcomes, including increased mortality. Smart infusion pump interoperability with electronic health records (EHRs) has the potential to reduce intravenous (IV) medication administration errors. Smart Infusion pumps safely deliver IV medications using drug libraries that set standard dosing limits. Interoperability is their ability to wirelessly connect to EHRs to receive medications orders directly minimizing error-prone manual programming steps. However, despite being implemented over a decade ago, its real-world impact remains largely underexplored.

A systematic literature review (SLR) of PubMed/Medline and Embase in November 2024 identified peer-reviewed studies assessing medication administration errors pre- and post- interoperability implementation in the inpatient hospital setting. The primary outcome measured error types directly impacted by interoperability. The secondary outcome assessed the cumulative reduction in medication administration errors.

Three studies met the inclusion criteria, spanning general community hospitals, pediatric facilities, and intensive care units (ICUs). For the primary outcome of assessing medication administration errors impactable by interoperability, interoperability implementation resulted in a 15.4% to 54.8% reduction in specific medication administration errors. For the secondary outcome of all medication administration errors, the cumulative reductions in medication administration errors post-implementation ranged from 21.2% to 90.5%, with variability influenced by baseline compliance, study setting, and patient populations.

Smart infusion pump interoperability demonstrated consistent potential to enhance medication safety by addressing key error types and reducing cumulative errors in real-world settings. However, future research is needed to assess its impact on adverse drug events, clinician workflows, and patient outcomes. These findings underscore the importance of tailored implementation strategies to maximize interoperability's effectiveness in improving patient safety.

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.

An open approach is widely used for the surgical treatment of acute groin hernia, however, in recent decades multiple studies have explored the safety and benefits of minimally invasive surgery (MIS) for acute groin hernia.

A systematic literature search was performed on the electronic databases and meta-analysis was performed using the RevMan 5.4.1.

Our study identified that the MIS for acute groin hernia is associated with significantly lower rate of bowel resection with better outcomes than an open approach. Similarly, superficial surgical site infections (SSI) and length of stay (LOS) were also significantly lower in the MIS group. However, there was no significant difference in the duration of operation, use of prosthesis, overall postoperative morbidity, incidence of seroma, hematoma, deep SSI, and hernia recurrence between the two treatment approaches.

MIS for acute groin hernia is associated with better outcomes than the open approach in terms of outcomes like the bowel resection rate, superficial SSI, and LOS.

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.

The global aging population faces great challenges. Wearable activity trackers have emerged as tools to promote physical activity among older adults, potentially improving health outcomes. However, the effectiveness of such interventions on physical activity, body composition, and physical function among community-dwelling older adults remains debated.

This study conducted a systematic review and meta-analysis to evaluate the impact of wearable activity tracker-based interventions on physical activity, body composition, and physical function among community-dwelling older adults.

We searched the PubMed, Embase, Web of Science, and CENTRAL databases from inception until January 2025 to identify related randomized controlled trials. The outcomes were focused on physical activity (physical activity time, daily step count, and daily sedentary time); body composition (BMI and body fat); and physical function (timed up and go test and chair stand test). Subgroup analysis by different controls (usual care or conventional interventions) and different follow-ups (immediate or short term) were performed.

In total 23 trials with 4566 participants were eligible for analysis. Compared to usual care, there was lo- to moderate-certainty evidence that the wearable activity tracker-based interventions significantly increased physical activity time (standardized mean difference [SMD]=0.28, 95% CI 0.10-0.47; P=.003) and daily step counts (SMD=0.58, 95% CI 0.33-0.83; P<.001) immediately after intervention, while no significant improvements were observed in daily sedentary time (mean difference [MD]=-1.56, 95% CI -10.88 to 7.76; I2=0%; P=.74). These interventions were at least as effective as conventional interventions but did not show superiority. Compared with usual care, the interventions using wearable activity trackers only demonstrated a notable increase in daily step count over short-term follow-up (SMD=0.23, 95% CI 0.11-0.36; P<.001). As for body composition and physical function, there was low- to moderate-certainty evidence that the wearable activity tracker-based interventions did not have a greater impact on BMI (MD=0.40, 95% CI -0.08 to 0.89; P=.11), body fat (MD=0.67, 95% CI -0.54 to 1.87; P=.28), the timed up and go test (MD=0.14, 95% CI -0.87 to 1.16; P=.78), or the chair stand test (SMD=-0.31, 95% CI -0.62 to 0; P=.05).

This systematic review and meta-analysis indicate that wearable activity tracker-based interventions were effective in enhancing physical activity with low to moderate certainty, but did not significantly impact body composition or physical function, with low to moderate certainty, among community-dwelling older adults, particularly immediately after intervention. This intervention showed a more pronounced impact when compared to usual care, rather than to conventional interventions, with low to moderate certainty. It is important to note that this intervention showed moderate-certainty evidence toward improving daily step count, supporting its sustained impact during short-term follow-up.

PROSPERO CRD42024516900; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024516900.

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.

The study aimed to assess the effectiveness and safety of fractional CO2 laser and 308 nm excimer laser in non-segmental vitiligo.

We carried out a systematic literature search in databases: Embase, Web of Science, PubMed, Wanfang and CNKI. Randomized controlled trials (RCTs) comparing the combined treatment of fractional CO2 and 308 nm excimer lasers with other treatments for non-segmental vitiligo were included. The primary outcomes were re-pigmentation rate and side effects.

Twelve RCTs involving a total of 1,064 patients were included. Our results showed significantly higher rates of excellent response (≥75% re-pigmentation) (RR = 1.53, 95%CI: 1.31, 1.78; p < .001) and good response (50-75% re-pigmentation) (RR = 1.14, 95%CI: 1.03, 1.26; p = .015) in combined treatment group than the control group. A subgroup analysis considering control treatment suggested that, the combination treatment yielded a superior rate of excellent response when compared to either fractional CO2 laser or 308 nm excimer laser. It also demonstrated a superior rate of good response compared to the fractional CO2 laser, while showing a comparable effect to 308 nm excimer laser alone. Regarding safety, the adverse event rates were comparable between the two groups (RR = 0.67, 95%CI: 0.43, 1.07; p = .093). Meta-regression analysis indicated that none of these potential factors (mean age, gender, disease onset and vitiligo subtype) had any significant effect on excellent response rate. Results of trial sequential analysis (TSA) for excellent response rate suggested that current conclusions regarding combination treatment are adequate, and additional explorations are unlikely to alter the conclusion.

Our results suggested that, the combined treatment of fractional CO2 and 308 nm excimer lasers seems to be an effective and well-tolerated modality for non-segmental vitiligo. It significantly improves the re-pigmentation rate without posing serious side effects. More high-quality, large-scale RCTs are warranted to further validate these results and explore the long-term efficacy and safety of this treatment approach.

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.

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.

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.