Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I2). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I2 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I2 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I2 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I2 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I2 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I2 43%), LBW (RR 0.78, CI:0.64-0.95, I2 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I2 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

Psoriasis impacts patients' mental and physical health, prompting interest in psychosocial interventions.

To compare and rank different psychosocial interventions for psoriasis and their effects on well-being and mental health.

A systematic search was conducted using Cochrane Library, EMBASE, Medline, and PsycINFO (via the OVID) from their inception to 6 February 2024. Trials investing in psychosocial therapy in psoriasis patients were included using A random-effects network meta-analysis (NMW) within a Bayesian framework focusing on dermatology life quality index (DLQI), depression, and anxiety, along with adherence to treatment. The risk of bias was assessed by the Cochrane Handbook.

Thirteen studies with 6 treatments and 1233 patients were included. The quality of the included studies was low. For DLQI, 9 studies were eligible, mindfulness + treatment as usual (TAU) was better than TAU (MD = -7.21, 95%CI [-14.89, 0.54]). Cognitive behavioral therapy (CBT) + TAU were more effective in improving HADS-anxiety (MD = -2.17, 95%CI [-3.86, -0.49]) and HADS-depression (MD = -1.58, 95%CI [-3.65, 0.68]). Regarding adherence, CBT + TAU (MD = 0.84, 95%CI [-0.62, 2.27]) ranked first, followed by motivational interviewing + TAU.

We confirmed the effectiveness of psychosocial interventions on patients' well-being and mental health and recommended several interventions for clinical practice. However, the results should be cautiously interpreted, due to lacking high-quality and more replication studies.

Emerging research suggests that Janus kinase-signal transducer and activator of transcription (JAK-STAT) inhibitors may be associated with a higher risk of serious infection for patients with rheumatoid arthritis. However, there is no consensus on whether JAK inhibitors increase the risk of serious infection in patients with Immune-mediated inflammatory skin diseases (IMISDs).

To ascertain the correlation between JAK inhibitor use and the risk of serious infection in patients with IMISDs.

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and registered Clinical Trials were searched up to June 1, 2024, using specific search terms related to JAK inhibitors and IMISDs. Randomized clinical trials (RCTs) comparing JAK inhibitors with a control group in patients with IMISDs were included. Studies focusing on cohort studies, case reports, case series, review articles, pooled analysis studies, post hoc analyses and topical JAK inhibitors were excluded. Data were extracted independently by two authors, focusing on serious infections defined according to each study's criteria. Crude numbers for serious infections were pooled and underwent meta-analysis. We assessed the primary outcome regarding the occurrence of severe infections for each study.

Thirty-two randomized clinical trials involving 11,917 patients were included. Serious infections were reported in 0.62% of patients receiving JAK inhibitors and 0.51% of controls. Meta-analysis found no significant increase in risk of serious infection (I2=0.00%, RR, 0.68; 95% CI, 0.43-1.07). Subgroup analyses revealed no significant heterogeneity based on condition (p = .56) or medication (p = .69).

This meta-analysis demonstrates that JAK inhibitors do not significantly increase the risk of serious infections in IMISD patients compared to control treatments. These findings support the safety of JAK inhibitors in this population. Future research should focus on real-world evidence to further assess their risk-benefit profile in dermatological practice.

Cardiac diseases that require surgical intervention present a unique challenge during pregnancy and may affect both maternal and neonatal outcomes. This systematic review and meta-analysis aimed to evaluate maternal and neonatal outcomes in pregnant females undergoing cardiac surgery.

A comprehensive manual and electronic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Sciences databases for studies published up to 31st May 2024. Eligible studies were required to report maternal and neonatal outcomes of women who underwent cardiac surgery during pregnancy. Random-effects meta-analysis was conducted to estimate pooled maternal and neonatal mortality proportions, and the results were presented as risk ratios (RR) with 95% confidence intervals (CIs).

Seventeen studies met the inclusion criteria, comprising a total sample size of 196 pregnant women who underwent cardiac surgery. Cardiac surgery during pregnancy was significantly (p < 0.001) linked to increased maternal and neonatal mortality, with pooled RR of 4.9% (CI: 2.1%-7.6%) and 26.5% (CI: 19.7%-33.4%), respectively.

This study highlights the significant risks associated with cardiac surgery during pregnancy, such as increased risk of maternal and neonatal mortality and higher incidence of preterm labor. Our findings underscore the importance of specialized care and multidisciplinary management for pregnant women with cardiac conditions. Further research is warranted to identify strategies for risk mitigation and improved outcomes in this vulnerable population.

This study aims to evaluate the risks associated with Sulfasalazine (SSZ) and 5-aminosalicylic acid (5-ASA) use during pregnancy on perinatal outcomes in women with Inflammatory Bowel Diseases (IBD). We compared these outcomes with those of healthy pregnant women and with pregnant women with IBD not on medication.

We searched Medline, Embase, CINAHL, Scopus, and PubMed databases up to December 27, 2023. We also screened reference lists of identified studies and utilized SCOPUS to find additional relevant research.

We included studies that specifically examined SSZ/5-ASA usage during pregnancy. Our outcomes of interest included congenital malformations, stillbirths, neonatal outcomes, preterm delivery, live births, small for gestational age, and pregnancy loss.

Pooled odds ratios (OR) were calculated using a random-effects model to accommodate within-study and between-study variability, given the substantial heterogeneity from differences in study designs and methodologies. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).

Fifteen observational studies with 2,076,932 participants were included. SSZ/5-ASA use during pregnancy was linked to a significant increase in congenital malformations (OR: 1.33, 95 % CI: 1.17-1.50), stillbirths (OR: 5.12, 95 % CI: 2.74-9.57), and preterm delivery (OR: 1.94, 95 % CI: 1.49-2.52) compared to healthy controls. However, no significant risks were found when compared with pregnant women with IBD not on medication.

The observed risks appear related to the disease rather than medication, suggesting treatment may mitigate adverse outcomes. Distinguishing between the effects of disease and medication poses ethical challenges in pregnant populations.

The global prevalence of kidney stones (KS) has been on the rise in recent years. Numerous studies have suggested an association between urine microbes and KS, although the precise underlying mechanisms remain unclear. This meta-analysis and systematic review aim to investigate the urine microbiota composition in patients with KS and delineate the disparities in urine microbiota between healthy individuals and KS patients.

A systematic search was conducted on PubMed, Embase, and Web of Science databases to identify relevant studies. Seven studies were selected for analysis to compare the urinary microbiota profiles of KS patients with controls. This research adhered to the PRISMA guidelines, with data extraction performed independently by two researchers. The study outcomes focused on assessing differences in the α-diversity index of urinary microbiota between KS patients and healthy controls, as well as discrepancies in microbiota abundance at the phylum, genus, and species levels. Statistical analyses were carried out using Review Manager 5.4.1 and Stata 17.0 software. The I2 statistic was utilized to evaluate result heterogeneity, and a sensitivity analysis was conducted to explore potential sources of heterogeneity. Publication bias was assessed through funnel plots and Egger's tests. This study is registered with PROSPERO (No. CRD42024506599).

We have searched PubMed, Embase and Web of Science and analyzed statistics by using Review Manager 5.4.1 and Stata 17.0 software. Our research has included seven articles with a total of 162 kidney stone patients and 139 healthy controls. Based on our results, compared to healthy controls, the α-diversity of KS patients including Shannon index is significantly lower (SMD -0.55, 95 % CI, -1.10∼ -0.01). However, the relative abundances of Acinetobacter, Pseudomonadota and Corynebacterium of patients are higher than healthy controls, while the abundances of Bacilliota and Bacteroides are lower.

The meta-analysis and systematic review has indicated that the urinary microbiota is not only different between patients with KS and healthy people, but also relates to the pathogenesis of kidney stones. The results suggests that diet modification or appropriate use of antibiotics may effectively prevent the development of KS.

This systematic review evaluates the clinical effectiveness of the spontaneous awakening trial (SAT)-spontaneous breathing trial (SBT) protocol in mechanically ventilated sedated patients (MVSPs) within intensive care units (ICUs). Methods: A comprehensive search identified 18 studies involving 12 284 patients from 11 countries. Outcomes included weaning success, mechanical ventilation (MV) duration, sedation time, complications, cognitive impairment, ICU stay length, and mortality. Results: Implementing the ABCDE bundle, particularly the paired SAT-SBT protocol, significantly reduced ventilation and sedation time by nearly 50%. The intervention was associated with decreased medication use, improved patient wakefulness, and higher extubation success rates. The intervention group showed shorter durations of MV, ICU, and hospital stays. Cognitive impairment was less frequent in the intervention group at the 3-month follow-up. Nurse workload was unaffected, and 1-year mortality was lower in the SAT-SBT group. Conclusion: The systematic review supports the clinical effectiveness of the paired SAT-SBT protocol within the ABCDE bundle for MVSPs in ICUs. The protocol improved weaning outcomes, reduced ventilation and sedation time, decreased complications, and shortened durations of MV and ICU stay. The findings underscore the benefits of a comprehensive approach integrating SAT and SBT in managing MVSPs. Further research is needed to optimize intervention timing, address implementation challenges, assess cost-effectiveness, and determine generalizability across diverse patient populations and healthcare settings.

Fucoxanthin, a marine carotenoid primarily found in brown algae and microalgae, offers significant health benefits, including antioxidant, anti-obesity, and anti-cancer effects. While brown algae remain the dominant commercial source, microalgae such as Phaeodactylum tricornutum are emerging as promising candidates for large-scale, sustainable fucoxanthin production. This review explores advancements in fucoxanthin biosynthesis, focusing on cultivation methods, extraction techniques, and genetic engineering strategies. Different cultivation systems - including autotrophic, heterotrophic, and mixotrophic approaches - have been assessed for their biomass yield, cost-effectiveness, and scalability, together with a quantitative meta-analysis to highlight specific trends or correlations in fucoxanthin production. The efficiency and environmental impact of extraction methods, such as supercritical fluid extraction, ultrasound-assisted extraction, and microwave-assisted extraction, have also been evaluated. In addition, synthetic biology and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based genetic modifications show potential for enhancing fucoxanthin biosynthesis. However, challenges remain in terms of cost, scalability, and regulatory constraints. This review highlights the need for integrated biotechnological solutions to enhance commercial viability, combining metabolic engineering, efficient extraction techniques, and optimized cultivation strategies. As demand continues to grow in the nutraceutical, pharmaceutical, and cosmetic industries, ongoing advancements in microalgae-based fucoxanthin production will be critical for ensuring sustainable and cost-effective manufacturing.

According to previous studies, the efficacy of xanthine oxidase inhibitors (XOIs) in patients with chronic heart failure (CHF) is still controversial. Therefore, the purpose of this study was to investigate the efficacy of XOIs in patients with CHF.

Up to July 2024, we searched PubMed, EMBASE, Medline, Web of Science, and Cochrane Library for studies on the efficacy of XOI in patients with CHF. The main results included all-cause mortality, cardiovascular (CV) mortality, and heart failure (HF) hospitalization rates. The results were evaluated by hazard ratio (HR) and 95% confidence interval (95% CI).

A total of eight studies were included in this meta-analysis, of which five were cohort studies and three were randomized controlled trials (RCTs). The total sample size was 301,345. The experimental group was exposed to allopurinol or hydroxypurinol. The all-cause mortality (HR = 1.26, 95% CI 1.05-1.51, p = 0.013) and CV mortality (HR = 1.58, 95% CI 1.17-2.14, p = 0.03) in the experimental group were higher than those in the control group. In terms of HF hospitalization, there was no difference between both groups (HR = 1.21, p = 0.292). Subgroup analysis showed that the CV hospitalization rate of the experimental group was higher than that of the control group, regardless of frequency and dose levels. The all-cause mortality in the low-dose group was higher than that in the control group (HR = 1.39, p = 0.033). The CV mortality of the low-dose group (HR = 1.55, p = 0.006) and the prevalent group (HR = 1.50, p = 0.042) was higher than that of the control group.

Purine XOI exposure may be unfavorable for the prognosis of CHF patients and is affected by the frequency and dose of use.

Pressure injuries (PIs) are a major global health challenge. As PI-related healthcare costs continue to rise and patient safety is increasingly impacted, nurses are actively working to design and implement effective prevention strategies, particularly focusing on skin care, to prevent PIs in high-risk patients. Recent advances in incorporating plant-based topical agents into comprehensive care bundles for PI prevention have shown promising potential, though the results remain somewhat variable.

To evaluate effectiveness of plant-based topical agents in preventing PIs and their impact on PI incidence, time to PI formation and adverse events.

A systematic review was performed and reported according to the PRISMA guidelines. PubMed, Cochrane Library, EMBASE, PROQUEST Health Research Premium Collection, Clinical Key, MEDLINE, CINAHL, Google Scholar, and Airiti Library from database inception to May 2024.Two researchers independently screened randomised controlled trials published in Chinese and English. Screening, data extraction, and quality evaluation were independently performed by two reviewers using the Cochrane RoB 2.0 tool and GRADE to assess the strength of evidence. Disagreements were resolved by a third reviewer. Due to the heterogeneity of the intervention, a meta-analysis was not feasible; consequently, the findings were synthesised narratively.

Ten randomised controlled trials were included, consisting of 2364 patients without PI and no sensitivity to plant-based topical agents. The plant-based topical agents used in the interventions included olive oil (n = 6), sweet almond oil (n = 1), aloe vera gel (n = 2), aloe vera gel-olive oil compound (n = 1), peppermint oil gel (n = 1), and henna paste (n = 1). PI incidence was lower in the intervention groups compared to control groups, but the time to PI formation was inconsistent. No or mild adverse events were reported. The overall risk of bias was categorised as 'some concerns' (n = 5) and 'high risk' (n = 5).

This review found that different plant-based topical agents can be effective in preventing PI and can be an option for PI prevention. Higher-quality studies are needed to validate effectiveness of plant-based topical agents in preventing PI and to clarify their mechanisms of action. We suggest incorporating plant-based topical agents into PI care protocols and in-service education to ensure consistent usage. Implementation can start with high-risk PI patients in critical/home care settings to prevent PI occurrence.

PROSPERO Registration Number CRD42024567522.

Plant-based topical agents like olive oil and aloe vera show potential in preventing pressure injuries in high-risk patients, but more high-quality research is needed to validate their effectiveness and mechanisms.

This qualitative systematic review aimed to synthesize and discuss family members' perspectives of helpful and unhelpful factors in family therapy (FT) sessions, to benefit the application of FT interventions and training. Eleven studies met eligibility criteria and were critically appraised and thematically synthesized. Four themes resulted: therapist qualities contributing to the therapeutic alliance, practitioners' use of therapeutic techniques, intervention delivery, and family engagement with the process. Helpful factors included therapist warmth, kindness, and genuine care; therapist connecting with family in a sensitive, respectful, and nonjudgmental manner; effective use of therapeutic techniques that facilitated self-reflection, emotional expression, communication, and perspective-taking; therapy sessions conducted collaboratively with active family participation; focusing on family strengths and resources; and tailoring format to family needs. Unhelpful factors included participants sharing before ready, therapist siding with a family member, therapy process not matching family needs, and insufficient progress early on. Implications for practice and future research are discussed.

Coral reefs face severe threats from climate change and local stressors like wastewater pollution, which significantly impact reef ecosystems but remain underexplored. Reef fish are essential for supporting human livelihoods through fisheries and maintaining ecosystem functions such as nutrient cycling and algae control. While most research focuses on wastewater's effects on benthic communities, its impact on reef fish physiology, behavior, and community structure is poorly understood. Few studies apply trait-based approaches to evaluate wastewater's influence on fish's ecological roles. This study systematically reviews 52 papers and conducts a meta-analysis of eight control-impact studies to assess wastewater effects on reef fish taxonomic and functional structure. Taxonomy-based metrics revealed mixed responses, with studies reporting declines, increases, or no changes in abundance, richness, and biomass in polluted sites. Functional analysis provided clearer patterns: polluted sites were dominated by smaller, high-resilience species at mid-trophic levels, while control sites supported larger, low-resilience species at diverse depths and trophic levels. Functional richness was generally higher in control sites. Pollutant-specific effects varied: sediments impaired feeding efficiency and growth, while nutrient enrichment shifted species composition by favoring lower trophic levels. These findings demonstrate the limitations of taxonomy-based metrics and highlight the value of functional approaches for detecting early ecosystem degradation. Integrating functional ecology with wastewater characterization enhances predictions of ecological responses and supports targeted management strategies. This research emphasizes the urgency of addressing wastewater pollution to safeguard reef biodiversity and ecosystem services critical to human well-being.

Arthroscopic Bankart repair can be performed via a more contemporary knotless procedure or a more traditional knotted procedure. Nonetheless, comparisons between these two techniques remain controversial.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted. Randomized controlled trials (RCTs) and cohort studies directly comparing the knotless and knotted arthroscopic Bankart procedures were included. The primary outcomes were rates of recurrent instability and revision surgeries. Secondary outcomes encompassed number of anchors, operative time, improvements in functional scores including Rowe score and Constant-Murley score (CMS), pain level assessed by the visual analogue scale (VAS) score, range of motion (ROM), adverse events, and radiological results. Quality assessment was performed using RoB2 and MINORS tools. Meta-analysis pooled RCT data using Review Manager 5.4.1, and non-pooled outcomes from cohort studies or limited RCT data were reported separately.

This meta-analysis included nine studies with a total of 729 patients. Pooled data from three RCTs demonstrated no significant differences between the two techniques in terms of re-dislocation (P = 0.78), recurrent anterior subluxation and positive apprehension test (P = 0.78), revision surgery (P = 0.94), number of anchors used (P = 0.26), or improvements in Rowe score (P = 0.15). For outcomes not suitable for pooling, qualitative analysis of trends indicated comparable outcomes between the groups, except a slightly reduced operative time in the knotless repair group. Adverse events were infrequently reported and occurred at similar rates in both groups. Limited radiological data from one RCT showed no significant differences in MRI parameters at the 24-month follow-up.

Both techniques demonstrate comparable clinical outcomes. The only potential advantage of the knotless technique is a possible reduction in operative time, though its clinical significance remains uncertain. Given the limitations of the evidence, these findings should be interpreted cautiously.

Not applicable.

CRD42024586135.

There is controversy about a possible link between hormonal contraception, specifically injectable depot medroxyprogesterone acetate (DMPA) and HIV acquisition. Following the results of a large randomised controlled trial, there is a need to update the previous version of this Cochrane review.

To determine the effects of hormonal contraception on HIV acquisition in women who live in settings with high HIV prevalence.

We searched CENTRAL, MEDLINE, Embase, SCOPUS, Global Index Medicus and trial registries (together with reference checking, citation searching and contacting study authors), to identify studies up to 13 September 2023.

We included randomised controlled trials (RCTs) comparing hormonal contraception with non-hormonal or other methods of contraception for women at high risk of HIV.

Outcomes of interest were HIV acquisition, pregnancy, discontinuation of method, amenorrhoea, adverse events and condomless sexual activity.

We used the Cochrane risk of bias 2 tool to assess bias in the RCTs.

We synthesised results for each outcome using random-effects meta-analysis where possible and meaningful. We assessed the certainty of evidence with GRADE.

We included four trials with 9726 participants, conducted across four countries.

DMPA injection compared to copper intrauterine device (IUD) DMPA compared to copper IUD likely results in little to no difference in HIV acquisition (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.82 to 1.26; 2 RCTs, n = 6417; moderate-certainty evidence), resulting in one more woman per 1000 acquiring HIV (from 9 fewer to 13 more). DMPA compared to copper IUD results in a slight reduction in pregnancy (RR 0.53, 95% CI 0.39 to 0.71; 1 RCT, n = 5216; high-certainty evidence), resulting in 21 fewer women per 1000 becoming pregnant (from 27 to 13 fewer). DMPA compared to copper IUD results in a reduction in discontinuation of method (RR 0.50, 95% CI 0.40 to 0.62; 1 RCT, n = 5216; high-certainty evidence) and in adverse events (RR 0.53, 95% CI 0.38 to 0.75; 1 RCT, n = 5216; high-certainty evidence). In the DMPA group 'any unprotected sex' was reported at 66.4% of follow-up visits, compared to 70.9% in the copper IUD group. Levonorgestrel (LNG) implant compared to copper IUD LNG compared to copper IUD likely results in little to no difference in HIV acquisition (RR 0.84, 95% CI 0.66 to 1.06; 1 RCT, n = 5159; moderate-certainty evidence), resulting in nine fewer women per 1000 acquiring HIV (from 18 fewer to 3 more). LNG compared to copper IUD likely results in a slight reduction in pregnancy (RR 0.67, 95% CI 0.51 to 0.89; 1 RCT, n = 5220; moderate-certainty evidence), resulting in 15 fewer women per 1000 becoming pregnant (from 22 to 5 fewer). LNG compared to copper IUD likely results in little to no difference in adverse events (RR 0.85, 95% CI 0.63 to 1.14; 1 RCT, n = 5220; moderate-certainty evidence) and discontinuation of method (RR 1.03, 95% CI 0.87 to 1.24; P = 0.71; 1 RCT, n = 5220; moderate-certainty evidence). DMPA injection compared to LNG implant DMPA compared to LNG probably slightly increases HIV acquisition (RR 1.25, 95% CI 0.98 to 1.58; 1 RCT, n = 5144; moderate-certainty evidence), resulting in 11 more women per 1000 acquiring HIV (from 1 fewer to 26 more). DMPA compared to LNG probably results in little to no difference in pregnancy (RR 0.78, 95% CI 0.56 to 1.09; 1 RCT, n = 5222; moderate-certainty evidence), resulting in seven fewer women per 1000 becoming pregnant (from 13 fewer to 3 more). DMPA compared to LNG reduces adverse events (RR 0.63, 95% CI 0.44 to 0.90; 1 RCT, n = 5222; high-certainty evidence), and discontinuation of methods (RR 0.48, 95% CI 0.39 to 0.60; P < 0.00001; 1 RCT, n = 5222; high-certainty evidence). No included studies in the above comparisons measured amenorrhoea. In the DMPA group 'any unprotected sex' was reported at 66.4% of follow-up visits, compared to 69.4% in the LNG implant group. DMPA injection compared to NET-EN injection The evidence is very uncertain about the effect of DMPA compared to NET-EN on HIV acquisition (RR 0.67, 95% CI 0.19 to 2.35; 1 RCT, n = 450; very low-certainty evidence) resulting in nine fewer women per 1000 acquiring HIV (from 22 fewer to 36 more); and pregnancy (RR 2.03, 95% CI 0.19 to 22.19; 1 RCT, n = 449; very low-certainty evidence), resulting in five more women per 1000 becoming pregnant (from 4 fewer to 94 more). DMPA compared to NET-EN probably increases amenorrhoea (RR 1.12, 95% CI 0.89 to 1.41; P = 0.33; 1 RCT, n = 449; moderate-certainty evidence). Discontinuation of methods was not measured.

HIV incidence was high in all groups, regardless of contraceptive used, as would be expected in a setting with high HIV prevalence. All contraceptives used in the included studies are widely used and known to prevent pregnancy. When comparing different contraceptive methods, DMPA injections compared to copper IUD may result in little to no difference in HIV acquisition and result in a slight reduction in pregnancy. LNG implants compared to copper IUDs likely result in little to no difference in HIV acquisition and in a slight reduction in pregnancy. DMPA injections compared to LNG implants likely result in a slight increase in HIV acquisition and likely result in little to no difference in pregnancy. The evidence is very uncertain about the effect of DMPA compared to NET-EN on HIV acquisition and pregnancy. HIV acquisition and pregnancy are important outcomes that have a long-lasting impact. Access to safe, effective contraception is important for women wanting to prevent unplanned pregnancies, as pregnancies have long-lasting physical, social and economic ramifications. Evidence from included studies shows that across groups, many participants report engaging in condomless sexual activity, even when living in high HIV prevalence settings. HIV prevention methods such as pre-exposure prophylaxis and HIV education remain crucial in the fight against HIV.

This Cochrane review had no dedicated funding.

Protocol available via (DOI: 10.1002/14651858.CD015701).

Depression seriously affects people's quality of life, and there is an urgent need to find novel drugs to cure treatment-resistant depression. Berberine (BBR), extracted from Coptis chinensis Franch., Phellodendron bark, Berberis vulgaris, and Berberis petiolaris, could be a potential multi-target drug for depression. To summarize the effects of BBR on depression in terms of in vitro or in vivo experiments, we searched electronic databases, such as PubMed, Web of Science, Google Scholar, Wanfang Database, and China National Knowledge Infrastructure, from inception until May 2024. Then, we summarize that BBR has indirect antidepressant properties to improve depressive symptoms, manifesting in modulating the gut microbial community, strengthening the intestinal barrier, increasing the abundance of short-chain fatty acid-producing bacteria, and regulating tryptophan metabolism. BBR also exerts antidepressant-like effects via remodulating nuclear factor-erythroid 2-related factor 2/antioxidant response element pathway, hypothalamic-pituitary-adrenal axis, and peroxisome proliferators-activated receptor-delta. Nevertheless, further clinical trials and more high-quality animal studies are needed to show the actual clinical value of BBR for depression.

While acute appendicitis is the most frequent surgical emergency in children, its diagnosis remains complex. Artificial intelligence (AI) and machine learning (ML) tools have been employed to improve the accuracy of various diagnoses, including appendicitis. The purpose of this study was to systematically review the current body of evidence regarding the efficacy of AL and ML approaches for the diagnosis of acute pediatric appendicitis.

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles from Pubmed, Scopus, and iEEE Xplore. Study information, methodological details, and outcome metrics were extracted and summarized across studies. Quality of reporting was appraised using The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement.

Fourteen studies were included in the final analysis of which ten were published after 2019. Two studies originated in the United States while half were carried out in Europe. Artificial Neural Network and Random Forest AI methods were the most commonly used modeling approaches. Commonly used predictors were pain and laboratory blood findings. The average area under the curve that was reported among the fourteen studies was greater than 80 %.

AI and ML technologies have the potential to improve the accuracy of acute appendicitis diagnosis in pediatric patients. Further investigation is needed to identify barriers to adoption of these technologies and to assess their efficacy in real world usage once integrated into clinical workflows.

The purpose of this study is to assess whether early surgical intervention for first-time patellar dislocations in paediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment.

Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first-time patellar dislocations in paediatric patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores, evaluating function, were abstracted. Weighted means and meta-analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the methodological index for non-randomized studies criteria for non-randomized studies and the ROB2 tool for randomized controlled trials (RCTs).

A total of 11 studies and 761 patients were included in this review. The weighted mean post-operative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow-up of 53.2 months (12-168). The relative risk (RR) of redislocation was 0.82 (95% confidence interval [CI]: 0.65-1.04, I2 = 0%, p = 0.11), favouring surgery compared to conservative management. A subgroup meta-analysis of two recent RCTs with 110 patients demonstrated an RR of redislocation of 0.53 (95% CI: 0.31-0.91, I2 = 0%, p = 0.02), favouring surgery. Kujala scores among three comparative studies showed a mean difference of -2.7 (95% CI: -6.1 to 0.68, I2 = 0%, p = 0.12), favouring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux-Goldwaith and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups.

Surgical management for first-time patellar dislocations in a paediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found.

Level IV.

Interventions on chemsex, namely, the intentional use of specific drugs to enhance or intensify sexual experiences by gay, bisexual, and other men who have sex with men, are diverse. Despite evidence of their impact on physical, mental, and sexual health, there is no clear agreement on the best intervention strategies and approaches. In this review, we aimed to analyze and synthesize existing research on interventions addressing chemsex among gay, bisexual, and other men who have sex with men, as well as transgender and non-binary people.

We conducted a systematic search of the electronic databases Web of Science, Scopus, ScienceDirect, PubMed, and SciELO for articles published between April and May 2024. In total, 272 articles were identified, of which 12 were reviewed.

Despite the limited evidence and heterogeneity of the findings, the results suggested that the available interventions can improve various factors associated with sexual, mental, and physical health.

This systematic review provides a better understanding of the interventions aimed at addressing chemsex. However, the paucity of available treatments underscores the need to implement evidence-based intervention programs aimed at improving the health of people involved in chemsex beyond mere screening.

To investigate the outcomes of inlay positioned scaffolds for rotator cuff healing and regeneration of the native enthesis after augmentation of rotator cuff tendon repairs in preclinical studies.

A literature search was performed using the PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Preclinical studies reporting on outcomes after inlay tendon augmentation in rotator cuff repair were included. Preclinical study quality was assessed using an adapted version of the Gold Standard Publication Checklist for animal studies. The level of evidence was defined based on the inclusion of clinical analyses (grade A), biomechanical analyses (grade B), biochemical analyses (grade C), semiquantitative analyses (grade D), and qualitative histologic analyses (grade E).

Thirteen preclinical studies met the inclusion criteria. Quality assessment scores ranged from 4 to 8 points, and level-of-evidence grades ranged from B to E. Sheep/ewes were the main animal rotator cuff tear model used (n = 7). Demineralized bone matrix or demineralized cortical bone was the most commonly investigated scaffold (n = 6). Most of the preclinical evidence (n = 10) showed qualitative or quantitative differences regarding histologic, biomechanical, and biochemical outcomes in favor of interpositional scaffold augmentation of cuff repairs in comparison to controls.

Inlay scaffold positioning in preclinical studies has been shown to enhance the healing biology of the enthesis while providing histologic similarities to its native 4-zone configuration.

Although onlay positioned grafts and scaffolds have shown mixed results in preclinical and early clinical studies, inlay scaffolds may provide enhanced healing and structural support in comparison owing to the ability to integrate with the bone-tendon interface.

The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed in 2017 in order to establish a standardized approach for reporting key characteristics in platelet rich plasma (PRP)-based studies. However, the adherence to the guidelines from authors publishing data on studies related to the use of PPR in the management of osteochondral lesions of the talus (OLTs) has not yet been determined. The purpose of this study was to analyze how well clinical trials on PRP interventions for OLTs adhered to the MIBO guidelines.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review of the PubMed, Embase and Cochrane Library databases. Inclusion criteria clinical studies that assessed PRP interventions for OLTs. The original 23 MIBO checklist items were separated and modified into a 46-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 46-point checklist.

A total of 9 studies (356 patients) with a weighted mean age of 42.1 ± 6.1 years were included in this study. The weighted mean follow-up was 32.2 ± 8.7 months. Overall, only 42.8 % ± 5.2 % of the 46-point MIBO checklist items were reported per article with no articles displaying adherence rates of 100 %. No articles had adherence rates ≥ 50 %, 6 (66.7 %) had adherence rates between 40.0 % and 49.9 % and 3 (33.3 %) had adherence rates less than 39.9 %. There was no difference in mean adherence rates between studies published prior to publication of the MIBO guidelines in May 2017 (41.7 %) and after publication of the MIBO guidelines in May 2017 (44.0 %) (p = 0.6473). There was variation in adherence rates between categories with the "Postoperative Care" category having the highest adherence rate (83.3 %) while the "Activation" category and the "Whole Blood Processing" had the lowest adherence rates (5.6 %).

This systematic review demonstrated that clinical studies evaluating outcomes following the use of PRP in the setting of OLTs poorly adhered to MIBO guidelines. None of the included studies had adherence rates ≥ 50 % and only 1 of the 12 MIBO categories had adherence rates ≥ 80 %. Interestingly, there was no difference in the mean adherence rates in studies conducted before and after publication of the MIBO guidelines in May 2017. This study underscores the need for superior reporting of critical data related to PRP in studies evaluating outcomes in patients with OLTs augmented with PRP.

Endovascular treatment of aortic coarctation (CoA) constitutes a valuable alternative with low morbidity and mortality. The aim of this systematic review and meta-analysis was to assess the technical success, re-intervention, and mortality after stenting for CoA in adults.

The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and PICO (patient, intervention, comparison, outcome) model were followed. An English literature data search was conducted, using PubMed, EMBASE, and CENTRAL, until December 30, 2021. Only studies reporting on stenting, for native or recurrent CoA, in adults were included. The risk of bias was assessed using the Newcastle-Ottawa Scale. A proportional meta-analysis was performed to assess the outcomes. Primary outcomes were technical success, intra-operative pressure gradient and complications, and 30-day mortality.

Twenty-seven articles (705 patients) were included (64.0% males, 34.0±13.6 years). Native CoA was present in 65.7%. Technical success was 97% (95% confidence interval [CI], 0.96%-0.99%; p<0.001, I2=9.49%). Six (odds ratio [OR]: 1%; 95% CI, 0.00%-0.02%; p=0.002, I2=0%) ruptures and 10 dissections (OR: 2%; 95% CI, 0.001%-0.02%; p<0.001, I2=0%) were reported. The intra-operative and 30-day mortality were 1% (95% CI, 0.00%-0.02%; p=0.003, I2=0%) and 1% (95% CI, 0.00%-0.02%; p=0.004, I2=0%), respectively. The median follow-up was 29 months. Sixty-eight re-interventions (OR: 8%; 95% CI, 0.05%-0.10%; p<0.001, I2=35.99%) were performed; 95.5% were endovascular. Seven deaths were reported (OR: 2%; 95% CI, 0.00%-0.03%; p=0.008, I2=0%).

Stenting for CoA in adults presents high technical success and the intra-operative and 30-day mortality rates were acceptable. During the midterm follow-up, the re-intervention rate was acceptable, and mortality was low.Clinical ImpactAortic coarctation is a quite common heart defect that may be diagnosed in adult patients, as a first diagnosis in native cases or as a recurrent after previous repair. Endovascular management using plain angioplasty has been associated to a high intra-operative complication and re-intervention rate. Stenting in this analysis seems to be safe and effective as is related a high technical success rate, exceeding 95%, with a low intra-operative complication and death rate. During the mid-term follow-up, the re-interventions rate is estimated at less than 10% while most cases are managed using endovascular means. Further analyses are needed on the impact of stent type on endovascular repair outcomes.

The objective of this systematic review was to assess the incidences and associations of early postoperative stroke and death among patients undergoing inner branched thoracic endovascular aortic repair (TEVAR) of arch pathologies.

Electronic bibliographic sources (PUBMED, EMBASE, and CENTRAL) were searched up to February 2022 using a combination of thesaurus and free-text terms to identify the studies using branched TEVAR to treat aortic arch disease. The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All observational studies investigating the prognosis of inner branched TEVAR in the treatment of aortic arch pathologies were included. Independent extraction of articles was performed by two authors using predefined data fields, including study quality indications. All pooled analyses were based on a random-effects or fixed model according to the heterogeneity.

A total of 23 case series totaling 532 participants were included after screening. After optimized selection (largest sample size, most detailed data, lowest risk of bias) from the overlapping data, 12 studies with 289 participants were included in data synthesis. The pooled incidence of 30-day postoperative stroke was 10.6% (95% CI 7.0%-14.2%; p=.41, I2=3%). Pooled 30-day mortality was 4.9% (95% CI 2.0%-7.8%; p=.38, I2=7%). Combined early stroke/death was 15.7% (95% CI 11.2%-20.3%; p=.30, I2=15%). Subgroup analyses of 11 studies (without data missing) showed that a higher incidence of 30-day postoperative stroke was found in studies with aged participants (age≥71.3 years, p=.010), the higher percentage of COPD (≥30%, p= .011) and non-dissection-related pathologies (≥60.8%, p=.011). The higher 30-day postoperative mortality was found in studies with a high percentage of previous coronary artery disease (≥34.5%, p=.023).

This review demonstrated that there were acceptable rates of 30-day postoperative stroke and death among patients undergoing inner branched TEVAR. It is strongly necessary to perform a rigorous risk assessment of aortic plaque embolism and coronary artery disease when the surgical plan of the inner branched TEVAR is determined.Clinical ImpactTreatment arch pathologies with inner branched TEVAR provides acceptable early stroke rate and mortality. Aortic pathology mainly influenced the early stroke rate, and early recognizing high-risk patients for aortic plaque embolism is of supreme importance for reducing the early stroke rate. In addition, the history of coronary artery disease was strongly associated with early mortality, and attention should be paid to the coronary artery assessment and perioperative management of these patients.

To explore the relationship between body mass index (BMI) and the recurrence risk of stroke.

We searched databases, including the Web of Science, Cochrane Library, Embase, PubMed, Chinese Biomedical Literature (CBM), CQVIP, WanFang Database, and China National Knowledge Infrastructure (CNKI), from inception to February 2025, to collect literature on BMI and the recurrence risk of stroke. After two researchers independently screened the literature, extracted the literature data, and assessed the quality of the literature included in the study, a meta-analysis was conducted using Stata 16.0 software, and the dose-response relationship between BMI and the recurrence risk of stroke was analyzed using generalized least squares trend estimation method (GLST) and restricted cubic spline function.

A total of 18 studies were included, involving 165,366 patients. In terms of stroke recurrence risk, compared with normal-weight patients, underweight patients [relative risk (RR) = 1.59, 95% confidence interval (CI) 1.33-1.90, I2 = 0%, p = 0.444] had a higher recurrence risk of stroke, whereas overweight (RR = 0.91, 95% CI 0.86-0.96, I2 = 0%, p = 0.454) and obese patients (RR = 0.89, 95% CI 0.84-0.94, I2 = 13.1%, p = 0.330) had a lower recurrence risk of stroke. The results of the linear trend show that for every unit increase in BMI, the recurrence risk of stroke decreases by 2% (RR = 0.98, 95% CI 0.96-0.99, p < 0.001).

Increased BMI is associated with a decreased recurrence risk of stroke. Underweight is a risk factor for stroke recurrence, whereas overweight and obesity are protective factors for stroke recurrence. Overweight and obesity may be beneficial for secondary prevention in stroke patients.

Not applicable.

Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and meta-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation.

A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt.

The meta-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23 s, 95 % confidence interval [CI] 2.42 to 4.04; I2 = 96 %). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95 % CI 1.20 to 1.44; I2 = 76 %) and borderline reduced the total number of intubation attempts (MD -0.08, 95 % CI -0.15 to 0.00; I2 = 53 %).

While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.

To investigate the efficacy and safety of transient receptor potential (TRP) channel modulators for dry eye.

A thorough search for randomized clinical trials was conducted in seven databases up to February 16, 2024. Suitable studies were identified according to inclusion and exclusion criteria, extracted data were synthesized and analyzed using Review Manager 5.4, and risk of bias and quality of evidence were assessed using recommended tools.

Six trials with 884 patients using two kinds of TRP channel modulators (TRPV1 antagonist and TRPM8 agonist) were included. TRP channel modulators were effective in reducing subjective symptom scores (standardized mean differences [SMD], -0.41; 95 % confidence interval [CI], -0.75 to -0.07), corneal fluorescence staining (mean differences [MD], -0.19; 95 % CI, -0.37 to -0.02), impact on quality of life and daily function, and increasing the non-anesthetic Schirmer's test score (MD, 11.71; 95 % CI, 9.59 to 13.83), instant tear meniscus height (MD, 245.52; 95 % CI, 14.02 to 477.02), improvement in conjunctival hyperemia (risk ratio [RR], 2.08; 95 % CI, 1.07 to 4.06). There was no increased incidence of adverse events with TRP modulators compared to vehicle solution controls.

TRP channel modulators have shown positive therapeutic effects in reducing the symptoms and signs of dry eye and improving the quality of life associated with the disease without raising the risk of adverse events. These modulators are expected to become a new therapy for dry eye.

This study aims to summarize the graft dimensions, failure rates, return-to-sport rates and patient-reported outcome measures (PROMs) following anterior cruciate ligament reconstruction (ACLR) with six or eight-strand hamstring tendon autografts (6SHG or 8SHG).

Three databases were searched from inception to 12 February 2024. The authors adhered to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. All clinical studies reporting patient demographics, objective clinical outcomes and PROMs following ACLR with 6SHG or 8SHG were included for data synthesis. PROMs included the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores.

Thirteen studies comprising 1103 patients were included (mean age: 30.6 years). The transtibial technique was used in all studies, except one study using anatomic ACLR (n = 38), and one study using transtibial and all-inside ACLR (n = 41). Eight studies comprising 512 patients used 6SHG, four studies comprising 507 patients 8SHG and two studies comprising 97 patients used either. Mean graft diameters ranged from 8.0 to 9.2 mm (6SHG) and 9.1 to 9.9 mm (8SHG). Mean graft lengths for 49 6SHG patients ranged from 60.0 to 83.3 mm. The failure rate for 817 patients (6SHG or 8SHG) was 4.8% (0.0%-20.0%). The return-to-sport rate for 112 patients (6SHG or 8SHG) was 75.9% (69.7%-100.0%). Mean IKDC, Lysholm and Tegner scores for 6SHG or 8SHG were 88.4 (86.1-96.3), 91.7 (90.4-96.5) and 6.9 (6.5-7.3), respectively.

Both 6SHG and 8SHG produced graft diameters <8 mm. Data regarding PROMs suggested good patient satisfaction based on established criteria. Re-rupture and return-to-sport rates were 4.8% and 75.9%, respectively.

Level IV.

The aim of this study was to perform a systematic review and meta-analysis to identify sociodemographic barriers that could contribute to the underutilization of epilepsy surgery.

PubMed, EMBASE, and Web of Science databases were systematically reviewed from January 2002 until August 2024. The studies examining the impact of sociodemographic barriers on epilepsy surgery were included. The primary outcomes were the odds ratio (OR) and 95 % confidence intervals (CI) for receiving surgery compared to not-receiving surgery in persons with epilepsy. Race/ethnicity, sex, and insurance had sufficient data to perform a meta-analysis of OR and 95 % CI.

Overall, 1,520,813 patients from 12 studies were evaluated, among which relevant studies were selected for comparing sex (338,170 males and 341,821 females), race (1,056,571 White, 224,693 Hispanic, and 239,549 Black/African-American [Black/AA]), and insurance (232,908 private, 190,849 Medicaid, and 204,478 Medicare). Black/AA patients were significantly less likely to have surgery compared to Whites (OR 0.46, CI 0.35-0.61) or Hispanics (OR: 0.54, CI 0.43-0.67). White patients were more likely to have surgery than other groups examined (OR 1.61, CI 1.28-2.02). There were no significant differences in surgical odds when comparing males to females (OR 1.00, CI 0.97-1.03). Compared to the private insurance, patients with Medicaid (OR 0.61, CI 0.49-0.75) or Medicare (OR: 0.49, CI 0.32-0.77) were less likely to obtain surgery.

This meta-analysis highlights the impact of race/ethnicity, sex, and insurance status in the likelihood of receiving epilepsy surgery and can inform targeted interventions and policies aimed at ensuring equity for disadvantaged groups.

This meta-analysis aimed to compare the efficacy and safety of iGlarLixi with those of insulin glargine for treating type 2 diabetes (T2D).

A systematic search of PubMed, the Cochrane Library, and EMBASE was conducted to identify randomized controlled trials (RCTs) that compared the use of iGlarLixi with the use of insulin glargine in patients with T2D. The meta-analysis protocol was registered at PROSPERO. The primary outcomes of interest were changes in hemoglobin A1c (HbA1c) and body weight. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models.

We included 7 RCTs comprising 2229 men and 1926 women, of whom 2075 (49.94%) were randomized to iGlarLixi. Compared with insulin glargine, iGlarLixi decreased HbA1c (MD: -0.50%; 95% CI: -0.65% to -0.35%; p < 0.00001) and body weight (MD: -1.17 kg; 95% CI: -1.36 kg to -0.98 kg; p < 0.00001) and self-measured plasma glucose (MD: -0.97 mmol/L; 95% CI: -1.27 mmol/L to -0.68 mmol/L; p < 0.00001) and increased the percentage of patients achieving HbA1c < 7% (RR: 1.66; 95% CI: 1.31 to 2.11; p < 0.0001), the percentage of patients achieving HbA1c < 6.5% (RR: 2.11; 95% CI: 1.53 to 2.92; p < 0.00001), and HbA1c < 7.0% without weight gain and/or without severe or blood glucose-confirmed hypoglycemic episodes (RR: 2.18; 95% CI: 1.76 to 2.69; p < 0.00001). However, a higher incidence of gastrointestinal adverse events (RR: 2.02; 95% CI: 1.61 to 2.54; p < 0.00001) and adverse events (RR: 1.08; 95% CI: 1.02 to 1.14; p = 0.008) was associated with iGlarLixi than with insulin glargine.

Compared with insulin glargine, iGlarLixi is superior in reducing blood glucose levels and facilitating weight loss. Nevertheless, its administration is also linked to a heightened occurrence of gastrointestinal and adverse events.

Singing bowl has traditionally been utilized to promote healing and relaxation. This systematic review aimed to analyze all available clinical evidence, and determine any beneficial or adverse effects of singing bowl in any population.

Databases searched included PubMed, Embase, the Cochrane Library, PsyINFO, CINAHL, CNKI, VIP, Wanfang, Sinomed from database inception to July 2024. Clinical studies of singing bowl therapy, regardless of research type, population, and intervention were included. The risk of bias of randomized controlled trials (RCTs) was assessed using the Cochrane tool. Data from randomized trials were analyzed and presented as the mean difference with 95 % confidence interval, and the results from two or more separate trials with same study type that evaluated similar populations, interventions, comparisons and outcomes were statistical pooled using meta-analysis by Stata.16 software.

Nineteen clinical studies originated from eight countries and published between 2008 and 2024 were identified. Half were RCTs (9), the remainder included case series studies (7), randomized crossover studies (2) and non-RCT (1). Evidence showed that singing bowl has been applied to a wide range of conditions, including the elderly, surgery, Parkinson's disease, pain, cancer, neurological function, sleep disorder, depression, anxiety, autism spectrum disorder, as well as physiological and psychological function, and it has mainly focused on outcomes related to mental health.

Singing bowl may have potential to alleviate anxiety, depression, improve quality of sleep and cognitive function in various patient groups, and change autistic behavior. It also shows potential benefits in physiological improvements like electroencephalography.

PROSPERO, CRD42025639808.

This systematic review investigates the effectiveness of workplace interventions to support young workers' work environment, safety and health.

A systematic search was conducted in bibliographic databases including PubMed, Web of Science Core Collection and PsycInfo for English or Scandinavian articles published from 2007 to 2022. The PICO strategy guided the assessment of study relevance and the bibliographical search for randomized controlled trials (RCTs) and non-RCTs in which (1) participants were young workers (mean age: 15-29), (2) interventions were initiated and/or carried out at the workplace, (3) a comparison group was included, and (4) an outcome measure related to work environment, safety and health was reported. We categorized each included study using the intervention classification framework. The quality assessment and evidence synthesis adhered to the guidelines developed by the Institute for Work & Health (Toronto, Canada).

A total of 33 high and medium quality studies showed a moderate level of evidence for no benefit of 'Mental training' on stress. We found limited evidence of a positive effect of the following intervention types: 'Attitude and belief' on mental health problems, 'Behavior based' on anxiety, and 'Multifaceted' on hand eczema. We found limited evidence for no benefit of the following intervention types: 'Mental training' on mental health problems, and 'Physiological modifications' on musculoskeletal disorders. The remaining intervention types showed mixed or insufficient evidence.

Except for a moderate level of evidence for no benefit of 'Mental training' on stress, the evidence synthesis recommends, that there is not enough evidence from the scientific literature to guide current practices. The results emphasizes a strong need for high quality interventions specifically aiming at increasing or maintaining young workers' work environment, safety and health. Included studies focused mainly on individual measures, highlighting the need for studies investigating possible preventive measures at the group or organizational level.

Recommendations that are equipped with essential and adequate information promote adherence and support evidence-informed decision-making, which are crucial attributes of patient-centered care when caring for patients with multiple coexisting health conditions.

To systematically evaluate the content of recommendations of Clinical Practice Guidelines in Canada.

We searched PubMed, MEDLINE, Embase, and professional organization websites to identify 18 Canadian guidelines addressing 14 diseases prevalent in adults with multimorbidity in nonhospital settings. Two reviewers independently appraised the included guidelines using the international AGREE II tool, extracted 2,509 recommendations and assessed each recommendation to determine the presence of primary health outcomes, as well as secondary demographics and the number of involved diseases. We stratified the findings by potential modifiers: level of evidence (LOE) and type of recommendations (e.g., screening and diagnosis).

Half of the guidelines were high-quality, with all domains scoring 50% or higher. The format and definitions of LOE were found to be heterogeneous. A significant portion focused on a single disease (72%), did not include any demographic information (72), or missed health outcomes (66%). Health outcomes were more frequently addressed in pharmacological (17.6%) and Nonpharmacological (14.5%) management recommendations than in screening (0.7%) and diagnosis (1.1%) recommendations.

There is significant variation in guidelines. For health professionals such as primary care whose patients have multiple conditions, this variation is unacceptable. A centralized guideline development agency would reduce inconsistencies in formatting among guidelines, promoting adherence. Recommendations equipped with adequate information are pivotal in supporting patient-centered care through evidence-informed decision-making. PROSPERO registration: CRD42020105261.

There is a general lack of guidelines on nonoperative treatment in juvenile idiopathic scoliosis (JIS). This review aims to explore factors determining bracing success in JIS and to identify limitations in current literature.

A literature search was conducted according to the PRISMA 2020 guidelines. Data extraction focused on the factors affecting bracing success, including pre-brace curve magnitude in Cobb angle, curve type, pre-brace rib vertebral angle difference, in-brace correction, brace type, brace-wear compliance, the time of brace initiation, and bracing duration. Bracing success is defined as 1) avoidance of corrective surgical intervention (curve exceeding 45° at maturity) and/or 2) major curve Cobb angle of < 5° progression at maturity. Meta-analysis was performed for individual factors.

After initial and full-text screening, 16 articles were included in the review. Pooled odds ratio (OR) from eight studies and 560 patients using the threshold of Cobb angle of 30° revealed that patients with pre-brace curve < 30° were associated with bracing success (odds ratio (OR) 3.58; 95% CI 2.26 to 5.65; p < 0.001; I2 = 0.08). Major thoracic curves were associated with reduced likelihood of bracing success compared to thoracolumbar/lumbar curves (OR 0.49; 95% CI 0.28 to 0.86; p = 0.010; I2 = 0.35). Full-time compliance was significantly associated with bracing success (OR 5.22; 95% CI 2.24 to 12.19; p < 0.001; I2 = 0.76).

This review identified that a pre-brace major Cobb angle < 30° and full-time compliance of at least 18 to 20 hours/day are prognostic factors favourable for bracing success, while presence of thoracic curves is prognostic for unfavourable brace outcome. Longer bracing duration does not translate to a higher success rate. Clinicians should devise more efforts to modify patient compliance in order to achieve optimal brace outcomes. The general lack of high-quality evidence and heterogeneity of results in existing studies indicates the need for further rigorous research on JIS.

Children with Juvenile idiopathic arthritis (JIA) often experience growth retardation due to various factors. The advent of biologic therapies has revolutionized the management of aggressive forms of JIA. This systematic review aims to provide updated insights into the impact of biologic treatments on growth retardation in pediatric JIA patients. Following PRISMA guidelines, we systematically searched Medline, Embase, and the Cochrane Library for eligible articles. Included were cohort studies, trials, and retrospective studies that evaluated growth outcomes in children with JIA receiving biologic therapy. Twelve studies published between 2003 and 2018 were analyzed, encompassing 1513 patients with a mean age of 11.4 years. Tumor necrosis factor alpha inhibitors were the predominant biologic agents used (75.8%), with a mean follow-up duration of 2 years post-biologic therapy initiation. Growth assessment criteria included Height Standard-deviation-score (HSDS), growth velocity, and height velocity (cm/year). Before biologic treatment, 15% of patients exhibited growth delay, while 75.4% had impaired growth. Following biologic therapy, growth delay decreased to 8% and impaired growth to 36.8%. Patients with systemic JIA showed lower changes in growth parameters compared to others, and no significant differences were observed between different biologic drugs. However, lower growth velocity changes were noted in patients treated with multiple biologic agents. Two studies suggested that growth catch-up was most pronounced during the first year of treatment. This systematic review highlights the potential of biologic therapies in mitigating growth impairment associated with JIA. Despite observed positive effects, further research is warranted to elucidate underlying mechanisms and optimize treatment strategies.

Endometrial osseous metaplasia is a rare condition defined as the presence of heterotopic bone in the endometrium. A retrospective, monocentric analysis was conducted, including patients with endometrial osseous metaplasia, and a systematic review of the literature was performed. The retrospective analysis included 10 cases. Most patients (n = 9) were of reproductive age and had a history of miscarriage. The main symptoms were infertility (n = 4) and menstrual cycle disorders (n = 4). The size and the uterine site of the metaplasia varied. It is crucial not to underestimate it, especially in infertile patients with anamnesis of recurrent miscarriages.

Abdominal aortic aneurysms (AAAs) are abnormal dilatations of the aorta that most commonly affect its infrarenal segment, but can become more difficult to repair when they are close to or next to the renal arteries. The optimum treatment for these complex AAAs is unknown. One option is fenestrated endovascular aneurysm repair (FEVAR), which involves using fenestrations or scallops in the graft to facilitate access to the visceral arteries.

To assess the benefits and harms of complex stent-graft fenestrated endovascular aneurysm repair (FEVAR) versus open surgical repair (OSR) or conservative (non-operative) management for people with complex AAAs.

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov without language, publication year or publication status restrictions (published, unpublished, in press or in progress) on 28 March 2023.

We considered all randomised controlled trials (RCTs) and quasi-RCTs, comparing treatment of complex AAA with FEVAR versus open surgical repair or conservative management in adults undergoing primary repair of complex AAA.

Two review authors independently screened studies obtained from the search for potential inclusion in the review, in accordance with the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes were all-cause mortality (30 days and one year), aneurysm-related mortality at one year and length of hospital stay. Secondary outcomes were renal dysfunction at one year, reintervention rate at one year, visceral vessel patency at 30 days and one year, participant-reported health-related quality of life at one year, adverse events at one year and aneurysm-related mortality at 30 days.

We found no studies fulfilling the inclusion criteria.

We did not identify eligible RCTs or quasi-RCTs that compared treatment of complex AAAs with FEVAR versus open surgical repair or conservative management. This is a difficult area in which to conduct research due to low incidence rates and aneurysm heterogeneity. Future studies could consider commissioning agreements mandating patient inclusion in studies to make the generation of high-quality evidence in this area feasible.

Pyrocarbon has been trialed as an alternative bearing surface to metal for young active patients with glenohumeral joint arthritis. The aim of this study was to systematically review and summarize the available evidence on reported outcomes of pyrocarbon implants in shoulder arthroplasty.

A systematic review was conducted according and reported according to standardized guidelines. Patient demographics, complications, implant survivorship and patient-reported outcome measures were extracted and included in the quantitative analysis. Outcome data was summarized with weighted mean differences and proportions.

Fifteen studies were included with 904 patients and a median follow-up of 38 months. The pooled mean range of motion improvement was 43.9 degrees (95% confidence interval [95% CI] 36.7-51.2) in forward elevation and 24.1 degrees (95% CI 18.4-29.9) in external rotation. Pooled mean Constant Score improvement was 34.7 (95% CI 29.4-40.1) and Subjective Shoulder Value improvement was 40.6 (95% CI 33.4-47.8). The overall pooled re-operation rate was 8.03% (95% CI 5%-12.7%).

Pyrocarbon shoulder implants demonstrated improvements in functional outcomes with low revision rates at early- to mid-term follow-up. Further well-designed prospective studies with long-term follow-up are required to verify the safety and efficacy of pyrocarbon implants in shoulder arthroplasty.

Ménière's disease is a chronic inner ear disorder characterized by recurrent vertigo, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. For patients with debilitating symptoms unresponsive to conservative treatment, intratympanic gentamicin is a therapeutic option. However, its efficacy and safety remain uncertain.

This systematic review aims to evaluate the effectiveness and safety of intratympanic gentamicin in Ménière's disease, focusing exclusively on randomized controlled trials (RCTs).

A comprehensive literature search was conducted to identify RCTs comparing intratympanic gentamicin with placebo or no treatment. Primary outcomes included vertigo frequency and severity, quality of life, and incidence of serious adverse events. Data were analyzed using the GRADE approach to assess risk of bias and certainty of evidence.

Three RCTs were included, demonstrating a significant reduction in vertigo frequency and severity in patients treated with intratympanic gentamicin compared to placebo. However, the evidence quality was rated very low due to small sample sizes and methodological limitations.

Findings suggest that intratympanic gentamicin may reduce vertigo in Ménière's disease. However, due to the limited certainty of the evidence, further research with larger sample sizes and standardized outcome measures is necessary to clarify its benefits and risks.

Extended cholecystectomy (EC) is recommended for T1b gallbladder cancer (GBC), but the optimal surgical procedure for T1b GBC remains controversial. This study aims to compare the prognosis of T1b GBC patients who underwent simple cholecystectomy (SC) vs. EC from a long-term survival perspective.

We performed a systematic search up to August 06, 2024, using MEDLINE (PubMed), EMBASE, Web of Science and Cochrane Library. The main outcomes were overall survival (OS) and disease-specific survival (DSS). We evaluated the quality of the studies included and the risk of bias, calculated the pooled hazard ratios (HRs) for OS and DSS and conducted the sensitivity analysis.

A total of 8 retrospective studies involving 2,097 T1b GBC patients (SC = 1,263, EC = 408) were included. The pooled result of OS showed that the EC group had a significantly better OS than the SC group (pooled HR = 0.73; 95% CI = 0.59-0.89; P = 0.002). The pooled result of DSS indicated that EC significantly improved DSS of T1b GBC compared to SC (pooled HR = 0.47; 95% CI = 0.29-0.77; P = 0.003).

EC should be chosen as the optimal surgical procedure for patients with T1b GBC from the standpoint of long-term postoperative survival. However, further analysis of more comprehensive studies will be necessary in the future to improve the quality of evidence.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42023449431, PROSPERO CRD42023449431.

Vitiligo is a chronic autoimmune skin depigmenting condition. IFN-γ, TNF-α and granzyme B play key roles in vitiligo pathogenesis, some findings suggest their roles may be contradictory.

We aimed to assess IFN-γ, TNF-α and granzyme B levels in blood and skin of vitiligo patients using a meta-analysis approach. Additionally, we evaluated their association with disease activity.

A Meta-analysis was conducted using Review Manager 5.4 software. A total of 55 studies including 3,023 vitiligo patients and 2,534 controls were included in the study.

Pooled results from our meta-analysis indicated significantly elevated IFN-γ protein and transcript levels in blood and skin of vitiligo patients (p < 0.05). TNF-α protein levels were also significantly increased in blood and skin of vitiligo patients (p < 0.05). IFN-γ and TNF-α levels were significantly higher in the lesional skin as compared to non-lesional skin (p < 0.05). Furthermore, elevated levels of IFN-γ and TNF-α were observed in patients with active vitiligo (p < 0.05). Additionally, our study suggested a significant increase in granzyme B levels in vitiligo patients (p < 0.05).

Overall, the meta-analysis suggests that IFN-γ, TNF-α and granzyme B play a crucial role in vitiligo pathogenesis and progression and may serve as potential therapeutic targets for managing the disease. The PROSPERO registration no. for meta-analysis is CRD42024620274.

The predictive value of tumor mutation burden (TMB) on the efficacy of immunotherapy has been confirmed in multiple cancer types in previous studies. For urothelial carcinoma (UC) patients treated with immune checkpoint inhibitors (ICIs), whether TMB is a suitable biomarker to predict the benefit of ICIs remains a matter of much debate. We conducted this meta-analysis to evaluate the role of TMB in patients with UC treated with ICIs.

Two investigators independently searched the literature, screened eligible studies, extracted valid data, and scored quality assessments. Meta-analyses of the effect size hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS), and effect size odds ratio (OR) for objective response rate (ORR) were performed and visualized with forest plots using the STATA14.0 software. The statistical difference in benefit from ICIs for UC patients between the high TMB group and the low TMB group was significant when the p-value <0.05. Sensitivity analysis and publication bias further verified the stability and reliability of statistical results.

A total of 2,499 patients from 14 studies were included in this meta-analysis. The results indicated that UC patients with high TMB showed significantly longer OS and PFS than those with low TMB after ICI treatment (OS: HR 0.69, 95% CI 0.62, 0.76, p < 0.05; PFS: HR 0.67, 95% CI 0.59, 0.76, p < 0.05). The high TMB group exhibited a superior response to ICIs than the low TMB group, with no significant difference (OR 1.64, 95% CI 0.94, 2.86, p = 0.08). The results were stable and reliable, with no publication bias.

This meta-analysis demonstrated that UC patients with high TMB exhibited significantly longer survival than those with low TMB after ICI treatment. TMB may be a favorable predictor for UC immunotherapy in future clinical practice.

https://www.crd.york.ac.uk/prospero/, identifier CRD42025642602.

Postoperative cognitive dysfunction (POCD) is prevalent after cardiac and non-cardiac surgeries. It has been generally accepted that POCD is caused by an inflammatory response. This study aimed to determine whether mini-mental state examination (MMSE) scores and the serum levels of two prominent inflammatory factors, S-100B protein (S-100B) and neuron-specific enolase (NSE), can predict POCD among patients undergoing non-cardiac surgeries.

A comprehensive literature search was conducted using electronic databases such as PubMed, Web of Science, Scopus, Google Scholar, and Embase up to 14, January 2025 to identify eligible observational studies evaluating the relationship between the incidence of POCD and the serum levels of S100B, NSE, and MMSE score before surgery and 24 h and 7 days after surgery among patients undergoing non-cardiac surgeries.

Our findings demonstrated that patients who developed POCD had higher S100B levels 24 h after surgery compared to before surgery. Compared to pre-operative levels, there were no significant differences in S100B levels at 7 days, NSE levels at 24 h or 7 days, and MMSE scores at 24 h or 7 days after surgery. Age-based analysis revealed that patients with POCD aged ≥60 had higher S100B levels at 24 h post-operative. Among different surgery types, S100B and NSE levels increased significantly 24 h after spinal surgery, while MMSE scores significantly decreased after spinal surgery.

S100B may help the early detection of POCD, and the prognostic value of S100B can be evaluated in future studies. Unlike S100B, NSE and MMSE did not show significant differences between POCD and non-POCD groups.

Salbutamol, an agonist of the β2-adrenergic receptor, has demonstrated positive outcomes in spinal muscular atrophy (SMA). This systematic review and meta-analysis aimed to investigate its efficacy and safety in patients with SMA. Four biomedical databases (PubMed, Embase, Web of Science, Cochrane Library) and three conference abstract repositories were systematically searched on 1 February 2025 for related clinical studies. Primary outcomes were the motor function, respiratory function, and the peripheral survival motor neuron (SMN) transcript levels of SMA patients pre- and post-salbutamol. Secondary outcomes included musculoskeletal function metrics, patient-reported symptoms, and adverse events. A total of eight studies involving 154 subjects were included in the final analysis. Qualitative analysis revealed that a significant number of patients reported subjective improvements. Additionally, salbutamol has been shown to improve respiratory function and contribute to weight gain in certain younger individuals. Meta-analysis demonstrated that, in two selected studies, patients under 6 years old showed a substantial improvement in the Revised Upper Limb Module (RULM) scores (mean difference (MD) = 3.89, 95% confidence interval (CI) 0.35-7.43, P = 0.03) with no significant heterogeneity. Salbutamol also elevated the levels of peripheral SMN2 full-length transcripts, with statistical significance observed at 6 months (MD = 25.13, 95% CI 16.12-34.13, P < 0.00001) and sustained through to 12 months.

 Salbutamol represents a safe therapeutic option that holds considerable promise in the management of SMA, particularly among clinical responders and younger subgroups. Double-blind, randomized, controlled trials are required to confirm these findings.

• Clinical trials in neuromuscular junction disorders report motor function gains associated with β2-agonists therapy, attributed to both muscle trophic effects and NMJ synaptic modulation. • Salbutamol, a β2-adrenergic receptor agonist, has been shown to increase full-length SMN2 mRNA and functional SMN protein levels in SMA patient-derived fibroblasts.

• Salbutamol possesses the potential to improve motor function in patients with SMA and represents a safe therapeutic option that holds considerable promise in the management of SMA. • The potential mechanism of salbutamol in treating SMA patients may involve enhancing SMN2 transcript expression via cAMP regulation and increasing SMN protein levels by inhibiting ubiquitin-mediated SMN degradation through the β2 adrenergic receptor-PKA pathway. • Salbutamol emerges as a cost-effective and viable option for SMA patients in underdeveloped regions who lack access to or cannot afford disease-modifying treatments.