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Li X, Cao Y, Lin J, Cai R, Zhang L, Liu Y. Effects of gonadotropin-releasing hormone antagonist (GnRH-ant) cessation on trigger day in a GnRH-ant protocol: a meta-analysis. J OBSTET GYNAECOL 2025; 45:2444496. [PMID: 39731472 DOI: 10.1080/01443615.2024.2444496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 12/13/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol. METHODS We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate. RESULTS Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, I2 = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, I2 = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, I2 = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, I2 = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, I2 = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I2 = 0%). CONCLUSIONS Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.
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Affiliation(s)
- Xueying Li
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yafang Cao
- Sichuan Second Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jinli Lin
- Reproductive and Infertility Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Rui Cai
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Linhao Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yao Liu
- Department of Gynecology, Zunhua People's Hospital, Zunhua, Hebei, China
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Yang H, An T, Zhao Y, Shi X, Wang B, Zhang Q. Cardiovascular safety of Janus kinase inhibitors in inflammatory bowel disease: a systematic review and network meta-analysis. Ann Med 2025; 57:2455536. [PMID: 39838595 PMCID: PMC11755742 DOI: 10.1080/07853890.2025.2455536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/02/2025] [Accepted: 01/11/2025] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND AND OBJECTIVE Janus kinase (JAK) inhibitors (JAKinibs) are effective for inflammatory bowel disease (IBD), but their cardiovascular safety is inconclusive. We aim to assess the cardiovascular risks associated with JAKinibs in IBD patients. PATIENTS AND METHODS Systematic searches of seven databases and ClinicalTrials.gov from inception to February 2024 were conducted. Outcomes included major adverse cardiovascular events (MACE), venous thromboembolism events (VTE) and cardiovascular events (CVE), which were separately evaluated based on whether or not the dose was considered. P-score was applied to rank interventions. RESULTS A total of 26 trials involving 10,537 IBD patients were included, and results showed no significantly increased risk of MACE, VTE and CVE was associated with JAKinibs. However, when the dose was considered, Tofacitinib 5 mg BID (versus placebo) showed a trend towards an increased risk of MACE [odds ratio (OR)=1.05, 95% confidence interval (CI): 0.23-4.82], as well as Upadacitinib 30 mg QD (versus placebo) showed a trend towards increased risks of VTE (OR=1.36, 95% CI: 0.23-8.03) and CVE (OR=1.08, 95% CI: 0.24-4.85), and ranked higher than placebo for the risk of VTE [P-score=0.766 (versus 0.722)]. Notably, Deucravacitinib ranked lowest for all cardiovascular risks, and significantly decreased the risks of VTE (OR=0.03, 95% CI: 0.00-0.87) and CVE (OR=0.03, 95% CI: 0.00-0.87) compared with placebo. CONCLUSIONS Although a trend of increased cardiovascular risks was found considering dose, no significantly increased cardiovascular risk was associated with JAKinibs in IBD patients, and Deucravacitinib significantly decreased the risks of VTE and CVE.
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Affiliation(s)
- Huibin Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ting An
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxuan Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaojing Shi
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingyu Zhang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
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Zhang X, Zhao M, Zeng T, Wei X. Death preparedness interventions for patients with advanced cancer: A systematic review. Asia Pac J Oncol Nurs 2025; 12:100697. [PMID: 40321363 PMCID: PMC12049812 DOI: 10.1016/j.apjon.2025.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 04/07/2025] [Indexed: 05/08/2025] Open
Abstract
Objective This study aims to synthesize and critically evaluate the current evidence on interventions aimed at enhancing death preparedness among patients with advanced cancer. Methods A comprehensive search of PubMed, Embase, Cochrane Library, CINAHL, ProQuest, and Web of Science was conducted to identify relevant studies. The review followed Systematic Review and Meta-Analysis Preferred Reporting Items (PRISMA) guidelines, with a structured assessment of study quality and intervention outcomes. Results Nine studies involving a total of 876 patients with advanced cancer met the inclusion criteria. Interventions demonstrated significant improvements in overall death preparedness, with additional benefits observed in psychological well-being and functional status. Most interventions incorporated death education, psychological support, and meaning-centered psychotherapy. Conclusions Interventions appear to be effective in enhancing death preparedness among patients with advanced cancer. Future research should focus on refining intervention components, clearly defining outcome measures, and aligning strategies with individualized patient needs and goals. Systematic review registration PROSPERO CRD420250652562.
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Affiliation(s)
- Xi Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meizhen Zhao
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tieying Zeng
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Wei
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Cheungpasitporn W, Wathanavasin W, Thongprayoon C, Kaewput W, Tapolyai M, Fülöp T. Critical appraisal of systematic reviews and meta-analyses: a step-by-step guide for nephrologists. Ren Fail 2025; 47:2476736. [PMID: 40143401 PMCID: PMC11951313 DOI: 10.1080/0886022x.2025.2476736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/20/2025] [Accepted: 02/28/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process. METHODS This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I2 statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings. RESULTS The I2 statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional. CONCLUSION By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.
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Affiliation(s)
| | - Wannasit Wathanavasin
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Charat Thongprayoon
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Mihály Tapolyai
- Department of Nephrology, Szent Margit Kórház, Budapest, Hungary
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Tibor Fülöp
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Zhang F, Bai Y, Huang L, Zhong Y. Cardiopulmonary fitness in children/adolescents with chronic kidney disease and the impact of exercise training: a systematic review and meta-analysis of observational study and randomized controlled trials. Ann Med 2025; 57:2458197. [PMID: 39908064 PMCID: PMC11800338 DOI: 10.1080/07853890.2025.2458197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/30/2024] [Accepted: 01/12/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate differences in cardiopulmonary fitness between healthy controls and children/adolescents with chronic kidney disease (CKD) and the effects of exercise training. METHODS PubMed, Embase, Scopus and Web of Science were searched for published studies from reception to 14 June 2023, and updated search on 15 October 2023. The included observational studies reported on cardiorespiratory fitness, included maximal oxygen uptake (VO2max), peak oxygen consumption (VO2peak) and 6-minute walk distance (6MWD), in children/adolescents with CKD and age-matched healthy controls, as well as clinical intervention trials of exercise training on cardiorespiratory fitness in samples of children and/or adolescents up to 19. RESULTS Fifteen observational studies and five clinical trials were included, respectively. The studies found that the mean cardiopulmonary fitness was 1.82 standardized mean differences (SMDs) units (95% confidence interval (95% CI) 1.43-2.20) lower in children/adolescents with CKD than in healthy controls or reference values. Except for pre-dialysis CKD patients, peritoneal dialysis, haemodialysis and kidney transplant recipients had significantly lower cardiorespiratory fitness than healthy controls. The results of a meta-analysis based on a pre-post single-arm trial showed that compared to baseline, exercise training improved the 6MWD by approximately 58.17 m (95% CI 16.27-100.06), with very low evidence. CONCLUSIONS This systematic review and meta-analysis of observational studies and clinical trials that included children/adolescents with CKD found that cardiorespiratory fitness is severely reduced in this population and that exercise training may be an effective strategy for improvement. Given the low evidence certainty, additional high-quality trials are necessary.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifei Zhong
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Fahrbach K, Cichewicz A, Chu H, Di Fusco M, Burnett H, Volkman HR, Akin-Fajiye M, Mendoza CF, Cappelleri JC. Comparative effectiveness of Omicron XBB 1.5-adapted COVID-19 vaccines: a systematic literature review and network meta-analysis. Expert Rev Vaccines 2025; 24:416-432. [PMID: 40357526 DOI: 10.1080/14760584.2025.2505754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2025] [Revised: 05/06/2025] [Accepted: 05/09/2025] [Indexed: 05/15/2025]
Abstract
INTRODUCTION Comparative effectiveness data of COVID-19 vaccines remain limited. We conducted a systematic review and network meta-analysis (NMA) feasibility assessment of effectiveness studies of Omicron-adapted COVID-19 vaccines. RESEARCH DESIGN AND METHODS Searches in MEDLINE and Embase up to February 2025 identified studies comparing the effectiveness of Omicron-adapted COVID-19 vaccines, either directly or against no recent vaccine. Two investigators independently selected articles reporting adjusted vaccine effectiveness (VE). A feasibility assessment determined the appropriateness of a common comparator and evaluated effect modifiers (EMs). Data extraction and risk-of-bias assessment were performed by one investigator and validated by a second investigator. Bayesian NMAs using random-effects models were performed for base-case analyses, data permitting. RESULTS The review identified 25 studies for Omicron-adapted COVID-19 vaccines: 16 for XBB formulations, eight of which were included in NMAs, all for mRNA formulations, representing 29.9 million participants. BNT162b2 had the largest evidence base. Comparisons between XBB.1.5-adapted BNT162b2 (Comirnaty) and mRNA-1273 (Spikevax) found that both vaccines are effective and comparable against XBB-related hospitalizations, infections, and medically attended visits in adults Among elderly, the estimated effectiveness against XBB-related hospitalizations favored BNT162b2. CONCLUSIONS Findings of this NMA of observational studies support the effectiveness of XBB.1.5-adapted mRNA vaccines. Limitations included assumptions on EMs and sparse evidence networks.
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Affiliation(s)
- Kyle Fahrbach
- Evidence Synthesis, Evidera Inc., Wilmington, NC, USA
| | | | - Haitao Chu
- Statistics, Pfizer Inc., New York, NY, USA
| | - Manuela Di Fusco
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY, USA
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Tang J, Wang B, Yuan Q, Li X. Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis. Ren Fail 2025; 47:2485375. [PMID: 40204427 PMCID: PMC11983538 DOI: 10.1080/0886022x.2025.2485375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/09/2025] [Accepted: 03/19/2025] [Indexed: 04/11/2025] Open
Abstract
OBJECTIVES This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence. METHODS A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis. RESULTS A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels. CONCLUSIONS This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis. REGISTRATION NUMBER PROSPERO CRD42024525375.
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Affiliation(s)
- Jiayi Tang
- The First Hospital of China Medical University, Shenyang, China
| | - Bei Wang
- Nursing School, China Medical University, Shenyang, China
| | - Qin Yuan
- Nursing School, China Medical University, Shenyang, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang, China
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Zhang X, Lao X, Liao S, Ye C, Wang C. Efficacy of Shenkang Injection combined with renin-angiotensin-aldosterone system blockers in diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials. Ren Fail 2025; 47:2499231. [PMID: 40425314 PMCID: PMC12117859 DOI: 10.1080/0886022x.2025.2499231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 04/04/2025] [Accepted: 04/16/2025] [Indexed: 05/29/2025] Open
Abstract
OBJECTIVE Shenkang injection (SKI), a Traditional Chinese Medicine formulation, is widely used in China for diabetic nephropathy (DN). This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SKI combined with renin-angiotensin-aldosterone system (RAAS) blockers in patients with DN. METHODS A comprehensive search of seven databases was conducted up to September 18, 2024, for randomized controlled trials (RCTs) comparing SKI plus RAAS blockers versus RAAS blockers alone in DN patients. Meta-analysis was performed using RevMan 5.3 and Stata 17.0, with effect sizes expressed as weighted mean differences (WMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 18 RCTs involving 1,497 patients were analyzed. Combination therapy significantly improved total effective rate (TER) (MD 2.61, 95% CI 1.62-2.64) and reduced key renal and metabolic markers. Urinary protein excretion rate (UPER), serum creatinine (SCr), blood urea nitrogen (BUN), 24-hour urinary protein (24h-UTP), total cholesterol (TC), and triglyceride (TG) levels all significantly decreased in the combination group. Subgroup analysis showed that patients aged ≤55 years had greater reductions in SCr (WMD -25.62, 95% CI -29.41 to -21.83) and BUN (WMD -2.51, 95% CI -2.75 to -2.27). Sensitivity analysis confirmed the robustness of findings. No publication bias was detected for TER, SCr, BUN, 24h-UTP, TG, and adverse reactions, though UPER and TC showed potential bias. CONCLUSION SKI combined with RAAS blockers may enhance renal function and metabolic profiles in DN patients. Further high-quality RCTs are needed to validate these findings and assess long-term safety.
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Affiliation(s)
- Xinyue Zhang
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuyuan Lao
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shengchun Liao
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- TCM Institute of Kidney Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chaoyang Ye
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- TCM Institute of Kidney Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- TCM Institute of Kidney Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Jiang S, Liu S, Xiao G, Liu K, Li J. Atherogenic index of plasma and the clinical outcome of patients with acute coronary syndrome: a meta-analysis. Ann Med 2025; 57:2442532. [PMID: 39727274 DOI: 10.1080/07853890.2024.2442532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS. MATERIALS AND METHODS Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity. RESULTS Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity. CONCLUSION A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.
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Affiliation(s)
- Sihai Jiang
- Department of Emergency, Shaoyang Central Hospital, Shaoyang, China
| | - Suying Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Shaoyang University, Shaoyang, China
| | - Guie Xiao
- Department of Emergency, Shaoyang Central Hospital, Shaoyang, China
| | - Kexuan Liu
- Department of Emergency, Shaoyang Central Hospital, Shaoyang, China
| | - Jialin Li
- Department of Emergency, Shaoyang Central Hospital, Shaoyang, China
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Huh MD, Le SN, O'Brien KS, Keenan JD, Stewart JM. Potential Efficacy of Metformin for Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. OPHTHALMOLOGY SCIENCE 2025; 5:100741. [PMID: 40230880 PMCID: PMC11994399 DOI: 10.1016/j.xops.2025.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 02/02/2025] [Accepted: 02/10/2025] [Indexed: 04/16/2025]
Abstract
Topic Metformin, a widely used diabetes medication, has shown potential for treating age-related macular degeneration (AMD) due to its antioxidative, anti-inflammatory, and antiangiogenic properties. This study aims to systematically review and analyze the efficacy of metformin in reducing AMD prevalence. Clinical Relevance Metformin's potential to serve as a treatment for AMD could significantly reduce the burden of vision loss, offering a cost-effective and widely accessible solution. Methods A systematic search was conducted in OVID Embase, OVID MEDLINE, Cochrane Library, and Web of Science databases on May 2, 2024. Both observational and interventional studies were included if they involved oral metformin use before AMD diagnosis. Data were extracted and analyzed using a random-effects model meta-analysis, with subgroup analyses based on study design, AMD subtype, sex, and metformin dosage. Results Eighteen observational studies were identified, which together included a total of 2 683 234 individuals. Nine studies had a case-control design, 7 were retrospective cohort studies, and 2 were cross-sectional studies. The meta-analysis revealed a significant reduction in the odds of AMD among metformin users (pooled odds ratio [OR] = 0.86, 95% confidence interval = 0.79-0.93, P = 0.0002, I2 = 90%). The association was significant in both patients with diabetes (pooled OR = 0.89) and without diabetes (pooled OR = 0.70), although only 2 studies reported nondiabetic ORs. Dose-response analysis revealed significant protective effects at low doses. Sensitivity analysis indicated that the removal of an outlier study did not alter the overall effect. Bias analysis using the Risk of Bias in Nonrandomized Studies of Interventions tool revealed significant risks of bias, particularly due to confounding. Conclusion Although the current evidence suggests a potential protective role of metformin in AMD, all studies showing an effect of metformin have been observational and thus subject to bias. Randomized clinical trials are needed to determine the effectiveness of metformin for preventing the onset of AMD. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Matthew D. Huh
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Simon N. Le
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Kieran S. O'Brien
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jeremy D. Keenan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Buur C, Zachariae R, Marello MM, O'Connor M. Risk factors for depression, anxiety, and PTSS after loss: A systematic review and meta-analysis. Clin Psychol Rev 2025; 119:102589. [PMID: 40344861 DOI: 10.1016/j.cpr.2025.102589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 04/16/2025] [Accepted: 04/30/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Bereavement can lead to complicated grief reactions including clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTSS) post-loss. Gaining insight into specific and shared risk factors for these complicated grief reactions can help identify individuals needing support. METHODS A comprehensive systematic review and meta-analysis of risk factors for post-loss depression, anxiety, and PTSS. PsycInfo, PubMed, Web of Science, and CINAHL were searched to identify risk factors for inclusion in the meta-analysis. RESULTS The systematic review included 144 studies. Most risk factors were of small magnitude. For depression, 21 risk factors were analyzed, with six analyses of adjusted risk factors reaching statistical significance. Pre-loss depression was the strongest risk factor (ESr = 0.25, 95 %CI [0.03,0.45]). Of nine analyzed risk factors for PTSS, four reached statistical significance, with the death of a close relative yielding the largest effect (ESr = 0.24, 95 %CI [0.01,0.44]). Only female gender significantly predicted anxiety (ESr = 0.21, 95 %CI [0.09,0.32]). Female gender, the death of a partner, and violent/unnatural losses were transdiagnostic risk factors. CONCLUSIONS An overview of risk factors for three complicated grief reactions, including their predictive strength, is presented. The results provide insights into transdiagnostic risk factors and can aid early identification of people at risk of complicated grief reactions.
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Affiliation(s)
- C Buur
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; The Danish National Center for Grief, Copenhagen, Denmark.
| | - R Zachariae
- Unit for Psycho-Oncology and Health Psychology, Dept. of Oncology, Aarhus University Hospital and Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M M Marello
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M O'Connor
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; The Danish National Center for Grief, Copenhagen, Denmark
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Wu Y, Zhong Y, Xu C, Li H, Chen M, Xu L. Interventions for Maintaining Pelvic Floor Health During Pregnancy: A Systematic Review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2025; 30:e70077. [PMID: 40492459 DOI: 10.1002/pri.70077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 05/09/2025] [Accepted: 05/28/2025] [Indexed: 06/12/2025]
Abstract
BACKGROUND AND PURPOSE Pregnancy is a unique life stage for women and is also an independent risk factor for pelvic floor disorders (PFD). Physiological changes during pregnancy can weaken pelvic floor support, potentially leading to common pelvic floor dysfunctions such as urinary incontinence, fecal incontinence, chronic pelvic pain, sexual dysfunction, rectus diastasis, and pelvic organ prolapse if left unaddressed. Early preventive interventions are recommended to reduce the overall incidence of PFD. This review aims to summarize various preventive health care strategies for pelvic floor health during pregnancy. METHODS A comprehensive review of the literature was conducted, focusing on studies related to pelvic floor health care during pregnancy. Relevant articles were selected based on their contributions to understanding preventive measures and interventions aimed at maintaining pelvic floor health. RESULTS The research findings outline effective methods for pelvic floor health care during pregnancy, including health education, breathing exercises, pelvic floor muscle training, weight management, perineal massage, and holistic exercise programs. The literature search spanned six electronic databases (PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and Weipu) with 60 studies meeting inclusion criteria. Given the profound impact of pelvic floor dysfunction on women's quality of life, these strategies can specifically alleviate pelvic floor strain during pregnancy, improve delivery outcomes, promote postpartum recovery, and reduce the risk of PFD, thereby playing a significant role in supporting the overall health of mothers. DISCUSSION Emphasizing early management of pelvic floor health is crucial for the recovery of pelvic floor tissues in pregnant women and should be widely implemented in clinical practice. Healthcare providers should consider each pregnant woman's individual health status, physical abilities, and maternal-fetal safety to develop personalized exercise plans, employing appropriate strategies for early intervention against the pelvic floor during pregnancy which may successfully prevent pelvic floor disorders in women.
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Affiliation(s)
- Yuxuan Wu
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanbo Zhong
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
| | - Chao Xu
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
| | - Hang Li
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
| | - Mengting Chen
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
| | - Ling Xu
- Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, Shanghai, China
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Medeisyte R, Nuzum E, John A, Tsipa A, Fearn C, Charlesworth G, Crutch SJ, El Baou C, Stewart GR, Kurana S, Brotherhood EV, Flanagan K, Salmoiraghi A, Kerti A, Stott J, Desai R. Risk of suicide in people living with dementia and comorbid mental health conditions: A systematic review and meta-analysis. J Affect Disord 2025; 379:835-844. [PMID: 40097114 DOI: 10.1016/j.jad.2025.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 03/11/2025] [Accepted: 03/12/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND People with dementia (PwD) are more vulnerable to experiencing suicidal ideation than the general population. Within this group, certain risk factors such as being younger and male increase risk of death by suicide. However, currently little is known on whether comorbid mental health conditions in this population also elevate the risk of suicide outcomes. We aimed to determine if comorbid mental health conditions increased the risk of suicidal ideation, suicide attempts and death by suicide in PwD. METHODS Five databases were searched from inception to July 2023. Peer-reviewed publications reporting data for suicide outcomes in PwD with a comorbid mental health condition were included. Random effects meta-analyses models were used to calculate the pooled effect sizes. RESULTS 22 relevant studies were identified for inclusion 14 of which reported sufficient data to be included in the meta-analyses. In PwD, those with a general psychiatric comorbidity were at increased risk of death by suicide (OR = 2.61, [95%CI: 1.47; 4.63]). Those with comorbid depression or anxiety were at increased risk of all suicide outcomes (depression: ideation OR = 5.11, [95%CI:1.73;15.07], attempt OR = 7.75, [95%CI:2.68;22.41], death OR = 3.44 [95%CI:1.65;7.18]; anxiety: ideation OR = 3.69, [95%CI:1.41;9.66]; attempt OR = 2.27, [95%CI:1.08;4.78]; death OR = 2.36, [95%CI:2.02;2.75]). PwD and comorbid personality disorder and substance use were at increased risk of suicide attempt (OR = 4.60, [95%CI:1.36;15.55] and death by suicide (OR = 2.19, [95%CI:1.80;2.66] respectively. CONCLUSION Comorbid mental health conditions put PwD at increased risk of suicide outcomes. There is an urgent need for the assessment and monitoring of mental health in PwD in routine care to mitigate suicide risk.
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Affiliation(s)
- Radvile Medeisyte
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Eleanor Nuzum
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Amber John
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Anastasia Tsipa
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Caroline Fearn
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Georgina Charlesworth
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK; Research and Development, North East London NHS Foundation Trust, London, UK
| | | | - Céline El Baou
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Gavin R Stewart
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Suman Kurana
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | | | - Katie Flanagan
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | | | - Amy Kerti
- Betsi Cadwaladr University Health Board, Cymru NHS, Wales, UK
| | - Joshua Stott
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK
| | - Roopal Desai
- ADAPT Lab, Clinical, Educational and Health Psychology Department, University College London, London, UK.
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Lin SS, Chen CR, Xu WC, Fu J, Xu JQ, Liang ZH. Association between anemia and the risk of diabetic foot ulcer: A meta-analysis. World J Diabetes 2025; 16:105155. [DOI: 10.4239/wjd.v16.i6.105155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/07/2025] [Accepted: 04/23/2025] [Indexed: 06/13/2025] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, and anemia is commonly observed in diabetic patients. However, the relationship between anemia and the risk of developing DFUs remains unclear.
AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.
METHODS A systematic search was conducted across PubMed, Embase, and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients. The primary outcome was an association between anemia and DFU risk, expressed as odds ratios (ORs). Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin levels between patients with and without DFU. Statistical analyses were performed using random-effects models to account for heterogeneity.
RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis. The results indicated a significant association between anemia and an increased risk of DFUs (eight studies, n = 166173, OR: 2.72, 95%CI: 1.73–4.25, P < 0.001; I2 = 93%). Subgroup analyses supported consistent findings across various patient characteristics, analytic models, and study quality scores (P for subgroup differences, all > 0.05). Additionally, each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs (four studies, n = 2543, OR: 1.65, 95%CI: 1.21–2.27, P = 0.002; I2 = 68%). Furthermore, diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs (nine studies, n = 3986, mean difference: -2.13 g/dL, 95%CI: -2.58 to -1.68, P < 0.001; I2 = 90%).
CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients. Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs, emphasizing the need for early interventions. Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.
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Affiliation(s)
- Shi-Shuai Lin
- Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Cun-Ren Chen
- Department of Endocrinology, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Wei-Cheng Xu
- Department of Burn and Skin Repair Surgery, Affiliated Clinical College of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Jia Fu
- Department of Burn and Skin Repair Surgery, Affiliated Clinical College of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Jia-Qin Xu
- Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Zun-Hong Liang
- Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
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Gao H, Wang G, Zhang X, Guo H, Pang L, Gu J. Meta-Analysis of the Effects of Cognitive Behavioral Therapy on Dietary Habits and Emotional Outcomes in Patients With Obesity Undergoing Metabolic and Bariatric Surgery. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2025:S1499-4046(25)00309-4. [PMID: 40493004 DOI: 10.1016/j.jneb.2025.05.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 05/07/2025] [Accepted: 05/11/2025] [Indexed: 06/12/2025]
Abstract
INTRODUCTION To evaluate the effects of cognitive behavioral therapy (CBT) on physical, behavioral, and psychosocial outcomes in patients with obesity undergoing metabolic and bariatric surgery (MBS) through a meta-analysis. METHOD Randomized controlled trials assessing the therapeutic effects of CBT in patients undergoing MBS were searched in databases including PubMed, Embase, Cochrane Library, and Web of Science. The search cutoff date was February 7, 2025. Data analysis was performed using Stata (version 16.0, StataCorp, 2019). RESULTS A total of 7 randomized controlled trials were included in the final analysis. The meta-analysis indicated that CBT appeared to significantly decrease anxiety, depressive symptoms, uncontrolled eating, and emotional eating immediately after the intervention, but these effects seemed to disappear at the 1-year follow-up. In addition, CBT seemed not to affect weight, body mass index, physical quality of life, and mental quality of life at any time. DISCUSSION CBT may alleviate anxiety, depressive symptoms, uncontrolled eating, and emotional eating in the short term. IMPLICATIONS AND CONCLUSIONS Our findings suggest that CBT may enhance psychosocial and behavioral health among patients with obesity undergoing MBS. Future randomized controlled trials with larger sample sizes and longer follow-ups are needed to evaluate their long-term impacts.
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Affiliation(s)
- Haowen Gao
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guiqi Wang
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinxin Zhang
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Haobing Guo
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liyun Pang
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingfeng Gu
- Department of Gastroenterology Diagnosis and Treatment I (Weight Loss and Metabolic Diseases), The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Farhana S, Frawley J, Safi N, Anazodo A, Mcgee R, Remond M, Sullivan E. Perinatal outcomes for infants exposed to systemic cancer treatment during gestation: a systematic review and meta-analysis. BMJ Open 2025; 15:e084717. [PMID: 40490371 DOI: 10.1136/bmjopen-2024-084717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2025] Open
Abstract
OBJECTIVES The incidence of cancer diagnosed during pregnancy is increasing, but data relating to perinatal outcomes for infants exposed to systemic cancer treatment in utero remain limited. This systematic review and meta-analysis aimed to synthesise evidence from the available literature to investigate whether perinatal outcomes for babies born to women with gestational cancer differ based on whether they are exposed to systemic cancer treatment in utero. DESIGN A systematic review was conducted according to PRISMA-P guidelines. We extracted raw data from the eligible studies to calculate ORs and 95% CIs for perinatal outcomes reported in the included studies. DATA SOURCES A comprehensive search of Medline, Embase, Cochrane Library and CINAHL databases identified studies published between January 2001 and May 2025. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review that reported on both a study group (women with gestational cancer who received systemic therapy during pregnancy) and a comparison group (women with gestational cancer who did not receive systemic therapy during pregnancy). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. Perinatal outcomes included spontaneous abortion, pregnancy termination, intrauterine growth restrictions (IUGR), stillbirth, intrauterine foetal death, neonatal mortality, preterm birth (<37 weeks), Apgar score at 5 min, small for gestational age (SGA), low birth weight, congenital anomalies, admission to neonatal intensive care (NICU) and long-term infant and child outcomes (cognitive skill and academic achievement) following systemic therapy. Raw data were extracted from the eligible studies to calculate ORs and 95% CIs for perinatal outcomes, and the ROBINS-I tool was used to assess bias. RESULTS Five cohort studies (a total of 416 women and 427 neonates exposed to systemic therapy in utero) met the inclusion criteria. Across these studies, a higher rate of preterm birth was consistently observed among exposed neonates compared with those unexposed, with reported ORs ranging from 1.85 to 24.00. Although effect sizes varied and CIs were wide, the overall trend suggests a potential association between in utero exposure to systemic therapy and increased risk of preterm birth. No significant differences were observed in the rates of spontaneous abortion, congenital anomalies, stillbirth, IUGR or SGA births between exposed and non-exposed babies. CONCLUSION Very few studies have compared outcomes of systemic therapy-exposed and non-exposed babies of women with gestational cancer. These studies are of limited quality. The available evidence suggests that while some studies indicate a possible association between systemic cancer therapy and increased risk of preterm birth, the overall findings should be interpreted cautiously given the small sample sizes, lack of adjusted analyses, and clinical heterogeneity among included studies. Further research is required to better understand the impact of systemic therapy exposure in utero on perinatal outcomes.
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Affiliation(s)
- Sultana Farhana
- Department of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Frawley
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Nadom Safi
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Richard Mcgee
- Department of Health, Department of Paediatrics Campbeltown Hospital, Campbeltown, Sydney, New South Wales, Australia
- The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Marc Remond
- The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Elizabeth Sullivan
- The University of Newcastle Australia, Callaghan, New South Wales, Australia
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Wen J, Zheng B, Fu T. CXCL12 expression and the survival of patients with gastric cancer: a meta-analysis. Clin Exp Med 2025; 25:191. [PMID: 40481962 PMCID: PMC12145318 DOI: 10.1007/s10238-025-01674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Accepted: 04/05/2025] [Indexed: 06/11/2025]
Abstract
Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide. CXCL12, a chemokine involved in tumor progression and metastasis, has been inconsistently associated with GC survival. This meta-analysis aimed to evaluate the prognostic significance of CXCL12 expression in GC patients. A comprehensive literature search was conducted in PubMed, Embase, and Web of Science. Observational studies assessing tumor CXCL12 expression and survival outcomes in GC patients were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model by incorporating heterogeneity. Ten studies comprising 1361 GC patients were included. High CXCL12 expression was significantly associated with poorer overall survival (OS) (HR: 1.85, 95% CI 1.51-2.26, p < 0.001) with mild heterogeneity (I2 = 17%). Subgroup analyses revealed that the association between high CXCL12 expression and OS was stronger in studies defining high expression as above the median density value (HR: 2.63, 95% CI 1.79-3.86) than in those using any positive expression (HR: 1.61, 95% CI 1.30-2.00; p for subgroup difference = 0.03). Additionally, a more pronounced association was observed in studies with follow-up durations ≥ 36 months (HR: 2.42, 95% CI 1.84-3.18) compared to those with < 36 months (HR: 1.59, 95% CI 1.28-1.99; p = 0.03). The pooled results also indicated an association between high CXCL12 expression and worse progression-free survival (PFS) (HR: 1.52, 95% CI 1.05-2.20, p = 0.03). High CXCL12 expression is associated with poorer survival outcomes in GC patients.
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Affiliation(s)
- Jinxiu Wen
- Department of Gastrointestinal and Hernia Surgery, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, No. 733, Wenxiang Road, Yuancheng District, Heyuan, 517000, China
| | - Bingbing Zheng
- Department of Gastrointestinal and Hernia Surgery, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, No. 733, Wenxiang Road, Yuancheng District, Heyuan, 517000, China.
| | - Ting Fu
- Department of Gastrointestinal and Hernia Surgery, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, No. 733, Wenxiang Road, Yuancheng District, Heyuan, 517000, China
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Chen X, Fan Y, Chen J, Tu H. Clinical efficacy and complications of 10 surgical interventions for cervical ossification of the posterior longitudinal ligament: an updated systematic review and network meta-analysis. J Orthop Surg Res 2025; 20:576. [PMID: 40483495 PMCID: PMC12144785 DOI: 10.1186/s13018-025-05878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2025] [Accepted: 05/01/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND The optimal surgical techniques for cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial due to insufficient high-level evidence. We investigated the following surgical approaches for cervical OPLL: anterior decompression and fusion (ADF), anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), anterior cervical discectomy and fusion (ACDF), posterior decompression with instrumented fusion (PDIF), posterior decompression and fusion (PDF), laminectomy (LC), laminoplasty (LP), laminectomy with fusion (LF), and vertebral body sliding osteotomy (VBSO). METHODS We systematically searched PubMed, Embase, Ovid, the Cochrane Library, and Web of Science from database inception through October 30, 2024. Our search identified both randomized and non-randomized controlled trials compar ing the following surgical interventions: ACDF, ADF, ACCF, ACAF, PDIF, PDF, LC, LP, LF, and VBSO. The extracted data were subjected to network meta-analysis. Our analysis included the following outcome measures: Patient demographic characteristics, Japanese Orthopaedic Association (JOA) scores, JOA improvement rates, overall complication rates, excellent/good recovery rates, cervical lordosis characteristics, Visual Analog Scale (VAS) scores, Neck Disability Index (NDI) scores, surgical duration and intraoperative blood loss. RESULTS In our analysis of 50 studies involving 8705 patients, ACAF demonstrated the most significant improvements in JOA scores, cervical lordosis, VAS scores, and NDI scores. ADF showed the greatest increase in JOA improvement rate, while VBSO had the highest rate of excellent and good postoperative recovery. ACDF was associated with the fewest total complications and the shortest surgical duration. Finally, LC resulted in the lowest intraoperative blood loss. CONCLUSION This studies demonstrate that ACAF significantly improves JOA scores and cervical lordosis while reducing VAS and NDI scores. Additionally, it achieves higher postoperative JOA improvement rates and excellent/good recovery rates, with fewer total complications and reduced intraoperative blood loss. Based on these findings, ACAF can be one of the preferred options for clinicians treating cervical OPLL, but it requires high surgical experience and strict indication selection. Additionally, the surgical team need to develop the best surgical plan based on imaging features and patient functional needs.
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Affiliation(s)
- Xiao Chen
- Department of Orthopedics, The First People's Hospital of Neijiang, Neijiang, Sichuan, China
| | - Yuanhe Fan
- Department of Orthopedics, The First People's Hospital of Neijiang, Neijiang, Sichuan, China.
| | - Jie Chen
- Department of Orthopedics, The First People's Hospital of Neijiang, Neijiang, Sichuan, China
| | - Hongliang Tu
- Department of Orthopedics, The First People's Hospital of Neijiang, Neijiang, Sichuan, China
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Liu S, Ma J, Zhang L, Yang Y, Han Z, Tian L. Circulating leptin levels in thyroid dysfunction: a systematic review and meta-analysis. BMC Endocr Disord 2025; 25:140. [PMID: 40481466 PMCID: PMC12142830 DOI: 10.1186/s12902-025-01943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 04/17/2025] [Indexed: 06/11/2025] Open
Abstract
PURPOSE Leptin is an important regulator of energy homeostasis, analogous to thyroid hormone (TH). The purpose of this study was to investigate circulating leptin levels in thyroid dysfunction (TD) patients and the role of TH levels. METHODS The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were independently searched by two researchers, from inception until February 3, 2024, and updated on February 15, 2025. Pooled standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated by the random effects model. RESULTS Thirty-eight studies reported circulating leptin levels in TD and control with euthyroidism, 4295 subjects were included in total, of which 1277 were hypothyroidism, 540 were hyperthyroidism, and 2478 were control. Compared to euthyroidism, leptin levels were significantly higher in hypothyroidism, and not significantly altered in hyperthyroidism (SMD [95%CI] = 0.71 [0.38, 1.04] and -0.03 [-0.57, 0.51], respectively). The subgroup analysis indicated that, compared to euthyroidism, leptin levels were significantly higher in subjects regardless of overt and subclinical hypothyroidism (SMD [95%CI] = 0.76 [0.25, 1.26] and 0.41 [0.11, 0.70], respectively), and not significantly different in overt hyperthyroidism (SMD [95%CI] = -0.14 [-0.74, 0.45]). Furthermore, when compared to age-, gender-, and body mass index (BMI)-matched euthyroidism, leptin levels were significantly higher in hypothyroidism and had no significant difference in hyperthyroidism (SMD [95%CI] = 0.66 [0.24, 1.07] and -0.43 [-1.13, 0.27], respectively). A total of 16 studies analyzed the correlations between leptin levels and TH levels in TD, 488 were hypothyroidism and 206 were hyperthyroidism. Following correlation analysis, leptin levels displayed a positive correlation with thyroid-stimulating hormone (TSH) levels (r = 0.19) and a negative correlation with triiodothyronine (T3) levels (r = -0.40) in TD. CONCLUSION Compared to euthyroidism, circulating leptin levels were significantly higher in hypothyroidism, and not significantly altered in hyperthyroidism. Besides, leptin levels in TD may be directly regulated by TSH and T3 levels, independent of BMI. TRIAL REGISTRATION CRD42024561055.
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Affiliation(s)
- Shanshan Liu
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, 730000, China
| | - Jun Ma
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, 730000, China
| | - Leyuan Zhang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, 730000, China
| | - Yanlong Yang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, 730000, China
| | - Ziqi Han
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, 730000, China
| | - Limin Tian
- Department of Endocrinology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610000, China.
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20
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Amankwah EK, Mosha M, Dean J, Mayer J. Association between medical comorbidities at diagnosis and paediatric acute lymphoblastic leukaemia and lymphoblastic lymphoma outcomes: protocol for a systematic review. BMJ Open 2025; 15:e083782. [PMID: 40480668 DOI: 10.1136/bmjopen-2023-083782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2025] Open
Abstract
INTRODUCTION Medical comorbidity at diagnosis is associated with treatment outcome in cancer. The aim of this project is to synthesise the evidence on the association between medical comorbidities and paediatric acute lymphoblastic leukaemia and lymphoblastic lymphoma outcomes. METHODS AND ANALYSIS A systematic review of the literature will be conducted by developing a search strategy that will combine medical subject headings and natural language key words related to acute lymphoblastic leukaemia or lymphoma, medical comorbidities and treatment-related outcomes. We will search MEDLINE and EMBASE to identify studies in human subjects and written in English from the inception of each database to 30 September 2022. Two authors will independently screen the titles and abstracts of retrieved studies based on the inclusion and exclusion criteria to identify potentially eligible studies. Full-text articles of eligible studies and final included articles will be retrieved and reviewed in a similar manner by two independent reviewers. Data extraction from included articles will be conducted independently by two authors using a standardised data extraction form. Risk of bias in the included studies will be assessed using existing relevant tools. A narrative and tabular summary of the data, including outcomes, will be provided if the data do not warrant a meta-analysis. If a meta-analysis is feasible, we will pool all the effect estimates. Heterogeneity among study effect sizes will be tested with Cochran's Q test and quantified by the I2 statistic. ETHICS AND DISSEMINATION This study will not include the collection of original data, but it will be a summary of aggregate existing data. Thus, ethics approval is not applicable. The findings of the study will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42022366669.
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Affiliation(s)
- Ernest K Amankwah
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maua Mosha
- Epidemiology and Biostatistics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jennifer Dean
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jennifer Mayer
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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21
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Wang Q, Huang Z, Chair SY. Exercise-based interventions for preventing and treating cancer therapy-related cardiovascular toxicity: a systematic review and meta-analysis. BMC Cardiovasc Disord 2025; 25:433. [PMID: 40468186 PMCID: PMC12135320 DOI: 10.1186/s12872-025-04865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2025] [Accepted: 05/14/2025] [Indexed: 06/11/2025] Open
Abstract
PURPOSE This review aimed to evaluate the effects of exercise-based interventions on cancer therapy-related cardiovascular toxicity (CTR-CVT) in individuals with cancer. METHODS Four databases (MEDLINE, Embase, Web of Science, and CENTRAL) were searched to identify eligible studies. Randomized controlled trials examining the effects of exercise-based interventions on CTR-CVT in cancer patients published in English were included. The risk of bias of included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. The meta-analysis was performed using statistical software R. The PRISMA statement was followed. RESULTS Thirty studies with 2484 participants were included. Our findings revealed that compared to the control group, exercise-based intervention improved VO2peak (mean difference [MD]: 1.62, 95% confidence interval [CI]: 0.94 to 2.30), resting diastolic blood pressure (MD: -4.43, 95% CI: -8.72 to -0.13), and resting heart rate (MD=-3.74, 95% CI: -6.59, -0.89) among individuals with cancer. Evidence on other study outcomes remains unclear. CONCLUSION The findings of this review demonstrate the potential role of exercises in preventing and treating CTR-CVT. Further research is warranted to strengthen the current evidence and fill the gaps identified in this review. REGISTRATION The review protocol was registered in PROSPERO (ID: CRD42022380550).
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Affiliation(s)
- Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Zehao Huang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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22
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Zamani K, Rostami P, Darehbagh RR, Afraie M, Moradi Y. Hepatitis B and C virus infection and risk of multiple myeloma: a systematic review and meta-analysis. BMC Cancer 2025; 25:998. [PMID: 40468263 PMCID: PMC12135261 DOI: 10.1186/s12885-025-14420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Accepted: 05/30/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a clonal proliferative disorder of plasma cells with limited curative options. Hepatitis B (HBV) and hepatitis C (HCV) viruses have been implicated in the development of various hematological malignancies, but their association with MM remains unclear. This systematic review and meta-analysis aimed to investigate the risk of MM in individuals with HBV and HCV infections. METHODS A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and additional sources for cohort and case-control studies published between January 1990 and January 2025. The relative risk (RR) of developing MM in individuals with HBV and HCV infections was pooled using a random-effects model. Subgroup analyses were performed based on age, geographic region, and diagnostic method. The Newcastle-Ottawa Scale (NOS) was used to assess study quality. Statistical heterogeneity was evaluated using the I² statistic, and publication bias was assessed using Egger's test. RESULTS Seventeen studies, comprising 1 cohort and 16 case-control studies, were included. Nine studies examined the association between HBV and MM, yielding a pooled RR of 1.25 (95% CI: 0.99-1.58) with moderate heterogeneity (I² = 56.52%). Fifteen studies evaluated the association between HCV and MM, with a pooled RR of 1.84 (95% CI: 1.27-2.67), indicating a higher risk in HCV-infected individuals. Subgroup analysis revealed a stronger association in European populations for both HBV (RR: 1.67, 95% CI: 1.05-2.66) and HCV (RR: 2.27, 95% CI: 1.21-4.25). No significant publication bias was detected for either HBV or HCV analyses. CONCLUSION HBV and HCV infections are associated with an increased risk of developing multiple myeloma, with HCV demonstrating a stronger association. These findings highlight the importance of screening and monitoring patients with chronic hepatitis for potential hematological malignancies, especially in high-risk regions.
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Affiliation(s)
- Kamran Zamani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Poorya Rostami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Maryam Afraie
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Spanoudakis E, Vampertzis T, Wadia F, Rad DR, Barmpagianni C, Zervos IA, Tsiridis E, Galanis N. Botulinum toxin in fracture management: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:233. [PMID: 40467894 PMCID: PMC12137460 DOI: 10.1007/s00590-025-04295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 04/04/2025] [Indexed: 06/11/2025]
Abstract
PURPOSE Using botulinum toxin (BoNT) as an adjunct in fracture management is a novel approach with the potential to improve clinical outcomes, particularly in atypical fractures and patients with concurrent neuromuscular disorders. This scoping review explores the literature on BoNT's effectiveness in facilitating fracture healing and immobilisation across various fracture types. METHODS The PubMed, Embase, and Cochrane databases were searched with defined operators. Two investigators conducted independent searches, which were combined. Animal studies, case reports, case series, cohort reviews and randomised control trials were included. RESULTS Fifty studies were identified for screening, from which 15 studies were included in the review. The findings highlight mixed outcomes in BoNT's role in enhancing bone healing and reducing muscle-induced displacement. While BoNT injections demonstrated potential benefits in specific cases, such as atypical fractures, periprosthetic fractures and fractures in patients with motor dysfunctions, results from animal studies were inconsistent, showing varied effects on callous formation and bone mineral density. CONCLUSION Clinical applications of BoNT in fracture management indicate its utility as an immobilisation agent to promote fracture healing and reduce complications. However, this review highlights that further research is necessary to bridge the gap between experimental and clinical studies and to clarify BoNT's effectiveness in different use cases.
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Affiliation(s)
- Emmanuel Spanoudakis
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | | | - Farokh Wadia
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Darius Rares Rad
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Eleftherios Tsiridis
- Papageorgiou General Hospital, Thessaloniki, Greece
- Aristotle University of Thessaloniki, Thessaloniki, Greece
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24
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Soon XQ, Gedye K, Benschop J, Gartrell B. Molecular detection of Chlamydia psittaci in birds: a systematic review. Avian Pathol 2025; 54:279-298. [PMID: 39697165 DOI: 10.1080/03079457.2024.2443952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 12/10/2024] [Accepted: 12/13/2024] [Indexed: 12/20/2024]
Abstract
Molecular methods are currently the most sensitive for detecting Chlamydia psittaci in birds. Most laboratories have developed their own molecular assays or adapted published protocols, often making slight modifications to fit their specific study purposes. The sensitivity and specificity of a molecular test depend on the target gene, primer sequences, types of molecular test, DNA extraction method, and sampling methods. We reviewed 120 articles published between 2000 and 2020 to compile information on the molecular detection of C. psittaci in birds. Of the ten genomic targets currently available to detect C. psittaci in birds, the ompA gene was the most widely used. In published surveillance studies, of the fourteen molecular test types, conventional PCR and quantitative PCR were applied the most. A testing strategy using a hierarchical approach that includes molecular tests of genus- and species-specific targets is recommended to detect other avian chlamydial species besides the well-recognized C. psittaci. Samples should be sourced from both the respiratory and gastrointestinal tracts whenever possible for better accuracy. High-quality DNA can be obtained when the sample is preserved in optimal medium and temperature, and an optimized DNA extraction protocol is applied. Standardization and validation of molecular Chlamydia tests are needed to enhance the comparability and reliability of assays to detect C. psittaci and other chlamydiae species in birds.RESEARCH HIGHLIGHTSHierarchical molecular testing is recommended for the detection of avian C. psittaci.Key molecular tests for surveillance were conventional PCR and quantitative PCR.The most used genomic target to detect C. psittaci in birds was the ompA gene.
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Affiliation(s)
- Xue Qi Soon
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science - Tāwharau Ora, Massey University, Palmerston North, New Zealand
- Wildbase, School of Veterinary Science - Tāwharau Ora, Massey University, Palmerston North, New Zealand
| | - Kristene Gedye
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science - Tāwharau Ora, Massey University, Palmerston North, New Zealand
| | - Jackie Benschop
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science - Tāwharau Ora, Massey University, Palmerston North, New Zealand
| | - Brett Gartrell
- Wildbase, School of Veterinary Science - Tāwharau Ora, Massey University, Palmerston North, New Zealand
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Garcia-Becerra CA, Arias-Gallardo MI, Soltero-Molinar V, Juarez-Garcia JE, Rivera-Rocha MI, Parra-Camaño LF, Garcia-Becerra N, Garcia-Gutierrez CM. Is biparametric MRI a feasible option for detecting clinically significant prostate cancer?: A systematic review and meta-analysis. Urol Oncol 2025; 43:396.e9-396.e17. [PMID: 39753482 DOI: 10.1016/j.urolonc.2024.12.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 09/09/2024] [Accepted: 12/10/2024] [Indexed: 05/19/2025]
Abstract
BACKGROUND Multiparametric MRI (Mp-MRI) is a key tool to screen for Prostate Cancer (Pca) and Clinically Significant Prostate Cancer (CsPca). It primarily includes T2-Weighted imaging (T2w), diffusion-weighted imaging (DWI), and Dynamic Contrast-Enhanced imaging (DCE). Despite its improvements in CsPca screening, concerns about the cost-effectiveness of DCE persist due to its associated side effects, increased cost, longer acquisition time, and limitations in patients with poor kidney function. Recent studies have explored Biparametric MRI (Bp-MRI) as an alternative that excludes DCE. OBJECTIVES The main objective of this study is to compile and evaluate updated results of Bp-MRI as a diagnostic alternative to detect CsPca. METHODS A systematic review was conducted using PubMed, Central Cochrane, and ClinicalTrialls.gov registry. Inclusion criteria was focused on observational and experimental studies that assessed a direct comparison of Bp-MRI and Mp-MRI for CsPca detection. The primary outcomes included were necessary to create a contingency 2×2 table and CsPca prevalence from each study. The secondary outcomes included were demographic data and imaging protocol features. The statistical analysis used a Bivariate Random-Effect model to estimate the pooled sensitivity, specificity, and area under the curve (AUC). An univariate random-effect model was conducted to estimate the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies -2 tool. RESULTS From 534 articles initially identified, 19 studies met the inclusion criteria with a total of 5075 patients. The pooled sensitivity estimated was 0.89, pooled specificity was 0.73, and AUC was 0.90; these results showed a slight increase compared to previous studies. CONCLUSION The results obtained showed that Bp-MRI is a feasible alternative to detect CsPca, which demonstrates high diagnostic accuracy and avoids the drawbacks associated with DCE. REGISTRY This is a sub-analysis of the protocol registered at PROSPERO (CRD42024552125).
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Affiliation(s)
| | | | - Veronica Soltero-Molinar
- Basic Science Institute, School of Medicine, Autonomous University of Guadalajara, Guadalajara, México
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Akabane M, Imaoka Y, Nakayama T, Esquivel CO, Sasaki K. Effect of sarcopenia on the survival of patients undergoing liver transplantation: a meta-analysis. Surg Today 2025; 55:803-813. [PMID: 39928119 DOI: 10.1007/s00595-025-03008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 10/18/2024] [Indexed: 02/11/2025]
Abstract
PURPOSE The relationship between sarcopenia and post-liver transplant (LT) mortality is still not well understood. This study aims to provide an updated and comprehensive meta-analysis evaluating the impact of sarcopenia on the survival of LT patients. METHODS We conducted searches in PubMed, Web of Science, and EMBASE up until May 2, 2024, without language restrictions. The primary outcome measured was the overall post-LT mortality risk associated with sarcopenia. The DerSimonian-Laird random effects model was used to calculate pooled adjusted hazard ratios (HRs). RESULTS Eighteen cohort studies comprising a total 6297 LT patients were included. The overall prevalence of sarcopenia was 27% (95% CI: 26%-28%), and this rate was lower when sarcopenia was defined using the third lumbar-skeletal muscle index in men, and among patients with lower Child-Pugh class. Sarcopenia remained significantly associated with higher mortality, with a pooled adjusted HR of 1.55 (95% CI 1.28-1.89). This association held across subgroups based on sex, study location, sarcopenia definition, study quality, and living donor LT recipients. A sensitivity analysis excluding groups with a high proportion of hepatocellular carcinoma patients showed similar findings (HR 1.63, 95% CI 1.13-2.35). No significant heterogeneity was identified in any of the analyses. CONCLUSIONS This meta-analysis shows that sarcopenia is significantly associated with increased mortality after LT. Thus, the risk of sarcopenia should be factored into the initial evaluation of LT candidates.
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Affiliation(s)
- Miho Akabane
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Yuki Imaoka
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Toshihiro Nakayama
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Carlos O Esquivel
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA.
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Pirozzi MA, Franza F, Chianese M, Papallo S, De Rosa AP, Nardo FD, Caiazzo G, Esposito F, Donisi L. Combining radiomics and connectomics in MRI studies of the human brain: A systematic literature review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2025; 266:108771. [PMID: 40233442 DOI: 10.1016/j.cmpb.2025.108771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 03/17/2025] [Accepted: 04/09/2025] [Indexed: 04/17/2025]
Abstract
Advances in MRI techniques continue to open new avenues to investigate the structure and function of the human brain. Radiomics, involving the extraction of quantitative image features, and connectomics, involving the estimation of structural and functional neural connections, from large amounts and different types of MRI data sets, represent two key research areas for advancing neuroimaging while exploiting progress in computational and theoretical modelling applied to MRI. This systematic literature review aimed at exploring the combination of radiomics and connectomics in human brain MRI studies, highlighting how the combination of these approaches can provide novel or additional insights into the human brain under normal and pathological conditions. The review was conducted according to the Preferred Reported Item for Systematic Reviews and Meta-Analyses (PRISMA) statement, seeking documents from Scopus and PubMed archives. Eleven studies (out of the initial 675 records) have met the established criteria and reported combined approaches from radiomics and connectomics. Three subgroups of approaches were identified, based on the MRI modalities used to obtain radiomic and connectomic features. The first group of 3 studies combined radiomics and connectomics applied to structural MRI (sMRI) data sets; the second group of 5 studies combined radiomics applied to sMRI data and connectomics applied to diffusion (dMRI) and/or functional MRI (fMRI) data sets; the third group of 3 studies combined radiomics and connectomics applied to fMRI. This review highlighted the recent growing interest in combining MRI-based radiomics and connectomics to explore the human brain for neurological, psychiatric, and oncological conditions. Current methodologies and challenges were discussed, pointing out future research directions to improve or standardize these approaches and the gaps to be filled to advance the field.
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Affiliation(s)
- Maria Agnese Pirozzi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Federica Franza
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Marianna Chianese
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Simone Papallo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Alessandro Pasquale De Rosa
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy.
| | - Leandro Donisi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, Naples 80138, Italy
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Jia S, Zhang M. Frailty and the Survival of Patients With Endometrial Cancer: A Meta-Analysis. Res Nurs Health 2025; 48:371-384. [PMID: 40065737 DOI: 10.1002/nur.22456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/19/2025] [Accepted: 02/11/2025] [Indexed: 05/04/2025]
Abstract
The aim of this study is to investigate the association between frailty and overall survival (OS) and progression-free survival (PFS) in women with endometrial cancer (EC). Frailty is increasingly recognized as a significant predictor of outcomes in cancer patients, yet its impact on survival among EC patients remains unclear. This study is a systematic review and meta-analysis. PubMed, Embase, and Web of Science from database inception to September 28, 2024 were searched for cohort studies evaluating frailty in relation to survival in EC patients. Inclusion criteria focused on studies reporting hazard ratios (HRs) for OS or PFS, comparing frail versus nonfrail patients. A random-effects model was applied. Eight cohort studies involving 486,138 women reported the outcome of OS, and 4 of them involving 378 women also reported the outcome of PFS. Frailty was associated with poor OS (HR: 1.78, 95% confidence interval [CI]: 1.56-2.03, p < 0.001) without significant heterogeneity (I2 = 0%). Sensitivity analyses confirmed the stability of this association. Subgroup analyses according to the mean age of the patients, tools for evaluating frailty, follow-up duration, and study quality score showed consistent results (p for subgroup difference: 0.35-0.98). Four studies indicated a significant association between frailty and worse PFS (HR: 1.91, 95% CI: 1.24-2.95, p = 0.003), also with no heterogeneity (I2 = 0%). The results of the study conclude that frailty is associated with poor survival in EC. Although these findings should be validated in large prospective cohort studies, this meta-analysis highlights the possible role of frailty assessment in risk stratification and prognostic prediction of patients with EC. No patient or public contribution.
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Affiliation(s)
- Shanshan Jia
- Oncology Ward 1, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Min Zhang
- Gynecology Ward, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
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Pan H, Logan DB, Stephens AN, Payre W, Wang Y, Peng Z, Qin Y, Koppel S. Exploring the effect of driver drowsiness on takeover performance during automated driving: An updated literature review. ACCIDENT; ANALYSIS AND PREVENTION 2025; 216:108023. [PMID: 40174509 DOI: 10.1016/j.aap.2025.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/08/2025] [Accepted: 03/27/2025] [Indexed: 04/04/2025]
Abstract
INTRODUCTION Vehicle automation technology has considerable potential for reducing road crashes associated with human error, including issues related to driver drowsiness. However, before full automation becomes available on public roads, it will be essential for drivers to take back control from automated driving systems when requested. This poses a challenge for drivers, particularly as automation may further exacerbate drowsiness. This paper aims to update a systematic review published in 2022 (Merlhiot & Bueno, Accident Analysis and Prevention, 170, 106536), to discuss factors affecting driving drowsiness and takeover performance with a particular focus on those not identified in previous review. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, three databases: Web of Science, PubMed and Scopus were searched for studies published between March 2021 and October 2024. The following eligibility criteria were applied for study inclusion: 1) participants must have interacted with a simulated or real-world vehicle featured with driving automation Level 2 or above; 2) with at least one measurement indicator of driver drowsiness; 3) with at least one measurement indicator of takeover performance; 4) be conducted within a controlled experimental design. From an initial selection of 182 articles from databases, a total of twelve published articles were obtained after removing duplicates, title, abstracts and full texts checking. Additionally, 17 articles from the previous review were included, resulting in a total of 29 articles for this review study. RESULTS Driver drowsiness (e.g, increased Karolinska Sleepiness Scale levels, blink frequency) tended to increase with both the duration of automated driving and automation levels. Engaging in non-driving related tasks (NDRTs) alleviates drowsiness (e.g, lower heart rate and percentage of eye closure), but reduces takeover performance (e.g., longer braking reaction times, stronger longitudinal acceleration, shorter minimal time to collision). Compared to older drivers, younger drivers were more susceptible to drowsiness, while older drivers had worse takeover performance (e.g., delayed steering reaction time, higher collision rates). Sleep inertia and circadian rhythms were also identified as factors influencing takeover performance. The road monitoring task helps prevent excessive participation in NDRTs and improves takeover performance (e.g, reduced brake reaction times and maximum steering velocity, increased the minimum time to collision). Digital voice assistants and scheduled manual driving help maintain alertness (e.g, decreased blink duration) and enhance takeover performance (e.g, shorter reaction time to resume steering). There were several limitations of the methodologies applied in the existing studies, among which were: 1) a lack of verification through real-world driving experiments; 2) insufficient diversity in the measurement of driver drowsiness; 3) singularity of takeover scenarios; 4) failure to reveal the mechanism by which drowsiness affects takeover performance. CONCLUSION Factors such as duration of automated driving, NDRT engagement, driver age, sleep-related issues and automation levels influence the development of drowsiness and subsequent takeover performance. This literature review highlights several necessary directions for future research: 1) what underlying factors affect drowsiness and take over performance; 2) how to prevent the occurrence of driver drowsiness; 3) how to alleviate driver drowsiness once it occurs; 4) how to assist drowsy drivers to regain control of the vehicle safely and quickly.
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Affiliation(s)
- Hengyan Pan
- Monash University Accident Research Centre, Monash University, Melbourne 3800, Australia; College of Transportation Engineering, Chang'an University, Xi'an 710018, China.
| | - David B Logan
- Monash University Accident Research Centre, Monash University, Melbourne 3800, Australia.
| | - Amanda N Stephens
- Monash University Accident Research Centre, Monash University, Melbourne 3800, Australia.
| | - William Payre
- National Transport Design Centre, Coventry University, Coventry CV1 2TT, UK.
| | - Yonggang Wang
- College of Transportation Engineering, Chang'an University, Xi'an 710018, China.
| | - Zhipeng Peng
- School of Economics and Management, Xi'an Technological University, Xi'an 710021, China.
| | - Yang Qin
- College of Transportation Engineering, Chang'an University, Xi'an 710018, China.
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Melbourne 3800, Australia.
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Sousa SSDS, Nery ES, Giuffrida FMA. Low-carbohydrate diet in type 1 diabetes: A systematic review. Clin Nutr ESPEN 2025; 67:250-256. [PMID: 40097047 DOI: 10.1016/j.clnesp.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 02/19/2025] [Accepted: 03/10/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND The treatment of type 1 diabetes mellitus (T1D) consists of applying insulins with different action profiles and ingesting known amounts of nutrients from the diet. Although there is no specific recommendation regarding the distribution of these macronutrients, low-carbohydrate (LC) diets seem to show promise in some types of diabetes, but their role in T1D is still controversial, given the potential glycemic improvement, but with the concurrent possibility of changes in other parameters such as lipids. This systematic review aimed to evaluate the metabolic effects of these diets on T1D. METHODS A systematic review in PubMed, Embase, and Lilacs with publications from the last 10 years was used as a data source. RESULTS Nine clinical trials were included. We have found LC diet to be associated with increased time in range in continuous glucose monitoring (+5.68 %, p = 0.01); decreased time below range (-0.53 %, p = 0.01 with 54 mg/dL threshold and -2.28 %; p = 0.01 with 70 mg/dL threshold), coefficient of variation (-5.51 %; p = 0.01), total insulin daily dose (-8.39 %; p = 0.01), and systolic blood pressure (-4.83 mmHg, p = 0.04). CONCLUSIONS LC diets show potential benefit in metabolic control of people living with T1D, warranting the design of future robust clinical trials.
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Affiliation(s)
| | - Erick Santos Nery
- Universidade do Estado da Bahia - UNEB, Departamento de Ciências da Vida, Salvador, BA, Brazil
| | - Fernando M A Giuffrida
- Universidade do Estado da Bahia - UNEB, Departamento de Ciências da Vida, Salvador, BA, Brazil.
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Saad Sayed M, Rath S, Rasool W, Saeed F, Kashif H, Amer M. Efficacy of Liposomal Bupivacaine Versus Standard Bupivacaine Following Abdominal Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Pract 2025; 25:e70048. [PMID: 40387544 DOI: 10.1111/papr.70048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 04/02/2025] [Accepted: 05/05/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND The development of liposomal bupivacaine (LB) as an anesthetic was widely lauded due to the potential benefits this drug claimed to carry. This systematic review and meta-analysis aimed to assess the efficacy of LB versus standard bupivacaine (SB) in improving postoperative outcomes, including pain scores and morphine use. METHODS PubMed, Cochrane CENTRAL, Web of Science, and MedLine databases were searched until April 2024. All trials evaluating the efficacy of LB versus SB in abdominal surgeries like colorectal procedures, bariatric surgeries, and hemorrhoidectomy were included. Data analysis was conducted in Review Manager employing a random-effects model. RESULTS Eight clinical trials with 810 patients were included. No statistically or clinically significant result was obtained on using LB over SB in reducing postoperative pain score on postoperative day 0 (POD0) (mean difference (MD) = -0.19, [95% confidence interval (CI): -0.91, 0.53]; p = 0.60), POD1 (MD = -0.11 [95% CI: -1.12, 0.91]; p = 0.84), POD2 (MD = -0.18 [95% CI: -0.57, 0.22]; p = 0.22), and POD3 (MD = 0.01 [95% CI: -0.55, 0.22]; p = 0.57). Additionally, there was no reduction in morphine use in PODs 0-3, time to ambulation, hours to postoperative flatus, or length of hospital stay between the groups. CONCLUSION Our findings showed that LB is not superior to SB in the surgical plane for individuals undergoing abdominal procedures.
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Affiliation(s)
| | - Shree Rath
- All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Warda Rasool
- King Edward Medical University, Lahore, Punjab, Pakistan
| | - Fatima Saeed
- United Medical and Dental College, Karachi, Sindh, Pakistan
| | - Haider Kashif
- Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Mohab Amer
- Faculty of Medicine, Helwan University, Cairo, Egypt
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Au HCT, Lam PH, Lim PK, McIntyre RS. Role of Glucagon-Like Peptide-1 on Amyloid, Tau, and α-Synuclein: Target Engagement and Rationale for the Development in Neurodegenerative Disorders. Neurosci Biobehav Rev 2025; 173:106159. [PMID: 40252880 DOI: 10.1016/j.neubiorev.2025.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 04/08/2025] [Accepted: 04/13/2025] [Indexed: 04/21/2025]
Abstract
INTRODUCTION Glucagon-like Peptide-1 (GLP-1) and Glucagon-Like Peptide-1 receptor agonist (GLP-1 RA) administration has been associated with neuroprotective effects in neurodegenerative disorders. We conducted a comprehensive synthesis of known effects of GLP-1 and GLP-1 RAs on the cognitive, cellular, and molecular changes in neurodegenerative diseases. METHODS We examined preclinical and clinical paradigms that investigated changes in neurodegenerative disease pathology following administration of GLP-1 and GLP-1 RAs. Relevant articles were retrieved through OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), PubMed, and Web of Science from database inception to September 27th, 2024. Primary studies investigating the aforementioned changes following GLP-1 and GLP-1 RA administration were retrieved for analysis (n = 62). RESULTS GLP-1 and GLP-1 RAs (i.e. dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide) improved cognitive and motor function in neurodegenerative diseases in preclinical and clinical paradigms. Additionally, GLP-1 and GLP-1 RAs were associated with modulating changes in neuroinflammation, oxidative stress, and proliferative pathways. DISCUSSION We observed that GLP-1 and GLP-1 RAs modulate molecular and cellular changes known to govern the phenomenology of neurodegenerative diseases. Future research should examine the interaction between signaling molecules, neuronal subpopulations, and cognitive effects affected by GLP-1 and GLP-1 RA administration.
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Affiliation(s)
- Hezekiah C T Au
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.
| | - Pak Ho Lam
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Poh Khuen Lim
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Miroshnychenko A, Roldan YM, Ibrahim S, Kulatunga-Moruzi C, Dahlin K, Montante S, Couban R, Guyatt G, Brignardello-Petersen R. Mastectomy for Individuals with Gender Dysphoria Younger Than 26 Years: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2025; 155:915-923. [PMID: 39252149 DOI: 10.1097/prs.0000000000011734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND Gender dysphoria (GD) refers to psychological distress associated with the incongruence between one's sex and one's gender. In response to GD, birth-registered female patients may choose to undergo mastectomy. In this systematic review, the authors summarize and assess the certainty of the evidence about the effects of mastectomy. METHODS We searched MEDLINE, Embase, PsycINFO, Social Sciences Abstracts, LGBTQ+ Source, and Sociological Abstracts through June 20, 2023. We included studies comparing mastectomy to no mastectomy in birth-registered patients younger than 26 years with GD. Outcomes of interest included psychological and psychiatric outcomes, and physical complications. Pairs of reviewers independently screened articles, abstracted data, and assessed risk of bias of the included studies. We performed meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS We included 39 studies. Observational studies ( n = 2) comparing mastectomy to chest binding provided very low-certainty evidence for the outcome of GD. One observational study comparing mastectomy to no mastectomy provided very low-certainty evidence for the outcomes of global functioning and suicide attempts, and low-certainty evidence for the outcome nonsuicidal self-injury (adjusted OR, 0.47; 95% CI, 0.22 to 0.97). Before-and-after ( n = 2) studies provided very low-certainty evidence for all outcomes. Evidence from case series ( n = 34) studies ranged from high to very low certainty. CONCLUSIONS Case series studies demonstrated high-certainty evidence for the outcomes of death, necrosis, and excessive scarring; however, these are limited in methodologic quality. In comparative and before-and-after studies, the evidence ranged from low to very low certainty.
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Affiliation(s)
| | - Yetiani M Roldan
- From the Department of Health Research Methods, Evidence and Impact
| | - Sara Ibrahim
- From the Department of Health Research Methods, Evidence and Impact
| | | | | | | | | | - Gordon Guyatt
- From the Department of Health Research Methods, Evidence and Impact
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Mulraney M, Rincones O, Bryant C, Saredakis D, Ghezzi E, Lampit A. A mixed methods systematic review of assistance dogs for people with autism. Neurosci Biobehav Rev 2025; 173:106160. [PMID: 40239907 DOI: 10.1016/j.neubiorev.2025.106160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 04/08/2025] [Accepted: 04/14/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES To critically examine and synthesise the available evidence regarding the impact of assistance dogs on individuals with autism. STUDY DESIGN Mixed methods systematic review with meta-analysis of quantitative data and meta-aggregation of qualitative data. Studies were eligible for inclusion if they included participants with autism and data describing the impact, effectiveness, or participant experience with an assistance dog or a companion dog. DATA SOURCES CENTRAL, Embase, MEDLINE, and PsycINFO. DATA SYNTHESIS Fourteen studies (one randomised controlled trial, three cohort, seven cross-sectional, and three single-arm studies) were included in the meta-analysis and 13 studies (eight cross-sectional, three longitudinal, and two case studies) were included in the meta-aggregation. There was some quantitative evidence that assistance dogs may be associated with benefit, but the pooled effect sizes are similar to those associated with companion dogs. The qualitative data suggested that parents perceived a broad range of benefits of assistance dogs but may be unprepared for the challenges associated with owning an assistance dog. CONCLUSION There is a lack of compelling evidence to suggest that assistance dogs confer unique benefits for individuals with autism. The evidence base is limited and of poor quality thus the potential benefits identified need to be interpreted with caution. Interpreting the quantitative and qualitative studies together, the findings indicate many potential benefits of assistance dogs for people with autism could be achieved by a companion dog.
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Affiliation(s)
- Melissa Mulraney
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | | | - Chloe Bryant
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
| | | | | | - Amit Lampit
- National Disability Insurance Agency, Australia; Department of Psychiatry, University of Melbourne, Australia
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Zhang Y, Chen Y, Guo C, Li S, Huang C. Systemic immune-inflammation index as a predictor of survival in non-small cell lung cancer patients undergoing immune checkpoint inhibition: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2025; 210:104669. [PMID: 39978427 DOI: 10.1016/j.critrevonc.2025.104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 02/06/2025] [Accepted: 02/16/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND This meta-analysis aims to evaluate the association between pretreatment systemic immune-inflammation index (SII) levels and progression-free survival (PFS) and overall survival (OS) in NSCLC patients receiving immune checkpoint inhibitors (ICIs). METHODS A systematic search was conducted across PubMed, Embase, and Web of Science. Hazard ratios (HRs) with 95 % confidence intervals (CIs) for PFS and OS were extracted or calculated. Random-effects models were employed to pool the results and subgroup analyses were performed based on study characteristics, treatment regimens, and analytical methods. RESULTS Two prospective and 11 retrospective studies involving 2342 NSCLC patients treated with ICIs were included. A high pretreatment SII was significantly associated with poor PFS (HR: 2.05, 95 % CI: 1.59-2.64, p < 0.001; I2 = 42 %) and poor OS (HR: 1.54, 95 % CI: 1.29-1.82, p < 0.001; I2 = 22 %). Subgroup analyses according to the country of the study, lines of treatment, cancer stage, methods for determining the cutoffs of SII, and the analytic models showed consistent results (p for subgroup difference all > 0.05). Interestingly, the subgroup analyses indicated a stronger association in patients receiving ICIs alone versus those receiving concurrent chemotherapy (p for subgroup difference = 0.04). CONCLUSIONS High pretreatment SII is associated with worse PFS and OS in NSCLC patients treated with ICIs, particularly for the patients receiving ICIs alone without concurrent chemotherapy.
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Affiliation(s)
- Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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Nguyen P, Sanderson B, Makama M, Mills K, Ammerdorffer A, Gülmezoglu AM, Vogel JP, McDougall ARA. Polyphenols for the Prevention or Management of Preeclampsia: A Systematic Review and Meta-Analysis. BJOG 2025; 132:867-879. [PMID: 40025969 PMCID: PMC12051244 DOI: 10.1111/1471-0528.18106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/29/2025] [Accepted: 02/04/2025] [Indexed: 03/04/2025]
Abstract
OBJECTIVES To evaluate the effects of polyphenol-containing products during pregnancy on preeclampsia-related maternal and neonatal outcomes. DESIGN Systematic review and meta-analysis. SETTING Nine databases and one trial registry, from inception to August 11th, 2023. POPULATION/SAMPLE Randomised controlled trials where women received polyphenolic-containing products (as standardised extracts or dietary supplements) compared to placebo or standard care. METHODS All review stages were conducted by two independent reviewers. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method using a framework for studies with few events. MAIN OUTCOME MEASURES Clinical outcomes combining the core outcome set for preeclampsia and WHO's priority outcomes. RESULTS Fourteen trials investigating six candidates were included. In women with preeclampsia, the addition of epigallocatechin gallate (EGCG) to nifedipine may reduce the time needed to achieve blood pressure control (mean difference (MD) = -14.10 min, 95% CI -18.46 to -9.74) and increase the time to the next hypertensive crisis (MD = 3.10 h, 95% CI 2.35 to 3.85) compared to nifedipine alone (1 trial, 349 women; low certainty). Similarly, the addition of resveratrol to nifedipine may reduce the time needed to achieve blood pressure control (MD = -15.50 min, 95% CI -19.83 to -11.17) and increase the time to the next hypertensive crisis (MD = 2.50 h, 95% CI 2.09 to 2.91) (1 trial, 349 women; low certainty). No differences were observed for other outcomes or candidates (Salvia miltiorrhiza, Bryophyllum pinnatum , raspberry and cranberry extracts). CONCLUSIONS ECGC and resveratrol supplements have been investigated for potential effects in managing clinical signs and symptoms of preeclampsia; however, evidence on the clinical and adverse effects of polyphenols is limited and uncertain.
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Affiliation(s)
- Phi‐Yen Nguyen
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneAustralia
| | - Ben Sanderson
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneAustralia
| | - Maureen Makama
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneAustralia
| | - Kate Mills
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneAustralia
| | | | | | - Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneAustralia
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Porter JE, Dabkowski E, Smith W, Fernando A, Seaward L. An analysis of systemic incident investigation methodologies applied in serious injury or fatality events: A rapid systematic review. PUBLIC HEALTH IN PRACTICE 2025; 9:100598. [PMID: 40104248 PMCID: PMC11914981 DOI: 10.1016/j.puhip.2025.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 01/09/2025] [Accepted: 01/10/2025] [Indexed: 03/20/2025] Open
Abstract
Objective This rapid review examines studies that have applied an accident causation analysis method building upon the seminal systematic review conducted by Hulme et al. (2019). Study design A rapid review of the literature. Methods The following databases, Scopus, EBSCO, Academic Search Compete, CINAHL Complete, MEDLINE, APA PsycArticles, APA PyscINFO, Business Source Ultimate, Business Source Complete, Web of Science and Science Direct were searched for articles that were published from 2019 to June 2023. Eligible studies applied accident analysis modelling to serious injury and fatalities across a variety of industries. Results A total of five papers met the inclusion criteria of the rapid review. The studies applied a variety of accident causation models from single large-scale accidents to multiple accident analysis originating predominately from manufacturing industries. The data continued to support the evidence of accident causation analysis models focus on errors, malfunctions, and deficiencies rather than a whole of systems approach and remained complex and difficult to interpret. Based upon the core elements of existing models and following the rapid review of the literature, a novel accident causation analysis approach called the SCALE® Process Model was introduced. Conclusion There is need to further explore research-based incident analysis reporting systems that can be applied across a variety of industries and disciplines. The SCALE® Process Model uses systemic techniques to provide a deeper understanding of how multiple factors contribute to the severity of an event aiding in reducing the incidence of serious injuries and fatalities.
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Affiliation(s)
- Joanne E Porter
- Director of the Collaborative Evaluation and Research Centre (CERC) Federation University Australia, Gippsland, Victoria, Australia
| | - Elissa Dabkowski
- Research Fellow Collaborative Evaluation and Research Centre (CERC) Federation University Australia, Gippsland, Victoria, Australia
| | | | | | - Liz Seaward
- Collaborative Evaluation and Research Centre (CERC) Federation University Australia, Gippsland, Victoria, Australia
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Patsouras M, Wright C, Caluzzi G, Kuntsche E, Kuntsche S. Dissolving contradictory demands: A systematic review of alcohol use of working mothers. Drug Alcohol Depend 2025; 271:112664. [PMID: 40215872 DOI: 10.1016/j.drugalcdep.2025.112664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 02/23/2025] [Accepted: 03/21/2025] [Indexed: 05/06/2025]
Abstract
BACKGROUND Working mothers perform 'double shifts' of paid and domestic labour. Increased rates of employment among mothers in high income countries, and the impact of the alcohol industry actively promoting alcohol to working mothers, makes it crucial for preventative efforts to understand the factors driving alcohol use among this population. This systematic review of qualitative and quantitative studies provides an overview of the drinking patterns of working mothers and their predictors. METHODS Four databases were systematically searched in August 2024. The population of interest were adult women in high income countries, who were both mothers of at least one dependent child and employed in any capacity. The methodological quality was assessed using the Mixed Methods Appraisal Tool. Following a convergent integrated approach, narrative synthesis was conducted for all studies. RESULTS Of the 4623 records maintained for screening, 22 articles (15 quantitative and 7 qualitative) were included. Working mothers were more often drinkers and consumed a higher quantity per occasion (including binge and risky drinking) in comparison to mid-life women and non-working mothers. Alcohol use was also linked to managing emotional states, as a commodity to 'cope' with gendered norms. Living in a society with increased gender equity and being partnered or married had a protective effect on heavy drinking and consumed quantity. CONCLUSIONS Working mother's drinking is governed by gender norms and expectations, and countries who advance policies to improve the acceptability and compatibility of motherhood and employment may reduce working mother's alcohol use.
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Affiliation(s)
- Maree Patsouras
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
| | - Cassandra Wright
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Menzies School of Health Research, Northern Territory, Australia; Burnet Institute, Melbourne, Australia
| | - Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; The Bouverie Centre, La Trobe University, Melbourne, Australia
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Ries JD, De Santis C, Dagne MB, Ouabicha K, Sood P, Heyn PC. The redundant landscape of meta-analyses: Evaluating exercise interventions for older adults with cognitive impairment. Ageing Res Rev 2025; 108:102754. [PMID: 40253011 DOI: 10.1016/j.arr.2025.102754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 03/28/2025] [Accepted: 04/11/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Exercise to benefit cognition in older adults with cognitive impairment is well-studied. A recent proliferation of synthesis studies might be a positive contribution to the science; however, redundancy in research can be wasteful and detrimental to drawing confident conclusions about the evidence. This synthesis-based method study was designed to analyze: 1) the frequency and growth patterns of meta-analyses (MAs) and randomized controlled trials (RCTs) on this topic; and 2) the redundancy rate of the RCT studies included in MAs. METHODS This study was borne of a living systematic review, following standard synthesis methodology (PROSPERO registration, librarian-assisted search algorithms developed for multiple databases, searches updated regularly with most recent search in 2025). Frequency counts determined the number of RCTs and how many times they were included across the MAs. RESULTS Forty MAs were identified and included in the synthesis representing a total of 728 RCT studies. After reviewing RCT duplicates, 276 (37.9%) unique RCT studies comprised this body of evidence. Among these, 153 RCTs were cited in only one MA and 123 were cited in 2-19 different MAs. Thus, 452 (62.1%) of all RCTs used across the 40 MAs were redundant (i.e., represented in more than one MA). CONCLUSIONS This study found substantial redundancy in the RCTs used in MAs evaluating the cognitive impact of exercise for older adults with cognitive impairment. Replication is common practice in research but reliance on the same RCTs in multiple MAs creates an illusion of robustness when, in fact, the strength and diversity of the evidence may be more limited. Research redundancy is wasteful and may actually stagnate advancement of this science.
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Affiliation(s)
- Julie D Ries
- Center for Optimal Aging, Marymount University, Arlington, VA, USA; Physical Therapy Program, School of Health Sciences, College of Health and Education, Marymount University, USA.
| | - Claudia De Santis
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Epidemiology and Statistics Unit, Italy.
| | | | - Kaoutar Ouabicha
- Center for Optimal Aging, Marymount University, Arlington, VA, USA; University of Sidi Mohamed Ben Abdellah (USMBA) Department of Medicine, Fes, Morocco.
| | - Pallavi Sood
- Center for Optimal Aging, Marymount University, Arlington, VA, USA.
| | - Patricia C Heyn
- Center for Optimal Aging, Marymount University, Arlington, VA, USA.
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Fleming SA, Fleming RAF, Peregoy J. The non-cariogenic effects of aspartame: A systematic review and meta-analysis. J Dent 2025; 157:105715. [PMID: 40157710 DOI: 10.1016/j.jdent.2025.105715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/30/2025] [Accepted: 03/21/2025] [Indexed: 04/01/2025] Open
Abstract
OBJECTIVES This systematic review and meta-analysis evaluated the cariogenicity of aspartame and explored mechanisms of action. DATA, SOURCES, AND STUDY SELECTION A literature search was conducted across PubMed, Web of Science, Scopus, and CENTRAL on February 16th, 2024 (registered with PROSPERO CRD42024513463). Eligible studies evaluated the cariogenicity of aspartame in humans, animals, and dental samples compared to sucrose or other controls. Random effects meta-analysis was conducted on caries incidence, acidogenicity, oral bacterial composition, and mineralization for preclinical and clinical trials. Certainty was assessed using the GRADE framework. CONCLUSION Four studies in bovine blocks, seven preclinical trials in rats, and two clinical studies were identified. In clinical studies aspartame was less acidogenic than sucrose (standardized mean difference [95 % confidence interval]: 3.07 [-0.97, 7.10], very low certainty), and similar to water (-0.51 [-1.51, 0.48], low certainty). Preclinical studies indicated aspartame did not promote caries development (-0.01 [-0.31, 0.30], low certainty), reduced caries compared to sucrose (-2.51 [-3.50, -1.52], moderate certainty), but had minimal impact when added to sucrose (-0.53 [-1.29, 0.23], very low certainty), except when assessed in sulcal caries (-0.86 [-1.70, -0.02]). Aspartame had minimal effect on bacterial composition. Studies on bovine blocks indicated aspartame was less acidogenic and erosive than sucrose. While aspartame is a non-cariogenic alternative to sucrose, there is limited evidence supporting anti-cariogenicity. The reduction in caries observed with aspartame use is likely due to its role in minimizing sugar intake rather than biological activity. More long-term studies in humans are needed to fully assess aspartame's impact on oral health. CLINICAL SIGNIFICANCE Replacement of sugar with aspartame may help maintain healthy oral pH in humans. Animals fed aspartame instead of sugar consistently develop fewer caries, and lab tests indicate aspartame lessens oral acids and dental erosion compared to sugar.
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Tao Y, Yang Y, Luo B, Lian D, Weng J, Li F, Yan J, Chen Y. Did Economic Evaluations on Pharmaceuticals and Vaccination for COVID-19 Maintain Adequate Reporting Quality? A Systematic Review and Quantitative Analysis. J Evid Based Med 2025; 18:e70040. [PMID: 40490654 DOI: 10.1111/jebm.70040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 05/07/2025] [Accepted: 05/26/2025] [Indexed: 06/11/2025]
Abstract
AIM This study seeks to assess the reporting quality of published health economic evaluations (HEEs) on vaccination and pharmaceuticals for Coronavirus Disease 2019 (COVID-19), and identify potential predictors associated with reporting quality. METHODS A systematic literature search was performed in PubMed, Web of Science, Embase, the Cochrane Library, INAHTA, and Chinese databases (e.g., SinoMed, CNKI, and WANGFANG Database). HEEs published between January 1, 2020, and August 20, 2022, that considered both costs and outcomes of vaccination and pharmaceuticals for COVID-19 were included. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement scored the reporting quality for incorporated studies. A linear regression analysis was employed to characterize the impact of various features on reporting quality. RESULTS Fifty-two studies were included in the analysis. The average CHEERS score was 18.54±3.41, with the scoring rate of reporting quality was 67% (±12%). The most inadequately reported items included health economic analysis plan, time horizon, valuation of outcomes, heterogeneity, uncertainty, distributional effects, and stakeholder involvement. Higher reporting compliance was associated with articles applying a longer time horizon (no less than 1 year) and those using a societal perspective (p < 0.05). The investigations that did not specify a study perspective received the lowest scores among the subgroups. CONCLUSION Overall, the included HEEs on vaccination and pharmaceuticals for COVID-19 had moderate reporting quality. Future HEEs should be transparently and sufficiently reported in accordance with standard guidelines (e.g., the CHEERS 2022 statement), to increase the interpretability of results, improve the reporting quality, and better inform the decision-making.
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Affiliation(s)
- Ying Tao
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Bingxing Luo
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dai Lian
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Junling Weng
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Fuming Li
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Juntao Yan
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Hung CH, Kwok YC, Yip J, Wong HH, Leung YY. Bioabsorbable Magnesium-Based Materials Potential and Safety in Bone Surgery: A Systematic Review. Craniomaxillofac Trauma Reconstr 2025; 18:24. [PMID: 40276521 PMCID: PMC12015880 DOI: 10.3390/cmtr18020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 03/28/2025] [Accepted: 04/01/2025] [Indexed: 04/26/2025] Open
Abstract
The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases, followed by manual and reference searches. The articles selected were evaluated for patient characteristics, biocompatibility, the need for revision surgery, bone union rates, and the incidence of gas formation associated with implant degradation. Out of the 631 initially identified articles, 8 studies including a total of 386 patients were included in the final qualitative analysis. The magnesium (Mg) group carried a lower rate of revision surgery (1/275) when compared to the titanium (Ti) group (18/111). A high rate of bone union was found in the Mg group and a low infection rate (3/275) was found in the Mg group. The serum level of Mg and calcium (Ca) were not found to be affected. Mg implants are applied in various orthopedic surgeries but they are not applied in in oral or maxillofacial surgeries. Mg implants appear to be a safe alternative for bone fixation and are resorbable. Future research into the application of Mg implants in bone fixation in different anatomical sites is essential to fully harness their potential benefits for patients.
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Affiliation(s)
- Chun Ho Hung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; (C.H.H.); (Y.C.K.); (J.Y.); (H.H.W.)
| | - Yui Chit Kwok
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; (C.H.H.); (Y.C.K.); (J.Y.); (H.H.W.)
| | - Jason Yip
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; (C.H.H.); (Y.C.K.); (J.Y.); (H.H.W.)
| | - Ho Hin Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; (C.H.H.); (Y.C.K.); (J.Y.); (H.H.W.)
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; (C.H.H.); (Y.C.K.); (J.Y.); (H.H.W.)
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Kugel J, Laukkonen RE, Yaden DB, Yücel M, Liknaitzky P. Insights on psychedelics: A systematic review of therapeutic effects. Neurosci Biobehav Rev 2025; 173:106117. [PMID: 40127876 DOI: 10.1016/j.neubiorev.2025.106117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 02/18/2025] [Accepted: 03/16/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Insight - a sudden change in understanding or perspective that feels true or reliable - is a common occurrence during psychedelic experiences, and often considered by clinicians and patients to be central to their therapeutic value. However, their occurrence and role has not been systematically assessed. OBJECTIVES We reviewed all peer-reviewed studies that published data on insight catalysed by a classic psychedelic at psychoactive levels to elucidate several aspects of psychedelic-catalysed insight, including its prevalence, relationship to dose, time-course, and relationship to therapeutic outcomes. Risk of bias was assessed regarding selection, reliability, causality, and transparency. PROSPERO registration: CRD42023405854 FINDINGS: The final database and key bibliography searches were completed on July 13, 2024. We screened 741 abstracts and included 98 studies (40 survey, 58 interventional). Insight was positively correlated with psychedelic dose, and was significantly higher following psychedelics in 43 of 46 (93 %) studies that presented a comparison to a placebo condition. Crucially, 25 of 29 studies (86 %) found that insight was associated with therapeutic improvement, and this relationship was often stronger than mystical-type experience, which has received more research attention. INTERPRETATION This review indicates that psychedelic-catalysed insight is associated with therapeutic improvement, suggesting its importance for clinical practice and for understanding the mechanisms of psychedelic therapy. LIMITATIONS Heterogeneous study designs and operationalisations of insight precluded a meta-analytic summary. Publication bias and selective reporting is possible, given insight was typically not a primary outcome of the included studies.
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Affiliation(s)
- Joshua Kugel
- Department of Psychiatry, School of Clinical Sciences, Monash University, Australia; School of Psychological Sciences, Monash University, Australia.
| | | | - David B Yaden
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States
| | - Murat Yücel
- Department of Psychiatry, School of Clinical Sciences, Monash University, Australia; QIMR Berghofer Medical Research Institute, Australia
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Australia; School of Psychological Sciences, Monash University, Australia
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Killu K, Patino-Sutton C, Kysh L, Castriotta R, Oropello J, Huerta L, Engracia D, Merchant K, Wee CP, Cortessis VK. The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis. J Ultrasound 2025; 28:281-294. [PMID: 39419883 PMCID: PMC12145375 DOI: 10.1007/s40477-024-00958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/18/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVES Septic shock in critically ill patients can increases morbidity and mortality. We aimed to study the effect on outcomes when integrating point of care (POC) echocardiography in the management of septic shock patients in the Intensive Care Unit (ICU) who are being treated according to the Surviving Sepsis Campaign (SSC) guidelines. METHODS An electronic search of MEDLINE through PubMed, clinical trials.gov and google scholar was conducted for the period from January 1990-January 2024 to identify studies of septic shock adult and pediatric patients in the ICU managed according to SSC guidelines with or without POC echocardiography. Three reviewers extracted data independent of each other. Cochrane collaboration tool was used for bias assessment. Random effect meta-analysis used to pool data. RESULTS A total of 1701 articles identified. Seven studies included in the final report with a total of 3885 patients. POC echocardiography guided septic shock management was associated with lower in-hospital and 28-day mortality (sOR = 0.82 [95%CI: 0.71-0.95], p = 0.01), more frequent initiation of inotropic support (sOR = 2.42 [95%CI 1.92-3.03], p < 0.0001) and shorter time to achieve lactate clearance (SMD = - 0.87 h [95%CI - 1.23 h to - 0.51 h], p < 0.0001). Summary estimates did not achieve significance for effect of POC echocardiography on 24-h fluid intake (SMD = - 2.11 ml [95%CI - 5.93 ml to 1.72 ml], p = 0.28) on mechanical ventilation-free days (SMD = 0.03 days [95%CI - 0.04 to 0.10], p = 0.94). Shock reversal time analysis was less meaningful due to the small number of studies reporting outcome. CONCLUSIONS POC echocardiography guided management in septic shock patients in the ICU can lead to a decrease in mortality, increase in initiation of inotropic support, and a decrease in lactate clearance time. Larger cohort studies and data collection and analysis are needed for further understanding and optimizing standardization of protocols for POC echocardiography use in septic shock patients in the ICU.
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Affiliation(s)
- Keith Killu
- Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA.
| | - Cecilia Patino-Sutton
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Keck School of Medicine, Norris Medical Library, University of Southern California, Los Angeles, CA, USA
- Davis Library, Univercity of California, Davis, CA, 95616, USA
| | - Richard Castriotta
- Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA
| | - John Oropello
- The Ichan School of Medicine at the Mount Sinai Hospital, New York, NY, USA
| | - Luis Huerta
- Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA
| | - Dominic Engracia
- Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA
| | - Karim Merchant
- Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA
| | - Choo Phei Wee
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Victoria Kristence Cortessis
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Stevens CJ, Borg D, Brade C, Carter S, Filingeri D, Lee J, Lim L, Mündel T, Taylor L, Tyler CJ. Head, Face, and Neck Cooling for Performance: A Systematic Review and Meta-Analysis. Int J Sports Physiol Perform 2025; 20:743-763. [PMID: 40355096 DOI: 10.1123/ijspp.2024-0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 03/13/2025] [Accepted: 03/22/2025] [Indexed: 05/14/2025]
Abstract
PURPOSE Cooling the head, face, and neck can have strong perceptual effects that contribute to improved performance. This systematic review aimed to determine the effect of cooling strategies targeting the head, face, and neck on physical and cognitive performance, determine any associated physiological and perceptual responses, synthesize adverse events, and provide practical applications. METHODS We conducted a systematic review and multilevel meta-analysis, adhering to PRISMA guidelines. Studies that investigated the effect of cooling strategies targeting the head, face, or neck on a physical or cognitive task using a controlled trial design were included. RESULTS Sixty-three studies were identified, involving 618 participants (86.6% male). Cooling strategies included water-perfused devices (18.7%), phase-change neck collars (17.3%), fanning/cold air (14.7%), phase-change headwear (13.3%), ice/gel packs (13.3%), cold towels (5.3%), menthol application (4.0%), water spraying/dousing (4.0%), or a combination of strategies (9.3%). The effect of cooling on both self-paced and fixed-intensity exercise tasks was inconclusive; the 95% CI of the pooled effect was compatible with no effect and medium beneficial effects but not harmful effects. We were unable to pool cognitive data. Cooling reduced the skin temperature at the target site and improved thermal sensation and comfort. Effects on heart rate and core and mean skin temperatures were negligible. Adverse events were rare, and no intervention subgroup was superior. CONCLUSION We recommend that athletes experiment with a range of head-, face-, and neck-cooling strategies, including using different doses and timings, to determine the optimal strategy for their individual and sport context.
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Affiliation(s)
- Christopher J Stevens
- Physical Activity, Sport and Exercise Research (PASER) Theme, Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - David Borg
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Carly Brade
- School of Allied Health, Exercise Science Discipline, Curtin University, Bentley, WA, Australia
| | - Sarah Carter
- Discipline of Exercise and Sports Science, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Davide Filingeri
- Thermosenselab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Jason Lee
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Heat Resilience and Performance Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louisa Lim
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Toby Mündel
- Hydration Exercise and Temperature Laboratory, Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Lee Taylor
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Moore Park, NSW, Australia
- Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
| | - Christopher J Tyler
- School of Human and Life Sciences, University of Roehampton, London, United Kingdom
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Amorim CSDE, Silva LSLDA, Marañón-Vásquez GA, Magno MB, Pintor AVB, Pires PP, Maia LC, Pithon MM. IS THERE A CORRELATION BETWEEN OBJECTIVE AND SUBJECTIVE METHODS TO ASSESS DENTAL ANXIETY? A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2025; 25:102092. [PMID: 40335208 DOI: 10.1016/j.jebdp.2025.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 12/29/2024] [Accepted: 01/13/2025] [Indexed: 05/09/2025]
Abstract
OBJECTIVE To assess the evidence about the correlation between objective and subjective methods for evaluating dental anxiety. METHODS Eligibility criteria were defined as follows: Patients (P): individuals in the dental care context; Index test (I): subjective methods; Reference test (R): objective methods; Outcome (O): correlation between methods to dental anxiety evaluation. Searches were conducted in 7 databases and grey literature up to November 2023, without language or date restrictions. The QUADAS-2 tool was employed to evaluate Risk of bias. A random-effects meta-analysis was performed to calculate pooled correlation coefficients between methods on the basis of the objective method analyzed. The GRADE approach was utilized to assess evidence certainty. RESULTS A total of 29 studies, with 1891 participants aged 3 to 82 years, were included, with 22 studies participating in the meta-analysis. The Risk of bias was mostly "unclear" due to inadequate methodology detail. Weak correlations were observed between subjective methods and heart rate (r 0.15 [0.08, 0.21], P < .001, I2 = 56%) and alpha-amylase (r 0.25 [0.11, 0.38], P < .001, I2 = 43%. Subjective methods showed a moderate correlation with cortisol analysis (r 0.40 [0.33, 0.47] P < .001, I2 = 72%). No other objective method displayed a significant correlation with subjective methods. The certainty of evidence was very low. CONCLUSION The findings can suggest a correlation between the following subjective and objective methods: ACDAS, DAS, MCDAS, MDAS and Cortisol; CFSS-DS, DAS, MCDAS, MDAS and Alpha-amylase; and DAS, DAS-R, MDAS, S-DAI, Venham Picture Anxiety, Venham Picture Test and Heart rate. Nonetheless, these results lack conclusiveness due to their very low certainty of evidence. REGISTRATION PROSPERO database registration number CRD42022298589.
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Affiliation(s)
- Camila Silva DE Amorim
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Larissa Soares Lima DA Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, USP, Ribeirão Preto, SP, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Andréa Vaz Braga Pintor
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Pedro Paulo Pires
- Department of Psychometrics, Institute of Psychology, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil.
| | - Matheus Melo Pithon
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil; Department of Health I, Southwest Bahia State University, UESB, Jequié, BA, Brazil
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Srinivasan M, Kamnoedboon P, Nantanapiboon D, Papi P, Romeo U. Non-surgical management of peri-implantitis with photodynamic therapy: A systematic review and meta-analysis of clinical parameters and biomarkers. J Dent 2025; 157:105680. [PMID: 40081730 DOI: 10.1016/j.jdent.2025.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 03/07/2025] [Accepted: 03/08/2025] [Indexed: 03/16/2025] Open
Abstract
OBJECTIVE To evaluate the clinical and biomarker outcomes of photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (MD) in the management of peri‑implantitis, and to compare its efficacy to MD alone or other non-surgical treatment modalities. DATA AND SOURCES Electronic searches in PubMed, Web of Science, and CENTRAL were conducted. 4675 studies published until November 2023 were screened. Clinical studies reporting on non-surgical treatments involving PDT were selected. Meta-analyses assessed clinical parameters (bleeding on probing [BOP], probing depth [PD], plaque index [PI], crestal bone loss [CBL], clinical attachment level [CAL]) and biomarkers. STUDY SELECTION A total of 25 studies were included. The meta-analysis of randomized controlled trials revealed that both MD alone and MD+PDT significantly improved clinical and biomarker outcomes compared to baseline. The addition of PDT provided greater improvements at 3 months for BOP (SMD:0.90; 95 % CI:1.53 to -0.28; p = 0.005), PD (SMD:1.15; 95 % CI:1.72 to -0.58; p < 0.0001), PI (SMD:0.74; 95 % CI:1.15 to -0.33; p = 0.0004) and CBL (SMD:0.38; 95 % CI:0.73 to -0.03; p = 0.04). The additional benefits of PDT were less pronounced on CAL, mucosal recession, and inflammatory biomarkers. No significant changes were observed over extended follow-up periods. CONCLUSIONS Adjunct PDT significantly enhanced clinical outcomes, particularly for the short-term, with the most notable benefits observed in BOP, PD, PI, and CBL reductions. However, additional benefits in CAL, mucosal recession, and inflammatory biomarkers outcomes remain limited. Standardized protocols and long-term studies are warranted. CLINICAL SIGNIFICANCE PDT as an adjunct in non-surgical peri-implantitis management improves short-term clinical outcomes, particularly for BOP, PD, PI, and CBL. The benefits of adjunctive use with mechanical debridement offer a promising and minimally invasive approach. Further long-term research is needed to establish its role in routine clinical practice.
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Affiliation(s)
- Murali Srinivasan
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Porawit Kamnoedboon
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Dusit Nantanapiboon
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Piero Papi
- Clinic of General, Special Care, and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy.
| | - Umberto Romeo
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
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Fujimoto K, Utsumi M, Suzuki A, Harada N. Determinants of Infection Prevention and Control Practices in Japanese Nursing Homes: A Scoping Review. Nurs Health Sci 2025; 27:e70125. [PMID: 40414795 DOI: 10.1111/nhs.70125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 03/24/2025] [Accepted: 04/22/2025] [Indexed: 05/27/2025]
Abstract
Understanding the determinants influencing healthcare workers' (HCWs) behaviors is essential for promoting infection prevention and control (IPC) in Japanese nursing homes (NHs). This scoping review aimed to map IPC determinants in Japanese NHs using two behavior change frameworks and to identify research gaps. We conducted a scoping review using three databases, following the Joanna Briggs Institute methodology. Reviewers independently screened reports, assessed eligibility, and extracted IPC behavior determinants. Extracted data were mapped and thematically analyzed using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation-Behavior model. Of 1778 records identified, 22 reports published between 2006 and 2021 met the inclusion criteria. We codified 70 determinants and generated 15 themes. Most reports addressed barriers related to limited IPC knowledge, skills, resources, and systems. Facilitators were mainly codified within motivation-related TDF domains, where an underexplored research gap was identified. Further research focusing on IPC motivation and a deeper understanding of NH contexts is important for developing context-appropriate IPC promotion strategies. A participatory approach involving NH residents and HCWs may be helpful in future research.
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Affiliation(s)
- Kanako Fujimoto
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Momoe Utsumi
- Graduate School of Health and Nursing Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Division of Health Sciences, Graduate School of Medicine, The University of Osaka, Osaka, Japan
| | - Ayako Suzuki
- Department of Infection Prevention and Control, Hitachi General Hospital, Ibaraki, Japan
| | - Nahoko Harada
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
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Niederberger M, Sonnberger M. The participation of lifeworld experts in Delphi processes: A reflection on method and practice. MethodsX 2025; 14:103274. [PMID: 40230552 PMCID: PMC11995758 DOI: 10.1016/j.mex.2025.103274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/18/2025] [Indexed: 04/16/2025] Open
Abstract
Delphi studies have established themselves in the health sciences as a means to systematically and, ideally, synthesize expert opinions into a consensus on concrete issues. As participatory health research increases in relevance, lifeworld experts (e.g., patients, caregiving relatives) are being included in Delphi surveys and their opinions placed alongside those of professional and scientific experts. Looking at the theory and methodology, we discuss the opportunities and challenges concerning result quality and derive practical implications for conducting Delphi studies involving lifeworld experts alongside scientific and/or professional experts. Delphi techniques are understood here to be social interaction processes whose outcomes are a result of the participating experts' conscious, cognitive judgment processes, and also shaped by individual, situational and cultural factors. The more heterogeneous the expert panel, in particular when lifeworld experts are participating, the more these influences vary. Expert panel composition and how diversity is handled prove significant to Delphi study results. Our argument is based on an in-depth analysis of a systematic review of Delphi studies with lifeworld experts. We found that the inclusion of lifeworld experts in Delphi studies usually occurs relatively unsystematically and, furthermore, that results are not analysed separately according to expert group, although there would be good reasons for this. We have oriented the reporting here on PRISMA. To enhance the outcomes of Delphi studies that incorporate lifeworld experts alongside scientific and/or professional experts, we put forward specific recommendations that address potential biases arising from the participation of lifeworld experts.
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Affiliation(s)
- Marlen Niederberger
- PH Schwäbisch Gmünd, Institut für Gesundheitswissenschaften, Abt. Für Forschungsmethoden in der Gesundheitsförderung und Prävention, Oberbettringer Str. 200, Schwäbisch, Gmünd 73525, Germany
| | - Marco Sonnberger
- University of Stuttgart, Department of Sociology of Technology, Risk and Environment (SOWI V), Seidenstrasse 36, Stuttgart 70174, Germany
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Carratalà-Castro L, Munguambe S, Saavedra-Cervera B, de Haas P, Kay A, Marcy O, Nabeta P, Ssengooba W, Ghimenton-Walters E, Acácio S, Bonnet M, Ehrlich J, DiNardo AR, Vasiliu A, Lange C, Hermans S, Mandalakas AM, López-Varela E, García-Basteiro AL, Stool4TB Global Partnership. Performance of stool-based molecular tests and processing methods for paediatric tuberculosis diagnosis: a systematic review and meta-analysis. THE LANCET. MICROBE 2025; 6:100963. [PMID: 39547244 PMCID: PMC12062341 DOI: 10.1016/j.lanmic.2024.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND There has been a global pursuit to improve the diagnosis of tuberculosis in young children by applying diagnostic methods on accessible biospecimens such as stool. We aimed to conduct a systematic review on the accuracy of stool-based molecular tests for tuberculosis diagnosis in children and to assess the impact of the available pre-processing methods and other design characteristics. METHODS In this systematic review and meta-analysis, we evaluated studies in children younger than 16 years with presumptive tuberculosis that were published in English, Spanish, French, and Portuguese from Jan 1, 2000, to May 3, 2024, in MEDLINE, Embase, and Embase Classic, comparing the molecular detection of Mycobacterium tuberculosis DNA in stool with microbiological tests on other samples or a clinical diagnosis. We did not exclude studies based on geographical location, sample size, or study design if they were reporting primary data. Two independent reviewers (LC-C and SM) screened titles, abstracts, and full-text articles for eligibility and extracted data on study characteristics, study population, and diagnostic performance. If information relevant to the main analysis was not reported in the article, the corresponding authors were contacted. Point estimates and 95% CIs were calculated for sensitivity and specificity for each study and for the different molecular tests (Xpert MTB/RIF, Xpert Ultra MTB/RIF [Cepheid, Sunnyvale, CA, USA], and other tests) versus a reference standard (culture only, any bacteriological confirmation, and tuberculosis case definition). Sensitivity and specificity were stratified by the stool processing method. We also quantified the additionality of stool Xpert Ultra tests for tuberculosis bacteriological confirmation. The protocol was registered with PROSPERO, CRD42022341514. FINDINGS A total of 4521 records were identified through the database search, one record was identified from an article bibliography, and 67 studies were retained for full-text reading. 39 studies were included in the qualitative synthesis, 35 of which were included in the meta-analyses. When using any bacteriological confirmation from a respiratory sample as the reference standard, stool Xpert sensitivity was 0·60 (95% CI 0·48-0·71), stool Xpert Ultra sensitivity was 0·73 (0·63-0·81), and sensitivity was 0·44 (0·29-0·60) for other in-house molecular methods combined. When using tuberculosis case definition as the reference standard, stool Xpert sensitivity was 0·23 (0·11-0·41), stool Xpert Ultra sensitivity was 0·38 (0·22-0·56), and sensitivity was 0·17 (0·09-0·23) for other in-house molecular methods. The addition of stool Xpert Ultra increased bacteriological confirmation of tuberculosis by 38·6% overall. Further, the utilisation of centrifuge-free simplified methods improved the sensitivity of stool Xpert Ultra when using any bacteriological confirmation as a reference standard (0·77 [0·66-0·85] for centrifuge-free methods vs 0·61 [0·41-0·78] for non-centrifuge-free methods). INTERPRETATION This systematic review and meta-analysis supports the use of Xpert Ultra in stool samples as a diagnostic tool for paediatric tuberculosis diagnosis. Stool-based Xpert Ultra can contribute to increase the bacteriological confirmation in this population, even when respiratory specimens are also tested. FUNDING The EDCTP2 programme supported by the EU via Stool4TB Project and the European Society of Pediatric Infectious Diseases.
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Affiliation(s)
- Lucía Carratalà-Castro
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Belén Saavedra-Cervera
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Wellcome Sanger Institute, Hinxton, UK
| | - Petra de Haas
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Alexander Kay
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini
| | - Olivier Marcy
- University of Bordeaux, Inserm U1219, IRD EMR271, Bordeaux, France
| | | | - Willy Ssengooba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Elisabetta Ghimenton-Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK; North Tees and Hartlepool NHS Foundation Trust, Hardwick Road, Stockton on Tees, UK
| | - Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Maryline Bonnet
- TransVIHMI, University of Montpellier, IRD, INSERM, Montpellier, France
| | - Joanna Ehrlich
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Andrew R DiNardo
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini; Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anca Vasiliu
- Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Christoph Lange
- Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; Respiratory Medicine andInternational Health, University of Lübeck, Lübeck, Germany
| | - Sabine Hermans
- Amsterdam University Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Centre for Tropical and Travel Medicine, Department of Infectious Diseases, Amsterdam, Netherlands
| | - Anna M Mandalakas
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain; Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain.
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Collaborators
Alberto Garcia-Basteiro, Elisa Lopez-Varela, Belen Saavedra-Cervera, Lucia Carratala-Castro, Sergi Sanz, Joanna Ehrlich, Fernández-Escobar Carlos, Makhosazana Dlamini, Gcinile Dlamini, Nomathemba Dlamini, Nkulungwane Mthethwa, Nokwanda Kota, Mbongeni Dube, Busizwe Sibandze, Mangaliso Ziyane, Durbbin Mulengwa, Nontobeko Maphalala, Babongile Nkala, Nosisa Shiba, Faith Dlamini, Fortunate Shabalala, Sindisiwe Dlamini, Gugu Maphalala, Lindiwe Dlamini, Sisi Dube, Sozinho Acacio, Shilzia Munguambe, Lee Joao Fonseca, Nércio Machele, Miguel Cumbe, Edson Tereso Mambuque, Agostinho Lima, Katia Magul, Gustavo Tembe, Benilde Violeta Mudumane, Farida Cebola, Jorcelina Rungo, Alberto Bila Junior, Neide Gomis, Willy Ssengooba, Joachim Nsubuga Kikoyo, George William Kasule, Patricia Mwachan, Maria Nassolo, Moorine Sekkadde, Sabine M Hermans, Sujan Katuwal, Matthew Ang, Anca Vasiliu, Anna Maria Mandalakas, Andrew DiNardo, Rojelio Mejia, Jason Bacha, Alexander Kay, Debrah Vambe, Abigail Seeger, Christoph Lange, Irina Kontsevaya, Collins Musia, Lilian Komba, Lwijisyo Minga, Lumumba Mwita, Mtafya Bariki, Nyanda Elias Ntinginya,
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