Acute leukemia (AL) presents significant health challenges, particularly in children, and iron plays a critical role in cellular processes that could influence cancer development. The study was motivated by the need to clarify the potential role of iron supplementation during pregnancy in influencing the risk of developing childhood leukemia.

This meta-analysis adhered to PRISMA guidelines and systematically searched PubMed, Scopus, and Web of Science databases up to April 2024 for relevant observational studies. Inclusion criteria focused on case-control studies assessing the relationship between iron supplementation during pregnancy and leukemia risk, reporting odds ratios (ORs) with 95% confidence intervals (CIs). Data extraction and quality assessment were performed independently by two researchers using the Newcastle-Ottawa Scale (NOS). Statistical analysis involved calculating overall relative risk (RR) using a random-effects model and assessing heterogeneity through Cochran's Q test and the I2 statistic. Publication bias was evaluated using Egger's and Begg's tests.

The study analyzed data from 9 studies with 12 data sets involving a total of 4281 participants (2327 cases and 1954 controls). The findings indicated no significant association between iron supplementation during pregnancy and the overall risk of childhood leukemia (OR:1.01; 95% CI: 0.84-1.21, I2 = 63.2%). Also, no relationship was found between receiving iron supplements during pregnancy and the risk of AML (OR:1.01; 95% CI: 0.84-1.21, I2 = 56.6%) and ALL (OR:1.00; 95% CI: 0.81-1.24, I2 = 67.3%).

This study found no significant association between iron supplementation during pregnancy and AL risk among case-control studies. Further research is needed to explore the potential influence of genetic and environmental factors on this relationship.

Virological failure (VF) significantly threatens the efficacy of antiretroviral therapy (ART) programs in East Africa. This systematic review and meta-analysis assess the prevalence and predictors of VF among individuals living with HIV.

We searched PubMed, Web of Science, African Journals Online, and EMBASE for relevant studies. Heterogeneity was assessed using the I2 statistic, and random-effects models addressed between-study variability. Publication bias was examined through funnel plots, Egger's regression, and Begg's tests. Subgroup analyses and meta-regression explored heterogeneity sources and potential VF predictors. Analyses were conducted using MedCalc version 20.010, adhering to PRISMA 2020 guidelines.

Twenty-five records were included, with a sample size of 29,829 people living with HIV on ART. The pooled prevalence of VF in East Africa was 19.4% (95% CI: 15.2%-24.0%), with substantial heterogeneity across studies. Sociodemographic predictors of VF included male sex (30.9%, p < .001), unmarried status (28.2%, p < .001), lower educational attainment (33.0%, p < .001), non-formal employment (47.2%, p < .001), and urban residence (51.2%, p < .001). Clinical factors associated with higher VF rates were ambulatory status (44.7%, p < .001), low CD4 count (35.1%, p < .001), low haemoglobin (52.2%, p < .001), advanced HIV stage III/IV (44.2%, p < .001), HIV/TB co-infection (24.3%, p < .001), and other opportunistic infections (20.5%, p = .008). Treatment-related factors associated with VF were first-line nevirapine-based regimen (27.7%, p = .009) and poor ART adherence (41.76%, p < .001).

Sociodemographic factors, advanced HIV disease, co-morbidities, poor adherence, and specific first-line ART regimens are key predictors of virological failure. Targeted, multidisciplinary interventions focusing on routine viral load monitoring, adherence support, and addressing socioeconomic barriers are essential to improve ART outcomes in East Africa.

Cognitive behavioural therapy (CBT) is a recommended first-line treatment for depression. Evidence mainly derives from studies in secondary care, though most treatment occurs in primary care. This review examined efficacy of CBT, cognitive therapy (CT), or behavioural activation (BA) for depression within primary care. Databases were searched for trials up to 23rd July 2024. Risk of bias was assessed using the Cochrane risk-of-bias tool, version 2.0.44 studies were included. CBT, CT, and BA significantly reduced depression symptoms compared to inactive controls (k = 40, g = 0.44, p < .001), but not active comparators (other therapies, medication or exercise) (k = 9, g = -0.06, p = .24). Heterogeneity was significant in studies comparing CBT, CT, or BA to inactive controls, but not in studies using active comparators. Most studies were rated at high risk of bias (36 studies, 81.8 %), predominantly due to use of patient-rated outcome measures in non-blinded studies, lack of ITT analyses, and lack of pre-registering protocols, all of which may result in inflated effect sizes. Although CBT, CT, or BA appears effective for depression in primary care against usual care or waiting list controls, when compared to active comparators no significant difference is seen, likely a result of variability in the quality of the included studies. Large studies of improved quality (including use of blinded observer-rated outcome measures and ITT analyses) may be required to justify guideline recommendations for CBT over other interventions for depression specifically in primary care.

Non-cystic fibrosis bronchiectasis (NCFB) is often complicated by chronic Pseudomonas aeruginosa infection. Inhaled antibiotics, such as tobramycin, have been explored for their efficacy in managing these infections, but their efficacy and safety in NCFB remains uncertain.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of inhaled tobramycin in NCFB patients. PubMed, EMBASE, Cochrane Library, and ISI Web of Science databases were searched up to June 2024 using predefined keywords. Studies comparing inhaled tobramycin versus placebo were included if they reported outcomes related to P. aeruginosa eradication, sputum density, exacerbations, hospital admissions, and adverse events.

Nine RCTs involving 772 patients met the inclusion criteria. Inhaled tobramycin significantly increased P. aeruginosa eradication rates compared to placebo (I2 = 22.0 %, P = 0.255; RR 2.422, 95 % CI 1.570 to 3.738, P < 0.001). There was a marked reduction in hospital admissions (I2 = 27.9 %, P = 0.250; WMD -0.523, 95 % CI -0.879 to -0.167, P = 0.004) but no significant difference in exacerbation rates (I2 = 31.9 %, P = 0.196; RR 0.837, 95 % CI 0.519 to 1.349, P = 0.464). Adverse events leading to trial discontinuation were higher in the tobramycin group (I2 = 0.0 %, P = 0.634; RR 1.968, 95 % CI 1.197 to 3.236, P = 0.008).

Inhaled tobramycin therapy demonstrated efficacy in eradicating P. aeruginosa and reducing hospital admissions in patients with NCFB. However, no significant impact on exacerbation rates was observed, and the higher incidence of adverse events necessitates careful consideration in clinical practice.

Obstructive sleep apnea (OSA), a sleep disorder, is associated with cognitive decline and is potentially linked to glymphatic system dysfunction. This meta-analysis investigates glymphatic function in severe OSA (apnea-hypopnea index ≥30) using the Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index.

This study followed PRISMA guidelines for systematic reviews and meta-analyses. A comprehensive search of PubMed, Web of Science, Scopus, and Embase was conducted from inception to January 20, 2024. Studies investigating the ALPS index in OSA using DTI were included. Analyses included a random-effects meta-analysis, sensitivity analysis, meta-regression, publication bias evaluation (funnel plot, Egger's test, and Begg's test), and risk of bias assessment.

Systematic review identified four studies (137 patients with severe OSA and 170 healthy controls (HCs)). Pooled analysis revealed a significant reduction in the DTI-ALPS index in severe OSA patients compared to HCs (standardized mean difference: -0.95, 95 % CI: -1.46 to -0.44, p < 0.001), indicating impaired glymphatic function. Heterogeneity was moderate to high (I2 = 76.07 %), but sensitivity analyses confirmed robustness. Meta-regression analyses identified the sources of heterogeneity as the apnea-hypopnea index (β = -0.039, p = 0.009) and the Epworth Sleepiness Scale (β = -0.150, p = 0.032), with no effects observed for age or male ratio. Qualitative (funnel plot) and quantitative publication bias assessments (Egger's and Begg's tests) showed no significant bias, and risk of bias evaluations using the Newcastle-Ottawa Scale indicated high methodological quality across studies.

These findings suggest that severe OSA disrupts glymphatic activity. The DTI-ALPS index emerges as a promising tool for assessing glymphatic dysfunction in OSA.

Developmental psychology focuses on how psychological constructs change with age. In cognitive development research, however, the specifics of this emergence is often underspecified. Researchers often provisionally assume linear growth by including chronological age as a predictor in regression models. In this work, we aim to evaluate this assumption by examining the functional form of age trajectories across 25 phenomena in early linguistic and cognitive development by combining the results of multiple meta-analyses in Metalab, an open database. Surprisingly, for most meta-analyses, the effect size for the phenomenon did not change meaningfully across age. We investigated four possible hypotheses explaining this pattern: (1) age-related selection bias against younger infants; (2) methodological adaptation for older infants; (3) change in only a subset of conditions; and (4) positive growth only after infancy. None of these explained the lack of age-related growth in most datasets. Our work challenges the assumption of linear growth in early cognitive development and suggests the importance of uniform measurement across children of different ages.

Endometriosis is a common cause of chronic pelvic pain and lacks precise pathophysiological mechanisms. Advanced oxidation protein products (AOPPs), markers of oxidative stress and inflammation, are implicated in pain-related diseases and have been suggested to play a crucial role in endometriosis pathophysiology. We aim to assess the significance of AOPP in endometriosis by analyzing their levels across serum, follicular fluid, peritoneal fluid, and ovarian endometrioma tissue, and their association with different disease stages. A systematic review of articles published up to Nov 2024 examining AOPP levels in endometriosis patients compared to controls was conducted (PROSPERO: CRD42022343714). Using the Newcastle-Ottawa Scale (NOS), the quality and risk of bias of included studies were assessed, and publication bias was evaluated using Egger's and Begg's tests. The analysis 12 studies involving 561 control patients without endometriosis and 670 patients with endometriosis. Compared to controls, elevated AOPP levels were observed in endometriosis patients' serum and peritoneal fluid. Patients with type III/IV endometriosis exhibited higher AOPP levels in serum and plasma compared to control patients, suggesting a potential association with disease severity. The study underscores the potential of AOPP levels as biomarkers for endometriosis severity and proposes them as pharmacological targets for disease management, including pelvic pain treatment.

Antibiotic resistance presents a substantial threat to global public health. One of the primary contributors to antibiotic resistance is the irrational use of antibiotics. This study aimed to comprehensively assess the prevalence and associated factors of antibiotic self-medication (ASM) practices among the pediatric population in India.

A comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar to identify relevant articles published up to December 2024. Inclusion criteria included studies reporting the prevalence rate of ASM practices among the pediatric population in India. Quality assessment of the included studies was conducted using the JBI tool for prevalence studies. Data were extracted using a standardized form and analyzed using R software with a random-effects model.

Seventeen studies involving 7847 children were analyzed. The pooled prevalence of pediatric ASM in India was 19.8% (95% CI: 13.5; 28.2; I2 = 98.2%; p < 0.01). Regional disparities were observed (p < 0.01), with the northern region exhibiting the highest prevalence at 30.7%. No significant difference in prevalence was found between studies that recruited participants from hospital and community settings (p = 0.0552). Key factors associated with pediatric ASM included financial constraints, time constraints, perceptions of mild illness, and limited healthcare access. Common sources for procuring antibiotics were local pharmacies, leftover medications, and friends/family members. Information sources regarding the use of antibiotics included previous prescriptions, friends/family members, media, past experiences, and pharmacists. The mean duration of antibiotic consumption was 2.5 days.

Self-medication with antibiotics was prevalent among the pediatric population in India. Therefore, government and policymakers should take necessary measures to promote the responsible use of antibiotics.

Compassion fatigue is the emotional response generated by continuous exposure to human suffering and is especially common among nursing professionals. This phenomenon can lead to decreased empathy and increased emotional exhaustion while affecting the quality of care.

To synthesize information from primary studies that have used and evaluated interventions aimed at managing compassion fatigue in nursing professionals.

A systematic review with meta-analysis of studies with randomized and nonrandomized control groups.

Medline, CINAHL, Scopus, and Web of Science databases were searched for studies published between 2013 and 2023. The search was conducted in January 2024 to identify control group studies that provided quantitative pre-post data on both groups of compassion fatigue assessed with the Professional Quality of Life Scale (ProQol). Quality was assessed using the RoB2 and ROBINS-I scales. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024537935).

The search strategy yielded a total of 1006 records, of which 11 studies were selected; these provided a total of 763 participants. Most of the interventions consisted of providing knowledge and skills to increase resilience, emotional well-being, and stress coping. The interventions had an average duration of 6 weeks distributed in 9 sessions with an average of 90 minutes. After the intervention, a statistically significant increase in satisfaction was obtained and a statistically significant reduction in fatigue and burnout.

Interventions aimed at reducing compassion fatigue are effective among nursing professionals. In the future, further high-quality research with prospective follow-up designs is required.

To analyze randomized controlled trials evaluating the effectiveness of machine learning (ML)-based interventions in promoting physical activity.

Evidence on the effectiveness of ML-based interventions to increase physical activity from randomized controlled trials is limited. Synthesizing existing evidence is crucial for nurses to integrate such advancements into their care and implement health-promoting interventions.

Randomized controlled trials from 2013 to 2024 have been accessed by PubMed, EBSCO, Cochrane, and Turkish national databases. The study was conducted and reported in accordance with the PRISMA statement. The methodological quality was assessed using the Cochrane Risk of Bias 1 (RoB 1) tool. Ten studies with a total sample size of 2269 individuals were included.

Analysis of studies showed that ML-based lifestyle interventions are effective in detecting physical activity levels, increasing daily step count and moderate to vigorous physical activity, predicting adherence to physical activity levels goals, and tailoring recommendations and feedback. Meta-analysis revealed that ML interventions significantly increased daily step count (Hedge's g = 0.402, 95% CI: 0.231-0.573, p<0.000).

The studies involving ML-based physical activity promotion initiatives led by nurses were limited. The inclusion of studies published only in English and Turkish may have excluded potentially valuable data.

ML can effectively support public health initiatives by enabling self-monitoring, personalized recommendations, adaptive interventions, and predicting future physical activity behavior.

Nurses can leverage ML algorithms to provide timely, tailored, and cost-effective care to promote physical activity. To integrate ML into public health initiatives, and develop programs aligned with care models, it is essential to create opportunities and policies that support collaboration between nurses and software developers with nurses leading the process.

Elevated levels of LDL and triglycerides, along with low levels of HDL, are key contributors to cardiovascular disease. If the increase of harmful fats is prevented, it will be a great step towards the prevention of diseases. The two drugs atorvastatin and rosuvastatin are the most commonly used drugs to reduce LDL and triglycerides and increase HDL in patients. The present study aimed to compare the effectiveness of Rosuvastatin and Atorvastatin on changes in LDL, TG and HDL using a systematic review and meta-analysis method.

The present study was conducted on the basis of the protocol of systematic review and meta-analyses. The ISI, Cochrane Library, Google Scholar, PubMed, Scopus, and Elsevier databases were independently searched by two researchers using Mesh keywords in different regions of the world during 2003 to 2025. Data was analyzed using the STATA software.

Effectiveness of Atorvastatin on the reduction of LDL was 51.49 mg/dl (42.75-60.23 %, CI =95 %) versus Rosuvastatin with a reduction of 55.66 mg/dl (46.32-65 and CI =95 %). The effectiveness of Atorvastatin on the rise of HDL was 1.85 mg/dl (-3.23-0.46 and CI =95 %) versus Rosuvastatin with a rise of 3.87 mg/dl (2.08-5.66 and CI =95 %); and the effectiveness of atorvastatin on the reduction of TG was 24.76 mg/dl (18.14-31.88 and CI = 95 %) versus the effectiveness of Rosuvastatin with a reduction of 31.98 mg/dl (24. 41-39.55 and CI = 95 %).

According to research results, Rosuvastatin was better than Atorvastatin and decreased triglyceride and LDL and increased HDL in all cases.

Helicobacter pylori (Hp) infection has been implicated in both gastric and extra-gastric diseases, including periodontitis.

This meta-analysis investigated the association between Helicobacter pylori (Hp) infection and periodontitis by systematically reviewing eight studies. The analysis was conducted using the R package "meta," employing both fixed effects and random effects models. The level of heterogeneity among the studies was assessed using the I-squared statistic and tau values. Publication bias was evaluated through funnel plots, Begg's rank correlation, and Egger's regression tests to ensure the robustness of the findings.

The meta-analysis included a total of 6061 observations, with 1404 cases of periodontitis. The fixed effects model produced an odds ratio (OR) of 2.3392 (95% confidence interval [CI]: 2.0207-2.7078), and the random effects model yielded a similar OR of 2.3220 (95% CI: 2.0050-2.6892). The I-squared statistic indicated low to moderate heterogeneity among the studies. Subgroup analyses demonstrated consistent associations across different Hp diagnostic methods.

Hp infection is significantly associated with an increased risk of periodontitis, highlighting its role in both gastric and oral health.

Black seed is known for its health benefits in traditional medicine. While recent studies suggest it may improve cardiometabolic health, its impact on type 2 diabetes mellitus (T2DM) remains unclear. This study aims to meta-analysis randomized controlled trials (RCTs) to assess the effects of black seed supplementation on cardiometabolic indices in T2DM patients.

Following PRISMA guidelines, a comprehensive database search was conducted up to January 2025, and data were extracted from relevant RCTs. Mean differences (MD) and standard deviations (SD) were analyzed using a random-effects model, heterogeneity was assessed, and publication bias was evaluated.

The pooled meta-analysis of 16 RCTs showed that black seed supplementation significantly reduced fasting blood glucose (FBG) (MD: -21.43 mg/dL; p = 0.005), hemoglobin A1c (HbA1c) (MD: -0.44; p = 0.01), total cholesterol (TC) (MD: -18.80 mg/dL; p = 0.04) and low-density lipoprotein (LDL) (MD: -19.53 mg/dL; p = 0.003). No significant effects were observed for 2-hour postprandial glucose (2-hpp), fasting insulin, homeostatic model assessment (HOMA), triglycerides (TG), high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and body weight, or body mass index (BMI). Subgroup analyses revealed that black seed supplementation effectively reduced FBG for longer than 8 weeks; additionally, HbA1c, HOMA, and LDL in higher doses (>1 g/day), shorter durations (≤8 weeks), and use of the oil form.

Black seed supplementation appears to significantly improve FBG, HbA1c, TC, and LDL levels in patients with T2DM. However, no significant effects were observed on other metabolic parameters, including insulin, TG, liver enzymes, kidney function, or body weight. These findings suggest that black seed may be a beneficial adjunct therapy for glycemic and lipid control in T2DM patients but require further research to confirm its broader metabolic effects.

Summarizing the association between patient age and vital pulp therapy (VPT) outcomes is important to improve clinical decision-making.

To investigate whether patient age is a predictor of VPT success/survival, using a research question based on the PICOTS acronym: (P) participants presenting mature permanent teeth undergoing VPT; (I) participants age; (C) gender, systemic condition, preoperative symptoms/diagnosis, caries extent/location, restoration extent/type, bleeding time; (O) clinical and radiographic success/survival; (T) data collected immediately before and during the clinical procedure and follow-up performed at least 1 year later; (S) clinical trials and observational studies developed in dental schools and services.

PubMed, EMBASE, Lilacs and Web of Science databases were searched for studies published from inception to 29 June 2024. Two independent reviewers selected and extracted data; senior reviewers resolved disagreements. Study characteristics were tabulated, and a meta-analysis was conducted, using RevMan software. The QUIPS tool assesses the risk of bias, whilst the GRADE criteria assess the certainty of evidence.

Thirty-four studies were included in the qualitative synthesis, and 23 in the meta-analysis. Bivariate associations showed higher direct pulp capping (DPC) success rates for participants younger than 40 years [OR = 4.85, 95% CI (2.27-10.39)]. The association between age and full pulpotomy (FP) + partial pulpotomy (PP) survival was not significant in multivariate meta-analysis [HR = 1.02, 95% CI (0.98-1.05)]. Bias related to outcome measurements, confounding/statistical analysis and reporting were the main concerns of the studies' quality, and the overall risk of bias was moderate to high. The certainty of the evidence was very low for the analysis of the DPC 25-year-old cut point, high for the multivariate analysis and moderate for the other analysis.

Age did not influence PP and FP outcomes. In contrast, it is associated with DPC success, probably influenced by difficulties during direct inspection of pulp tissue. Further studies with multivariate-adjusted analyses are required to improve the certainty of the evidence.

Patient age is not associated with the outcomes of PP and FP in permanent teeth but should be considered a risk predictor for patients over 40 years old undergoing DPC.

CRD42021273826 (PROSPERO).

A previous, individual patient-level meta-analysis of randomized controlled trials (RCTs) demonstrated the overall survival (OS) benefit of short-term androgen deprivation therapy (ST-ADT) when delivered with radiation therapy (RT) for the subset of patients with intermediate-risk prostate cancer (IR-PCa). However, because of inclusion criteria, several studies such as NRG/RTOG 0815, GETUG-14, and DFCI 95-096 were excluded. Thus, we conducted the present analysis, inclusive of all studies to define the current role of ST-ADT in IR-PCa.

A systematic review was conducted of phase 3 RCTs published or presented between January 1980 and October 2024 which profiled the comparative efficacy of radiation therapy ± ST-ADT in patients with IR-PCa. A study-level, random-effects meta-analysis was performed. The primary endpoint of this meta-analysis was OS, with secondary endpoints of time-to-biochemical failure (BF) ± biochemical-progress-free survival (bPFS). Meta-regression was used to explore trial-level factors associated with treatment effects. Synthetic individual patient-level OS data were pooled for confirmation and used to estimate the relative and absolute survival benefit.

Seven RCTs (NRG/RTOG 9408, DFCI 95-096, TROG 96.01, PCS III, EORTC 22991, NRG/RTOG 0815, and GETUG-14) reporting outcomes of 6179 patients were identified. The pooled hazard ratios (HRs) for HROS, HRBF, and HRBF+bPFS were 0.88 (95% confidence interval [CI], 0.79-0.97; P = .01), 0.50 (95% CI, 0.37-0.68; P < .001), and 0.54 (95% CI, 0.46-0.65; P < .001), respectively. ST-ADT duration, RT dose, and Gleason score trial population composition were each associated with an increased benefit of ST-ADT for biochemical disease control (all P < .05) but not for OS (all P > .05). Pooling of simulated, patient-level data confirmed the presence of a survival benefit (HROS, 0.85 [95% CI, 0.76-0.96], log-rank P = .021), corresponding to an absolute survival benefit of 5% benefit at 10 years.

The present analysis confirms current knowledge that ST-ADT improves both OS and prostate-specific antigen-based outcomes for unselected patients with IR-PCa to a clinically significant degree.

While numerous reviews examine digital interventions, including computer game-based, evidence regarding their effectiveness for ADHD symptoms remains mixed. Focusing on computer game-based interventions, this study aims to identify specific intervention features and trial-related factors that influence outcomes in pediatric ADHD symptoms through a systematic review and meta-analysis of randomized controlled trials.

Comprehensive literature searches were conducted in Web of Science, PubMed and PsycINFO. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Seventeen studies were included. Beyond common game characteristics, some interventions incorporated additional elements-such as neurofeedback, physical exercise via virtual reality (VR) and social components-allowing subgroup analyses. The neurofeedback subgroup showed the largest effect size (standardized mean difference (SMD)=-0.51, 95 % confidence interval (CI) [-0.88, -0.15], heterogeneity index (I2)=45.85 %, p < 0.05, very low certainty of evidence), followed by the physical exercise/VR subgroup (SMD=-0.40, 95 %CI [-0.76, -0.04], I2=0.00 %, p < 0.05, very low certainty of evidence). Other subgroups, including those with social components or without additional elements, did not show significant effect sizes. The physical exercise/VR subgroup demonstrated small-to-medium effect sizes in both inattention and hyperactivity/impulsivity subscales, whereas the neurofeedback subgroup showed similar effects only in inattention. Trial-level factors, including participant demographics and intervention duration, showed no significant relationship with SMD in meta-regression.

Although inconclusive, synergizing with game dynamics, neurofeedback and physical exercise/VR may enhance effectiveness of computer game-based interventions in addressing pediatric ADHD symptoms. Particularly, interventions with physical exercise/VR have potential to address both inattention and hyperactivity/impulsivity.

Self-monitoring devices that measure the urinary sodium-to-potassium (Na/K) ratio, urinary salt or sodium excretion, or salt concentration in foods have emerged as tools that can guide dietary adjustments for blood pressure (BP) control. This systematic review and meta-analysis investigated whether these self-monitoring devices can help to control BP in adults. The PubMed, Cochrane Library, and Ichushi-Web databases were searched to identify randomized controlled trials that compared the effect of these devices (with or without additional dietary education) plus usual care on BP with that of usual care alone. The pooled effect of weighted mean difference between the intervention and control groups at the end of follow-up was estimated by random-effects meta-analysis. The primary outcome was the change in BP. Secondary outcomes included changes in the urinary Na/K ratio, and sodium and potassium excretions. Of 1525 studies screened, eight (with 1442 participants) were eligible for inclusion. Meta-analysis showed greater reductions in systolic BP by 2.45 (95% confidence interval, 0.04, 4.86) mmHg and diastolic BP by 1.38 (-0.15, 2.90) mmHg in the intervention vs. control groups. However, heterogeneity was high (I² = 69.4% for systolic BP and 65.1% for diastolic BP). The BP-lowering effect was not statistically different across different follow-up durations (4 weeks or 2-6 months) and intervention approaches (self-monitoring alone or combined with dietary education) (all p values for heterogeneity >0.1). Reductions in the urinary Na/K ratio and sodium excretion were greater in the intervention group. Self-monitoring devices may assist with BP reduction by promoting decreased sodium intake and increased potassium intake.

Stevia is an intense, calorie-free sweetener that is frequently used to reduce energy intake; however, studies examining its effects on appetite and energy intake have produced mixed results, indicating that a definitive consensus has not yet been reached. This systematic review and meta-analysis aimed to determine the impact of stevia on appetite and energy intake in adults. The PROSPERO registration number for this research is CRD42023414411. The databases PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar were systematically searched. In addition, the reference lists of extracted articles and pertinent reviews were examined. Two evaluators performed screening, quality assessment, and data extraction independently. Furthermore, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was employed to systematically assess the certainty level of the evidence presented in our study. Eleven clinical trials with a total of 428 participants were included. We found no significant changes in any appetite scores following stevia consumption (very low to moderate certainty of the evidence). Moreover, subgroup analyses demonstrated the scores of desires to eat increased significantly in the oral intake of stevia and not enteral intake subgroup (WMD: 0.45; 95% CI: 0.009, 0.89; P = 0.046). In addition, the number of studies reporting energy intake was limited, preventing a meta-analysis of this variable. In conclusion, stevia consumption has no significant effect on appetite scores in adults but it seems that more long-term clinical trials are needed to obtain more accurate results. PRACTITIONER POINT: Stevia, as a non-nutritive sweetener, has no significant effect on appetite scores in adults.

To compare and rank the efficacy of different non-pharmacological interventions on anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients.

In recent years, numerous non-pharmacological interventions have been developed to address anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients. However, it remains unclear which non-pharmacological intervention serves as the most effective and preferred approach.

A systematic review and network meta-analysis in accordance with the PRISMA guidelines.

Relevant randomised controlled trials were extracted from eight electronic databases. A network meta-analysis was then performed to evaluate the relative efficacy of the non-pharmacological interventions for liver transplantation patients. The quality of the data was assessed using the Cochrane Risk of Bias tool. We registered this study in PROSPERO, number CRD42023450346.

A total of 25 randomised controlled trials were included. Spouse support education combined with mindfulness training, individualised psychological intervention, and cognitive behavioural therapy were found to be significantly effective for both anxiety and depression. The top three interventions against anxiety were spouse support education combined with mindfulness training, individualised psychological intervention, and exercise rehabilitation training. Meanwhile, individualised psychological intervention, spouse support education combined with mindfulness training, and cognitive behavioural therapy were the top-ranked three interventions for reducing depression. Sleep hygiene education was the most effective to improve sleep disorders. Continuous care based on a mobile medical platform emerged as the most effective intervention in improving the quality of life.

Several non-pharmacological interventions appeared to be effective in treating anxiety, depression, sleep disorders, and improving the quality of life among liver transplantation patients. More high-quality clinical trials should be incorporated in the future to investigate the reliability of existing findings.

Healthcare professionals should be encouraged to apply these promising non-pharmacological interventions during clinical care.

This study did not directly involve patients or public contributions to the manuscript.

To assess the effectiveness of acceptance and commitment therapy (ACT) in reducing depressive and anxiety symptoms in older adults.

A systematic review and meta-analysis.

Nine databases were searched for publications up to 2 April 2024, using combinations of search terms related to depression, anxiety, ACT, older adults and randomised controlled trials (RCTs). Two researchers were selected according to inclusion and exclusion criteria, data extraction and methodological quality evaluation, and Stata 16.0 software was used for meta-analysis.

Seven articles were included in a systematic review and six were in a meta-analysis. The results indicated that, compared to the control group, ACT had a small but significant effect in reducing depressive symptom (SMD = -0.22, 95% CI, -0.38 to -0.06, p < 0.001; 576 older adults; low-quality evidence), while it showed a small, non-significant effect on reducing anxiety symptoms (SMD = -0.29, 95% CI, -0.73 to 0.15, p = 0.194; 576 older adults; very low-quality evidence). Subgroup analysis based on the different control conditions may have some enlightenment on the sources of heterogeneity.

ACT can be an important component of future psychotherapy for older adults, as it may alleviate depressive symptoms. However, high-quality studies with large samples, multiple centres and long follow-up durations should be performed to further reliably assess the treatment effects of depressive symptoms and explore potential benefits for anxiety symptoms.

This study evaluated how different exercise interventions affect maximal oxygen uptake (VO2max) in adults with overweight or obesity. We systematically searched five databases from inception to February 2025 to identify relevant randomized controlled trials (RCTs). We used the Cochrane risk of bias tool. A Bayesian network meta-analysis with a random-effects model was conducted. A total of 93 RCTs involving 4,446 participants were included. The network meta-analysis showed high-intensity interval training (HIIT) ranked highest (Surface Under the Cumulative Ranking Curve [SUCRA]: 82.5%; Standardized Mean Difference [SMD]: 4.85; 95%Credible Interval [CrI]: 3.90, 5.80), followed by high-intensity aerobic training (HAT) (SUCRA: 76.7%; SMD: 4.72; 95%CrI: 3.78, 5.68), and combined aerobic and resistance training (CT) (SUCRA: 69.1%; SMD: 4.52; 95%CrI: 3.48, 5.60), with resistance training (RT) least effective (SUCRA: 18.3%; SMD: 2.57; 95%CrI: 1.32, 3.86). All six interventions effectively improved VO2max in overweight or obese adults. Among them, HIIT was most beneficial. Coaches and fitness professionals should consider these findings to help adults with overweight or obesity achieve optimal outcomes.

Allergic rhinitis (AR) due to pollen affects an estimated 18% of adults globally, but is often trivialized. While there is evidence for an association between high pollen exposure and cardiovascular morbidity and mortality, as well as multiple plausible mechanisms suggesting pathways via blood pressure (BP) elevation, no overview exists to date. This systematic review and meta-analysis aims to investigate whether 1) pollen-related AR and 2) exposure to airborne pollen are associated with BP and/or hypertension. We further evaluated which personal characteristics may modify a potential association and identified research gaps.

We searched the PubMed, ScienceDirect, EMBASE, and Web of Science databases and systematically reviewed studies focusing on human populations published between 1 January 1990 and 20 September 2023 that presented data on the association between pollen-related AR or pollen exposure and BP or hypertension. We assessed the risk of bias with a customized version of the Risk of Bias tool by the Office of Health Assessment and Translation of the National Toxicology Program (OHAT), conducted random effects meta-analyses of comparable studies and assessed the certainty of evidence according to OHAT recommendations. We carried out sensitivity analyses, excluding studies with a high bias rating.

We identified 24 studies, ranging in sample size from 41 to 9'548'939 participants. Of these, 23 had a cross-sectional design, and the remaining article included both cross-sectional and longitudinal analyses. Investigated exposures were binary pollen-related AR status (23 studies) and within and outside of pollen season (one study), but no study investigated measured pollen exposure (zero studies). Around half of the studies (13/24) were afflicted with high selection and confounding bias. Data from 22 studies using pollen-related AR status as exposure could be included in meta-analysis, to which eleven studies contributed hypertension data, four studies BP data, and seven studies both. In meta-analysis, we found an adjusted odds ratio of 1.16 (95 % confidence interval (CI): 0.91, 1.47) for hypertension and mean differences of 0.99 (95 % CI: -0.09, 2.07) and 0.40 (95 % CI: -0.41, 1.21) for adjusted systolic and diastolic BP, respectively. Results for crude pooled meta-estimates were similar, and none showed statistically significant differences. We rated the overall certainty in the evidence as very low, mainly due to cross-sectional designs, selection and confounding bias and indirectness of exposure.

This review shows that there is insufficient evidence to decide whether pollen-related AR is associated with BP or hypertension to date, and therefore does not support a clear mediating role of BP in the relationship between pollen allergy and cardiovascular events. Studies that 1) investigate BP or hypertension as the main outcome and provide adjusted estimates to avoid selection and confounding bias, 2) define AR as solely triggered by pollen and 3) have longitudinal designs were not identified. The certainty of the evidence is therefore limited by (1) reliance on cross-sectional studies, which prevents conclusions about causality, (2) high risk of selection and confounding biases which could not be adjusted for, (3) heterogeneous and indirect definitions of pollen-related AR, and (4) an exclusively binary exposure assessment (with or without pollen-related AR), which limited the ability to study an exposure gradient. Given these limitations, further cross-sectional studies are unlikely to yield clearer results, whereas repeated measurement designs could offer more valuable insights.

This review was primarily funded by the Swiss National Science Foundation (SNSF, grant No. 185864) and the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No. 853568). We pre-published the protocol and search strategy on the PROSPERO website (registration number CRD42022381907).

Caregivers of children and adolescents with chronic illnesses often experience mental health challenges, which increase their risk of poor quality of life. This systematic review evaluates the effectiveness of case management interventions in improving caregivers' positive mental health, psychological distress, and satisfaction with health care services. We included (cluster) randomized controlled trials that evaluated the effects of case management. Systematic searches were conducted in PubMed, Scopus, CENTRAL, and PsycINFO up to 30 June 2024. Risk of bias was assessed using the Cochrane tool (RoB 2), and multi-level meta-analyses were performed for post-intervention outcomes, while follow-up data were synthesized qualitatively due to limited long-term evidence. A total of 17 studies were included, providing multiple effect estimates for different types of outcomes, showing small positive effects of case management on mental health (analyses based on 8 studies), psychological distress (6 studies), and satisfaction with health services (9 studies). Although case management interventions show promise in supporting carers, the limited number of studies limits the strength and generalizability of the findings. Further research is needed to explore the long-term effectiveness of such interventions. Trial Registration: The review protocol was prospectively registered at PROSPERO (CRD4202453375).

Despite the widespread use of acupuncture, its effectiveness and safety in treating Tourette syndrome (TS) remain controversial. Our research seeks to further evaluate the safety and effectiveness of acupuncture as a replacement therapy approach for children with TS. We conducted a comprehensive search for studies published from their inception to October 2023. The statistical analysis and subgroup analysis were conducted by software. Conduct a meta-analysis on the extracted data using the appropriate effect models. The meta-analysis was conducted on 26 studies consisting 1862 pediatric patients, which were selected from 976 identified articles. Acupuncture group demonstrated a significantly lower risk with a risk ratio (RR) of 0.29 (95% confidence interval [CI] = 0.19, 0.44, P < .0001), with only 5% of participants experiencing adverse reactions. Acupuncture treatment resulted in an 18% improvement in total effectiveness rates (RR = 1.18, 95% CI = [1.12, 1.25], P < .00001). The pooled data demonstrated that acupuncture therapy had a significant advantage in reducing the total score with the weighted mean difference (WMD) -4.92 (95% CI = [-6.38, -3.45], P < .00001) of the Yale Global Tic Severity Scale (YGTSS), the motor tic scores (WMD = -2.24, 95% CI = [-3.14, -1.35], P < .00001), the vocal tic scores (WMD: -2.34, 95% CI = [-3.31, -1.37], P < .00001), and the Traditional Chinese Medicine Syndrome Scores (TCMSS) (WMD: -2.47, 95% CI = [-2.87, -2.07], P < .0001). This meta-analysis reveals that acupuncture is more effective than most existing treatments in mitigating the symptoms of motor and vocal tics in children with TS, while also reducing the incidence of adverse reactions.

Dietary patterns play a crucial role in osteoporosis prevention and management. Patients with osteoporosis need to select a dietary pattern for prevention. This meta-analysis aims to examine the influence of eight distinct dietary patterns on the risk of osteoporosis, including dietary inflammatory index (DII), Western/unhealthful dietary pattern, dietary approaches to stop hypertension (DASH), prudent/healthful dietary pattern, aquatic dietary pattern, plant-based diet index (PDI), healthful PDI, and unhealthful PDI.

Embase, Web of Science, PubMed, and Cochrane Library were systematically searched for observational studies up to April 10, 2025. Meta-analysis was conducted using random-effect models. Heterogeneity was evaluated by subgroup analyses and publication bias was assessed by Egger's test. If there was a risk of bias, the sensitivity analysis and trim-and-fill analysis were conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) were combined to compare the lowest and highest dietary pattern categories.

A total of 2,620 studies were retrieved, among which 2,600 were excluded. 20 observational studies, involving 8 dietary patterns were included, with 426,292 participants. The highest DII (OR: 1.82; 95% CI: 1.39, 2.37; P < 0.001) and the high adherence of unhealthful PDI (OR: 1.37; 95% CI: 1.11, 1.68; P = 0.003) were correlated with an increased risk of osteoporosis. Conversely, the highest category of the prudent/healthful dietary pattern (OR: 0.66; 95% CI: 0.53, 0.83; P < 0.001) presented a low osteoporosis risk. The Western/unhealthful dietary pattern, DASH, aquatic dietary pattern, and high adherence to PDI and healthy PDI dietary patterns were not associated with osteoporosis risk (All P > 0.05).

High DII or unhealthy PDI scores were associated with an increased risk of osteoporosis, while high adherence to prudent/healthy dietary patterns reduced the risk of osteoporosis.

This paper was registered with PROSPERO (CRD42024585588).

Sexual dysfunction is prevalent in people with multiple sclerosis (PwMS) and considerably affects their quality of life. Although sexual function (SF) is crucial in PwMS, its relationship with other characteristics remains insufficiently understood.

This review aimed to consolidate the evidence comparing SF between PwMS and healthy controls (HCs) and to explore its correlation with various demographic, clinical, and psychological factors.

The PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were systematically searched up to July 28, 2024, to identify studies comparing SF between PwMS and HCs or assess its correlation with various demographic, clinical, and psychological characteristics. Random effects models were used in R software version 4.4.0 to estimate the pooled standardized mean difference (SMD) and pooled correlations, with their 95% CIs as the effect size metrics.

In this review, 61 studies comprising 16 266 PwMS were included. The meta-analysis indicated that SF was significantly reduced in PwMS compared to HCs, with females with MS (FwMS) showing lower Female Sexual Function Index scores (SMD: -0.41, 95% CI, -0.61 to -0.20, P < .0001) and males with MS (MwMS) demonstrating reduced International Index of Erectile Function scores (SMD: -0.77, 95% CI, -1.32 to -0.22, P < .01). Correlation analyses highlighted associations between reduced SF and higher Expanded Disability Status Scale (EDSS), longer disease duration, and depression in gender-aggregated analyses. Reduced SF was also found to correlate with older age, higher EDSS scores, depression, and fatigue in FwMS.

The findings of the included studies indicated that SF is lower in PwMS compared to HCs and is influenced by age, disease duration, depression, and the EDSS. Further studies on the effects of comorbidities, medications, and MS classification on the SF of PwMS are warranted.

The objective of this meta-analysis was to assess the influence of three-dimensional (3D) printing technology on open reduction and internal fixation (ORIF) of acetabular fractures from current randomized controlled trials (RCTs).

A structured meta-analysis was conducted, and we searched online databases for published RCTs related to 3D printing and acetabular fracture, including PubMed, Cochrane Library, ScienceDirect, Wan fang, and CNKI up to November 2024. The outcome data of intraoperative blood loss, operation time, hip function (Harris score), quality of fracture reduction (Matta score) and incidence of complications were extracted. Stata16.0 and RevMan5.3 were used for our meta-analysis.

19 RCTs met our inclusion criteria and a total of 1046 patients were included in this meta-analysis. The meta-analysis showed significant difference in intraoperative blood loss (WMD = -274.65, 95% CI [-326.47, -222.83]), operation time (WMD = -53.26, 95% CI [-63.72, -42.80]), intraoperative fluoroscopy (WMD = -5.24, 95% CI [-6.57, -3.91]), instrumentation time (WMD = -35.31, 95% CI [-53.42, -17.21]), and post-surgery Matta score (RR = 1.17, 95% CI [1.09, 1.25]), incidence rate of complications (RR = 0.34, 95%CI [0.22, 0.52]). There is no significant difference in time from injury to operation (WMD=-0.06, 95%CI [-0.36, 0.24]) and Harris score (RR = 1.22, 95%CI [0.83, 1.79]) between two groups.

3D printing group showed reduced intraoperative blood loss, shorter operation time, faster instrumentation, less intraoperative fluoroscopy, better post-surgery reduction, and reduced incidence rate of complications. Therefore, based on existing research, ORIF guided by 3D printing technology should be a more effective method for treating acetabular fractures.

Health professionals (HPs) who work on the front lines are more likely to contract COVID-19.Healthmanners of HPs impact control and prevention activities employed in answer to the contagion crisis. Therefore, this systematic review and meta-analysis aimed to assess the pooled level of practice and associated factors toward COVID-19 prevention among HPs in Ethiopia. PubMed, Scoups, Web of Science, Google Scholar (search engine), Google Advance, and Cochrane Library were searched from December 20, 2023 -January 30, 2024. Data was dugout using Microsoft Excel (version 10) and analysis was computed using STATA version 11. Funnel plot and quantitatively further through Egger's regression test, with P < 0.05 was used to check publication bias. I2 statistics were used to check the heterogeneity of the studies. Pooled analysis was used using a weighted inverse variance random-effects model. A subgroup analysis was conducted based on publication year and region. Meta-regression and sensitivity analysis were used. Eighteen studies with 7,775 Health professionals were included in the review process. Among them, 57.03% (95% CI; 48.41, 65.65%) of HPs practice correctly. Although the risk factors reported were inconsistent between studies, access to infection prevention training (IP) (AOR = 1.79; 95% CI 1.54, 2.08), good knowledge (AOR = 1.92; 95% CI 1.38, 2.66), MSc degree and above (AOR = 3.53; 95% CI 2.64, 4.71), and positive attitude (AOR = 2.19; 95% CI 1.50, 3.19) were significant predictors of good practice. Nearly 43% of health professionals had poor practice. Good knowledge, positive attitude, level of education, and infection prevention training were the main determinants of good practice. The responsible authorities do emphases to halt barriers and improving the zero infection principles of health professionals during the pandemic.

Several studies revealed that synbiotics have been beneficial in managing non-alcoholic fatty liver disease (NAFLD), but the findings are conflicting. We aimed to assess the effect of synbiotic supplementation on cardiovascular risk factors in patients with NAFLD.

A thorough literature search was conducted to identify relevant studies up to July 2024, including publications from Pubmed, Embase, Cochrane, Scopus, and the Web of Science. Standardized mean difference (SMD) was used, and data with a 95% confidence interval (CI) were presented.

Sixteen RCTs were included, involving NAFLD patients and synbiotic supplementation. No significant effects were found on blood pressure (SBP: SMD - 6.68, p = 0.234; DBP: SMD - 4.31, p = 0.391), anthropometric measures (weight: SMD - 0.78, p = 0.126; BMI: SMD - 0.21, p = 0.182; waist circumference: SMD - 0.53, p = 0.095), or lipid profile (triglycerides: SMD - 3.67, p = 0.266; total cholesterol: SMD - 0.61, p = 0.059; low-density lipoprotein: SMD - 3.09, p = 0.215; high-density lipoprotein: SMD 0.49, p = 0.219). Synbiotics significantly reduced CRP levels (SMD - 1.83, p = 0.019) but had no significant effect on TNF-α (SMD - 1.95, p = 0.087). Synbiotic led to a significant reduction in weight following adjustment of publication bias (SMD - 1.16, p < 0.05).

Overall, synbiotic supplementation does not significantly impact blood pressure, anthropometric indices, or lipid profile parameters in patients with NAFLD, except for a significant reduction in weight after adjusting for publication bias. Synbiotic supplementation significantly reduces CRP levels but has no effect on TNF-α.

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

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

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

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

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

Sudden sensorineural hearing loss (SSNHL) is a medical emergency characterized by unexplained hearing loss, usually one-sided, of at least 30 dB across three or more contiguous frequencies within 72 h. This condition significantly impairs daily communication and has serious consequences for mental health, social relationships, and the overall quality of life. Hyperbaric oxygen therapy (HBOT) is being investigated as a potential adjuvant treatment for SSNHL alongside systemic steroids.

This systematic review and meta-analysis aimed to evaluate the efficacy of HBOT combined with systemic corticosteroids compared with corticosteroids alone in patients with SSNHL.

We searched PubMed, Cochrane, Scopus, Web of Science, and Google Scholar to identify 14 studies that matched our inclusion criteria of randomized controlled trials (RCTs) published in English, which evaluated HBOT alone or with corticosteroids in adults (≥ 18 years) diagnosed with SSNHL based on the AAO-HNS criteria, reporting pure-tone audiometry (PTA)-based outcomes. The analysis included 794 participants and evaluated outcomes such as improvements in Pure Tone Audiometry (PTA) thresholds, rates of hearing recovery, and adverse events.

Results indicated that the combined therapy of HBOT and systemic corticosteroids significantly improved low-frequency hearing thresholds (SMD: 0.83, 95% CI: 0.66-1.00, p < 0.0001) and increased the odds of complete recovery (OR: 2.05, 95% CI: 1.41-2.98, p = 0.0002). However, significant heterogeneity (I² = 96.7%) and variations in the treatment protocols were observed. Adverse events, including vertigo, have been reported but are generally mild.

This meta-analysis suggests that combining systemic corticosteroids with HBOT may improve hearing recovery in ISSNHL, particularly at lower frequencies within the first three months. However, high heterogeneity and the lack of statistical significance in the random-effects model call for cautious interpretation. Well-designed RCTs with standardized protocols and clear patient selection criteria are needed to confirm these findings. Future research should focus on identifying subgroups most likely to benefit and optimizing treatment protocols.

Exercise is the main treatment for patients with breast cancer-related lymphedema (BCRL) and different types of exercises were performed in these patients. However, it is unclear which type of exercise or combination of these is the most effective in reducing arm swelling and lymphedema-related symptoms, and quality of life in patients with BCRL.

This study aimed to compare the relative efficacy of different types of exercise in treating BCRL and determine the most effective exercise therapy for patients with BCRL.

This review will search English-language databases (Cochran Library, Cumulative Index to Nursing and Allied Health Literature, EBSCO, EMBASE, PubMed/Medline and Web of Science). The following Chinese-language databases will also be searched: Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Data and China Science and Technology Journal Database. The search was conducted up to 31 December 2024. Randomised controlled trials comparing different types of exercise on BCRL will be eligible. Data will be extracted from eligible trials by two independent researchers based on the selection criteria. Two reviewers will ascertain the risk of bias of the selected studies using a modified version of the Cochrane Risk of Bias Tool. The study's characteristics (study type, characteristics of the patients, intervention prescriptions) and primary outcomes (limb volume, physical function, physical and psychological symptoms) will be summarised in a narrative format. Meta-analyses (ie, network and pairwise) will be used to assess the indirect and direct effects of the exercise interventions. The relative effects of different types of exercise in treating BCRL will be examined by the surface under the cumulative ranking curve to calculate the ranking of treatments and determine the most effective intervention.

This review does not require ethical approval. The findings will be submitted for peer-reviewed publication.

The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (CRD42022370817).

This study aims to systematically evaluate the effects of exercise on cognitive function in individuals with Down syndrome (DS) through a comprehensive systematic review and meta-analysis. Five electronic databases (PubMed, Embase, Cochrane Library, Web of Science, and SPORTDiscus) were systematically searched from inception to February 10, 2025. Additional studies were identified through manual reference screening. Meta-analyses were performed using Stata 17.0. Exercise interventions were associated with significant improvements in cognitive function among individuals with DS (standardized mean difference = 0.50; 95% CI: 0.33,0.67; P < 0.01). Subgroup analyses revealed consistent benefits across cognitive domains, age groups, exercise intensities, and sample sizes. However, no significant effects were observed for interventions involving treadmill walking or single-session exercise. No substantial heterogeneity was detected within any subgroup, supporting the robustness of the findings. Conclusion: This systematic review and meta-analysis provide strong evidence that exercise is an effective strategy for enhancing cognitive function in individuals with DS. The consistency of the results across subgroups supports their generalizability. Future studies should focus on the long-term effectiveness and methodological quality of interventions to refine exercise-based strategies for cognitive rehabilitation in this population.

Beak and feather disease virus is a member of the family Circoviridae, and among birds, parrots are susceptible hosts. This study reported the global molecular prevalence and risk factors of BFDV infection in parrot species. Relevant studies were identified from PubMed, Scopus, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases. We retrieved 30 studies encompassing 16,901 parrots from 30 species across six continents and 34 countries, all published between 2003 and 2024. The results showed that the global molecular prevalence of BFDV, based on eligible areas, was 16.30% (95% CI, 11.40-22.00%) using a random-effects model. Subgroup analysis showed that there were significant differences among genera, with Agapornis having the highest prevalence of 26.60% (95% CI, 9.80-46.50%). There were significant differences in prevalence rates among the four sampling methods (p < 0.01) (blood, cloacal swabs, feather, and fecal). Blood samples exhibited the lowest prevalence at 11.2% (95% CI: 4.4-20.7%), suggesting that BFDV prevalence may be underestimated if only blood tests are used. In regions with distinct seasonal variation, the prevalence of BFDV (3.80%, 95% CI: 0.10-11.10%) was notably lower in summer, but higher in spring and autumn. Age subgroup prevalence varied significantly, with young birds having the highest prevalence at 22.5% (95% CI, 8.8-39.6%). No significant differences in the prevalence of BFDV were observed based on sex or sampling time. This study indicated that the global molecular prevalence of BFDV infection has increased in recent years, and that species, season, sampling methods and age are the main risk factors. By monitoring BFDV prevalence, identifying high-risk species, and elucidating key risk factors, we can develop targeted management strategies to mitigate viral transmission.

Clear recommendations for treating childhood obesity include family involvement, improving diet quality, reducing portion sizes, increasing physical activity, and decreasing sedentary behaviors.

This systematic review and meta-analysis aimed to provide evidence the effects of yoga interventions on BMI, weight, body composition, and vital signs in children or adolescents with overweight/obesity. This study searched the PubMed, Web of Science, and EBSCO databases to include all studies published up to June 2024. Methodological quality was assessed with the RoB 2. Randomized or nonrandomized controlled studies were included. The standardized mean difference with a 95% confidence interval was calculated. Heterogeneity was analyzed using the I2 test and Q statistic. Publication bias was assessed with the Egger regression test.

This meta-analysis included nine studies. Pooled evidence found that yoga significantly reduces BMI and body fat percentage in children or young people with overweight/obesity.

In conclusion, findings derived from pooled data yoga intervention is an effective method for weight management in children and adolescents with obesity. Additionally, considering that yoga is a calming and mind-body-based intervention, it is recommended that future studies also examine the psychological effects of yoga in children and adolescents with obesity.

Background: Gestational diabetes mellitus (GDM) is a common endocrine and metabolic disorder during pregnancy. However, current studies have not reached a consensus on the correlation between GDM and the risk of developing cancers. Objective: This systematic review and meta-analysis aims to comprehensively evaluate the association between GDM and the risk of overall cancer and cancers at specific sites (pancreatic cancer, thyroid cancer, liver cancer, lung cancer). Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, EMBASE, and Cochrane Library databases from the establishment of the databases to 16 January 2025. Two researchers independently assessed the quality of the included studies using the Newcastle-Ottawa Scale and extracted relevant data. Data were analyzed using STATA Version 17.0. Results: This systematic review and meta-analysis included a total of 8 studies involving 1,936,836 participants. We calculated the pooled hazard ratio (HR) to evaluate the association, and the results showed that the pooled HR for overall cancer risk was 1.16 (95%CI: 1.04-1.28), indicating a significant increase in the risk of overall malignancies among patients with GDM. GDM was also significantly associated with the risk of pancreatic cancer (HR = 2.80; 95%CI: 1.20-6.55), thyroid cancer (HR = 1.21; 95%CI: 1.08-1.36), and liver cancer (HR = 1.33; 95%CI: 1.10-1.61). Additionally, the association between GDM and lung cancer was close to being statistically significant (HR = 1.19; 95%CI: 0.98-1.44). Conclusion: Our study suggests that GDM is associated with an increased risk of overall cancer, as well as pancreatic cancer, thyroid cancer, and liver cancer.

Previous epidemiological studies have provided inconsistent findings regarding the association between metabolic syndrome (MetS) and risk of esophageal cancer.

We conducted a comprehensive literature search for prospective studies in MEDLINE and EMBASE databases through April 2024. Random-effects meta-analysis was used to calculate pooled hazard ratios (HR) with 95 % confidence intervals (CI) for the associations between MetS and risk of esophageal cancer by histological type. Between-study heterogeneity was assessed by Cochran's Q test and I2 statistics.

Among 8097 identified studies, six studies were included. MetS was associated with an increased risk of esophageal adenocarcinoma (pooled HR=1.24; 95 %CI, 1.07-1.42; Pheterogeneity=0.392, I2=3.8 %, N = 6), but not esophageal squamous cell carcinoma (HR=0.89; 95 % CI, 0.58-1.36; Pheterogeneity=0.040, I2=68.9 %, N = 3). An increased risk of esophageal adenocarcinoma was indicated for hyperglycemia (HR= 1.14; 95 % CI, 1.01-1.29; Pheterogeneity=0.693, I2=0.0 %, N = 3) and obesity (HR=1.50; 95 % CI, 1.24-1.82; Pheterogeneity=0.191, I2=34.5 %, N = 5), rather than the other components of MetS, i.e. hypertension or levels of triglyceride or high-density lipoprotein. Hypertension was associated with seemingly increased risk of esophageal squamous cell carcinoma (HR=1.39; 95 % CI, 0.93-2.09; Pheterogeneity=0.030, I2=71.4 %, N = 3), while obesity was associated with a decreased risk (HR=0.65; 95 % CI, 0.38-1.12; Pheterogeneity=0.009, I2=78.7 %, N = 3); no associations were observed for the other components of MetS with esophageal squamous cell carcinoma.

MetS, particularly hyperglycemia and obesity, may increase the risk of esophageal adenocarcinoma. MetS, by and large, may not influence the risk of esophageal squamous cell carcinoma.

As a common metabolic disease, type 2 diabetes mellitus (T2DM) is regulated by the ectoenzyme nucleotide pyrophosphatase phosphodiesterase 1 (ENPP1). A functional polymorphism of ENPP1 (rs1044498, K121Q) has been found to contribute to T2DM susceptibility. This study aims to analyze the combined association of ENPP1 rs1044498 polymorphism with T2DM risk. We searched for publications in Embase, Medline, EBSCO, PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang databases from January 2010 to December 2023. Pooled association strength was analyzed using either a random-effects or fixed-effects model, and expressed as combined odds ratios (ORs) with 95% confidence intervals (CIs). Data analysis was performed by STAT 12.0. Due to high heterogeneity, a random-effects model was used for the calculation. In the total population, ENPP1 rs1044498 was evidently related to an increased susceptibility to T2DM under the following models: Q vs. K (OR = 1.405, 95% CI = 1.059-1.863), KQ + QQ vs. KK (OR = 1.475, 95% CI = 1.075-2.023), QQ vs. KK + KQ (OR = 2.355, 95% CI = 1.302-4.262), QQ vs. KK (OR = 3.096, 95% CI = 1.393-6.882) and KQ vs. KK (OR = 1.399, 95% CI = 1.038-1.885). In ethnic subgroups, rs1044498 was associated with T2DM risk in Asians under the following models: Q vs. K (OR = 1.480, 95% CI = 1.017-2.154), KQ + QQ vs. KK (OR = 1.578, 95% CI = 1.047-2.379), QQ vs. KK+ KQ (OR = 3.709, 95% CI = 1.727-7.967), QQ vs. KK (OR = 5.049, 95% CI = 1.784-16.397) and KQ vs. KK (OR = 1.478, 95% CI = 1.008-2.167). The distinct association between rs1044498 and T2DM risk was discovered in the diagnostic criteria not shown subgroup and plasma subgroup. This study demonstrated high sensitivity with minimal publication bias. The ENPP1 121Q allele is a risk factor for T2DM, particularly in the Asian population.

To explore the global prevalence of varicose veins among healthcare workers and their associated risk factors.

Varicose veins are a common occupational disease among healthcare staff. To enhance the occupational health of this population, it is necessary to understand their prevalence and risk factors.

We searched databases including Embase, PubMed, Web of Science, and CINAHL. We used random-effects meta-analyses to estimate the pooled prevalence of varicose veins and associated risk factors (odds ratios) and conducted a narrative synthesis.

A meta-analysis comprising 9 studies revealed that the global prevalence of varicose veins among healthcare workers is 25% (95% CI, 18-31%). Subgroup analyses indicated that the highest prevalence, at 28% (95% CI, 9-47%), was in Middle East and North Africa. Compared with other methods, detection methods that include Doppler ultrasound examination and physical examination using the CEAP classification, along with questionnaire surveys, have both reported a higher prevalence rate of 28%. Additionally, the prevalence in developing countries, at 29% (95% CI, 19-38%), exceeds that in developed countries. The identified risk factor associated with the development of varicose veins among healthcare workers include female (OR = 3.29, 95%CI, 1.77-6.13), family history (OR = 1.86, 95%CI, 1.53-2.58) and being parous (OR = 1.75, 95%CI, 1.21-2.53).

Healthcare workers have a high prevalence of varicose veins, and hospital managers can take proactive measures against the identified risk factors to reduce the risk of disease and ensure the safety of medical care.

Not applicable.

Autism spectrum disorder encompasses diverse patterns of social communication and repetitive, restricted behaviours. Various interventions have been developed to reduce the negative consequences of this disorder and improve levels of functioning, and recently interest in parent-mediated interventions has increased. Previous reviews and meta-analyses have investigated the effects of the parent-mediated interventions, however; a systematic review with meta-analysis of high quality has not been performed since 2013. This protocol for a systematic review with meta-analysis aims to describe the methods and purpose of synthesising current evidence regarding the effects (both positive and adverse) of parent-mediated interventions in both children with autism and their parents.

Electronic searches will be conducted in Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Latin American and Caribbean Health Sciences Literature (LILACS), American Psychological Association PsycInfo (PsycInfo) and Science Citation Index Expanded (SCI-EXPANDED). Randomised clinical trials of parent-mediated interventions for children with autism and control groups of usual care, waiting list or no treatment will be included. Two reviewers will independently screen, select and collect data. Methodological quality of included studies will be evaluated using Cochrane methodology. The primary outcome will be autism symptom severity as measured by the Autism Diagnostic Observation Schedule. Secondary outcomes will be adaptive functioning, adverse effects, child language, child´s quality of life, parental quality of life and parental stress. Meta-analyses and Trial Sequential Analysis will be performed.

This is the study protocol for a systematic review and meta-analysis of parent-mediated interventions versus usual care for children with ASD. Results of the review will inform clinicians and parents about the current evidence of the effects, both positive and negative, of parent-mediated interventions on younger children with autism and their parents, through improved methodology and inclusion of new studies. PROSPERO registration number: 385188.

Bruxism, an involuntary clenching or grinding of teeth, is increasingly prevalent among athletes due to elevated stress, performance anxiety, and intense training. This systematic review analyzed 11 studies (2000-2023) on bruxism prevalence, underlying factors, and its impact on athletic performance. Data were extracted on prevalence, strength, endurance, coordination, reaction time, psychological stress, sleep quality, and injury risk. Random-effects models calculated pooled prevalence, standardized mean differences, and odds ratios. Bruxism prevalence among athletes ranged from 15 to 70%, with a pooled estimate of 38% (95% confidence interval: 25-52%), significantly higher than the general population's 8-20%. Combat sports (58%) and weightlifting (50%) showed the highest rates. Athletes with bruxism exhibited reduced strength (standardized mean difference=-0.48), endurance (standardized mean difference=-0.41), coordination (standardized mean difference=-0.45), slower reaction times (standardized mean difference=-0.33), elevated anxiety (standardized mean difference=0.62), poorer sleep quality (standardized mean difference=-0.56), and a 2.5-fold higher injury risk (odds ratio=2.5). Bruxism poses significant challenges for athletes, compromising oral health, sleep, and performance. Further research should clarify sport-specific risk factors and develop targeted management strategies to safeguard athletes' health and competitive outcomes.

To evaluate the impact of daytime, nighttime, and nocturnal blood pressures (BPs) fall on heart failure (HF).

We analyzed data from five cohorts including 15,526 treated hypertensive patients, experiencing 625 HF events, by study-level meta-analysis. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for 1SD increase in BP parameters or per group were calculated.

When individually analyzed after adjustment for covariates, clinic systolic BP (SBP) (HR 1.20, 95% CI 1.01-1.43), daytime SBP (HR 1.34, 95% CI 1.06-1.70), nighttime SBP (HR 1.43, 95% CI 1.20-1.71), nighttime diastolic BP (DBP) (HR 1.26, 95% CI 1.05-1.52), % of nocturnal SBP fall (HR 0.81, 95% CI 0.75-0.88), and nondipping (HR 1.64, 95% CI 1.54-1.98) were associated with HF. If daytime or nighttime BP was further adjusted for clinic BP results remained similar. When clinic, daytime, and nighttime BPs were mutually adjusted, nighttime SBP (HR 1.43, 95% CI 1.27-1.61) and nighttime DBP (HR 1.37, 95% CI 1.14-1.64) remained associated with the outcome. Heterogeneity across cohorts was explained by BP, sex, and follow-up duration. In sensitivity analyses, for daytime and nighttime BPs, no study had a relevant influential effect on overall estimates. Looking for publication bias and adjusting for missing studies by Duval and Tweedie's method, clinic SBP lost significance but daytime SBP, and nighttime SBP and DBP remained significantly associated with HF.

Daytime and nighttime BPs are stronger than clinic BP in predicting HF, nighttime BP is stronger than daytime BP, and a reduced nocturnal BP fall is associated with outcome.