A meta-analysis of Allgöwer-Donati versus interrupted vertical mattress suturing in preventing postoperative incisional complications of calcaneal fracture surgery: A systematic review and meta-analysis.

BACKGROUNDThe clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial, particularly under the enhanced recovery after surgery (ERAS) protocol. ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.AIMTo evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.METHODSA systematic review and meta-analysis were conducted by searching PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP Information, and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols. Primary outcomes included time to gastrointestinal function recovery, drainage tube removal time, postoperative complication rates, and length of hospital stay. Review Manager 5.4 was used for statistical analysis, and heterogeneity was assessed using the I2 statistic.RESULTSA total of 21 randomized controlled trials involving 1652 patients were included. Compared with routine abdominal drainage, the ERAS group without drainage showed significantly faster gastrointestinal recovery [standardized mean difference = -1.30, 95% confidence interval (CI): -1.66 to -0.94, P < 0.00001] and shorter hospital stay (standardized mean difference = -1.37, 95%CI: -1.86 to -0.88, P < 0.00001). The incidence of total postoperative complications was also significantly lower (odds ratio = 0.53, 95%CI: 0.40-0.70, P < 0.00001), particularly for anastomotic leakage and pulmonary infection. No significant differences were observed in surgical site infections or urinary tract infections. Sensitivity and subgroup analyses indicated stability of results, although some heterogeneity was noted.CONCLUSIONAvoiding routine abdominal drainage under ERAS could lead to faster recovery, reduced complications, and shorter hospital stay following radical gastrectomy, supporting the selective use of drainage rather than routine.

What's New in Orthopaedic Trauma.

This meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population.Databases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software.A total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = -1.28; 95% CI: -1.81, -0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: -0.34, 1.20; P = 0.27).For the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.

ObjectivesThis meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population.MethodsDatabases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software.ResultsA total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = −1.28; 95% CI: −1.81, −0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: −0.34, 1.20; P = 0.27).ConclusionsFor the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.

Midshaft (mid)-clavicle fractures are the most common type of clavicle fractures. The Kirschner wire (KW) and anatomic plate (AP) are two commonly used surgical treatment methods for mid-clavicle fractures, of which the use of an AP appears to be a more effective option. The present study performed a meta-analysis of a number of published studies on the treatment of mid-clavicle fractures with APs and KWs, in order to compare the advantages and disadvantages of the two treatments, so as to select a more effective treatment approach. The articles were obtained from several databases, including Cochrane Library, PubMed, Embase, CNKI, Wanfang, VIP and Chinese Biomedical Literature Database. The search period was from database establishment to June, 2021. Research was obtained by two authors who individually searched the aforementioned databases. For controversial studies, decisions were made by two authors (JZ and LW). A total of 20 studies involving 1,739 patients were included in the meta-analysis, including eight randomized controlled studies and 12 cohort trials. The results of the meta-analysis suggested that: Compared with the KW group, the AP group exhibited significant differences in incision length [standardized mean difference (SMD)=2.40; 95% confidence interval (CI), 1.93-2.86], constant function score (6 months; SMD=1.59; 95% CI, 1.29-1.89) and fracture healing time (SMD=-1.48; 95% CI, -2.09 to -0.87) (P<0.05). However, no significant differences were observed in the duration of the surgery (SMD=1.19; 95% CI, -0.19-2.57) and intraoperative blood loss (SMD=0.10; 95% CI, -3.13-3.32) (P>0.05). Compared with the KW group, significant differences were observed in post-operative efficacy (OR, 4.81; 95% CI, 3.10-7.46) and the incidence of post-operative complications (OR, 0.16; 95% CI, 0.05-0.55) in the AP group (P<0.05). On the whole, the AP and KW are two common materials for the clinical surgical treatment of mid-clavicle fractures. The present study confirmed that there was no significant difference between the two treatments as regards the duration of surgery and intraoperative blood loss; however, for post-operative shoulder joint function recovery, fracture healing state and healing time, the AP was significantly more effective than the KW. The post-operative complication rate of the AP group was significantly lower than that of the KW group. However, further prospective, large-sample randomized controlled studies are required to provide more concrete evidence for verification.

It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.

ObjectiveThe efficacy and safety of subxiphoid thoracoscopic thymectomy (SVATS) for early thymoma are unknown. The purposes of this meta-analysis were to evaluate the effectiveness and safety of SVATS for early thymoma, to compare it with unilateral intercostal approach video thoracoscopic surgery (IVATS) thymectomy, and to investigate the clinical efficacy of modified subxiphoid thoracoscopic thymectomy (MSVATS) for early anterior mediastinal thymoma.MethodsOriginal articles describing subxiphoid and unilateral intercostal approaches for thoracoscopic thymectomy to treat early thymoma published up to March 2023 were searched from PubMed, Embase, and the Cochrane Library. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and analyzed for heterogeneity. Clinical data were retrospectively collected from all Masaoka stage I and II thymoma patients who underwent modified subxiphoid and unilateral intercostal approach thoracoscopic thymectomies between September 2020 and March 2023. The operative time, intraoperative bleeding, postoperative drainage, extubation time, postoperative hospital stay, postoperative visual analog pain score (VAS), and postoperative complications were compared, and the clinical advantages of the modified subxiphoid approach for early-stage anterior mediastinal thymoma were analyzed.ResultsA total of 1607 cases were included in the seven studies in this paper. Of these, 591 cases underwent SVATS thymectomies, and 1016 cases underwent IVATS thymectomies. SVATS thymectomy was compared with IVATS thymectomy in terms of age (SMD = − 0.09, 95% CI: −0.20 to − 0.03, I2 = 20%, p = 0.13), body mass index (BMI; SMD = − 0.10, 95% CI: −0.21 to − 0.01, I2 = 0%, p = 0.08), thymoma size (SMD = − 0.01, 95% CI: −0.01, I2 = 0%, p = 0.08), operative time (SMD = − 0.70, 95% CI: −1.43–0.03, I2 = 97%, p = 0.06), intraoperative bleeding (SMD = − 0.30. 95% CI: −0.66–0.06, I2 = 89%, p = 0.10), time to extubation (SMD = − 0.34, 95%CI: −0.73–0.05, I2 = 91%, p = 0.09), postoperative hospital stay (SMD = − 0.40, 95% CI: −0.93–0.12, I2 = 93%, p = 0.13), and postoperative complications (odds ratio [OR] = 0.94, 95% CI: 0.42–2.12, I2 = 57%, p = 0.88), which were not statistically significantly different between the SVATS and IVATS groups. However, the postoperative drainage in the SVATS group was less than that in the IVATS group (SMD = − 0.43, 95%CI: −0.84 to − 0.02, I2 = 88%, p = 0.04), and the difference was statistically significant. More importantly, the postoperative VAS was lower in the SVATS group on days 1 (SMD = − 1.73, 95%CI: −2.27 to − 1.19, I2 = 93%, p < 0.00001), 3 (SMD = − 1.88, 95%CI: −2.84 to − 0.81, I2 = 97%, p = 0.0005), and 7 (SMD = − 1.18, 95%CI: −2.28 to − 0.08, I2 = 97%, p = 0.04) than in the IVATS group, and these differences were statistically significant. A total of 117 patients undergoing thoracoscopic thymectomy for early thymoma in the Department of Thoracic Surgery of the Second Hospital of Jilin University were retrospectively collected and included in the analysis, for which a modified subxiphoid approach was used in 42 cases and a unilateral intercostal approach was used in 75 cases. The differences between the two groups (MSVATS vs. IVATS) in general clinical characteristics such as age, sex, tumor diameter, Masaoka stage, Word Health Organization (WHO) stage, and intraoperative and postoperative conditions, including operative time, postoperative drainage, extubation time, postoperative hospital stay, and postoperative complication rates, were not statistically significant (p > 0.05), while BMI, intraoperative bleeding, and VAS on postoperative days 1, 3, and 7 were all statistically significant (p < 0.05) in the MSVATS group compared with the IVATS group.ConclusionThe meta-analysis showed that the conventional subxiphoid approach was superior in terms of postoperative drainage and postoperative VAS pain scores compared with the unilateral intercostal approach. Moreover, the modified subxiphoid approach had significant advantages in intraoperative bleeding and postoperative VAS pain scores compared with the unilateral intercostal approach. These results indicate that MSVATS can provide more convenient operation conditions, a better pleural cavity view, and a more complete thymectomy in the treatment of early thymoma, indicating that is a safe and feasible minimally invasive surgical method.

Role of Antimuscarinics Combined With Alpha-blockers in the Management of Urinary Storage Symptoms in Patients With Benign Prostatic Hyperplasia: An Updated Systematic Review and Meta-analysis.

Systemic inflammation and oxidative stress (OS) are associated with breast cancer. CoQ10 as an adjuvant treatment with conventional anti-cancer chemotherapy has been demonstrated to help in the inflammatory process and OS. This systematic review and meta-analysis of randomized clinical trials (RCTs) aimed to evaluate the efficacy of CoQ10 supplementation on levels of inflammatory markers, OS parameters, and matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMPs/TIMPs) in patients with breast cancer. A systematic literature search was carried out using electronic databases, including PubMed, Web of Science, Scopus, Google Scholar, and Embase, up to December 2020 to identify eligible RCTs evaluating the effect of CoQ10 supplementation on OS biomarkers, inflammatory cytokines, and MMPs/TIMPs. From 827 potential reports, 5 eligible studies consisting of 9 trials were finally included in the current meta-analysis. Quality assessment and heterogeneity tests of the selected trials were performed using the PRISMA checklist protocol and the I2 statistic, respectively. Fixed and random-effects models were assessed based on the heterogeneity tests, and pooled data were determined as the standardized mean difference (SMD) with a 95% confidence interval (CI). Our meta-analysis of the pooled findings for inflammatory biomarkers of OS and MMPs showed that CoQ10 supplementation (100mg/day for 45-90days) significantly decreased the levels of VEGF [SMD:-1.88, 95% CI: (-2. 62 to-1.13); I2=93.1%, p<0.001], IL-8 [SMD:-2.24, 95% CI: (-2.68 to-1.8); I2=79.6%, p=0.001], MMP-2 [SMD:-1.49, 95% CI: (-1.85 to-1.14); I2=76.3%, p=0.005] and MMP-9 [SMD:-1.58, 95% CI: (-1.97 to-1.19); I2=79.6%, p=0.002], but no significant difference was observed between CoQ10 supplementation and control group on TNF-α [SMD:-2.30, 95% CI: (-2.50 to-2.11); I2=21.8%, p=0.280], IL-6 [SMD:-1.56, 95% CI: (-1.73 to-1.39); I2=0.0%, p=0.683], IL-1β [SMD:-3.34, 95% CI: (-3.58 to-3.11); I2=0.0%, p=0.561], catalase (CAT) [SMD: 1.40, 95% CI: (1.15 to 1.65); I2=0.0%, p=0.598], superoxide dismutase (SOD) [SMD: 2.42, 95% CI: (2.12 to 2.71); I2=0.0%, p=0.986], glutathione peroxidase (GPx) [SMD: 2.80, 95% CI: (2.49 to 3.11); I2=0.0%, p=0.543]], glutathione (GSH) [SMD: 4.71, 95% CI: (4.26 to 5.16); I2=6.1%, p=0.302] and thiobarbituric acid reactive substances (TBARS) [SMD:-3.20, 95% CI: (-3.53 to-2.86); I2=29.7%, p=0.233]. Overall, the findings showed that CoQ10 supplementation reduced some of the important markers of inflammation and MMPs in patients with breast cancer. However, further studies with controlled trials for other types of cancer are needed to better understand and confirm the effect of CoQ10 on tumor therapy.

Analysis of the efficacy of metabolic and bariatric surgery on sarcopenic obesity: a systematic review and meta-analysis.

BackgroundInflammatory arthritis (IA) is a group of autoimmune arthritis characterized by a pro-inflammatory/anti-inflammatory disbalance of local mediators[1][2]. Research on the influence of gut microbiota(GM) on systemic IA has exploded in...

Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and is sometimes treated with bronchodilators. To assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis. We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January Week 2, 2014) and EMBASE (1998 to January 2014). Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo for bronchiolitis. Two authors assessed trial quality and extracted data. We obtained unpublished data from trial authors. We included 30 trials (35 data sets) representing 1992 infants with bronchiolitis. In 11 inpatient and 10 outpatient studies, oxygen saturation did not improve with bronchodilators (mean difference (MD) -0.43, 95% confidence interval (CI) -0.92 to 0.06, n = 1242). Outpatient bronchodilator treatment did not reduce the rate of hospitalization (11.9% in bronchodilator group versus 15.9% in placebo group, odds ratio (OR) 0.75, 95% CI 0.46 to 1.21, n = 710). Inpatient bronchodilator treatment did not reduce the duration of hospitalization (MD 0.06, 95% CI -0.27 to 0.39, n = 349).Effect estimates for inpatients (MD -0.62, 95% CI -1.40 to 0.16) were slightly larger than for outpatients (MD -0.25, 95% CI -0.61 to 0.11) for oximetry. Oximetry outcomes showed significant heterogeneity (I(2) statistic = 81%). Including only studies with low risk of bias had little impact on the overall effect size of oximetry (MD -0.38, 95% CI -0.75 to 0.00) but results were close to statistical significance.In eight inpatient studies, there was no change in average clinical score (standardized MD (SMD) -0.14, 95% CI -0.41 to 0.12) with bronchodilators. In nine outpatient studies, the average clinical score decreased slightly with bronchodilators (SMD -0.42, 95% CI -0.79 to -0.06), a statistically significant finding of questionable clinical importance. The clinical score outcome showed significant heterogeneity (I(2) statistic = 73%). Including only studies with low risk of bias reduced the heterogeneity but had little impact on the overall effect size of average clinical score (SMD -0.22, 95% CI -0.41 to -0.03).Sub-analyses limited to nebulized albuterol or salbutamol among outpatients (nine studies) showed no effect on oxygen saturation (MD -0.19, 95% CI -0.59 to 0.21, n = 572), average clinical score (SMD -0.36, 95% CI -0.83 to 0.11, n = 532) or hospital admission after treatment (OR 0.77, 95% CI 0.44 to 1.33, n = 404).Adverse effects included tachycardia, oxygen desaturation and tremors. Bronchodilators such as albuterol or salbutamol do not improve oxygen saturation, do not reduce hospital admission after outpatient treatment, do not shorten the duration of hospitalization and do not reduce the time to resolution of illness at home. Given the adverse side effects and the expense associated with these treatments, bronchodilators are not effective in the routine management of bronchiolitis. This meta-analysis continues to be limited by the small sample sizes and the lack of standardized study design and validated outcomes across the studies. Future trials with large sample sizes, standardized methodology across clinical sites and consistent assessment methods are needed to answer completely the question of efficacy.

The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) is to determine the effectiveness of probiotic supplementation on clinical symptoms, weight loss, glycemic control, lipid and hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome (PCOS). Eligible studies were systematically searched from Cochrane Library, Embase, Medline, and Web of Science databases until January 2019. Cochran (Q) and I-square statistics were used to measure heterogeneity among included studies. Data were pooled by using random-effect model and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). Eleven articles were included in this meta-analysis. Probiotic supplementation significantly decreased weight (SMD - 0.30; 95% CI, - 0.53, - 0.07; P = 0.01), body mass index (BMI) (SMD - 0.29; 95% CI, - 0.54, - 0.03; P = 0.02), fasting plasma glucose (FPG) (SMD - 0.26; 95% CI, - 0.45, - 0.07; P < 0.001), insulin (SMD - 0.52; 95% CI, - 0.81, - 0.24; P < 0.001), homeostatic model assessment for insulin resistance (HOMA-IR) (SMD - 0.53; 95% CI, - 0.79, - 0.26; P < 0.001), triglycerides (SMD - 0.69; 95% CI, - 0.99, - 0.39; P < 0.001), VLDL-cholesterol (SMD - 0.69; 95% CI, - 0.99, - 0.39; P < 0.001), C-reactive protein (CRP) (SMD - 1.26; 95% CI, - 2.14, - 0.37; P < 0.001), malondialdehyde (MDA) (SMD - 0.90; 95% CI, - 1.16, - 0.63; P < 0.001), hirsutism (SMD - 0.58; 95% CI, - 1.01, - 0.16; P < 0.001), and total testosterone levels (SMD - 0.58; 95% CI, - 0.82, - 0.34; P < 0.001), and also increased the quantitative insulin sensitivity check index (QUICKI) (SMD 0.41; 95% CI, 0.11, 0.70; P < 0.01), nitric oxide (NO) (SMD 0.33; 95% CI 0.08, 0.59; P = 0.01), total antioxidant capacity (TAC) (SMD 0.64; 95% CI, 0.38, 0.90; P < 0.001), glutathione (GSH) (SMD 0.26; 95% CI, 0.01, 0.52; P = 0.04), and sex hormone binding globulin (SHBG) levels (SMD 0.46; 95% CI, 0.08, 0.85; P = 0.01). Probiotic supplementation may result in an improvement in weight, BMI, FPG, insulin, HOMA-IR, triglycerides, VLDL-cholesterol, CRP, MDA, hirsutism, total testosterone, QUICKI, NO, TAC, GSH, and SHBG but did not affect dehydroepiandrosterone sulfate levels, and total, LDL, and HDL cholesterol levels in patients with PCOS.

BackgroundAllergic ocular symptoms, although frequently trivialised, are common and represent an important comorbidity of allergic rhinitis. Sublingual Immunotherapy (SLIT) is an effective and well‐tolerated treatment for allergic rhinitis, but its effects on symptoms of ocular allergy have not been well established.ObjectivesTo evaluate the efficacy of SLIT compared with placebo for reductions in ocular symptoms, topical ocular medication requirements and conjunctival immediate allergen sensitivity.Search methodsWe searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 1), MEDLINE (January 1950 to January 2011), EMBASE (January 1980 to January 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2011), Web of Science (January 1970 to January 2011), Biosis Previews, (January 1979 to January 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled‐trials.com) (January 2011), ClinicalTrials.gov (www.clinicaltrials.gov) (January 2011), the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.actr.org.au) (July 2010), SCOPUS (November 2008) and the UK Clinical Trials Gateway (January 2010). There were no language or date restrictions in the search for trials. All electronic databases except for SCOPUS, the UK Clinical Trials Gateway and ANZCTR were last searched on 19 January 2011.Selection criteriaRandomised controlled trials (RCTs), double‐masked and placebo controlled, which evaluated the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or allergic conjunctivitis (AC).Data collection and analysisThe primary outcome was the total ocular symptom scores. Secondary endpoints included individual ocular symptom scores (such as itchy eyes, red eyes, watery eyes, swollen eyes), ocular medication scores (eye drops) and conjunctival immediate allergen sensitivity (CIAS). Data were analysed and reported as standardised mean differences (SMDs) using Review Manager software.Main resultsForty‐two trials (n = 3958 total participants; n= 2011 SLIT and n = 1947 placebo) had available data to evaluate the efficacy of SLIT on AC and were included in the meta‐analyses. Heterogeneity among studies (I2 statistic) was around 50% or below for all endpoints. Sublingual immunotherapy induced a significant reduction in both total ocular symptom scores (SMD ‐0.41; 95% confidence interval (CI) ‐0.53 to ‐0.28; P &lt; 0.00001; I2 = 59%) and individual ocular symptom scores for red eyes (SMD ‐0.33; 95% CI ‐0.45 to ‐0.22; P &lt; 0.00001; I2 = 27%), itchy eyes (SMD ‐0.31; 95% CI ‐0.42 to ‐0.20; P &lt; 0.00001; I2 = 46%) and watery eyes (SMD ‐0.23; 95% CI ‐0.34 to ‐0.11; P &lt; 0.0001; I2 = 42%) compared to placebo. Those participants having active treatment showed an increase in the threshold dose for the conjunctival allergen provocation test (SMD 0.35; 95% CI 0.00 to 0.69; P = 0.05; I2 = 43%). No significant reduction was observed in ocular eye drops use (SMD ‐0.10; 95% CI ‐0.22 to 0.03; P = 0.13; I2 = 34%).Authors' conclusionsOverall, SLIT is moderately effective in reducing total and individual ocular symptom scores in participants with ARC and AC. There were however some concerns about the overall quality of the evidence‐base, this relating to inadequate descriptions of allocation concealment in some studies, statistical heterogeneity and the possibility of publication bias. There is a need for further large rigorously designed studies that study long‐term effectiveness after discontinuation of treatment and establish the cost‐effectiveness of SLIT.Plain Language SummarySublingual immunotherapy (tablets, spray or drops under the tongue) to treat inflammation of the conjunctiva due to allergyConjunctivitis means inflammation of the conjunctiva. The conjunctiva is the thin 'skin' that covers the white part of the eyes and the inside of the eyelids. Allergic conjunctivitis is the inflammation of the conjunctiva due to allergy. The most common cause is an allergy to pollen during the hay fever season. Symptoms include red eyes, itching, increased tearing and swelling of the conjunctiva and eyelids. If allergic conjunctivitis is combined with nasal allergy, the condition is termed allergic rhinoconjunctivitis. When medications do not provide enough relief another option is immunotherapy, which builds immunity to the allergen causing the reaction. Immunotherapy can be given under the tongue, nasally or by injection. This review included 42 trials with a total of 3958 participants with allergic conjunctivitis; 2011 who had sublingual immunotherapy and 1947 who had placebo. This review found that sublingual immunotherapy (that is, administered under the tongue) can reduce symptoms of allergic conjunctivitis.

We found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol and drugs. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. Whilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. We found low-quality evidence from few studies that interventions involving children are not beneficial.