Cochrane CENTRAL Research Articles

Rotations of teeth—a systematic review

BackgroundRotations are frequently evaluated through various assessment methods of crowding and arch dimension, with relatively few studies discussing the extent or direction of rotations and even fewer addressing the reliability of such assessments. This systematic review aims to comprehensively analyze existing classification systems for rotated teeth and assess rotation in anterior and posterior teeth, its clinical applicability, and its impact on retention and relapse.Search methodsTwo investigators conducted a comprehensive search in six databases, namely, PubMed, Scopus, Ovid, LILACS, Web of Science, and Cochrane CENTRAL, up to 28 March 2024. No specific start date was defined to ensure the inclusion of all relevant studies from the inception of each database, maximizing the comprehensiveness of our review. The search criteria included retrospective studies and the inclusion criteria were patients who were assessed for rotation in any age group. The exclusion criteria were patients who had undergone orthodontic treatment, who had fractured restorations or crowns, or who had any other tooth anomaly.Data collection and analysisIn total, 10 studies satisfying the inclusion criteria were included and 9 provided quantitative outcomes for the rotation of various teeth, while the remaining study offered qualitative results. The risk of bias assessment was performed with the help of the Newcastle–Ottawa quality assessment tool.ResultsThe skeletal Class II and Class III groups exhibited similar average positions of the first molar. Upper molar rotation was primarily observed in dental Class II patients, with a higher mesial rotation angle of 78.6°. Only one study measured the rotation for all permanent teeth. Seven studies used the mid-palatal raphe as the reference line for measuring molar rotation. No gender differences were found. It was found that there was no statistical significance in the mean values of molar rotation for the right and left sides as well as the maxillary and mandibular arches. The incisors demonstrated the highest degree of rotation (7.4°–20.2°), while the premolars and canines exhibited a slightly lower degree of rotation (3.3°–9.2°). In contrast, the molars displayed the lowest degree of rotation (0.8°–7.4°).ConclusionAfter reviewing all the studies, it was found that there is no adequate classification system to assess the rotation of anterior teeth and mandibular teeth. A universally accepted classification of tooth rotation, including a common reference line, is needed. The existing systems for posterior teeth need to be standardized and have a clinical utility to be widely accepted.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024524654, PROSPERO (CRD42024524654).

The Use of Fluorescent Markers to Detect and Delineate Head and Neck Cancer: A Scoping Review.

The aim of surgery for head and neck squamous cell carcinoma (HNSCC) is to achieve clear resection margins, whilst preserving function and cosmesis. Fluorescent markers have demonstrated potential in the intraoperative visualisation and delineation of tumours, such as glioma, with consequent improvements in resection. The purpose of this scoping review was to identify and compare the fluorescent markers that have been used to detect and delineate HNSCC to date. A literature search was performed using the Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, ClinicalTrials.gov and ICTRP databases. Primary human studies published through September 2023 demonstrating the use of fluorescent markers to visualise HNSCC were selected and reviewed independently by two authors. The search strategy identified 5776 records. Two hundred and forty-four full texts were reviewed, and sixty-five eligible reports were included. The most used fluorescent markers in the included studies were indocyanine green (ICG) (n = 14), toluidine blue (n = 11), antibodies labelled with IRDye800CW (n = 10) and 5-aminolevulinic acid (5-ALA) (n = 8). Toluidine blue and ICG both have limited specificity, although novel targeted options derived from ICG may be more effective. 5-ALA has been demonstrated as a topical marker and, recently, via enteral administration but it is associated with photosensitivity reactions. The fluorescently labelled antibodies cetuximab-IRDye800CW and panitumumab-IRDye800CW are promising options being investigated by ongoing trials. Multiple safe fluorescent markers have emerged which may aid the surgical resection of HNSCC. Further research in larger cohorts is required to identify which marker should be considered gold standard.

Association of Lipoprotein(a) With Major Adverse Cardiovascular Events Across hs-CRP: A Systematic Review and Meta-Analysis

BackgroundLipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. The relationship between Lp(a) and major adverse cardiovascular events (MACE) in the context of high-sensitivity C-reactive protein (hs-CRP) levels remains controversial due to conflicting results from previous studies. ObjectivesThis systematic review and meta-analysis aimed to clarify the association between Lp(a) and risk of MACE across different hs-CRP levels in both primary and secondary prevention settings. MethodsWe performed a systematic review by searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL (Wiley), and Web of Science (Clarivate) from their inception to February 2024. Eligible studies reported the association of Lp(a) with MACE stratified by hs-CRP level. Data extraction and quality assessment were systematically conducted. Meta-analyses used random-effects models to compute pooled HRs for individuals with low (<2 mg/L) and high (≥2 mg/L) hs-CRP levels. Subgroup analyses were performed in primary and secondary prevention populations. ResultsNine publications encompassing 11 studies that involved 562,301 participants met the inclusion criteria. The mean proportion of females was 39.9% and the weighted mean age for the entire cohort was 61.2 years. Elevated Lp(a) was significantly associated with MACE risk in both low and high hs-CRP groups, with pooled HR of 1.26 (95% CI: 1.11-1.42) and 1.33 (95% CI: 1.20-1.47), respectively. In the primary prevention group, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06-1.66) and 1.43 (95% CI: 1.13-1.82), respectively (subgroup difference, P = 0.65). The corresponding HRs for the secondary prevention population were 1.13 (95% CI: 1.00-1.27) and 1.31 (95% CI: 1.12-1.52), respectively (subgroup difference P = 0.13). ConclusionElevated Lp(a) is associated with an increased risk of MACE independent of hs-CRP levels in both primary and secondary prevention populations.

Assessing Patient Risk, Benefit, and Outcomes in Drug Development: A Decade of Abiraterone Clinical Trials

Purpose: Our study aimed to evaluate the risk and benefit profiles of clinical trials using abiraterone in cancer treatment.Materials and Methods: A comprehensive search was conducted on May 24, 2023, using databases such as PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov. We extracted data on adverse events, progression-free survival, overall survival, objective response rate (ORR), and prostate-specific antigen response rate (PSA-RR). The Common Terminology Criteria for Adverse Events were used to assess risks, while ORR and PSA-RR were used to assess benefits. Trials were categorized as positive, negative, or indeterminate based on their safety profiles and efficacy outcomes.Results: Nearly all clinical trials testing abiraterone in prostate cancer showed promising outcomes with 89% of studies meeting their endpoint. Our study supports abiraterone’s use in prostate cancer, its only U.S. Food and Drug Administration-approved indication to treat, with a median ORR of 20.0% and a median PSA-RR of 42.0%. However, when looking at the 3 novel indications tested, the risk-to-benefit profile was similar to that of its original approval. Even though most novel indications failed to meet their primary endpoint, the overall toxicity profile was similar to that found in prostate cancer.Conclusion: Abiraterone showed an overall risk-to-benefit portfolio that supports the use of its treatment in prostate cancer. Although the primary endpoints in ovarian and breast cancer trials were not met, the use was appropriate when assessing how the mechanism of action for abiraterone could be beneficial in patients with these types of cancers.

Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis.

Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.

Optimising the Dose of Static Stretching to Improve Flexibility: A Systematic Review, Meta-analysis and Multivariate Meta-regression.

Static stretching is widely used to increase flexibility. However, there is no consensus regarding the optimal dosage parameters for increasing flexibility. We aimed to determine the optimal frequency, intensity and volume to maximise flexibility through static stretching, and to investigate whether this is moderated by muscle group, age, sex, training status and baseline level of flexibility. Seven databases (CINAHL Complete, Cochrane CENTRAL, Embase, Emcare, MEDLINE, Scopus, and SPORTDiscus) were systematically searched up to June 2024. Randomised and non-randomised controlled trials investigating the effects of a single session (acute) or multiple sessions (chronic) of static stretching on one or more flexibility outcomes (compared to non-stretching passive controls) among adults (aged ≥ 18years) were included. A multi-level meta-analysis examined the effect of acute and chronic static stretching on flexibility outcomes, while multivariate meta-regression was used to determine the volume at which increases in flexibility were maximised. Data from 189 studies representing 6654 adults (61% male; mean [standard deviation] age = 26.8 ± 11.4years) were included. We found a moderate positive effect of acute static stretching on flexibility (summary Hedges' g = 0.63, 95% confidence interval 0.52-0.75, p < 0.001) and a large positive effect of chronic static stretching on flexibility (summary Hedges' g = 0.96, 95% confidence interval 0.84-1.09, p < 0.001). Neither effect was moderated by stretching intensity, age, sex or training status, or weekly session frequency and intervention length (chronic static stretching only) [p > 0.05]. However, larger improvements were found for adults with poor baseline flexibility compared with adults with average baseline flexibility (p = 0.01). Furthermore, larger improvements in flexibility were found in the hamstrings compared with the spine following acute static stretching (p = 0.04). Improvements in flexibility were maximised by a cumulative stretching volume of 4min per session (acute) and 10min per week (chronic). Static stretching improves flexibility in adults, with no additional benefit observed beyond 4min per session or 10min per week. Although intensity, frequency, age, sex and training status do not influence improvements in flexibility, lower flexibility levels are associated with greater improvement following both acute and chronic static stretching. These guidelines for static stretching can be used by coaches and therapists to improve flexibility. PROSPERO CRD42023420168.

Iliococcygeus fixation for the treatment of vaginal vault prolapse: a systematic review and meta-analysis.

It has been reported that approximately 80-90% of apical prolapse repair is through reconstructive or obliterative vaginal surgery. Although several procedures have been described, to date there is a lack of consensus on the best surgical procedure. The aim of this study was to perform a thorough review of the current literature on the efficacy and safety of the iliococcygeus fixation technique for the treatment of vaginal vault prolapse. A systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. was conducted using the PubMed/MEDLINE and Cochrane CENTRAL databases. Our analysis included randomized control trials and observational prospective or retrospective cohort studies that assessed the Iliococcygeus fixation, in terms of overall cure rate, failure rate, reoperation rate, and complications rate. The overall cure rate ranged from 74.4% to 98% in the considered studies with a pooled value of 84.9% (95% CI: 73.3% to 96.4%). The overall failure rate ranged from 4.8% to 23% with a pooled value of 13.6% (95% CI: 5.5% to 21.7%) while the pooled value of overall re-operation rate was 3.3% (95% CI: 0.6% to 6%), ranging from 0% to 6.8. The overall complication rate ranged from 0% to 33% with a pooled value of 10.4% (95% CI: 1.4% to 19.3%). Despite limitations due to the heterogeneity of study designs, our review, for the first time in the literature, demonstrated that fixation of the iliococcygeus appears to be an effective and safe option for the treatment of vaginal vault prolapse. However, future randomized controlled trials with rigorous methodological protocols are needed.

Systematic literature review and meta-analysis of health state utility values in metastatic castration-resistant prostate cancer.

Despite being an important goal, the preservation of quality of life of patients with metastatic castration-resistant prostate cancer (mCRPC) is poorly characterized across lines of therapy. In this review, a systematic literature review and meta-analysis were conducted to synthesize EuroQoL 5-Dimension (EQ-5D) data among adult men with asymptomatic or mildly symptomatic mCRPC in both first line (1L) and second line and later (2L+) therapy. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to October 2022 using Ovid. Supplemental searches of other data sources were also conducted (PROSPERO registration: CRD42021283512). Meta-analyses were conducted to estimate pooled EQ-5D index utility values and EQ visual analog scale (VAS) scores in both 1L and 2L+. Various sensitivity analyses were also conducted. Forty-five unique publications met the inclusion criteria. In primary studies, baseline EQ-5D index utility values ranged from 0.7 to 0.9 in 1L and 0.63 to 0.7 in 2L+. Twelve trials and observational studies were feasible for inclusion in the meta-analysis. The pooled mean baseline EQ-5D index utility value was estimated as 0.79 (95% CI, 0.70-0.84) and 0.69 (95% CI, 0.67-0.71) for 1L (n = 7 studies) and 2L + (n = 4 studies), respectively. The pooled mean baseline EQ VAS score was estimated as 74.63 (95% CI, 70.97-78.29) and 65.82 (95% CI, 64.53-67.11) in 1L and 2L+, respectively. Limitations include hampered comparability between studies due to heterogeneity in study design and geographical regions. This study provides a comprehensive synthesis of EQ-5D data presently available in adults with mCRPC in both 1L and 2L + therapy.

21. THE PREVALENCE OF CERVICAL CANCER SCREENING IN LOW AND MIDDLE-INCOME COUNTRIES: A LITERATURE REVIEW

Objectives: to determine the prevalence of cervical cancer screening in low and middle-income countries. Method: This literature review was conducted in accordance with the Cochrane Collaboration guidance for literature reviews and reported following the PRISMA statement. We conducted searches of electronic bibliographic databases including Pubmed, Embase, MEDLINE, Cochrane Systematic Reviews and Cochrane CENTRAL. Results: Our searches of the listed electronic databases generated 7,845 records. 23 studies met the inclusion criteria. The total sample size of female participants was 213,199. The definition of screening definitions were relatively similar among studies. Screening rates varied between studies (from 4% to 43%). The Pap smear test was the most common screening modality, next was Visual Inspection Acetic Acid (VIA). The overall prevalence of cervical cancer screening was still remarkably low 21.85% (95%CI: 20.56 - 22.32, I2 = 40%, p &lt;0.001). Conclusions: Despite global efforts to make screening approaches affordable and accessible, most women in low- and middle-income countries are not screened for cervical cancer.

Systematic review and meta-analysis of recombinant herpes zoster vaccine in immunocompromised populations.

Herpes zoster infection is common in immunocompromised individuals. Recently, the Advisory Committee on Immunization Practices recommended immunizing with the recombinant zoster vaccine (RZV). To evaluate the efficacy, immunogenicity and safety of RZV in immunocompromised individuals, such as transplant recipients, cancer patients undergoing chemotherapy, individuals with preexisting autoimmune diseases and HIV-infected patients. From January 1984 to October 2023, a systematic search of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed. Randomized clinical trials (RCT) evaluating RZV compared to placebo in immunocompromised adults were selected. Study characteristics and estimates on the incidence of herpes zoster, immune responses, and safety data were extracted from studies. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. Seven RCTs were included. Compared to placebo, RZV reduced the incidence of herpes zoster across all ages by 81% (RR: 0.19, 95%CI: 0.09, 0.44), with moderate heterogeneity across the studies (I2 = 60.49%; τ2 = 0.31; P = 0.07). RZV significantly increased humoral and cellular immunity one month after the last dose. Transplant and past malignancy were associated with lower immunogenicity. RZV was more reactogenic with more local and systemic adverse events. There was no difference in serious adverse events or death between the two arms. This study suggests that RZV reduces the risk of herpes zoster infection in immunocompromised individuals. This vaccine should be routinely offered to immunocompromised individuals, preferably before chemotherapy or treatment.

The Impact of Exercise and Protein Intake on Inflammaging: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.

Sarcopenia and cachexia lead to muscle wasting and increased health risks in older adults. Both sarcopenia and cachexia are associated with inflammaging, a chronic low-grade inflammatory state linked to aging. Strategies to preserve muscle mass and function are crucial for maintaining independence and quality of life among the elderly. This meta-analysis and systematic review was conducted to comprehensively assess the individual and combined effects of exercise training and protein supplementation on circulatory markers of inflammation in older adults. A systematic search of the PubMed, Scopus, Cochrane CENTRAL, and SPORTDiscus databases was conducted to identify relevant studies published until January 2024. The search focused on randomized controlled trials examining the impact of exercise training (Ex), protein consumption (Pro), or their combination (Ex-Pro) on inflammatory factors, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) compared with a control (Con). The meta-analysis revealed a significant decrease in CRP levels in the Ex vs Pro (P = .0003) and the Ex-Pro (P < .00001) group compared with the Ex group and in overall experimental (EXPL) subgroups (P = .0002) compared with the Con group. A similar reduction was found in IL-6 in the Ex group (P = .001), Ex-Pro group (P = .05), and EXPL (P = .0002) subgroup compared with the Pro group. However, for TNF-α levels, a significant reduction was noted only in the Ex-Pro group compared with the Ex group (P < .00001). Exercise training and protein supplementation, particularly when combined, show greater benefits in mitigating inflammaging. These findings highlight the importance of combined interventions against muscle wasting. Future studies and meta-analyses should further address the effects of Ex and Pro and Ex-Pro on inflammatory markers of older adults, considering specific conditions and larger sample sizes to identify optimal strategies for the aging population.

A systematic review and meta-analysis of patient-relevant outcomes in comprehensive cancer centers versus noncomprehensive cancer centers.

This systematic review describes difference in patient-relevant outcomes between comprehensive cancers (CCCs) versus non-CCCs. Studies were identified in PubMed, Cochrane CENTRAL, Epistemonikos, and gray literature from January 2002 to May 2024. Data were extracted and appraised by two authors. Results were narratively synthesized, and meta-analyzed where appropriate. Of 2272 records screened, 36 observational studies were included, predominantly from the United States, and focused on adults with solid cancers. Compared to non-CCCs, studies consistently or predominantly reported superior outcomes at CCCs relating to mortality and survival, quality of peri- and postoperative care, rates of cancer recurrence or progression, and impact on symptoms and health-related quality of life. Meta-analysis showed a significantly lower overall mortality risk of 23% in CCCs compared to non-CCCs (hazard ratio, 0.77; 95% confidence interval, 0.74-0.81, p<.001), with medium heterogeneity (I2=64.61%; Q-test=36.29, p<.01) observed between the studies. Studies reporting on health equity and costs outcomes consistently or predominantly favored non-CCCs over CCCs. Mixed results were reported for outcomes relating to time to care, palliative and end-of-life care, and health care utilization. The literature reports CCCs are associated with superior outcomes in many areas, especially around mortality and survival. Greater focus is needed to explore outcomes that are important to people with cancer including health-related quality of life, symptoms, and treatment experience, and economic evaluation. Rather than aiming for superior outcomes, CCCs should be striving to enable equitable, high value, patient-centered outcomes for all people affected by cancer.

Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy

Background: The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes. Methods: A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes Results: Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], −1.39; 95% confidence interval [CI], −2.33 to −0.45) and lower intraoperative blood loss compared with OPD (MD, −131; 95% CI, −146 to −117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34–45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes. Conclusions: The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD.

Minimizing Blood Loss Using Tranexamic Acid in Patients Undergoing Liposuction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Liposuction has become the most sought-after aesthetic surgery across the globe, increasing the demand for more developments in patient safety protocols. Evidence of the efficacy of tranexamic acid (TXA) in reducing intraoperative blood loss with minimal complications have led to its widespread applications across various surgical operations. However, the role and effectiveness of TXA in liposuction is not fully understood. Therefore, the purpose of this systematic review and meta-analysis is to investigate the effectiveness of TXA in minimizing intraoperative blood loss in patients undergoing liposuction. In adherence to the preferred reporting items for systematic reviews and meta-analysis guidelines, a comprehensive search was conducted in multiple databases including, PubMed, Cochrane CENTRAL, and Web of Science. Only randomized controlled trials (RCTs) were included without time frame limitations. Our primary outcomes were hemoglobin levels, hematocrit levels, lipoaspirate volume, and associated complications. This meta-analysis provides a comprehensive analysis of five RCTs published between 2021-2023, involving 334 patients. The pooled mean difference for postoperative hemoglobin levels was statistically significant in favor of local TXA administration (MD 0.54; P = 0.03; I2 = 0%). Analysis of postoperative hematocrit levels (g/dL) and lipoaspirate volume (L) mean differences were statistically insignificant (MD 0.76; P = 0.35; I2 = 0%) and (MD 0.19; P = 0.82; I2 = 85%) respectively. No complications related to the use of TXA occurred. Although a statistically significant difference was seen in postoperative hemoglobin levels, it is imperative that the results are interpreted with caution, given the preliminary nature of the observed effect. Further large well-designed RCTs are required to solidify current TXA protocols and to provide comprehensive guidelines for its application in liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of Web-Based Cognitive Behavioral Therapy for Depression: A Systematic Review of Randomized Controlled Trials.

Evidence-based practices were more effective in managing mental health disorders when compared to traditional, non-evidence-based approaches. Web-based cognitive behavioral therapy (CBT) interventions offer a wide variety of advantages among depressed patients as they offer a sense of anonymity, privacy, andaccessibility. This systematic review of randomized controlled trials (RCTs) aims to estimate the efficacy of several types of web-based interventions among patients with depression symptoms. This review was conducted according to the principles of the Cochrane Handbook for Systematic Reviews of Interventions and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature using five databases: PubMed, Medline, Ovid, Cochrane CENTRAL, and Scopus. Key terms for depression and web-based CBT included "Depression", "Cognitive behavioral therapy", "CBT", "Effectiveness", "Internet", and "Web-based".The included studies were published between 2019 and 2024 and assessed the risk of bias (ROB) using the ROB2 tool for RCTs.This search strategy yielded 2902 records, of which 1946 were duplicates and removed. The remaining 956 records underwent screening of their titles and abstracts, and 900 records were excluded. The full texts of the remaining 56 records were retrieved; 45 of them were excluded since 13 had thewrong study design, 10 had inappropriate outcomes, 12 had inappropriate populations, and 10 were out of the date range.All the included studies were 11 RCTs. Most studies assessed the efficacy of internet-based CBT (ICBT) or web-delivered CBT (wCBT). Control groups included the waitlist control (WLC) group and the treatment as usual (TAU) group, and one study included an active control group. Six studies compared the effects of guided or self-guided ICBT with control, three compared wCBT with control, one used internet self-guided intervention, and one employed an internet-based Functional Depression (iFD) program. Interventions were generally self-guided or guided by laypersons, nonspecialists, or automated systems. It can be concluded that despite the significance of most interventions favoring internet-based interventions compared to control groups, many limitations existed in the included studies, making it unclear whether the interventions would prove conclusive and reliable benefits. Therefore, more studies should be conducted on larger sample populations with prolonged duration.

Effectiveness of Probiotics, Prebiotics, and Synbiotics in Managing Insulin Resistance and Hormonal Imbalance in Women with Polycystic Ovary Syndrome (PCOS): A Systematic Review of Randomized Clinical Trials.

Background/Objectives: Polycystic ovary syndrome is a common endocrine disorder in women of reproductive age characterized by insulin resistance and hormonal imbalances. Recent research suggests that probiotics and synbiotics may improve these parameters by modulating the gut microbiota. This study systematically reviewed randomized clinical trials evaluating the impact of probiotic, prebiotic, and synbiotic supplementation on insulin resistance and hormonal parameters in women with PCOS. Methods: Exhaustive searches were conducted in PubMed, Cochrane CENTRAL, Scopus, Web of Science, and Embase, following PRISMA guidelines. Randomized trials assessing supplementation with probiotics, prebiotics, or synbiotics for at least 8 weeks in women diagnosed with PCOS according to the Rotterdam criteria were included. Data on participants, interventions, and outcomes related to insulin resistance and hormones were extracted. Results: Eleven studies from Iran involving overweight or obese women aged 15 to 48 were included. Probiotic and synbiotic supplementation showed significant improvements in insulin resistance (reductions in HOMA-IR, fasting glucose, and insulin), lipid profiles (decreased LDL and triglycerides; increased HDL), and hormonal balance (increased SHBG, decreased total testosterone). Synbiotics had more pronounced effects than probiotics or prebiotics alone. Adherence was high, and side effects were minimal. Conclusions: Despite promising results, limitations such as small sample sizes, homogeneous populations, and short intervention durations limit the generalization of the findings. Larger, longer, multicenter trials with diverse populations and standardized methodologies are needed to confirm the efficacy and safety of synbiotics in managing PCOS. Integrating these interventions could improve clinical management and quality of life for affected women, but additional evidence is required to support widespread use.

Abstract 4120583: Long term Safety and Efficacy of Ultrathin Bioabsorbable polymer sirolimus eluting Stents Versus Thin Durable polymer everolimus eluting Stents in Patients Undergoing Percutaneous Coronary Intervention: A systematic review and meta analysis

Background: First generation drug eluting stents (DES) with thick polymers may contribute to local vascular inflammation and late stent thrombosis. Thinner-strut DES (ultrathin), particularly those with biodegradable polymers, aim to reduce this risk by minimizing flow disturbance and vascular injury. However, the long-term safety and efficacy of ultrathin biodegradable polymer sirolimus eluting stents (BP-SES) compared to durable polymer everolimus eluting stents (DP-EES) are still uncertain. Thus, we performed a meta analysis to compare outcomes of these two stents. Methods: Inclusion criteria comprised randomized controlled trials comparing ultrathin BP SES and thin DP EES in patients undergoing percutaneous coronary interventions with long term follow-up of at least 3 years. We excluded cohort studies, case reports, editorials, conference abstracts, and animal studies. Primary outcomes were target lesion failure (TLF), cardiac death (CD), target-vessel myocardial infarction (TV-MI), and clinically indicated target lesion revascularization (CI-TLR). We systematically searched PubMed, Cochrane CENTRAL, and Scopus. Cochrane’s ROB 2.0 tool assessed trial quality, and RevMan software (5.4) performed the meta-analysis. Results: Our analysis included ten RCTs, totaling 16,216 patients, with 9,108 in the BP SES group and 7,108 in the DP EES group. TLF occurred in 905 patients (9.94%) in the BP-SES group and 821 patients (11.55%) in the DP-EES group, with no statistically significant differences between the groups (RR = 0.92, 95% CI = 0.85 to 1.01, p = 0.08). Additionally, there were no significant differences in cardiac death (RR = 1.00, 95% CI = 0.84 to 1.19, p = 1.00), TV-MI (RR = 0.91, 95% CI = 0.78 to 1.05, p = 0.19), and CI-TLR (RR = 0.88, 95% CI = 0.78 to 1.01, p = 0.06) between the two groups. Conclusion: The use of BP-SES did not result in higher rates of TLF, CD, TV-MI, or CI-TLR compared to DP-DES. These findings suggest that both BP-SES and DP-DES are viable options for PCI procedures, with comparable long-term safety profiles. However, some trials used strut thicknesses exceeding 70µm in cases requiring wider diameters, similar to the strut thickness in the DP-EES group. This makes it challenging to assess whether, in addition to biodegradable polymers, lower strut thickness contributes to reducing target lesion-related events. Further research may be needed to explore other relevant outcomes and to confirm these findings in diverse patient populations.

Abstract 4137065: Efficacy and Safety of Extracorporeal CPR in Out-of-Hospital Cardiac Arrest Survival and Neurological Integrity: a Meta-Analysis of Randomized Controlled Trials

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a significant public health challenge, with conventional cardiopulmonary resuscitation (CPR) often yielding limited success. Extracorporeal CPR (eCPR) has emerged as a potential adjunctive therapy to improve outcomes in OHCA patients. Purpose: To evaluate the efficacy and safety of eCPR compared to conventional CPR in OHCA. Methods: A comprehensive search of Cochrane CENTRAL, PubMed, Ovid Medline, and Web of Science databases was conducted independently until November 10, 2023. Randomized controlled trials (RCTs) comparing eCPR with conventional CPR in OHCA were included. Primary efficacy outcome was defined as survival to hospital discharge, while primary safety outcome was assessed for bleeding events. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. A sensitivity analysis was performed regarding whether the conclusions reached might differ substantially if a single study was omitted. Statistical analyses were performed with “meta” package in R (version 4.3.2) and Revman 5.4. Results: Four unique RCTs involving 435 patients were included in the analysis. ECCPR was associated with a significantly higher rate of survival at 1 month with good neurological outcome (Risk Ratio [RR] 1.55, 95% Confidence Interval (CI) 1.06 to 2.27, I 2 : 0%) but comparable at survival to hospital discharge (RR 1.10, 95% CI 0.16 to 7.30, I 2 : 47%) compared to conventional CPR. Furthermore, no significant differences were observed between eCPR and conventional CPR groups in survival rates at 3 months (RR 1,33, 95% CI 0.92 to 1.94, I 2 : 64%), survival at 6 months with good neurological outcome (RR 1.39, 95% CI 0.97 to 1.99, I 2 : 0%), and survival at 6 months (RR 2.79, 95% CI 0.33 to 23.28, I 2 : 63%). eCPR demonstrated a statistically significant elevation in bleeding events compared to conventional CPR (RR 4.25, 95% CI 2.37 to 7.64, I 2 : 0%). Sensitivity analysis revealed that none of the studies significantly influenced the pooled risk estimate to any great extent. Conclusion: eCPR shows beneficial results in improving short-term survival and neurological outcomes at 1-month post-OHCA. However, it is associated with an elevated risk of bleeding when compared to conventional CPR. Further investigations are imperative to delineate the specific patient populations that stand to gain the most benefit from ECPR intervention.

Abstract 4136604: Efficacy of angiotensin receptor blockers in thoracic aortic aneurysm: meta-analysis of randomized controlled trials

Background: Thoracic aortic aneurysm (TAA) poses a significant risk of aortic dissection and mortality. Angiotensin receptor blockers (ARBs) have been proposed as a potential therapeutic intervention to mitigate these risks but their effects are uncertain. Aim: To evaluate the efficacy of ARBs in patients with TAA. Methods: A comprehensive search of Cochrane CENTRAL, Ovid Medline R, Pubmed, and Web of Science yielded 2563 records, from which 8 unique randomized controlled trials (RCTs) (including 7 Marfan and 1 bicuspid aortic valve+TAA populations) comprising 1575 patients were included in the analysis. The primary outcome measures were aortic dissection and all-cause mortality. Pooled risk ratios (RR) or mean differences (MD) in an inverse variance random-effects model were generated and analyses were performed with “meta” package in R (version 4.3.2). Results: Our analysis reveals no significant beneficial effect of ARBs on aortic dissection (RR 0,62 [95%CI, 0,20; 1,92], I 2 :0%) and all-cause mortality (RR 0,61 [95%CI, 0,18; 2,05], I 2 :0%), irrespective of specific ARB agents (including losartan, irbesartan, and telmisartan), comparators (beta blocker, placebo, or no treatment), disease condition (Marfan syndrome or bicuspid aortic valve), and patient demographics (children or adults). Additionally, there were no significant differences observed between ARB and control groups in changes in ascending aorta and aortic annulus diameter, as well as aortic Z-score at the 3-year mark, including the annual change in ascending aorta (MD 0.04 mm/year [95% CI, -0.07 to 0.15], I 2 :0%) and aortic root diameter (MD -0.06 mm/year [95% CI, -0.22 to 0.10], I 2 :81%) by echocardiography. However, there was a significant reduction in aortic root diameter as assessed by MRI (MD -0.48 mm/year [95%CI, -0.89 to -0.08]) and echocardiography (MD -0.51 mm/3year [95%CI, -0.85 to -0.17]), with low heterogeneity when compared with control. Risk of aortic surgery and severe adverse events were also comparable. Conclusion: We found no significant beneficial effect of ARBs in reducing the risk of aortic dissection or all-cause mortality in patients with TAA. Despite observing a significant reduction in the aortic root diameter by MRI and echocardiography with ARB therapy, other imaging outcomes were comparable between ARB and control groups.

The Role of Energy Balance-Related Behaviors (EBRBs) and their Determinants on the Prevalence of Overweight and Obesity in Children in Need, in Greece: A Scoping Review.

There is scarce literature concerning 'children in need' at a European level (including Greece), particularly regarding energy balance-related behaviors (EBRBs) associated with overweight and obesity. This scoping review aimed to synthesize evidence on the EBRBs associated with overweight and obesity among 'children in need' in Greece and their key determinants. Inclusion criteria included children (0-18years) who were 'in need', living with overweight or obesity, residing in Greece, and which included data on EBRBs and their potential determinants. APA PsychInfo, CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, as well as grey literature (in Greek/English), were searched (without publication date limitations). Data was extracted using an adapted Joanna Briggs Institute tool. Seven studies were identified (n = 141-7,283 participants), highlighting prevalent EBRBs, categorized into groups; nutrition (lower diet quality, poor dietary habits, higher intake of carbohydrates, sugar sweetened beverage consumption, low adherence to the Mediterranean diet pattern, lack of daily breakfast consumption), sleep (low sleep duration), and sedentary behaviors / physical activity (television in children's bedrooms, high screen time, low physical activity, high sedentary time). Key determinants included low parental education, food culture, food preparation by grandmothers, the home environment, parental dietary choices, and lower socioeconomic status, etc. CONCLUSION: This review identified specific EBRBs associated with overweight and obesity affecting children in need in Greece and their determining factors. These findings should guide future research, tailored intervention programs, and public health policies (i.e. the European Child Guarantee Strategy) targeted at this understudied priority population of children in need, in Greece. Review registration number: Open Science Framework: https://osf.io/w7qdu.