Cochrane Collaboration Research Articles

Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review.

Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to "patellofemoral pain syndrome," "self-management," and "athletes." Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca. PRR1-10.2196/58340.

Impact of virtual consultations on quality of care in type 2 diabetes: a systematic review and narrative synthesis protocol.

Around 463 million people globally have diabetes, of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (ie, patient-centeredness, effectiveness, efficiency, timeliness, equity and safety). PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), COCHRANE Library, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration's tool will be used to assess the quality of the randomised studies, and the Risk of Bias in Non-Randomised Studies of Interventions will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 15 November 2023 (registration number: CRD42023474219). This review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.

Does the application of polywave light-curing units influence physico-mechanical properties of resin-based materials? A meta-analysis of In vitro studies

The objective of this study was to systematically review the existing literature and to assess the effect of the use of polywave light-curing units on the properties of resin-based materials. A thorough search was conducted across five electronic databases: PubMed (MedLine), ISI Web of Science, SciELO, Scopus, and EMBASE. Inclusion criteria comprised in-vitro studies that compared the effects of polywave light-emitting diode (LED) curing units with monowave LED curing units on resin-based material properties. Two reviewers evaluated the methodological quality of the included studies, considering parameters from previous systematic reviews. Meta-analyses were conducted using Review Manager version 5.3.5 (The Cochrane Collaboration, Copenhagen, Denmark). Overall, when the TPO photoinitiator was employed, the use of a polywave light-curing unit demonstrated statistically significant higher values solely for the degree of conversion (p<0.001) and hardness (p<0.01). No statistically significant differences were observed between monowave and polywave light curing units in the other evaluated properties. Based on the findings of this review, the use of polywave light-curing can be useful for polymerizing materials that contain photoinitiators other than camphorquinone in their composition.

Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis.

Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software. Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD=-1.64, 95% CI -2.27 to -1.02 p<0.00001, I2=88%). The ABC group had a significantly decreased number of debridements (SMD=-2.47, 95% CI -4.24 to -0.70, p<0.00001, I2=95%). The pooled data showed no significant difference (RR=0.41, 95% CI 0.12 to 1.39, p=0.84, I2=0%). This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications. PROSPERO CRD42023406017.

Influence of apical patency in endodontic treatment outcome – A systematic review of clinical studies

Objective: The aim of this systematic review was to evaluate the influence of maintaining apical patency (AP) in endodontic treatment outcome. Methodology: An electronic database search was performed in PubMed, Cochrane Library, LIVIVO, LILACS, and EBSCO host from inception till July 2024. The data from the included articles were extracted and the quality was assessed using the Cochrane Collaboration tool and ROBINS-I tool. Results: Five articles were included for the qualitative synthesis, and all the included articles were determined to have a low risk of bias. Maintaining the AP resulted in two-fold increase in the healing outcome with long-term follow-up. Conclusion: It can be concluded from this systematic review that maintaining AP is likely to enhance the endodontic treatment outcome. However, more long-term clinical studies are required to further evaluate the possible influence of AP. Registration: The protocol of this review was registered in the PROSPERO database with registration number: CRD42022374966.

Exploring the Synergistic Effects of Concurrent Exercise for Managing Type-II Diabetes Mellitus: A Meta-Analysis.

The effectiveness of concurrent exercise (CE) as an emerging approach for type-II diabetes mellitus (T2DM) patients was evaluated through a comprehensive search on Google Scholar, PubMed, Pedro, CINAHL, and Medline from 2015 to March 2023. Sixteen RCTs were selected which evaluated CE (aerobic + resistance in the same session) effects on a minimum of three days/week among T2DM patients, and the control group received usual care or no exercise. Studies that evaluated at least one glycaemic variable, i.e. HbA1C, fasting blood glucose level (FBGL), andHomeostatic Model Assessment for Insulin Resistance (HOMA-IR), were eligible. Intervention with a follow-up period of ≥8 weeks, patients of any age and gender, and literature in the English language were included. A rigorous review was performed using the Cochrane Collaboration risk of bias tool (RoB 2) to minimise biases, which include the randomisation process, deviation from intended intervention, missing outcome data, outcome measurement, and selection bias. CE significantly improved HbA1C (95% CI of -0.654 to 0.363, I2 = 84.92% moderate heterogeneity), FBGL (95% CI of -0.239 to 1.145, I2 = 93.74% - high level of heterogeneity), and insulin resistance (HOMA-IR) (95% CI of -0.593 to 0.544, I2 = 92.85% - high level of heterogeneity). Collectively, findings indicate the potential of CE as an intervention to impact glycaemic control in T2DM patients positively. However, the relatively high I² values suggest notable variability among studies, and further research to explore the factors contributing to this heterogeneity, exercise protocol along with progression, and duration of diabetes are needed, which is more challenging to determine a precise dose-response relationship. Therefore, more studies are required to provide thorough insights into these components for T2DM management. Key Words: Glycated haemoglobin, Glycaemic control, Insulin resistance, Physical exercise, Type-II diabetes mellitus.

Exploring the Synergistic Effects of Concurrent Exercise for Managing Type-II Diabetes Mellitus: A Meta-Analysis.

The effectiveness of concurrent exercise (CE) as an emerging approach for type-II diabetes mellitus (T2DM) patients was evaluated through a comprehensive search on Google Scholar, PubMed, Pedro, CINAHL, and Medline from 2015 to March 2023. Sixteen RCTs were selected which evaluated CE (aerobic + resistance in the same session) effects on a minimum of three days/week among T2DM patients, and the control group received usual care or no exercise. Studies that evaluated at least one glycaemic variable, i.e. HbA1C, fasting blood glucose level (FBGL), andHomeostatic Model Assessment for Insulin Resistance (HOMA-IR), were eligible. Intervention with a follow-up period of ≥8 weeks, patients of any age and gender, and literature in the English language were included. A rigorous review was performed using the Cochrane Collaboration risk of bias tool (RoB 2) to minimise biases, which include the randomisation process, deviation from intended intervention, missing outcome data, outcome measurement, and selection bias. CE significantly improved HbA1C (95% CI of -0.654 to 0.363, I2 = 84.92% moderate heterogeneity), FBGL (95% CI of -0.239 to 1.145, I2 = 93.74% - high level of heterogeneity), and insulin resistance (HOMA-IR) (95% CI of -0.593 to 0.544, I2 = 92.85% - high level of heterogeneity). Collectively, findings indicate the potential of CE as an intervention to impact glycaemic control in T2DM patients positively. However, the relatively high I² values suggest notable variability among studies, and further research to explore the factors contributing to this heterogeneity, exercise protocol along with progression, and duration of diabetes are needed, which is more challenging to determine a precise dose-response relationship. Therefore, more studies are required to provide thorough insights into these components for T2DM management. Key Words: Glycated haemoglobin, Glycaemic control, Insulin resistance, Physical exercise, Type-II diabetes mellitus.

Metoclopramide for analgesia in renal colic: a narrative systematic review

Metoclopramide, a prokinetic antiemetic with activity at multiple receptor types, may be a useful treatment for renal colic pain. This review investigated whether metoclopramide is an effective analgesic in the management of adults with renal colic.Eligible studies were randomised, quasi-randomised or case-control trials of metoclopramide for the management renal colic pain. Electronic database searches were performed in November 2022. Screening was performed by two authors independently; disagreement was resolved by discussion or by adjudication by a third author. The Cochrane Collaboration Risk of Bias Tool v2.0 was used to assess bias.Two studies were included, enrolling 279 patients. Heterogeneity of primary outcome measurement and comparators rendered meta-analysis inappropriate; a narrative review is presented. Both studies showed some evidence of analgesic effect. The largest study had a low risk of bias in all assessed domains, whilst the smaller study was at a high risk of bias.There is limited evidence that metoclopramide may be an effective analgesic in the management of renal colic, with the highest quality study demonstrating analgesic properties similar to an intravenous non-steroidal anti-inflammatory medication.Protocol registration Prospero (CRD42022346618).

Exploring the role of angiogenesis in fibrosis and malignant transformation in oral submucous fibrosis: a systematic review and meta-analysis.

Angiogenesis is a crucial molecular driver of fibrosis in various inflammatory lesions. Oral submucous fibrosis (OSMF) is a chronic inflammatory fibrotic disorder with malignant potential. The angiogenetic pathways in OSMF remain obscure due to limited research, necessitating an in-depth review. This review aimed to illuminate the cryptic pathogenetic mechanisms of angiogenesis in the disease progression/fibrosis of OSMF and its malignant transformation, providing insights for improved treatment. Extensive literature searches were conducted across an array of databases until October 2023. Original research articles on angiogenesis in OSMF were included, and the risk of bias was assessed using the modified Newcastle-Ottawa scale. RevMan ver. 5.4 (Cochrane Collaboration) was used for data analysis. Thirty-four articles were included for qualitative synthesis and seven for quantitative analysis. Findings revealed that angiogenesis was significantly increased in early-stage OSMF but decreased as the disease advanced. It was also associated with the severity of epithelial dysplasia and malignant transformation. A random-effects model confirmed the upregulation of angiogenesis as a significant risk factor in early-stage fibrosis and malignant transformation. The mounting evidence reinforces that angiogenesis plays a crucial role in the progression of early-stage fibrosis of OSMF and its malignant transformation, opening avenues for diagnostic and therapeutic interventions.

Blood pressure management protocol based on transtheoretical model effectiveness on self- care: A systematic review

Background: Hypertension is a prevalent medical condition associated with cardiovascular and kidney diseases, leading to premature death and disability. Despite medication use, hypertension continues to rise due to unhealthy lifestyles. Self-care strategies play crucial roles in effectively treating hypertension. We aimed to evaluate the effectiveness of interventions based on the transtheoretical model (TTM) in improving self-care, self-efficacy, and health-related quality of life (HRQOL) in hypertensive adults. Methods: A comprehensive search was performed in multiple databases using appropriate search strategies. Two independent reviewers screened articles, and assessed their adherence to the inclusion and exclusion criteria. The risk of bias in randomized controlled trials was assessed by the Cochrane Collaboration tool and quasi-experimental studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies. Results: The review included 24 studies with a total of 6553 participants. Most interventions aimed to encourage a healthier lifestyle and improve diet and physical activity. The message was delivered through various methods such as slide/tape messages, individual education/counseling sessions, telephone-delivered interventions, and multimedia training software based on the TTM. Control groups received physician visits or attended lifestyle lectures but did not receive specific behavior change programs like the intervention groups. Conclusion: Our results indicated that the TTM and stage of change model can be an appropriate framework for delivering educational messages to patients.

Can blood flow restriction induce cross-education of muscle strength and volume? A systematic review and meta-analysis.

This research systematically assesses the effects of low-load blood flow restriction on the cross-education of muscle strength and volume, providing evidence-based guidance for clinicians and rehabilitation therapists. The literature search utilized databases such as PubMed, Web of Science, and Embase. Quality assessment employed the Cochrane Collaboration's RCT bias evaluation tool. Data synthesis, forest plot creation, and publication bias assessment were performed with Reman 5.4 software. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202440038. Six meta-analyses, encompassing 259 undergraduate students, were performed. Results indicated a markedly enhanced cross-education effect in muscle strength induction via blood flow restriction, surpassing that of traditional unilateral training and control groups. Nonetheless, the cross-education impact on muscle volume induction showed no notable variance among the groups. Blood flow restriction has been shown to effectively induce cross-education in muscle strength. Nevertheless, additional research is required to determine its impact on muscle strength. Nevertheless, additional research is required to determine its impact on muscle volume cross-education. Reduced exercise intensity with blood flow restriction may augment neural activation, implying possible advantages in rehabilitative training for individuals with neurological conditionsmeriting additional investigation.

Evolving epidemiology, clinical features, and genotyping of dengue outbreaks in Bangladesh, 2000-2024: a systematic review.

The 2023 dengue outbreak has proven that dengue is not only an endemic disease but also an emerging health threat in Bangladesh. Integrated studies on the epidemiology, clinical characteristics, seasonality, and genotype of dengue are limited. This study was conducted to determine recent trends in the molecular epidemiology, clinical features, and seasonality of dengue outbreaks. We analyzed data from 41 original studies, extracting epidemiological information from all 41 articles, clinical symptoms from 30 articles, and genotypic diversity from 11 articles. The study adhered to the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and Cochrane Collaboration guidelines. A total of 565,438 dengue cases and 2,587 fatalities were documented from January 2000 to March 2024. Notably, 60% of cases during the 2019 and 2023 outbreaks were reported in regions previously considered non-endemic. Fatalities were more frequent among women (70%). The majority of the studies (95-100%) used the NS1Ag test, followed by IgG or IgM and RT-PCR tests. New hotspots of dengue transmission were identified in the southern (Khulna, 10.8% and Barishal, 11.8%) and southeastern (Chattogram, 13.8%) regions of Bangladesh. Serotyping was conducted on 92.4% (1,456 of 1,575) of isolates between 2012 and 2023. Of the four serotypes, DENV3 was the most prevalent (57%), followed by DENV2 (30%), DENV1 (11%), and DENV4 (<1%). Genotype DENV3-I (43 of 59 isolates) was the most prevalent, followed by DENV3-II (8 of 59). The highest frequency of dengue cases was observed in August (26.3%), followed by September (22.5%), October (20.2%), and November (13.08%). Fever (90.51, 95% CI 85-100%) was the most prevalent symptom, followed by headache (57.98, 95% CI 12-100%), vomiting (51.16, 95% CI 23-91%), abdominal pain (34.12, 95% CI 12-85%), and myalgia (25.53, 95% CI 13-85%), respectively. This study provides integrated insights into the molecular epidemiology, clinical features, seasonality, and transmission of dengue in Bangladesh and highlights research gaps for future studies.

Effects of Hyrax Maxillary Expander on Nasal Cavity and Upper Airway in Adolescents: A Systematic Review and Meta-Analysis.

Whether Hyrax maxillary expander is an effective treatment for maxillary transverse deficiency as well as expansion of the upper airway is still controversial. The study's purpose was to evaluate 3D changes in upper airway dimensions of adolescent patients measured primarily by cone-beam computed tomography (CBCT) after rapid maxillary expansion (RME) with the Hyrax maxillary expander. Studies up to 1 April 2024 were searched in the following databases: PubMed/MEDICINE, Web of Science, Cochrane Library, and Embase. Inclusion criteria were clinical trials and cohort studies that assessed the effect of RME in adolescent patients with upper airway stenosis using CBCT-based three-dimensional analysis. The risk of bias in the study outcomes was assessed using the Cochrane Collaboration's risk of bias tool, the GRADE method, and a tool for evaluating non-randomized controlled study (non-RCT) literature from a previous systematic review, depending on the types of articles. The study was reported in accordance with PRISMA guidelines. The study conducted a random effects meta-analysis of mean differences and 95% confidence intervals for changes in upper airway volumes, including the nasal cavity (NC), in the outcomes of 16 included studies, followed by subgroup analyses. A significant increase in nasopharynx volume was observed after rapid maxillary expansion (RME) by Hyrax maxillary expander (MD = 0.69, 95% CI (0.09~1.28), p = 0.02).

Lasers efficacy in pain management after primary and secondary endodontic treatment: a systematic review and meta-analysis of randomized clinical trials

Postoperative pain is a common concern following root canal treatments (RCT), impacting both patients and oral health practitioners. This systematic review and meta-analysis aimed to evaluate the effectiveness of laser treatment modalities in reducing postoperative pain compared to conventional methods after primary and secondary RCT in permanent mature teeth. A search of three electronic databases (PubMed, ScienceDirect, and The Cochrane Library) was conducted, using a broad range of keywords and terms. Gray literature and manual searches were conducted to complement the search. The inclusion criteria included randomized clinical trials based on the objective of the secondary study. A minimum sample size of 10 participants per group and a clearly defined criterion for postoperative pain assessment were required. The characteristics of the included studies were presented as tables. The Cochrane collaboration tool RoB 2.0 was used to assess the risk of bias within each study. Two reviewers extracted the data and assessed the studies independently, and discrepancies were resolved through consultation with a third reviewer. A random-effects model was employed for meta-analysis to estimate the overall effect measure. Heterogeneity was evaluated using Cochran’s Q test and the I2 index. Publication bias was explored via Funnel plots and Egger’s test. Subgroup analyses and meta-regression were conducted to assess variations among laser methods and examine the influence of independent factors. The significance threshold for all analyses was set at 5% (α = 0.05). Intraoral laser therapy demonstrated no significant advantage over conventional treatments but consistently outperformed placebo, particularly from 4 to 72 h post-treatment. Low-level laser therapy provided slight pain reduction in the first 8 h, though its effectiveness diminished in retreatment scenarios. Photodynamic therapy and laser disinfection showed marginal benefits, especially shortly after treatment, with reduced efficacy in longer-term or retreatment contexts. Further research is needed to explore different applications of laser modalities and assess distinct prognostic factors in more detail.

Effectiveness of psychological interventions in endometriosis: a systematic review with meta-analysis.

Endometriosis is a chronic gynecological disease associated with chronic debilitating pain, poor mental health and quality of life. The objective of this paper is to evaluate the effectiveness of psychological interventions aimed at improving the pain, quality of life and mental health of women with endometriosis. A systematic review (SR) of the literature with meta-analysis (MA) was carried out. MEDLINE, Embase, PsycINFO and CENTRAL were searched to locate Randomized Controlled Trials (RCTs). The risk of bias assessment of each study was conducted using the Cochrane Collaboration's RoB 2.0 tool. Seven RCTs were included (N = 757). The data obtained suggest that psychological interventions reduce dyspareunia [standardized mean difference (SMD): -0.54, 95% CI: -0.86, -0.22] and dyschezia [mean difference (MD): -2.90, 95% CI: -4.55, -1.26] and increase mental health levels (SMD: 0.70, 95% CI: 0. 42, 0.99); they also point to a large reduction in levels of trait anxiety (MD: -6.63, 95% CI: -8.27, -4.99) and depression (MD: -2.49, 95% CI: -3.20, -1.79), and a likely reduction in state anxiety (MD: -9.72, 95% CI: -13.11, -6.33) experienced by women with endometriosis. It was also identified that psychological interventions probably slightly reduce pelvic pain and may increase physical health. However, most of the included studies have a high overall risk of bias or have certain concerns, which limit conclusions about the certainty of the evidence. The available evidence indicates that psychological interventions are effective in improving the pain, quality of life and mental health variables of women with endometriosis. https://www.crd.york.ac.uk/prospero/, CRD42024516100.

Coronary access after Transcatheter Aortic Valve Replacement (TAVR): a systematic review and meta-analysis of observational studies

Abstract Introduction Over the past two decades, transcatheter aortic valve replacement (TAVR) has transformed the management of aortic stenosis, initially for high-risk surgical candidates and subsequently for low-risk patients. However, with the expanding indications for TAVR to younger, lower-risk patients, it is crucial to assess not only the short-term clinical outcomes but also the long-term considerations for future interventions. The prevalence of coronary artery disease (CAD) in TAVR patients is relevant, and the optimal timing of percutaneous coronary intervention (PCI) remains a question, given the technical challenges associated with coronary access in TAVR patients. Methods We conducted a systematic literature review and meta-analysis according to Cochrane Collaborations and PRISMA guidelines. We included 19 eligible trials involving 1533 patients who underwent coronary angiography after TAVR. The primary endpoint was the incidence of successful selective coronary re-access. Secondary endpoints included semi-selective and non-selective access rates. The analysis was stratified by balloon-expandable (BEVs) and self-expandable valve (SEVs) types. Results Successful coronary access after TAVR was feasible in the majority of patients, with a higher success rate observed for the left main coronary artery (LM) compared to the right coronary artery (RCA). Balloon-expandable valves demonstrated the highest success rates in coronary ostia cannulation, achieving nearly 100% success for both LM and RCA. Among self-expandable valves, the Evolut R/PRO showed superior success rates in selective coronary access (76,85% (95%CI 53,34-100%) for LM and 57,27% (95%CI 32,8-81,74%) for RCA) compared to the CoreValve (45,62% (95%CI 0-92,78%) for LM and 49,19% (95%CI 0-100%) for RCA). Notably, the majority of coronary angiograms were performed due to acute coronary syndrome, primarily non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA), 26,5% for NSTEMI and 23,4% for UA, respectively. Conclusions Selective coronary engagement after TAVR is generally achievable, with BEVs demonstrating superior success rates compared to SEVs. Among self-expandable valves, the Evolut R/PRO showed better outcomes than the CoreValve. These findings provide valuable insights into post-TAVR coronary access feasibility, reducing concerns about valve selection based on this criterion

Effect of the glucagon-like peptide-1 receptor agonists on diabetic peripheral neuropathy: A meta-analysis.

Previous researches found that glucagon-like peptide 1 receptor agonists (GLP-1RA) offer benefits beyond their anti-diabetic properties, including weight loss and cardiovascular disease prevention. However, the effects of GLP-1RA on diabetic peripheral neuropathy (DPN) remain unclear. This meta-analysis aims to assess the potential benefits of GLP-1RA treatment in DPN patients by evaluating peripheral neural function. Following the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a meta-analysis of the clinical trials investigating the impact of GLP-1RA treatment on peripheral neural function in patients with DPN. Outcomes were measured using electrophysiological tests, including nerve conduction velocity (NCV) and action potential amplitude. Our meta-analysis included six studies with 271 participants. Following GLP-1RA treatment, NCV significantly improved compared to the control group (MD 1.74; 95% CI 1.16 to 2.33; p < 0.001) and before treatment (MD 2.16; 95% CI 1.04 to 3.27; p < 0.001). Despite the improvement in NCV, blood glucose levels did not change significantly (MD -0.20 95% CI -0.87 to 0.46, p = 0.55) indicating that GLP-1RA enhances NCV through mechanisms other than glucose lowering. Nonetheless, as a result of the limited population studied, further research is needed to strengthen the reliability of these findings.

Association between pulse wave velocity and cerebral microbleeds: a systematic review and meta-analysis.

Cerebral microbleeds are associated with events that are among the highest mortality and disability events combined worldwide, as well as with hypertensive vasculopathy. The aim of the present study was to investigate the relationship between a marker of hypertensive vasculopathy, arterial stiffness assessed by pulse wave velocity, and cerebral microbleeds. A systematic review and meta-analysis was performed using PubMed, Scopus, and Web of Science, according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Cochrane Collaboration Handbook statements. Data extraction, quality assessment and statistical analyses were performed following pre-established criteria. Twenty-one studies involving 18,436 participants were included. Higher levels of pulse wave velocity were associated with a higher presence of cerebral microbleeds p-OR = 1.26 (95% CI; 1.09-1.45), with considerable heterogeneity; even adjusting for potential confounding variables p-OR = 1.12 (95% CI, 1.05-1.20), with substantial heterogeneity. Only the percentage of women was related to p-OR in the adjusted model. Sensitivity analyses confirmed the robustness of our results. Adjusted models showed publication bias. Higher levels of arterial stiffness are associated with greater presence of cerebral microbleeds. This phenomenon may be caused by damage to the brain under higher blood flow loads, in turn due to age-induced reversal of the stiffness gradient between large and small vessels. As the world's population is undergoing demographic ageing, our results underline the importance of establishing pulse wave velocity as a cardiovascular marker for early screening and delaying the onset of the characteristic signs of both diseases.

Clinical Efficacy and Safety of Misoprostol During Abdominal Myomectomy: An Updated Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials.

Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as "low" or had "some concerns" of bias in seven and eight RCTs, respectively; one RCT had an overall "high" risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = -180.2 mL, 95% CI [-224.04, -136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = -0.58 g/dl, 95% CI [-0.82, -0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI -3.34, -0.96], p < 0.001), mean operative time (MD = -12.95 min, 95% CI [-19.89, -6.01], p < 0.001), and mean hospital stay (MD = -0.14 days, 95% CI [-0.25, -0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion.

Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a -5.78 mm Hg (95% CI -7.97 mm Hg to -3.59 mm Hg; P<.001) reduction in systolic BP and a -3.28 mm Hg (95% CI -4.39 mm Hg to -2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: -6.50 mm Hg, 95% CI -9.00 mm Hg to -3.99 mm Hg vs -1.54 mm Hg, 95% CI -4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: -10.06 mm Hg, 95% CI -16.42 mm Hg to -3.70 mm Hg vs -4.13 mm Hg, 95% CI -5.50 to -2.75 mm Hg; P=.07); intervention duration (3 vs ≥6 months: -8.87 mm Hg, 95% CI -10.90 mm Hg to -6.83 mm Hg vs -5.76 mm Hg, 95% CI -8.74 mm Hg to -2.77 mm Hg; P=.09); and the number of BCTs (≥11 vs <11 BCTs: -9.68 mm Hg, 95% CI -13.49 mm Hg to -5.87 mm Hg vs -2.88 mm Hg, 95% CI -3.90 mm Hg to -1.86 mm Hg; P<.001). The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT.