Probiotics and postbiotics are essential components of modern dietary supplements, recognized for their beneficial effects on human health. While probiotics positively influence gut microbiota, digestion, and immune responses, their safety remains a concern, particularly in immunocompromised individuals, due to risks such as infections, transfer of antibiotic resistance genes, and systemic complications. In contrast, postbiotics-defined as inanimate microorganisms and/or their cellular components-offer a safer alternative by providing similar health benefits without the risks associated with live microorganisms. However, safety assessments of postbiotics remain limited and must address critical issues such as cytotoxicity, impurity profiles, and dose-response uncertainties, which are currently underexplored in the literature. Their enhanced stability under various environmental conditions further supports their application in inhibiting foodborne pathogens and extending product shelf life. This review critically evaluates the safety profiles of probiotics and postbiotics, offering a balanced analysis of their benefits and limitations, with particular attention to emerging safety concerns, risk assessment criteria, and applications in food safety and human health. Despite their promising safety profile, widespread adoption of postbiotics is hindered by the absence of standardized safety protocols and long-term toxicological data. Future research should therefore prioritize establishing evidence-based safety criteria, optimizing dosage and formulation for both probiotics and postbiotics, and addressing existing knowledge gaps through rigorous, targeted clinical studies, especially in vulnerable populations. A comprehensive literature search was conducted using the ISI Web of Knowledge, PubMed, Medline, Embase, Cochrane Register of Controlled Trials (CENTRAL), and Scopus databases covering the period from 2000 to 2025.

Incisional hernia is the most common postoperative complication of abdominal wall surgery that significantly increases morbidity. We aimed to evaluate recurrence rates and perioperative outcomes associated with Laparoscopic and open repair for Incisional hernia recurrence. A comprehensive and systematic literature search was conducted across PubMed, Embase, CINAHL Ultimate, Medline, Scopus, and the Cochrane Controlled Trials Register. Studies published between July 2013, and November 2024 were screened for inclusion. The data extracted included recurrence rates, surgical complications, bowel injury, and outcomes. Pooled risk ratios (RR) were calculated to compare the outcomes of Laparoscopic repair and Open repair. Statistical analysis was performed using STATA V17 using a random-effects model. A total of 15 randomized controlled trials (RCTs), encompassing 1502 patients from nine countries, met the eligibility criteria. The analysis revealed no significant difference in recurrence rates between LR and OR. However, LR was associated with a significantly lower likelihood of wound drainage (RR=0.07, 95% CI: 0.04-0.15) and a reduced risk of postoperative infection (RR=0.31, 95% CI: 0.17-0.55) compared to OR. Conversely, the risk of bowel injury (RR=2.80, 95% CI: 1.15-6.80, p=0.02), indicating that patients undergoing LR were nearly three times more likely to experience bowel injury than those undergoing OR. Laparoscopic repair of incisional hernias offers several advantages over open repair, including lower rates of wound infection. However, it is associated with a higher risk of bowel injury, necessitating careful patient selection and surgical expertise.

Background and Objectives: Corneal allogeneic intrastromal ring segments (CAIRS) are designed to decrease and stabilize the extent of corneal ectasia in keratoconus patients. This systematic review and meta-analysis evaluate the effectiveness of different surgical techniques for CAIRS preparation and the adjunctive use of corneal cross-linking. Materials and Methods: Following the PRISMA statement and checklist, a comprehensive search was conducted in Embase, Medline, and the Cochrane Controlled Trials Register, through the use of a systematic search approach in accordance with the Cochrane Collaboration guidelines. Results: Eighteen studies, involving 567 eyes of 459 patients, met the inclusion criteria. At one month postoperatively, CAIRS implantation significantly improved uncorrected visual acuity (UCVA) (-0.45 logMAR, 95% CI [-0.59 to -0.31], p < 0.001) and best corrected visual acuity (BCVA) (-0.36 logMAR, 95% CI [-0.46 to -0.25], p < 0.001). These improvements remained significant after one year (UCVA: -0.39 logMAR, 95% CI [-0.48 to -0.30], p < 0.001; BCVA: -0.34 logMAR, 95% CI [-0.50 to -0.18], p < 0.001). Similarly, mean simulated keratometry (Kmean) decreased by -4.42 D (95% CI [-5.94 to -2.90], p < 0.001) and maximum keratometry (Kmax) by -3.88 D (95% CI [-6.71 to -1.05], p < 0.001) at one month, with sustained reductions at one year (-3.59 D, 95% CI [-4.35 to -2.84], p < 0.001 and -3.73 D, 95% CI [-4.91 to -2.55], p < 0.001). No significant differences in surgical outcome have been observed between the different surgical techniques. Conclusions: CAIRS implantation appears to be an effective treatment option for keratoconus, regardless of the technique used for segment preparation or the addition of corneal cross-linking. No approach demonstrated clear clinical superiority over others in the first year after surgery.

BackgroundDepression and anxiety are common mental health problems among female adolescents worldwide, with higher prevalence rates in Sub-Saharan Africa (SSA). Existing reviews indicate that psychosocial interventions can reduce depression and anxiety in adolescents in SSA. However, no review has been conducted to examine the effectiveness of these interventions for female adolescents specifically.Aim(s)The primary aim of this study is to systematically review psychosocial interventions for depression and anxiety among female adolescents in SSA.Method and analysisA systematic search will be conducted across eight electronic databases—Medline, PubMed, PsycINFO, PsycArticles, Scopus, Cochrane Controlled Register of Trials (CENTRAL), Embase and Web of Science—to identify studies that meet the eligibility criteria. The study selection process will follow the PRISMA guidelines, and will be conducted in Covidence. The quality of the selected studies will be assessed using the Mixed Methods Appraisal Tool. A meta-analysis and narrative synthesis will be applied to the included studies. To complement the findings of the systematic literature review, the lived experience synthesis will be conducted. We will consult the Youth Advisory Group (YAG) composed of up to 10 young females with lived experience of depression and/or anxiety from SSA to get their perspectives, views, and suggestions on the results and dissemination of the prospective systematic review findings.DiscussionFindings from the review will inform government policies addressing female adolescent mental health problems in Sub-Saharan Africa. It will also inform future research by identifying gaps regarding the effectiveness of psychosocial interventions for female adolescents.ConclusionGiven the existing gender differences in adolescent mental health, it is imperative to synthesise evidence on the effectiveness of these interventions specifically for female adolescents.Systematic review registrationPROSPERO CRD420251059110

This systematic review and meta-analysis synthesized evidence on health-related quality of life (HRQoL), estimated using the EuroQol EQ-5D instrument, among individuals with type 2 diabetes mellitus (T2DM) and its complications in South Asian countries. We conducted a systematic search of PubMed-Medline, Scopus, Embase, Cochrane Controlled Register of Trials (CENTRAL) and Google scholar for studies reporting EQ-5D utility and VAS scores among individual with type 2 diabetes mellitus (T2DM) in South Asian countries. Eligible studies underwent a comprehensive systematic review and quality assessment using established appraisal tools. Mean EQ-5D scores were pooled in meta-analysis employing a random-effects DerSimonian–Laird model, and subgroup analyses were performed to explore sources of heterogeneity among the included studies. Meta-Regression analysis was conducted to evaluate the associations of age and disease duration with EQ-5D utility scores. The reviews protocol was registered in PROSPERO to ensure methodological transparency and reduce the risk of bias. A total of 22 studies conducted in individual with T2DM from South Asia were included. The pooled mean EQ-5D utility score was 0.75 (95% CI: 0.65–0.85) and mean Eq. 5D VAS score was 65.17 (95% CI: 57.81–72.54), indicating moderate HRQoL. individuals with T2DM complications had significantly lower scores utility score of 0.58 than compared to 0.81 among those without complications. Pain/discomfort and anxiety/depression were the most frequently reported domain with problems (58% and 53% respectively). Subgroup analyses revealed lower HRQoL for females, those with longer diabetes duration, with no comorbidities and in certain countries. Pooled utility values for T2DM individuals provide valuable insights into their HRQoL and are essential for informing health economics research. The observed associations between age, disease duration, and utility scores underscore the dynamic challenges of HRQoL over time, emphasizing the importance of tailored, long-term management strategies for diabetes care.

Air pollution has been linked to several neurological conditions, including stroke and neurodegenerative diseases. Evidence regarding its association with multiple sclerosis (MS) remains conflicting, limited by small sample sizes. PubMed, Embase, Scopus, and Cochrane controlled register of trials (CENTRAL) were searched on September 9, 2025 without any language or time restrictions. The inclusion criteria were observational studies that evaluated the association between exposure to air pollutants and MS development or severity. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled as effect estimates using the fixed or random effects model. Exposures included PM2.5, PM10, nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3). Outcomes were MS risk and severity, including relapses, disability progression measured with the Expanded Disability Status Scale (EDSS), and contrast-enhancing lesions (CELs) development. Twenty-two studies comprising 16,585,206 participants were included. Long-term exposure to PM2.5 (HR = 1.21; 95% CI: 1.07-1.38), PM10 (HR = 1.20; 95% CI: 1.02-1.42), and CO (HR = 3.85; 95% CI: 1.34-11.08) were associated with increased MS risk. Short-term exposure to PM2.5 (HR = 1.20; 95% CI: 1.01-1.43), PM10 (HR = 1.20; 95% CI: 1.01-1.45), NO2 (HR = 1.13; 95% CI: 1.02-1.25), and O3 (HR = 1.15; 95% CI: 1.04-1.27) were associated with relapses. Short-term exposure to PM2.5 (HR = 2.20; 95% CI: 1.05-4.60) and PM10 (HR = 1.02; 95% CI: 1.01-1.03) were linked to CELs, while PM10 (HR = 1.31; 95% CI: 1.04-1.65) was associated with disability progression. Long-term air pollution exposure was associated with higher MS risk, and short-term exposure with greater disease severity. Reducing air pollution may be a key strategy to protect brain health in MS.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrate cardiovascular benefits in diabetic populations, yet evidence in non-diabetic obesity remains limited. We searched PubMed, Excerpta Medica database (Embase), Cochrane Controlled Register of Trials (CENTRAL), and Web of Science (January 2015-January 2025) for randomized controlled trials evaluating GLP-1 RAs in non-diabetic adults with obesity (BMI ≥30 kg/m²), with composite major adverse cardiovascular events (MACE) as the primary outcome using random-effects models with risk ratios (RRs) and 95% confidence intervals (CIs). Sixteen trials (23,467 participants, median 68 weeks follow-up) were included, demonstrating that GLP-1 RAs reduced MACE by 20% (RR0.80, 95% CI 0.72-0.89), with strongest effects on stroke (RR 0.72), myocardial infarction (RR 0.84), and heart failure hospitalization (RR 0.82), alongside reductions in systolic blood pressure (4.2 mmHg), triglycerides (32 mg/dL), and high-sensitivity C-reactive protein (hsCRP) (38.6%), with 12.4% weight loss where mediation analyses showed 35%-55% of cardiovascular benefit was independent of weight reduction. GLP-1 RAs provide substantial cardiovascular protection in non-diabetic obesity through both weight loss-dependent and independent mechanisms, with acceptable safety profiles supporting their role in cardiovascular risk reduction.

Noninvasive ventilation (NIV) is an important treatment modality in the management of chronic obstructive pulmonary disease (COPD) by reducing respiratory distress, improving gas exchange and reducing exacerbations without the need for intubation and invasive airways. To synthesize data from randomized controlled trials (RCTs) and perform a meta-analysis to understand the beneficial effects of NIV across different COPD stages. A systematic literature review was performed using MEDLINE (PubMed) and Cochrane Register of Controlled Trials (CENTRAL) al databases for RCTs that involved the administration of NIV vs usual treatment (oxygen supplementation, pharmacological agents, nasal cannulation) in patients with stable COPD, acute exacerbations of COPD (AECOPD), and post-exacerbation COPD (PECOPD). Mortality, exacerbation and intubation rates, and arterial blood gases (PaCO2 and PaO2 levels) were assessed in both groups. RevMan software was used to assess the risk of bias and calculate the pooled odds ratio (OR), mean differences (MDs) and subgroup analyses with a random-effects model. A total of 51 RCTs were included in the meta-analysis with information from 3,775 patients. Meta-analysis of the data showed that there was a significant decrease in mortality outcomes (p < 0.001), intubation frequency (p < 0.001) and PaCO2 levels (p < 0.001) but no significant improvement in exacerbation frequency (p = 0.12) and PaO2 levels (p = 0.69). Subgroup analyses demonstrated no significant difference between COPD stage on mortality outcomes (p = 0.32), PaCO2 level (p = 0.12) and PaO2 level (p = 0.64). There was a significant decrease in intubation rate in AECOPD patients receiving NIV and a statistically nonsignificant difference in exacerbation frequency in stable COPD patients using NIV. The findings of this meta-analysis indicate a substantial overall enhancement in the frequency of exacerbations and intubations, mortality outcomes, and arterial gas levels among patients in various stages of COPD. Consequently, it is imperative to identify patients with COPD that are most likely to benefit from the use of NIV.

This systematic review and meta-analysis aimed to evaluate the efficacy of school-based physical education interventions for improving pre- and school-aged children's physical and mental health outcomes (3-12 years) and to examine whether effects vary across intervention and outcome types. Following PRISMA 2020 guidelines, an extensive search was conducted in Ovid MEDLINE, Embase, the Cochrane Controlled Trials Registry, and Scopus up to October 2023. Randomized controlled trials evaluating PE- or school-day activity-based interventions targeting physical and/or mental health outcomes in preschool (3-6 years) and school-aged children (6-12 years) were included. Random-effects meta-analysis (REML) was performed using standardized mean differences (SMDs), and heterogeneity was assessed using Q and I2 statistics. Subgroup analyses and influence diagnostics were conducted to explore between-study variability". Nineteen studies were included in the analysis. The results of the meta-analysis revealed no significant evidence of the effectiveness of these interventions on physical or mental health (1.61, 95CI; -1.37, 4.60; p = 0.29). The subgroup analysis results showed no significant difference between physical activity (0.05, 95%CI: -0.20, 0.29) and psychological exercise (0.06, 95%CI: -0.36, 0.24) (p = 0.58). Notably, substantial heterogeneity across studies indicates variability in the interventions' effects. The evidence remains inconclusive due to substantial heterogeneity, variability in intervention content, and differences in outcome measurement. Future trials should adopt standardized outcome measures, improve reporting of intervention implementation, and strengthen methodological rigor to enable more definitive synthesis of physical education intervention effects in children.

Background. Model-based systems engineering (MBSE) continues to improve and seeks to replace the current documentation-based approach with models that are selected depending on the stage of object cognition and the possibilities of obtaining information. The aim of the study was to determine the role of systems analysis in assessing the Strategy of the state anti-drug policy in the regional healthcare sector (system model), formalize approaches to the factors influencing the creation of a system model and its characteristics using the general principles of an effective MBSE architecture (model-based systems engineering). Materials and methods. The materials for the study were the published experience of Russian and foreign scientists associated with system analysis in various fields of activity. The search for publications for analysis devoted to the problem under study was conducted in databases (Medline, Cochrane Controlled Trials Register and others). The selection of research papers and articles was carried out from the electronic databases of the Scientific Electronic Library eLIBRARY.RU and the information and communication network "Internet" for the period from 2002 to 2024. Results. In a complex system, which is represented by a large number of participants implementing the Strategy, there is a difficulty in choosing the right level of abstraction and representing the logical parts of the dismembered system, identifying blocks, building architectural levels from abstractions aimed at identifying and using basic patterns and common characteristics of outwardly different objects. The study allowed us to partially formalize approaches for measuring existing system representations with the general principles of an effective MBSE architecture. The author came to the conclusion that the accumulation of information about the object of study, taking into account the registration of new components and connections, will lead to the receipt of projections of successive states of the developing system. As iterations are performed, a more adapted model of the current, studied or designed object will be created. Therefore, monitoring and control of the implementation of the Strategy with the introduction of necessary adjustments to improve efficiency will allow us to evaluate changes using information and analytical models. The implementation of principles, tools and methodologies for continuous improvement in an environment based on MBSE models will help to create a reference architecture for flows with digital tracking, which can be used to eliminate bottlenecks, defects and errors that threaten the successful implementation of programs and projects. EDN: UGLRFT

ObjectivesLipedema is a chronic condition that predominantly affects women, leading to painful, disproportionate fat distribution in the limbs. This systematic review and meta-analysis aimed to characterize health-related quality of life (HRQoL) across multiple domains in individuals with lipedema.MethodsWe systematically reviewed studies from inception to 3 July 2025 in MEDLINE (via PubMed) and Cochrane Controlled Register of Trials (CENTRAL) that primarily assessed HRQoL in individuals with lipedema. Data were extracted from studies using HRQoL assessment scales. The methodological quality of included studies was assessed using an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. The review protocol was pre-registered with PROSPERO (CRD42024590792). A random-effects meta-analysis was conducted to compute pooled mean HRQoL scores across various domains.ResultsFourteen cross-sectional studies involving nine countries and 3851 participants were included. The meta-analysis found significant impairments in multiple HRQoL domains: physical functioning (61.19, 95% CI: 56.77-65.60), pain (51.77, 95% CI: 45.01-58.53), social functioning (63.24, 95% CI: 58.44-68.04), emotional well-being (64.19, 95% CI: 59.86-68.52), and energy/fatigue (43.50, 95% CI: 39.32-47.68).ConclusionLipedema significantly affects HRQoL, with major deficits in physical, emotional, and social functioning. These findings highlight the need for greater clinical awareness and comprehensive management strategies, including both physical and psychological interventions, to improve the quality of life for individuals with lipedema. Further research is needed to explore long-term effects and optimize treatment approaches.

This review aims to investigate which environmental approaches to cognitive rehabilitation are effective in improving cognitive and related functional outcomes for adults with traumatic brain injury (TBI), and to identify the components of these approaches. Individuals with cognitive impairments after sustaining TBI often have limited self-awareness and capacity for goal-directed behavior. Therefore, they are less likely to benefit from cognitive rehabilitation approaches requiring active and self-directed engagement. These individuals may benefit from environmental approaches, which involve manipulating the environment (eg, modifying physical, social, or task-related aspects of an individual's surroundings) to support cognitive function, activity, and participation. However, the evidence base underpinning this is poorly understood, highlighting the need for research synthesis. This review will consider studies that include participants aged 18 years or older with a TBI and evaluate an environmental intervention. We will include randomized controlled trials written in English, irrespective of publication date or status. Outcomes of interest will include cognitive and related functional outcomes (eg, impairment, activity, participation). This review will follow the JBI methodology for systematic reviews of effectiveness. Information sources will include the Cochrane Controlled Register of Trials (CENTRAL), CINAHL (EBSCOhost), ClinicalTrials.gov, Embase (Ovid), PsycINFO (Ovid), MEDLINE (Ovid), and WHO International Clinical Trials Registry Platform (ICTRP). Two reviewers will independently select studies and extract data. Methodological quality will be appraised using the JBI Critical Appraisal Tool for Randomized Controlled Trials. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. Studies will be pooled with statistical meta-analysis where possible, accompanied by narrative synthesis. PROSPERO CRD42024592708.

IntroductionAbout 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, mindfulness-based cognitive therapy (MBCT) has increasingly been investigated in depressed patients with such ‘difficult-to-treat’ courses. This is a protocol for an individual participant data (IPD) meta-analysis aiming to determine efficacy and potential moderators of MBCT treatment effects in this group based on evidence from randomised controlled trials.Methods and analysisSystematic searches in PubMed, Web of Science, Scopus, PsycINFO, EMBASE and the Cochrane Controlled Trials Register for randomised controlled trials were completed on 17 June 2024. Authors of identified studies have contributed IPD, and data extractions have been completed. An update search will be conducted immediately before the start of data analyses. We will investigate the following outcomes: (a) self-reported and observer-reported severity of depression symptomatology, (b) remission and (c) clinically meaningful improvement and deterioration. One-stage and two-stage IPD-MA will be conducted with one-stage models using the observed IPD from all studies simultaneously as the primary approach. One-stage IPD models will include stratified study intercepts and error terms as well as random effects to capture between-study heterogeneity. Moderator analyses will test treatment-covariate interactions for both individual patient-level and study-level characteristics.Ethics and disseminationThe results will inform understanding of the use of MBCT in patients with current ‘difficult-to-treat’ depression and will contribute to arguments in favour of or against implementing MBCT as a treatment for this group. They will be published in a peer-reviewed journal and made available to stakeholders in accessible formats. No local ethical review was necessary following consultation with the Ethics and Governance Board of the University of Surrey. Guidance on patient data storage and management will be adhered to throughout.PROSPERO registration numberCRD42022332039.

Abstract Background Primary prevention of heart failure (HF) is important given its rising prevalence, associated disease burden, and healthcare expenditure.(1-3) Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve cardiovascular outcomes and we sought to establish the effect of GLP-1 RAs on HF events across randomised clinical trials. Purpose To perform a meta-analysis of the effect of GLP-1 RA on HF events as reported in published RCTs, and investigate for changes by clinically relevant subgroups. Methods We performed a systematic review of RCTs that evaluated the relationship between GLP-1 RAs and the development of HF using Medline, Embase and Cochrane-controlled Trials Register from inception through 10 January 2024. For meta-analysis we included RCTs with at least 5 new-onset heart failure events in either arm or where HF hospitalisation was included in the primary or secondary outcome. Results of the HF hospitalisation are expressed as relative risk (RR) with 95% confidence interval (CI) between the intervention and control group for each study. A fixed-effect model was used to combine results from studies when I2&amp;lt;50% and random-effect model when I2&amp;gt;50%. Risk of bias was assessed using the Cochrane RoB2 tool. Results From 2568 unique records we included 9 RCTs and 49 648 participants in quantitative synthesis (mean age: 64.0 years, 35.2% female, 87.2% hypertensive [mean SBP 135 mmHg], 62.7% diabetic, mean BMI 32.9) (Table 1). All trials included diabetes and/or obesity, and three trials included heart failure with preserved ejection fraction (HFpEF). Overall, risk of bias was low (67% low, 33% medium) and driven by outcome measurement (55% medium) as HF events were not in the primary endpoint of 8 (89%) of studies. On meta-analysis, GLP-1 RA reduced incident HF hospitalisation by 21% (RR 0.79, 95% CI 0.70-0.88) across the included RCTs (Figure 1). When analysing only RCTs which required HFpEF for inclusion, GLP-1 RA had a strong protective effect in new-onset HF hospitalisation (RR 0.45, 95% CI 0.31-0.65) (Figure 1), and in RCTs incorporating diabetes mellitus and/or obesity but not necessarily HF, treatment with GLP1-RAs reduced HF hospitalisation by 16% (RR 0.84, 95% CI 0.74-0.94) (Figure 1). Conclusions In this meta-analysis treatment with GLP-1 RAs reduced incident HF hospitalisation across randomised clinical trial populations with diabetes and/or obesity, as well as in patients with obesity and HFpEF.Table 1:Baseline RCT characteristics Figure 1:Forest plot of GLP-1 RA effect

Blood pressure targets after return of circulation following cardiac arrest in infants and children: a systematic review and meta-analysis.

Chronic postsurgical pain (CPSP), defined as pain persisting beyond the normal healing period, is a significant surgical complication. This systematic review evaluated the effectiveness of dexmedetomidine in preventing CPSP. A systematic search of PubMed/MEDLINE, the Cochrane Controlled Trials Register, Embase, and Wanfang Data was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions until 17 January 2025. Randomized controlled trials (RCTs) comparing dexmedetomidine with a placebo for the prevention of CPSP were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data were extracted independently by two researchers. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was CPSP incidence post-surgery. Secondary outcome was CPSP intensity post-surgery. Twenty-three RCTs involving 1979 patients were analyzed. Compared to controls, perioperative dexmedetomidine administration appeared to reduce CPSP rates at 3months [odds ratio (OR), 0.35; 95% CI, 0.23-0.54; P < 0.00001] and 6months (OR, 0.28; 95% CI, 0.18-0.42; P < 0.00001), and 12months (OR, 0.11; 95% CI, 0.03-0.43; P =0.001). Both intravenous (IV) and perineural dexmedetomidine reduced CPSP occurrence at 3months (IV administration, OR, 0.41; 95% CI, 0.25-0.67; P =0.003; perineural administration, OR, 0.26; 95% CI, 0.11-0.60; P =0.001) and 6months (IV administration, OR, 0.26; 95% CI, 0.16-0.41; P < 0.00001; perineural administration, OR, 0.35; 95% CI, 0.14-0.90; P =0.03). IV dexmedetomidine reduced CPSP occurrence at 12months (OR, 0.11; 95% CI, 0.03-0.43; P =0.001). In addition, dexmedetomidine reduces chronic pain severity at 6months (mean difference, -0.91; 95% CI, -1.17 to -0.64; P < 0.00001). Perioperative dexmedetomidine use was associated with an increased incidence of bradycardia (OR, 3.35; 95% CI, 1.15-9.81; P =0.03) but did not result in hypotension (OR, 1.37; 95% CI, 0.57-3.27; P =0.48). This systematic review and meta-analysis found that perioperative dexmedetomidine effectively reduces the occurrence of CPSP in surgical patients and serves as a valuable adjunct to standard analgesic regimens in surgery.

Challenges in identifying patients at high risk of asthma have driven the development of clinical prediction models (CPMs) to optimise workflows. However, concerns about the transparency and usability of these models remain. This study systematically reviewed previously developed CPMs for asthma diagnosis, focusing on their reporting, methodology, and applicability. We searched four databases—PubMed, Scopus, Embase, de an overview of existing diagnostic modand Cochrane Controlled Trials Register—using a pre-defined search strategy, covering their inception dates through September 2024. Grey literature and unpublished studies were identified through a search on Google Scholar. Data extraction followed the items and signaling questions outlined in TRIPOD+AI and PROBAST. The risk of bias and applicability of the included studies were evaluated using PROBAST. Sixty-nine studies were included in this review, with 54 using supervised machine learning (ML)-based methods and 15 using regression-based methods. Regression-based CPMs had a higher event per variable (median 16.2; IQR: 14.0–42.0) than ML-based CPMs (median 8.2; IQR: 4.6–50.6). Both approaches exhibited high bias risk, particularly in the analysis (100%) and participant (69.6%) domains. Of all studies, 37.7% did not report the method for handling missing data and 91.3% inadequately reported model performance measures. High applicability concerns were 81.5% for ML-based studies and 60.0% for regression-based studies. The majority of studies demonstrated poor methodology and significant applicability concerns, driven by critical flaws in participant recruitment, small sample sizes, handling of missing data, and predictor selection. It is well known that these pitfalls cause bias and reduce analytic power. CPM researchers should be aware of these pitfalls and adhere to TRIPOD+AI reporting guideline.

People with advanced chronic kidney disease (CKD) and secondary hyperparathyroidism (sHPT) refractory to medical therapy often require surgical parathyroidectomy. Severe and prolonged hypocalcemia immediately following parathyroidectomy for sHPT is often termed "hungry bone syndrome" (HBS). To systematically review the effect of pre-operative interventions on post-operative hypocalcemia, HBS, and other related outcomes in patients with CKD and sHPT undergoing parathyroidectomy. This is a systematic review study. Diverse study designs conducted in any country. Adult patients with CKD complicated by sHPT undergoing parathyroidectomy. Post-operative hypocalcemia, HBS, symptomatic hypocalcemia, and other related outcomes. We searched Ovid MEDLINE, Embase, and Cochrane Controlled Trials Registry from inception until June 2024 for trials and observational studies of adults with CKD and sHPT that evaluated pre-operative interventions aimed at reducing the risk of hypocalcemia following parathyroidectomy. After 2 phases of study screening conducted in duplicate, we extracted data on study design, patient characteristics, interventions, and outcomes. Hypocalcemia was defined as serum calcium <2.1 mmol/L and HBS as calcium <2.1 mmol/L for ≥4 days post-operatively. We evaluated the risk of bias and completed a narrative synthesis of the available literature across intervention types. We identified 3616 studies; 35 underwent full-text review, and 9 met final eligibility criteria. Interventions included pre-operative calcitriol (n = 2), pre-operative cinacalcet (n = 3), pre-operative alkaline phosphatase (ALP) measurement to guide intravenous (IV) calcium administration (n = 3), and pre-operative pamidronate (n = 1). All studies reported on at least one of: median/mean post-operative calcium (n = 7), incidence of post-operative hypocalcemia (n = 3), HBS (n = 1), and symptomatic hypocalcemia (n = 4). Interventions that reported on the risk of post-operative hypocalcemia included pre-operative pamidronate (n = 1, 37 participants, odds ratio [OR] = 0.003, 95% confidence interval [CI] = 0.000-0.072) and IV calcium guided by pre-operative ALP (n = 1, 271 participants, OR = 0.292, 95% CI = 0.175-0.488). There were insufficient data to meta-analyze study-specific effects for any intervention or outcome. Our study was limited by significant heterogeneity in outcome reporting, which resulted in substantial outcome reporting bias and prevented pooled analyses. Furthermore, no randomized control trials met our inclusion criteria, which limited assessment of publication bias. Pre-operative risk factors for HBS have been established in patients with CKD undergoing parathyroidectomy. However, limited research has evaluated pre-operative interventions to reduce the risk of HBS, and due to heterogeneity in outcome reporting across studies, there is still uncertainty about the effectiveness of such interventions. These findings support the need for future clinical trials.

Abstract Objective: Our goal is to evaluate the effectiveness and safety of lasers compared with mechanical staplers in pulmonary resections using a qualitative and systematic manner. Summary of background data: Laser technique is effective in pulmonary resections among patients with pulmonary disease. However, systematic review of this technique need to be made toascertain its key role in thoracosurgery domain. Methods: For randomized controlled trials (RCTs) published in Medline, Web of Science, Cochrane Controlled Trials Register (CCTR), and clinical trial databases from June 1979 to October 2022, we identified and synthesized three studes to compare the efficacy and safety of lasers and mechanical staplers in pulmonary resections based on selection criteria. Two reviewers independently assessed trial bias and extracted data to make a using a qualitative systematic review. Results: The three RCTs were obtained using surgery approach of video-assisted thoracoscopic surgery (VATS). The operating time of the laser group was longer than that of the staple group in Marulli study (WMD = 12.00 min, 95% CI -11.66 to 35.66 for McKenna, WMD = 39.00 min, 95% CI 21.82 to 56.18 for Marulli and WMD = 2.00 min, 95% CI -15.10 to 19.10 for Scanagatta), while the hospital stay of the laser group was comparative with that of the staple group (WMD = -2.00d, 95% CI -7.36 to 3.36 for McKenna, WMD = -3.00d, 95% CI -6.29 to 0.29 for Marulli and WMD = 0.00d 95% CI -1.69 to 1.69 for Scanagatta). Risk ratio (95%CI), expressed as the persistent air leaks of the laser group vs the staple group, was RR = 0.68 (95%CI 0.38 to 1.22) for McKenna, RR = 0.67 (95%CI 0.12 to 3.61) for Marulli, RR = 1.07 (95%CI 0.53 to 2.16) for Scanagatta, respectively and expressed as pneumothorax, RR = 7.09 (95%CI 0.90 to 55.95) for McKenna, RR = 0.33 (95%CI 0.01 to 7.76) for Marulli, RR = 6.28 (95%CI 0.34 to 117.39) for Scanagatta, respectively. At the 6th month follow-up, the mean postoperative forced expiratory volume in 1 second of the staple group was significantly improved compared with that of the laser group. The clinical symptoms and dyspnea index were improved by more than one grade 8 of 33 (24%) patients in the laser group and 26 of 39 (66%) patients in the staple group (p = 0.003). Conclusions: The lasers are effective and comparable with mechanical stapler technique in pulmonary resections except for the improved for dyspnea index.

To evaluate the effectiveness of various medications for the treatment of endometriosis-related pain through a network meta-analysis. A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Controlled Trials Register until July 22, 2024. We also searched ClinicalTrials.gov for additional data on recently completed trials or potentially eligible randomized controlled trials (RCTs) but found nothing. The analysis included randomized RCTs that used pharmacologic interventions for managing endometriosis-related pain. The primary efficacy outcome was endometriosis-associated pelvic pain, which included dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. The analysis adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A total of 31 RCTs involving 8,665 patients were included in the analysis. In terms of endometriosis-associated pelvic pain, four interventions demonstrated significantly greater efficacy compared with placebo: leuprolide combined with combined oral contraceptive pills (OCPs) (standardized mean difference [SMD] -1.40, 95% CI, -2.41 to -0.38), dienogest (SMD -1.20, 95% CI, -1.78 to -0.61), leuprolide alone (SMD -1.05, 95% CI, -1.64 to -0.45), and combined OCP (SMD -0.67, 95% CI, -1.25 to -0.09). Leuprolide combined with combined OCP emerged as the most effective treatment modality. In addition, elagolix and the combination of vitamin C and vitamin E were identified as the most effective interventions for dysmenorrhea and dyspareunia. For nonmenstrual pelvic pain, gestrinone demonstrated superior efficacy compared with placebo and all other interventions. This network meta-analysis indicates that leuprolide in combination with combined OCP, elagolix, vitamins C and E, and gestrinone may represent the most effective therapeutic options for alleviating endometriosis-associated pelvic pain, dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. These findings enhance our understanding of the relative efficacy of treatment strategies for pain associated with endometriosis. Future research should focus on conducting larger-scale and rigorously designed clinical trials within the target patient populations to further validate these results.