Cochrane Handbook For Systematic Reviews Research Articles

Hamstring autografts demonstrate either similar or inferior outcomes to quadriceps or bone-patellar tendon-bone autografts in revision anterior cruciate ligament reconstruction: A systematic review of comparative studies.

To evaluate the clinical outcomes in patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR) using hamstring tendon (HT) autografts with those using either quadriceps tendon (QT) or bone-patellar tendon-bone (BPTB) autografts or allografts. Three databases were searched on 8 August 2023. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, failure and return to sport (RTS) were extracted. Eleven studies comprising 859 patients were included in this review. Five studies compared HT and QT autografts. One study each reported greater IKDC scores (p = 0.04) and Tegner scores (p = 0.04) in the QT group, while one study each reported higher anterior translation (p = 0.04), rates of positive pivot shift (p = 0.03) and rates of failure (p = 0.03) in the HT group. Six studies compared HT and BPTB autografts with one study each reporting greater Lysholm scores (p = 0.02) and less side-to-side anterior laxity (p < 0.01) in the BPTB group. Two studies compared HT autografts with allografts with only one study reporting a faster time to RTS in the HT group than the allograft group (p < 0.001). All other comparisons were not significant. HT autografts result in either similar or inferior outcomes in r-ACLR when compared to QT or BPTB autograft options. Allografts resulted in similar outcomes to HT autografts apart from greater time to RTS for r-ACLR. Level III.

Evidence for Intermittent Theta Burst Transcranial Magnetic Stimulation for Dysphagia after Stroke: A Systematic Review and Meta-analysis.

Dysphagia is the most common serious complication after stroke, with an incidence of about 37-78%, which seriously affects the independence of patients in daily life and clinical recovery. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, is an emerging option for post-stroke dysphagia. Theta burst stimulation (TBS) is a new mode of transcranial magnetic stimulation that simulates the frequency of pulses released in the hippocampus.Intermittent theta burst stimulation (iTBS) has been shown to increase cortical excitability and improve swallowing function in patients. Our study sought to summarize existing clinical randomized controlled trials to provide evidence-based medical evidence for the clinical use of iTBS. A computer search was conducted on 4 Chinese (Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science) and 4 English (including Cochrane Library, Embase, PubMed, Web of Science) databases to retrieve all randomized controlled trials in Chinese and English that explored the effects of Intermittent Theta Burst Stimulation for post-stroke dysphagia. The retrieval years are from database construction to 23 November 2023. The primary outcome measure was a change in Penetration/Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS), Secondary outcomes included Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), water-swallowing test (WST) etc. A meta-analysis by Standardized Mean Difference (SMD) and 95% confidence interval (CI) was performed with RevMan 5.3. we appraise risk of bias(RoB) of each study with the Cochrane RoB tool. Detailed instructions for using the Cochrane RoB tool are provided in the Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Handbook). Nine studies were obtained from eight databases after screening by inclusion and exclusion criteria, 567 patients from 9 studies were included in the meta-analysis, and one study was included in the qualitative analysis due to different control groups. Two of the nine studies had an unclear risk of bias, and four studies were at low risk. The results showed that iTBS significantly improved SSA, PAS, FOIS, and PAS scores in stroke patients compared to the control group(P < 0.05), and promoted swallowing function recovery. Our systematic review provides the first evidence of the efficacy of iTBS in improving dysphagia in stroke patients. However, the number of available studies limits the persuasiveness of the evidence and further validation by additional randomized controlled trials is needed.

Complications following surgical treatment of patella fractures - a systematic review and proportional meta-analysis.

The aim of this systematic review and proportional meta-analysis was to identify complications of surgical treatment of patella fractures and to estimate their incidence. We extended existing knowledge on this topic by including several more recent and large-scale studies. This systematic review and meta-analysis were performed in accordance with the Cochrane Handbook for systematic reviews of interventions. After searching in PubMed, MEDLINE, EMBASE, Cochrane Library, and OpenGrey, all studies after 2000, with study populations > 100 patients, including only patients > 18 years and follow-up > 30 days, were included. Two independent authors assessed the literature search and extracted the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analysis was performed on complications pooled in infections, nonunion, symptomatic implant removal, and fixation failure. The data on complications were available from 14 studies, including a pool of 5659 patients. The most common complication was symptomatic implant removal, affecting. Surgically, treatment of patella fractures was associated with a high risk of complications. The most common complication was symptomatic implant removal, affecting 29.6% of patients. Other complications stated were fixation failure 5.2%, infections 3.1% and nonunion 1.7%.

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: A systematic review and meta-analysis of randomized controlled trials.

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on post-hysterectomy recovery. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to July 27, 2023. We identified randomized controlled trials (RCTs) involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery (QoR) scores. Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 hours following hysterectomy, as well as postoperative opioid consumption within 24 hours and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration post-hysterectomy. Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: A systematic review and meta-analysis of randomized controlled trials.

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on post-hysterectomy recovery. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to July 27, 2023. We identified randomized controlled trials (RCTs) involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery (QoR) scores. Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 hours following hysterectomy, as well as postoperative opioid consumption within 24 hours and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration post-hysterectomy. Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Effect of Corona Virus on Olfactory &amp; Gustatory Functions (Systematic Review Study)

Abstract Background Because of the rapid spreading of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection, the Coronavirus disease 2019 (COVID-19) outbreak was characterized as a pandemic by the WHO on March 11, 2020. Materials and Methods Following the PRISMA statement guidelines, we conducted this systematic review and meta-analysis according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct till December 2021 with relevant keywords. We included the whole clinical studies assessing olfactory and/or gustatory dysfunctions (OGD) in patients with COVID-19, studies including patients with a confirmed diagnosis of COVID-19 by a positive result of RT-PCR were included, studies that assessed the OGD by either subjective evaluation were also included, studies written in English languages only, all of the studies must have been written in English as a full-text manuscript, double or single-arm designs. Results A total of 12 studies were finally included for the final qualitative and quantitative analysis illustrating the association and the relationship between COVID-19 infection and olfactory and gustatory functions. The mean age of the participants was 49.12 years. The pooled analysis of the included studies showed a significant association of positive results between OGD and COVID-19 infection. Also, the analysis showed a significant association of positive results between either isolated olfactory or gustatory dysfunction and COVID-19 infection. Regarding the association between gustatory dysfunction in COVID-19 patients versus (Acute respiratory infection) ARI patients with no detectable virus, the analysis showed a significant difference between COVID-19 patients and ARI patients with no detectable virus regarding the gustatory dysfunction meaning there is a high association between gustatory dysfunction and COVID-19 patients other than ARI patients with no detectable virus. Finally, the pooled analysis of the included studies showed a significant difference between COVID-19 patients and ARI patients with other respiratory viruses (ORV) in terms of OGD. Conclusion Based on the available evidence, there are regional and chronological differences in the prevalence rates of olfactory and gustatory dysfunction. Future studies, particularly those that document the temporal relationship in the onset of these 2 symptoms, are needed.

Use of Drains in Spine Surgery Systematic Review &amp; Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Incidence of Recurrence Post Hemi Thyroidectomy in Thyroid Papillary Carcinoma: A Meta-Analysis

Abstract Background Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid carcinoma. It has an excellent prognosis, with a 10-year survival rate of more than 95 per cent, although outcome is poorer for aggressive subtypes. Aim of the Work Our work in this study shows that the incidence of recurrence post hemi thyroidectomy is significantly higher compared to post total thyroidectomy and in case of multifocal and insular carcinoma with hemi thyroidectomy it increases the incidence of recurrence and drastically affecting the 10-year survival rate and the quality of life. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till November 2021 relevant keywords. We used the following search strategy for searching different databases: (“Papillary Thyroid Cancer” OR “Papillary Thyroid Cancers” OR “Papillary Thyroid Carcinomas” OR “Papillary Carcinoma Of Thyroid” OR “Papillary Thyroid Carcinoma” OR “Familial Non medullary Thyroid Cancer” OR “Non medullary Thyroid Carcinoma” OR “Non medullary Thyroid Carcinomas” OR “Thyroid Carcinoma, Non medullary” OR “Thyroid Carcinomas, Non medullary”) AND (Hemithyroidectomy OR Thyroidectomy OR Thyroidectomies OR thyroid removal). All the references of the included studies were searched for relevant studies. Results Multifocality and insular carcinoma and bilaterality increase the incidence of recurrence drastically so it is recommended for total thyroidectomy. Gender plays a role in the aggressiveness of the tumor but not in the incidence of recurrence as this is determined by the selection criteria of the candidate and the surgical technique. We studied 7 risk factors through this meta-analysis and it is recommended for application of LNR as a post op prognostic tool for recurrence and to apply hemi thyroidectomy for tumor size &amp;lt;2 cm instead of &amp;lt; 4 also meticulous pre-operative workup, accurate risk assessment, stratification and staging this is to customize a road map for every patient through a multi-disciplinary team. Conclusion In this meta-analysis we found that in low grade differentiated papillary thyroid carcinoma the recurrence is higher with hemithyroidectomy than in total thyroidectomy after applying the ATA guidelines for 10 years retrospectively but in case of 10 year survival it showed no significant difference.

The Lateral Sinus Tarsi Approach in Fixation of Displaced Intra-Articular Calcaneal Fracture. A Systematic Review &amp; Meta Analysis

Abstract Background Minimally invasive reduction and fixation techniques via a sinus tarsi approach (STA) have been developed in an attempt to avoid the potential complications associated with an extensile lateral approach (ELA) and to be less invasive. Objective Minimally invasive approach including sinus tarsi approach (STA) in displaced intra articular calcaneal fracture displaced intra-articular calcaneal fractures (DIACF) with reference to: Change from baseline in calcaneal height, change from baseline in calcaneal width, change from baseline in calcaneal length, change from baseline in Bohler angle, change from baseline in Gissane angle. Methodology This meta-analysis was carried out in accordance with the Cochrane Handbook of Systematic Reviews of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the question of minimal invasive of lateral sinus tarsi in displaced intra articular calcaneal fracture. The study protocol was registered into the International Prospective Register of Systematic Reviews on September 09, 2020 with a registration number (PROSPERO: CRD42022359197). Results Running our search strategy on PubMed 69 studies, and the Cochrane library resulting in 221 studies and trials. We discarded 12 studies after screening the title and Abstract. Then we screened 18 studies to assess their eligibility for inclusion; and in last 10 years. The total sample size for this meta-analysis was 12 participants. 484 patients who completed STA surgery and 514 patients completed ELA surgery. Data Sources Medline databases (PubMed, cochrane) and all materials available in the Internet till 2023. Conclusion In conclusion, using the minimally invasive sinus tarsi approach (STA) is associated with a significant change in calcaneal height and Gissane angle when compared to extended lateral approach (ELA) when used to manage the displaced intra-articular calcaneal fractures (DIACF).

The effect of fenugreek on the severity of dysmenorrhea: a systematic review and meta-analysis.

Dysmenorrhea is the most common periodic pain, which affects more than 50% of women with regular menstruation. Fenugreek is one of the medicinal plants with analgesic properties. This study aimed to determine the effect of fenugreek application in the severity of dysmenorrhea and its side effects in women with dysmenorrhea. PICO: population: women with dysmenorrhea; intervention: fenugreek; comparison: control groups; and outcome: reduction in the severity of dysmenorrhea and its side effects Methodology: English database (PubMed, Cochrane Library, Scopus, and Web of Science) and Persian database [SID (Scientific Information Database) and Magiran] were used for research until February 11, 2023, using the keywords "Dysmenorrhea [Mesh]," "Foenum [Mesh]," "fenugreek [Mesh]," and "Trigonella [Mesh]." The reference list of the selected articles was also checked. The quality assessment was conducted through the Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. The RevMan 5.3 software was used to analyze and report the data of the entered studies. Meta-analysis results were reported with the standardized mean difference (95% confidence interval). A subgroup analysis was performed based on the type of control groups. The quality of evidence was assessed using the GRADE approach. After removing duplicates and ineligible cases, four articles were included in the systematic review out of the 1526 records obtained. The results showed that the pain intensity caused by primary dysmenorrhea decreased with fenugreek compared to placebo (pooled result SMD: -2.21; 95% CI: -3.26 to -1.17; Z: 4.17; P <0.001). There was no significant difference between fenugreek with mefenamic acid (SMD: 0.05; 95% CI: -0.57 to 0.67; Z: 0.17; P = 0.86) and fenugreek with Chandrasura churna (SMD: 0.06; 95% CI: -0.56 to 0.68; Z: 0.19; P = 0.85). Bias, in terms of incomplete outcome data and selective reporting, was low risk in all studies, and the available evidence was low quality according to the GRADE approach. The results showed that the effect of fenugreek on pain intensity in dysmenorrhea is highly uncertain. The true effect is likely to be substantially different from the estimate of effect. Regarding the importance of the health and quality of life of women of reproductive age and the low quality of evidence of the studies, clinical trials with stronger methodology are suggested in this field.

Effect of surgeon's seniority and subspeciality interest on mortality after emergency laparotomy: A systematic review and meta-analysis.

To evaluate effect of surgeon's seniority (trainee surgeon vs. consultant surgeon) and surgeon's subspeciality interest on postoperative mortality in patients undergoing emergency laparotomy (EL). A systematic review was conducted and reported according to the Cochrane Handbook for Systematic Reviews and the PRISMA statement standards, respectively. We evaluated all studies comparing the risk of postoperative mortality in patients undergoing EL between (a) trainee surgeon and consultant surgeon, and (b) surgeon without and with subspeciality interest related to pathology. Random effects modelling was applied for the analyses. The certainty of evidence was assessed using the GRADE system. Analysis of 256 844 patients from 13 studies showed no difference in the risk of postoperative mortality between trainee-led and consultant-led EL (OR: 0.76, p = 0.12). However, EL performed by a surgeon without subspeciality interest related to the pathology was associated with a higher risk of postoperative mortality compared with a surgeon with subspeciality interest (OR: 1.38, p < 0.00001). In lower gastrointestinal (GI) pathologies, EL done by upper GI surgeons resulted in higher risk of mortality compared with lower GI surgeons (OR: 1.43, p < 0.00001). In upper GI pathologies, EL done by lower GI surgeons resulted in higher risk of mortality compared with upper GI surgeons (OR: 1.29, p = 0.05). While confounding by indication cannot be excluded, level 2 evidence with moderate certainty suggests that trainee-led EL may not increase the risk of postoperative mortality but EL by a surgeon with subspeciality interest related to the pathology may reduce the risk of mortality.

Does orthodontic treatment using fixed appliances cause initial caries lesions?

Systematic review and meta-analysis of randomized clinical trials (RCTs), non-randomized studies of intervention (NRSIs), cohort and cross-sectional studies. The systematic review was registered in advance on PROSPERO, and was conducted following the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA checklist. An electronic search in three databases (PubMed, Scopus, and Embase) was conducted by two authors to evaluate studies published from 1990 until May 2023. The review question was defined in PICOS format as follows: Population (P), subjects with permanent dentition who having/had orthodontic therapy; Exposure (E), orthodontic therapy with fixed orthodontic appliance; Comparison/Control (C), no orthodontic treatment or intervention; Outcome (O), assessing incidence and/or prevalence of initial caries lesions (ICLs) at subject and teeth levels was the primary outcome, whereas evaluating the influence of demographics and treatment-related variables were secondary outcomes; studies (S), randomized clinical trials, non-randomized clinical studies, cohort and cross-sectional studies. Meta-analysis was conducted of three or more included studies had comparable findings. The following factors were calculated for each study; sample size, number of patients with ICLs, number of teeth with ICLs, number of teeth affected per patient, and number of surfaces affected. Statistical heterogeneity of effects among studies was assessed by means of the Cochran's test was used to evaluate the statistical heterogeneity of effects in the included studies. Funnel plot approach was used to assess publication bias, whereas Begg's and Egger's correlation test were used to identify asymmetry. Meta-analysis was conducted using a random effects model owing to high methodological and clinical heterogeneity. A descriptive analysis was presented when the meta-analyses appeared inappropriate. Statistical significance level was set at p < 0.05 for all statistical analyses. 21 studies were included in the qualitative synthesis (systematic review); 11 RCTs; 7 NRSIs, and 3 observation studies. Of the included studies, 19 studies were analyzed in the quantitative synthesis (meta-analysis). In regard to the prevalence rate of ICLs; 57% of patients had ICLs, with a mean of 2.24 lesions per patient and 22% of surfaces were affected. In regard to the incidence rate; 48% of patients developed new ICLs, with a mean of 2.29 new lesions per patient, and 15% of surfaces became affected. Both prevalence and incidence rates were positively associated with the duration of the orthodontic therapy (P = 0.01 and P < 0.01, respectively), illustrating an elevation in the ICLs numbers as the treatment duration (number of months) increases. There was no association between patients' age and ICLs numbers. Orthodontic therapy using fixed appliances can increase the risk of accumulating plaque and developing caries lesion. However, other risk factors may play a role in developing ICLs; thus, controlling for these factors is paramount to better evaluate the true influence of orthodontic therapy on the ICLs development. Implementing caries preventive measures during orthodontic treatment may be needed to minimize the potential risks.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke.

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis. We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions. A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores. The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

A scoping review of the effects of mushroom and fungus extracts in rodent models of depression and tests of antidepressant activity.

One of the most important developments in psychopharmacology in the past decade has been the emergence of novel treatments for mood disorders, such as psilocybin for treatment-resistant depression. Psilocybin is most commonly found in different species of mushroom; however, the literature on mushroom and fungus extracts with potential antidepressant activity extends well beyond just psilocybin-containing mushrooms, and includes both psychedelic and non-psychedelic species. In the current review, we systematically review the preclinical literature on mushroom and fungus extracts, and their effects of animal models of depression and tests of antidepressant activity. The PICO structure, PRISMA checklist and the Cochrane Handbook for systematic reviews of intervention were used to guide the search strategy. A scoping search was conducted in electronic databases PubMed, CINAHL, Embase and Web of Science. The literature search identified 50 relevant and suitable published studies. These included 19 different species of mushrooms, as well as seven different species of other fungi. Nearly all studies reported antidepressant-like effects of treatment with extracts. Treatments were most commonly delivered orally, in both acute and chronically administered studies to predominantly male rodents. Multiple animal models of depression were used, the most common being unpredictable chronic mild stress, while the tail suspension test and forced swim test were most frequently used as standalone antidepressant screens. Details on each experiment with mushroom and fungus species are discussed in detail, while an evaluation is provided of the strengths and weaknesses of these studies.

Efficacy and safety of erythritol air-polishing in implant dentistry: A systematic review.

Professional oral hygiene is essential to prevent peri-implant disease. Appropriate instruments should be employed for implant-supported restorations: they should effectively remove deposits without damaging dental implant surface. The aim of the present systematic review is to investigate the efficacy and safety of erythritol air-polishing in implant-supported rehabilitations, compared to alternative hygienic techniques. The guidelines reported in the indications of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were employed for this systematic review. The focused question was: 'what is the effect of erythritol air-polishing on dental implant surfaces regarding its cleansing efficacy and/or safety?' The final online search was conducted on 13 August 2023; MEDLINE-PubMed, Scopus and Cochrane Library were employed. Comparative invitro or invivo original studies were included. The initial database search yielded 128 entries; the final selection comprised 15 articles. The risk of bias was evaluated using the Newcastle Ottawa scale (NOS), the Cochrane Handbook for Systematic Reviews of Interventions, GRADE method. Ultrasonic scaling with PEEK tips, glycine air-polishing and cold atmospheric plasma were the devices most frequently compared to erythritol powder in the included studies. Erythritol air-polishing appeared to be significantly more effective in reducing biofilm compared to other treatments, without causing any significant damage to the implant surface and peri-implant tissues, promoting a good biological response. Erythritol air-polishing showed promising results for professional oral hygiene in implant-supported restorations. According to this systematic review, it is effective and safe for removing biofilm from titanium dental implants.

Identifying pulmonary embolism - high risk patients after total knee replacement: systematic review.

To determine the incidence, onset, risk factors and mortality of pulmonary embolism in total knee replacement patients. The systematic review was conducted in September 2022, and comprised search on PubMed, ScienceDirect, Scopus and Crossref databases for studies published from 1977 till September 7, 2022, in the English language related to the incidence of pulmonary embolism after primary total knee replacement. Cochrane Handbook for Systematic Reviews of Interventions was used to assess risk of bias, and the Newcastle-Ottawa Scale was used to assess the quality of evidence. Of the 3,910 studies initially identified, 66(1.68%) were analysed in detail, which together had 13,258,455 total knee replacement patients. Pulmonary embolism was reported in 76,515(0.58%) cases. The onset of pulmonary embolism ranged 2-150 days post-surgery. Patients with older age, diabetes mellitus, higher body mass index, atrial fibrillation, previous venous thromboembolism, high Charlson Comorbidity Index score, hypertension, arrhythmia and chronic heart failure were at significantly higher risk (p<0.05). The overall mortality rate of pulmonary embolism in such cases ranged 10.53-100%. Pulmonary embolism is a rare complication after orthopaedic surgery, but it has a very high mortality rate. By recognising the risk factors, attending physicians can optimise the use of chemoprophylaxis, thus preventing pulmonary embolism.

Natural supplementation to effectively combat cancer-related fatigue: Evidence from a meta-analysis on the use of guarana.

e24087 Background: Cancer-related fatigue (CRF) is one of the most common symptoms reported and is estimated to affect up to 90% of cancer patients during the course of the disease. CRF may persist even after the end of cancer treatment. There is no definitive effective treatment with a high level of evidence and several alternatives have been sought after to aid traditional medications, with emphasis on natural supplements as a form of adjuvant treatment. In previous studies carried out by the Department of Oncology at ABC Medical School, a purified extract of Guarana ( Paullinia cupana), a plant native to the Amazon, showed promising results in clinical trials with patients undergoing chemotherapy, but with a limited number of patients and, thus, lower level of evidence. Therefore, the present study carried out a systematic review and meta-analysis of the supplementation of Guarana and its derivatives to combat CRF to produce more robust evidence regarding its possible therapeutic effect. Methods: Systematic review with meta-analysis registered at the International Prospective Register of systematic reviews (PROSPERO) under code CRD42023484144. Two independent researchers searched for articles in English on PUBMED, MEDLINE and Cochrane Library using controlled vocabulary (MeSH terms) and keywords related to CFR, Guarana and its related terms. Eligible studies were selected based on predefined criteria and were assessed for quality according to Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers – any discrepancies were resolved by a third researcher. On the rare occasions in which a study was published as an abstract and then published as a full article, only its complete version was considered eligible for inclusion to avoid duplicates and reduce risk of bias. All analyses were conducted with RevMan 5.4.1 and employed random-effects model. Results: Of the 117 articles found, 4 full articles and 1 abstract were added to the meta-analysis, comprehending a total of 229 patients and the years of 2007-2023. With high heterogeneity between studies (I² = 78%, Chi² = 18.51, df = 4, P = 0.0010), our analysis found benefit in using guarana to combat CRF: Standard Mean Difference -0.77 (IC95% -1.34; -0.21), Test for overall effect: Z = 2.68 (P = 0.007). Conclusions: Our analysis supports the use of Guarana to combat Cancer-Related Fatigue. Further investigation with prospective randomized controlled trials should be carried out to validate our findings.

Effects of occupational health promotion interventions on health-related outcomes among employees of small businesses and self-employed individuals: A systematic review

BACKGROUND: Compared to workers of larger companies it is less clear what health promoting interventions might be beneficial for employees of small businesses and self-employed individuals. OBJECTIVE: Our aim was to critically appraise trials investigating health promotion programs among small business workers and self-employed individuals, by means of a systematic review. METHODS: We conducted a search of primary studies using MEDLINE, Web of Science, LIVIVO and the Cochrane library. Our assessment followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. RESULTS: We identified six trials including 5,854 participants from Asia, North America and Australia. Most were of moderate methodological quality, only one was of low quality. Some of the supervised psycho-educational lifestyle programs focusing on individual behavior changes showed benefits in terms of stress reduction and increased physical activity levels among small enterprise employees. CONCLUSIONS: There is a huge knowledge gap on evidence-based health promotion interventions for self-employed and for small business workers, especially in Europe.

Phosphodiesterase-5 inhibitors use and the risk of alzheimer's disease: a systematic review and meta-analysis.

The management of Alzheimer's disease (AD) poses considerable challenges, necessitating the pursuit of innovative therapeutic approaches. Recent research has spotlighted the promising role of phosphodiesterase type 5 inhibitors (PDE5Is) in reducing the prevalence of AD, utilizing their vasodilatory properties to suggest a potential neuroprotective effect. This meta-analysis and systematic review aims to assess the relationship between the use of PDE5Is and the risk of AD. A detailed examination was carried out across several electronic databases till March 2024, including PubMed, Web of Science, Scopus, CENTRAL, and Embase. The focus was on identifying studies that compare the occurrence of AD among PDE5I users vs non-users. Through a random-effects model, pooled hazard ratios (HRs) were calculated, in alignment with guidelines from the Cochrane Handbook for Systematic Reviews and Meta-Analysis and the PRISMA standards. This analysis included six studies, cumulating a participant count of 8,337,313, involving individuals treated with sildenafil, tadalafil, and vardenafil, against a control group undergoing other or no treatments. The cumulative HR for AD risk among PDE5I users versus the control group was 0.53 (95% CI: 0.32-0.86, p = 0.008), signaling a markedly reduced likelihood of AD development in the PDE5I group. Particularly, sildenafil usage showed a significant risk reduction (HR: 0.46, 95% CI: 0.31-0.70, p < 0.001), while findings for tadalafil and vardenafil were not significant. Test of subgroup differences found no difference between male and female participants in the risk of AD. Our findings suggest that the use of PDE5Is is associated with a reduced risk of AD, highlighting its potential as a protective agent against neurodegenerative diseases. Given the very low quality of evidence and the heterogeneity among the included studies, further high-quality research is warranted to confirm these findings and elucidate the underlying mechanisms. Register number PROSPERO 2024: CRD42024522197.

Effect of Nuts on Anthropometric and Glycemic Indexes and Blood Pressure in Secondary Cardiovascular Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Nut-enriched diets have a positive impact on cardiovascular risk factors, such as body mass, blood pressure, and fasting blood glucose. However, studies in individuals undergoing secondary cardiovascular prevention show controversial results. This systematic review with meta-analysis assessed the effect of nut supplementation on anthropometric, glycemic, and blood pressure indices in patients with atherosclerotic cardiovascular disease, as well as the frequency of adverse events. Six databases were used for the search-PubMed, Cochrane Library, EMBASE, BVS (Biblioteca Virtual da Saude), Web of Science, and ClinicalTrials.gov-until February 2023, with no language restrictions. The Cochrane Handbook for Systematic Reviews of Interventions methodology and the PICOS (Population, Intervention, Comparison, Outcome, Setting/design) strategy were used. Seven independent reviewers were involved in data extraction and resolution of disagreements. Certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. From 5187 records identified, 6 publications containing data referring to 5 randomized clinical trials (n = 436) were included in the final analyses. The nuts evaluated were almonds, pecans, Brazil nuts, and mixed nuts, with portions that varied between 5 g and 85 g (median: 30 g/day). The intervention period varied between 6 and 12 weeks. The nuts had no effect on fasting glucose and anthropometric indices, although the certainty of the evidence for most of these outcomes was low or very low. They also had no effect on systolic (mean difference [MD]: -1.16 mmHg [95% CI, -5.68 to 3.35], I2 = 0%-moderate certainty of evidence) or diastolic (MD: 0.10 mmHg [95% CI, -2.30 to 2.51], I2 = 0%-high certainty of evidence) blood pressure. It was not possible to aggregate data on adverse events. Nut supplementation had no effect on blood pressure, fasting glucose, or anthropometric profile in the context of atherosclerotic cardiovascular disease. PROSPERO registration no. CRD42020163456.