Cochrane Handbook For Systematic Reviews Research Articles

The potential role of vitamin E in patients with glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis.

As an antioxidant, vitamin E (VitE) may benefit the erythrocytes by protecting glutathione from oxidation by free radicals and peroxide-generating processes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines when reporting this systematic review. We searched 6 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) until May 8, 2022. We included all relevant studies. According to the study design, the Cochrane assessment tool (Risk of Bias 2), Risk Of Bias In Non-randomized Studies - of Interventions checklists, and National Institutes of Health tools were used to assess the risk of bias.Continuous data were pooled as a mean difference (MD) with a relative 95% confidence interval. The protocol was registered on PROSPERO (CRD42022333848). Six studies were included in the meta-analysis with a total of 181 patients. Compared with the control group, VitE significantly improved the hemoglobin level for chronic hemolysis (MD = 2.72 g/dL, P < .0001) and for acute hemolysis (MD = 1.18 g/dL, P < .0001). It also decreased the reticulocyte level for chronic hemolysis (MD = -1.39 P < .0001) and for acute hemolysis (MD = -1.42%, P < .0001). For before and after studies, the use of VitE significantly improved the level of packed cell volume (MD = 0.56%, P < .00001), red blood cell half-life (MD = 2.19 days, P < .0001), and decreased the reticulocytes level (MD = -1.41%, P < .00001). Among patients with glucose-6-phosphate dehydrogenase deficiency, VitE might provide benefits such as increasing the hemoglobin, packed cell volume levels, red blood cell half-life, and decreasing the reticulocyte level, so reducing hemolysis. Further high-quality, well-designed randomized controlled trials are recommended.

Asynchronous digital health interventions for reviewing asthma: A mixed-methods systematic review protocol.

People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care. We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma. Systematic review registration: PROSPERO registration number: CRD42022344224.

Virtual healthcare solutions for cardiac rehabilitation: a literature review.

Graphical AbstractAdherence to cardiac rehabilitation following a primary event has been demonstrated to improve quality of life, increase functional capacity, and decrease hospitalizations and mortality. Mobile technologies offer an opportunity to improve both the quality and utilization of cardiac rehabilitation, and recent clinical studies investigated this technology. This literature review summarizes the current use of mobile health, wearable activity monitors (WAMs), and other multi-component technologies deployed to support home-based virtual cardiac rehabilitation. The methodology was adapted from the Cochrane Handbook for Systematic Reviews of Interventions. We identified 2094 records, of which 113 were eligible for qualitative analysis. Different virtual cardiac rehabilitation solutions were implemented in the studies: (i) multi-component interventions in 48 studies (42.5%), (ii) WAMs in 27 studies (23.9%), (iii) web-based communications solutions, and (iv) mobile apps, both in 19 studies (16.4%). Functional capacity was the most frequently reported primary outcome (k = 37, 32.7%), followed by user adherence/compliance (k = 35, 31.0%), physical activity (k = 27, 23.9%), and quality of life (k = 14, 12.4%). Studies provided a mixed assessment of the efficacy of virtual cardiac rehabilitation in attaining either significant improvements over baseline or significant improvements in outcomes compared with conventional rehabilitation. Efficacy outcomes with virtual cardiac rehabilitation sometimes improve on the centre-based outcomes; however, superior clinical efficacy may not necessarily be the only outcome of interest. The promise of virtual cardiac rehabilitation includes the potential for increased user adherence and longer-term patient engagement. If these outcomes can be improved, that would be a significant justification for using this technology.

Indocyanine green-mediated antimicrobial photodynamic therapy as an adjunct to non-surgical periodontal treatment: a systematic review and meta-analysis.

Indocyanine green-mediated antimicrobial photodynamic therapy as an adjunct to non-surgical periodontal treatment: a systematic review and meta-analysis.

Non-invasive brain stimulation for limb motor function and daily living activity improvement in acute stroke: A meta-analysis

ObjectiveTo evaluate the effect of non-invasive brain stimulation (NIBS) in improving limb motor dysfunction and daily living activity during at the phase of acute stroke. Materials and MethodsRandomized controlled trials about the effect of NIBS on hemiparesis in acute stroke were retrieved from databases of China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, CBM, PubMed, Embase, Cochrane Library, and Web of Science from inception until January 3rd 2022. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using Review Manager 5.3 and STATA 14. The effect size was evaluated by using the weighed mean difference (WMD) and a 95% confidence interval (CI). The stability and sensitivity of the results and sources of heterogeneity were also analyzed. Results12 studies involving 639 patients were included. Our meta-analysis showed that NIBS could improve the Fugl-Meyer Assessment (weighed mean difference = 3.96, 95% confidence interval = 3.45 to 4.48) and Barthel Index (weighed mean difference = 12.29, 95% confidence interval = 4.93 to 19.66), while reducing the National Institutes of Health Stroke Scale (weighed mean difference = −2.37, 95% confidence interval = −3.43 to −1.31). ConclusionNIBS is effective in improving paretic limb motor function and activities of daily living in patients during at the phase of acute stroke.

Effect of platelet-rich fibrin on periapical healing and resolution of clinical symptoms in patients following periapical surgery: A systematic review and meta-analysis.

Adjuvant use of platelet-rich fibrin (PRF) in many areas of dentistry is well documented. However, its role in periapical surgery remains contested which requires further clarification by a higher level of evidence. The objective of this systematic review was to evaluate the effect of PRF on periapical surgery using meta-analysis. A comprehensive literature search was conducted in PUBMED, Cochrane Central Register of Controlled Trials, SCIENCE DIRECT, and GOOGLE SCHOLAR for randomized controlled trials (RCT) published until May 2021. Meta-analysis was performed for comparisons of baseline (pretreatment) versus posttreatment values for different measurement parameters (postoperative pain, peri apical healing both qualitatively and quantitatively). The risk of bias in all the included trials was assessed after the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Among the 356 eligible articles found in the initial search, 10 RCTs from 2011 through 2021 were included. Qualitative analysis of all the included studies showed that PRF may play a positive role in bone healing, reduction in periapical lesions, and enhancing quality of life using different imaging modalities. The results of the meta-analysis indicated a significant reduction in postoperative pain when PRF was used (standard mean difference [SMD] = 0.515; 95% confidence interval [CI] = 0.061- 0.969;P = 0.026; I 2 = 0%). However, there was no statistically significant association observed while evaluating peri apical bone healing both qualitatively (odds ratio [OR] = 1.427; 95% CI = 0.309-6.584; P = 0.648) and quantitatively measured by Cone beam computed tomography (SMD = -0.264; 95% CI = -0.974-0.447;P = 0.454) between PRF and control group. Considering the notable benefits demonstrated by use of PRF, it may be considered as a valuable adjunct in periapical surgery. However, more high-quality trials are necessary to assess the exact role of PRF.

Intervention Effect of Aerobic Exercise on Physical Fitness, Emotional State and Mental Health of Drug Addicts: A Systematic Review and Meta-Analysis.

This study aims to discuss evidence for the efficacy of aerobic exercise in reducing drug addiction and improving the physical and mental health of drug addicts. We systematically searched several online databases as of the end of September 2022, including PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, Science Direct, CNKI, VIP, CBM, and Wanfang. All articles were identified, screened and included according to the inclusion or exclusion criteria. The Cochrane Handbook for Systematic Reviews of Interventions was used as a criterion for assessing the methodological quality of included studies. Random and fixed effects models were used for the analysis of standard mean differences (SMD) or mean differences (MD) with their 95% confidence intervals (CI). A total of 27 studies involving 2022 drug addicts were finally included in the analysis. The results of the meta-analysis showed that aerobic exercise could improve the physical fitness [body fat percentage: MD = -0.74, 95%CI (-1.40, -0.08), vital capacity: MD = 213.79, 95%CI (46.28, 381.29), muscle force: MD = 1.21, 95%CI (0.34, 2.08), flexibility: MD = 4.61, 95%CI (2.98, 6.25), balance: MD = 9.95, 95%CI (6.29, 13.62)], regulate the systolic blood pressure: MD = -4.38, 95%CI (-7.08, -1.68), diastolic blood pressure: MD = -2.66, 95% CI (-3.82, -1.51), beats per minute: MD =-1.92, 95%CI (-3.19, -0.65); emotional state [anxiety: MD = -4.56, 95% CI (-5.67, -3.45), depression: MD = -3.28, 95%CI (-5.16, -1.39), drug craving: SMD= -1.68,95% CI(-2.56, -0.80)], and promote the mental health [anxiety: MD = -0.22, 95%CI (-0.33, -0.11), obsessive-compulsive: MD = -0.26, 95%CI (-0.50, -0.03), somatization: MD = -0.21, 95%CI (-0.27, -0.14), depression: MD = -0.21, 95%CI (-0.28, -0.15), psychoticcism: MD = -0.12, 95%CI (-0.18, -0.06), phobic anxiety: MD = -0.11, 95%CI (-0.16, -0.07), paranoid ideation: MD = -0.09, 95%CI (-0.15, -0.02), interpersonal sensitivity: MD = -0.16, 95%CI (-0.22, -0.10), hostility: MD = -0.12, 95%CI (-0.18, -0.05)], with statistically significant differences(p < 0.05)] of drug addicts. Thus, aerobic exercise could effectively improve the physical fitness, emotional state and mental health of drug addicts, and reduce their drug addiction. For clinical practitioners and researchers, this study could provide more reliable evidence for addiction treatment.

The Role of Percutaneous Tibial Nerve Stimulation (PTNS) in Low Anterior Resection Syndrome (LARS): A Systematic Review and Meta-analysis.

The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS). This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score-FIC, Obstructive Defecation Syndrome-ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool. Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: - 5.68, 95%CI: - 7.73, - 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS. The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS.

Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis.

Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6; SMD = -0.26, 95% confidence interval (CI): (-0.38, -0.14), I2 = 17%, P < 0.001]; systolic blood pressure [n = 5; SMD = -0.46, 95% CI: (-0.84, -0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. PROSPERO CRD42022300551.

Clinical efficacy of Danshen preparation in the treatment of vascular cognitive impairment: A systematic review and meta-analysis.

Danshen preparations are widely used in the treatment of ischaemic cerebrovascular disease. However, the clinical efficacy of such preparations remains unclear. Consequently, Danshen preparations are used to a lesser extent in vascular cognitive impairment (VCI). In this study, we aimed to systematically assess the clinical efficacy and safety of Danshen preparations in VCI. To this end, we examined and performed a meta-analysis (MA) of the evidence available from randomised controlled trials (RCTs) of Danshen preparations conducted in patients with VCI. We queried the following sources and collected all articles reporting on RCTs of Danshen preparations published prior to December 2021: PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Database (CQVIP), and China Biology Medicine (CBM) disc databases. The assessment of treatments that were included in references were performed by RevMan 5.2 software based on guidelines from Cochrane Handbook for Systematic Reviews of Interventions. We included a total of 12 RCTs that included data on clinical therapeutic effects. The evaluation criteria included the following: National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Assessment (MMSE), Montreal Cognitive Assessment (MOCA), Activities of Daily Living Scale (ADL), treatment effect index, and incidence of adverse reaction index. In the included studies, the observation groups included 656 cases and the control groups included 660 cases. The results of the MA were as follows: the mean difference (MD) value after combining the effect size for NIHSS was -2.91, with a 95% confidence interval (CI) of -4.22 to -1.59; the combined effect quantity hypothesis test revealed that Z = 4.33 (p < 0.00001), indicating that the score pertaining to the degree of neurological deficit (NIHSS) in the observation group after treatment was significantly lower than that in the control group. This result reveals that treatment with a Danshen preparation can reduce neurological deficit in VCI patients. The MD value after combining the effect size for mRS was -0.73, with a 95% CI of -0.85 to -0.61; the result of the combined effect quantity hypothesis test revealed that Z = 12.29 (p < 0.00001). These results indicate that the degree of disability was significantly reduced after treatment in the observation group. The MD value after combining the effect size for MMSE was 2.09, with a 95% CI of 0.33-3.84; the result of the combined effect quantity hypothesis test showed that Z = 2.33 (p = 0.02). These results indicate that the cognitive function score (MMSE) of the observation group after treatment was significantly higher than that of the control group and suggests that the cognitive function of VCI patients was improved after treatment with Danshen preparations. The MD value after combining the effect size for ADL was 8.79, with a 95% CI of 3.52 to 14.06; the result of the combined effect quantity hypothesis test indicated that Z = 3.27 (p = 0.001). These results showed that the life ability (ADL scale) scores of patients in the observation group after treatment were significantly higher than those in the control group, and reveals that after treatment with Danshen preparations, patients exhibited significant improvement in life ability. The MD value after combining the effect size for high-sensitivity C-reactive protein (hs-CRP) was -3.21, with a 95% CI of -4.21 to -2.22; the result of the combined effect quantity hypothesis test showed that Z = 6.31 (p < 0.00001), indicating that the hs-CRP level in the observation group was significantly decreased after treatment. The MD value after combining the effect size for interleukin (IL)-6 was -2.95, with a 95% CI of -3.86 to -2.04; the result of the combined effect quantity hypothesis test showed that Z = 6.36 (p < 0.00001). These results showed that the IL-6 level in the observation group was significantly decreased after treatment. The existing clinical evidence shows that Danshen preparations exert significant therapeutic effects on VCI patients and can ameliorate inflammatory conditions in these patients. In addition, Danshen preparations are relatively safe.

Nurse-led telehealth intervention effectiveness on reducing hypertension: a systematic review

BackgroundHypertension is a public health concern for many countries. The World Health Organization has established a global objective to reduce the prevalence of non-communicable diseases, including hypertension, which is associated with cardiovascular disease. Remote nursing interventions can potentially lessen the burden on the healthcare system and promote a healthier population. This systematic review aims to synthesize available evidence on the effectiveness of nursing-led telehealth interventions in reducing blood pressure in hypertensive patients.MethodsA systematic review was conducted. The search was performed from May to June 2021, in the databases: PubMed, Scopus, Cochrane Library, Web of Science, CINAHL, and ProQuest within 2010–2021 in English, Spanish and Portuguese. Randomized controlled trials and Quasi-experimental studies were considered. This systematic review followed the criteria of the Cochrane Handbook for Systematic Reviews of Interventions, with the support of the PRISMA guidelines and registered in PROSPERO. For critical analysis, the tools of the Joanna Briggs Institute were used.ResultsOf the 942 articles found, six controlled clinical trials and one quasi-experimental study were selected. Different nurse-led interventions (telehealth devices, remote video consultation, calls and email alerts) have demonstrated a significant decrease in blood pressure (especially systolic blood pressure) in the intervention groups. Nurse-led interventions also effect hypertension awareness, self-efficacy, and self-control. Positive effects on lowering cholesterol, consumption of fruits and vegetables, physical activity and adherence to medication were also described.ConclusionNurse-led interventions delivered remotely have a positive effect in lowering the blood pressure of patients with hypertension. Further research is required to support strategies that will deliver the best continuous, quality, and cost-effective nursing care.

Effects of different doses of glucocorticoids on postoperative atrial fibrillation: a meta-analysis

BackgroundPostoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery, and its occurrence is closely related to inflammation. This paper intends to apply meta-analysis to investigate the effect of glucocorticoids on POAF.MethodsPubMed, Embase, Web of Science, and Cochrane Library were searched using the internationally recognized systematic evaluation and retrieval strategy. Two review authors independently selected relevant studies and extracted data based on the Cochrane handbook for systematic reviews of interventions approach. Stata 17 was used for data analysis. In the subgroup analysis, we grouped the participant data according to differences in glucocorticoids dose and type of surgery. At the same time, we also conducted a meta-analysis on the possible infection and gastrointestinal injury caused by glucocorticoids use.Results27 studies and 14,442 patients were finally included. Results from the random-effects model indicated that the incidence of POAF was lower in glucocorticoid group (RR 0.80, 95% CI 0.71–0.92, P = 0.001). According to the subgroup analysis result, low doses of glucocorticoids reduced the incidence of POAF (RR 0.81, 95% CI 0.71–0.92, P = 0.001). The effect of high doses glucocorticoids on the POAF was not statistically significant (RR 0.81, 95% CI 0.56–1.19, P = 0.286). In the coronary artery bypass grafting (CABG) subgroup, the glucocorticoids reduced the incidence of POAF (RR 0.71, 95% CI 0.58–0.87, P = 0.001). In the CABG OR Valvular Surgery group, the effect of glucocorticoids on POAF was not statistically significant (RR 0.88, 95% CI 0.75–1.03, P = 0.108). 15 studies documented postoperative complications of infection, two studies were excluded from the system because the end point event was 0, and meta-analysis showed no increased risk of infection from glucocorticoid use (RR 0.85, 95% CI 0.68–1.06, P = 0.158). Eight studies documented the effects of glucocorticoids on gastrointestinal diseases, and meta-analysis showed no differences between the two groups (RR 1.12, 95% CI 0.83–1.50, P = 0.450).ConclusionThe use of glucocorticoids can reduce the incidence of POAF. The subgroup analysis result showed that low-dose glucocorticoids were more effective than high-dose glucocorticoids in inhibiting POAF. The use of glucocorticoids in CABG alone can better inhibit the occurrence of POAF. The effects of glucocorticoids on infection and gastrointestinal injury were not statistically significant.Review registration: PROSPERO, CRD42022304521.

Hypothermia combined with neuroprotective adjuvants shortens the duration of hospitalization in infants with hypoxic ischemic encephalopathy: Meta-analysis.

Objective: Therapeutic hypothermia (TH) is the current standard of care for neonatal hypoxic-ischemic encephalopathy (HIE), yet morbidity and mortality remain significant. Adjuvant neuroprotective agents have been suggested to augment hypothermic-mediated neuroprotection. This analysis aims to identify the classes of drugs that have been used in combination with hypothermia in the treatment of neonatal HIE and determine whether combination therapy is more efficacious than TH alone. Methods: A systematic search of PubMed, Embase and Medline from conception through December 2022 was conducted. Randomized- and quasi-randomized controlled trials, observational studies and retrospective studies evaluating HIE infants treated with combination therapy versus TH alone were selected. Primary reviewers extracted information on mortality, neurodevelopmental impairment and length of hospitalization for meta-analyses. Effect sizes were pooled using a random-effects model and measured as odds ratio (OR) or mean difference (MD) where applicable, and 95% confidence intervals (CI) were calculated. Risk of bias was assessed using the tool from the Cochrane Handbook for Systematic Reviews of Interventions. Results: The search strategy collected 519 studies, 16 of which met analysis inclusion criteria. HIE infants totaled 1,288 infants from included studies, 646 infants received some form of combination therapy, while 642 received TH alone. GABA receptor agonists, NMDA receptor antagonists, neurogenic and angiogenic agents, stem cells, glucocorticoids and antioxidants were identified as candidate adjuvants to TH that have been evaluated in clinical settings compared to TH alone. Length of hospitalization was significantly reduced in infants treated with combination therapy (MD -4.81, 95% CI [-8.42. to -1.19], p = .009) compared to those treated with TH alone. Risk of mortality and neurodevelopmental impairment did not differ between combination therapy and TH alone groups. Conclusion: Compared to the current standard of care, administration of neuroprotective adjuvants with TH reduced the duration of hospitalization but did not impact the risk of mortality or neurodevelopmental impairment in HIE infants. Meta-analysis was limited by a moderate risk of bias among included studies and small sample sizes. This analysis highlights the need for preclinical trials to conduct drug development studies in hypothermic settings to identify relevant molecular targets that may offer additive or synergistic neuroprotection to TH, and the need for larger powered clinical trials to determine the dose and timing of administration at which maximal clinical benefits are observed for adjuvant neuroprotectants.

Anti-Inflammatory Potency of Mangosteen (Garcinia mangostana L.): A Systematic Review

BACKGROUND: Mangosteen (Garcinia mangostana L.) is a tropical fruit, widely used in Southeast Asia as a health food and supplement, because of its beneficial effects on the body. In many studies, mangosteen is described to have many health effects such as antimicrobial, antioxidant, anti-proliferative, anti-carcinogenic, and antiinflammatory. The anti-inflammatory effect is important because many diseases have pathophysiology associated with the inflammatory process. AIM: This study aimed to assess and conclude the scientific database systematically to investigate the anti-inflammatory potency of mangosteen (Garcinia mangostana L.). METHODS: Cochrane handbook for systematic reviews and the guideline of preferred reporting items for systematic review and meta-analysis (PRISMA) were used as guidelines in this review. RESULTS: The authors searched the study in electronic databases which met inclusion and exclusion criteria. The authors independently evaluated 412 studies in database finding, 24 studies fulfilled the criteria for this review. CONCLUSION: Mangosteen (Garcinia mangostana L.) has anti-inflammatory potency (especially the component of xanthone and flavonoid) in various inflammatory conditions and diseases; such as obesity, skin disease, psychiatric disease, tooth disease, asthma, atherosclerosis, acetaminophen-induced hepatotoxicity, peritonitis, colitis, prostatic hyperplastic, arthritis, and soft-tissue inflammation.

Olive oil and body fat: a systematic review with meta-analysis.

Diet composition has a great impact on body composition. Several studies have suggested a beneficial effect of adding olive oil to a calorie-restricted diet as a weight loss strategy. However, there is no clear direction regarding the effect of olive oil on body fat distribution. This systematic review with meta-analysis aims to investigate the effect of olive oil consumption (for cooking or as a supplement) on body fat distribution in adults. The present study was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021234652). All randomized clinical trials of parallel or crossover design found in PubMed (via MEDLINE), EMBASE, Web of Science and Scopus databases that compared the effects of olive oil with other oils on body fat distribution in adults were included. 52 articles were included. The results indicate that the consumption of olive oil does not seem to alter the distribution of body fat, despite a small indication that supplementation in capsules can increase adipose mass (Mean Difference = 0.28 kg, 95% CI [-0.27, 0.83]; between-groups difference p = 0.59) and waist circumference (mean difference = 1.74 kg, 95% CI [0.86, 1.62]; between-groups difference p < 0.01) and decrease its auxiliary culinary use (mean difference = -0.32 kg, 95% CI [-0.90, 0.26]). Lean mass responds negatively to OO the higher the dose (slope = -0.61, 95% CI [-1.01, -0.21], p = 0.003) and time offered (slope = -0.8822, 95% CI [-1.44, -0.33], p = 0.002). In conclusion, this systematic review showed that OO ingestion in different delivery vehicles, dosages, and durations can interfere body composition. It is important to emphasize that some other aspects of the population and the intervention, that were not possible to be explored in the analysis, could confound the real effects of OO on body composition.

Vedolizumab subcutaneous formulation maintenance therapy for patients with IBD: a systematic review and meta-analysis

The application of vedolizumab (VDZ) subcutaneous (SC) formulation has brought more convenience and hope to patients with moderate-to-severe inflammatory bowel diseases (IBDs) in the coronavirus disease 2019 context. This study aimed to systematically evaluate all previous studies that used VDZ SC formulation for maintenance therapy in patients with IBD. Systematic review and meta-analysis. The search was conducted using the subject and free terms related to 'Vedolizumab', 'Subcutaneous', and 'IBD', in Embase, PubMed, Web of Science, Cochrane, and at ClinicalTrials.gov databases between 2008 and 2022. The methodological quality of randomized controlled trials (RCTs) and cohort studies was assessed using the Cochrane Handbook of Systematic Reviews and the Newcastle-Ottawa Scale, respectively. The endpoints included efficacy, safety, and immunogenicity. A total of 60 studies and 2 completed clinical registry trials were retrieved, of which 3 RCTs with high methodological quality, and 3 cohort studies with large heterogeneity were included in the meta-analysis. In the RCT study design, patients with ulcerative colitis (UC) under different conditions after treated with VDZ SC were significantly distinct than those for placebo (PBO) in clinical remission, endoscopic remission, and biochemical remission. In Crohn's disease (CD), the aforementioned parameters were slightly higher than those for PBO, but there was not statistically significant in endoscopic remission and the efficacy of anti-tumor necrosis factor-naive patients. The clinical remission, endoscopic remission, and biochemical remission in patients with UC after VDZ SC treatment were similar to those after intravenous (IV) treatment. The risk ratios in patients experiencing adverse events (AEs) and serious AEs after VDZ SC and PBO treatments were 86% and 89% in UC, and 96% and 80% in CD, respectively. Compared with IV, safety was not statistically different. The risk of developing anti-VDZ antibody after VDZ SC treatment was only 20% of that after PBO in patients with UC, but it was 9.38 times in CD. VDZ SC treatment maintained the clinical efficacy of IV induction in patients with IBD without increasing the safety risk, and the efficacy was more pronounced in patients with UC. Immunogenicity might be a potential factor for the decrease in efficacy rate in patients with IBD. INPLASY 2022120115.

A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach.

Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.

A systematic review of endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus following proximal humerus metastasis

Abstract Background The choice between cement spacer and endprosthesis in the treatment of metastatic lesions to the proximal humerus is increasingly controversial. However, it may be easier to categorize the patients, and their socioeconomic and perioperative parameters into two groups. Aim This work aims to review the available literature on the topic of endoprosthetic replacement versus cement spacer in the reconstruction of the proximal humerus following metastatic lesions to the proximal humerus regarding the surgical technique, its indications, its advantages, and limitations. Patients and methods We followed the preferred reporting items for systematic review and Meta-analysis (PRISMA) statement guidelines during this systematic review and performed all steps according to the Cochrane Handbook of Systematic Reviews of Intervention. Results Four studies were included in this systematic review, and a total of 100 patients were included (22 of which had cement spacer and 78 had endprosthesis). Several parameters were compared in the reviewed studies including the MSTS score of the patients; the primary tumor; postoperative complications; the patients’ age; follow-up periods; and the presenting symptoms of the patients. Conclusion This systematic review suggests that the cement spacer technique is not inferior to endoprosthetic replacement of the proximal humerus in cases of metastases. Therefore, we suggest that determining whether to use an end prosthesis or a cement spacer depends on categorizing the patients into two groups. Endoprosthetic replacement will be an appropriate choice for patients with preserved deltoid and axillary nerve function following resection, solitary and nonaggressive metastatic lesion, and long-life expectancy with minimal co-morbidities. We believe that cement spacer is a more appropriate choice in patients with nonfunctioning deltoid or axillary nerve following resection; multiple and aggressive metastatic lesions; short life expectancy with many co-morbidities, and poor socioeconomic status.

Effect of Local Antibiotic Prophylaxis on Postoperative Deep Infection in Fracture Surgery: A Systematic Review and Meta-Analysis.

Despite the use of systemic antibiotic prophylaxis, postoperative infection after fracture surgery remains an issue. The purpose of this systematic review and meta-analysis was to evaluate the effect of locally applied antibiotics on deep infection in fracture surgery in both the open and closed fractures. A comprehensive search of MEDLINE, Embase, and PubMed was performed from the date of inception to April 15, 2021, and included studies in all languages. Cohort studies were eligible if they investigated the effect on the infection rate of local antibiotic prophylaxis on deep infection after fracture surgery. This study was conducted according to the Cochrane Handbook for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials and the Methodological Index for Nonrandomized Studies tool where applicable. An inverse variance random-effects model was the primary analysis model because of the anticipated diversity in the evaluated populations. Univariate models were used when a single outcome was of interest. The risk of deep infection was significantly reduced when local antibiotics were applied compared with the control group receiving systemic prophylaxis only. This beneficial effect was observed in open fractures but failed to reach statistical significance in closed fractures. This meta-analysis suggests that there may be a significant risk reduction in deep infection rate after fracture surgery when local antibiotics are added to standard systemic prophylaxis, particularly in open fractures. Further high-powered Level I studies are needed to support these findings. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Smoking cessation for peripheral arterial disease: systematic review protocol.

peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. to assess the impact of smoking cessation interventions versus active comparator, placebo or no intervention, on peripheral arterial disease outcomes. we will use the Cochrane Handbook for Systematic Reviews of Interventions to guide whole this review process. We will consider parallel or cluster-randomised controlled trials (RCTs), quasi-RCTs, and cohort studies. We will search CENTRAL, MEDLINE, Embase, PsycINFO, LILACS and IBECS. We will also conduct a search of ClinicalTrials.gov and the ICTRP for ongoing or unpublished trials. Each research step will involve at least two independent reviewers. We will create a table, using GRADE pro GDT software, reporting the pooled effect estimates for the following outcomes: all-cause mortality, lower limb amputation, adverse events, walking distance, clinical severity, vessel or graft secondary patency, and QoL. we will assess these outcomes according to the five GRADE considerations to assess the certainty of the body of evidence for these outcomes, and to draw conclusions about the certainty of the evidence within the review.