Comparative Meta-analysis Research Articles

Unilateral Versus Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis.

Previous studies have shown a higher complication rate in bilateral (BL) compared to unilateral (UL) deep inferior epigastric perforator (DIEP) flap breast reconstructions. This systematic review and meta-analysis aimed to offer an update by including recent studies to thoroughly assess the complication rates in UL versus BL DIEP flap reconstructions and provide clear guidance for clinicians and their patients. A systematic review of the literature and comparative meta-analysis were performed to assess the differences in complication rates between UL and BL procedures. Only comparative studies that reported on postoperative complications after UL and BL DIEP flap breast reconstructions were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Five studies representing 5120 patients who underwent either UL or BL DIEP flap breast reconstructions were included. BL DIEP flap reconstructions were associated with a higher risk of total flap loss, with an OR of 1.48 (95% CI, 1.02-2.14) and a P value of 0.04. Conversely, the risk of reexploration surgery was reduced, with an OR of 0.68 (95% CI, 0.55- 0.84) and a P value of 0.0002. BL DIEP flap breast reconstruction carries a higher risk of complete flap loss compared with UL reconstructions, with a moderate risk increase. Despite this increased risk, the significant benefits of BL reconstruction make it a viable and recommended option for women requiring this type of surgery.

Increased Risk of Dentoalveolar Trauma in Patients with Autism Spectrum Disorder: A Systematic Review with Meta-Analysis

The prevalence of traumatic dental injuries (TDI) in patients with autism spectrum disorders (ASD) remains unclear. Given these discrepancies, an updated review of the evidence on the risk of TDI in patients with ASD is essential. This systematic review and meta-analysis aimed to evaluate the prevalence of TDI in patients with ASD and compare it to that in neurotypical patients. This study protocol was registered on PROSPERO (CRD42024580127) and followed the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. A comprehensive search of four databases—MEDLINE/PubMed, Web of Science, Scopus, and Embase—was conducted for articles published up to August 2024. Moreover, the gray literature (ProQuest) and reference lists were screened. The inclusion criteria required participants with ASD to assess TDI across deciduous, mixed, and permanent dentition regardless of age. No restrictions were applied on TDI type, language, or publication date. Additionally, case reports, reviews, letters, and studies addressing other oral disorders without specific TDI data were excluded. A single-arm meta-analysis evaluated the cumulative proportion and 95% confidence interval (CI) of TDI in patients with ASD. Moreover, a comparative meta-analysis was performed to assess the risk of TDI between ASD and neurotypical patients, calculating the odds ratio (OR) with a 95% CI, and a p < 0.05 was deemed significant, using the R program. Quality assessment was performed using the National Heart, Lung, and Blood Institute tool, and the certainty of evidence was evaluated using GRADE. A total of 22 studies were included to determine the overall prevalence of TDI, of which 16 studies directly compared patients with ASD to neurotypical individuals. In total, 3817 participants were evaluated, including 2162 individuals with ASD and 1655 neurotypical patients. A single-arm meta-analysis estimated a TDI prevalence of 22% (Confidence Interval [CI]: 17–27%) among patients with ASD. A significant difference in the risk was observed between ASD and neurotypical patients (p = 0.003; Odds Ratio [OR]: 1.67; CI: 1.19–2.26). However, substantial heterogeneity was observed in this analysis. Although the majority of studies were rated as high quality, the certainty of the evidence was considered very low. Despite the limitations of this study, the findings suggest that patients with ASD are at a higher risk of developing TDI than the risk observed in neurotypical patients. Therefore, preventive educational initiatives are recommended to reduce the risk of TDI in this population.

A comparative meta-analysis of structural magnetic resonance imaging studies and gene expression profiles revealing the similarities and differences between late life depression and mild cognitive impairment.

Late-life depression (LLD) predisposes individuals to cognitive decline, often leading to misdiagnoses as mild cognitive impairment (MCI). Voxel-based morphometry (VBM) can distinguish the profiles of these disorders according to gray matter (GM) volumes. We integrated findings from previous VBM studies for comparative analysis and extended the research into molecular profiles to facilitate inspection and intervention. We comprehensively searched PubMed and Web of Science for VBM studies that compared LLD and MCI cases with matched healthy controls (HCs) from inception to 31st December 2023. We included 13 studies on LLD (414 LLDs, 350 HCs) and 50 on MCI (1878 MCIs, 2046 HCs). Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) was used for voxel-based meta-analysis to assess GM atrophy, spatially correlated with neuropsychological profiles. We then used multimodal and linear-model analysis to assess the similarities and differences in GM volumetric changing patterns. Partial least squares (PLS) regression and gene enrichment were employed for transcription-neuroimaging associations. GM volumes in the left hippocampus and right parahippocampal gyrus are more affected in MCI, along with memory impairment. MCI was spatially correlated with a more extensive reduction in the levels of neurotransmitters and a severe downregulation of genes related to cellular potassium ion transport and metal ion transmembrane transporter activity. Compared to LLD, MCI exhibited more GM atrophy in the hippocampus and parahippocampal gyrus and lower gene expression of ion transmembrane transport. Our findings provided imaging-transcriptomic-genetic integrative profiles for differential diagnosis and precise intervention between LLD and MCI.

Valacyclovir versus valganciclovir for cytomegalovirus prophylaxis in kidney transplant recipients: a systematic review and comparative meta-analysis.

Valganciclovir (ValG) is the most widely used drug for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients (KTRs). However, it is associated with dose-limiting side effects and considerable costs. Some centers have identified valacyclovir (ValA) as an economically attractive alternative with a lower risk of bone marrow suppression. The comparative effectiveness of these two drugs is not well-established. This study aims to compare the efficacy and safety of ValA and ValG for CMV prophylaxis in KTRs. Searches were conducted of the Medline, Cochrane, Web of Science, Embase, and Ovid databases. Endpoints encompassed the incidence of CMV disease, CMV viremia, acute rejection, leukopenia/neutropenia, and other infections, including BK polyomavirus and non-CMV herpesviruses (HVs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Six studies, comprising 888 patients (438 receiving ValA), were included. The groups were comparable in CMV viremia incidence (RR, 0.70; 95% CI, 0.31-1.57; P=0.4) and the development of CMV disease (RR, 0.74; 95% CI, 0.09-5.97; P=0.8). No significant differences in acute rejection rates were observed (RR, 0.97; 95% CI, 0.50-1.91; P=0.8). However, the rate of leukopenia/neutropenia was significantly lower in the ValA group (RR, 0.57; 95% CI, 0.42-0.77; P<0.01). No significant differences were noted for BK viremia (RR, 0.67; 95% CI, 0.24-1.87; P=0.4) or other HV infections (RR, 1.43; 95% CI, 0.61-3.38; P=0.4). The drugs demonstrate comparable efficacy in preventing CMV infection following kidney transplantation. However, ValA may have a lower impact on bone marrow suppression.

Comparative Systematic Review and Meta-Analysis Between Robotic and Laparoscopic Abdominoperineal Resection for Rectal Cancer: Oncological and Short-Term Outcomes.

Minimally invasive surgery, especially robotic surgery, has become increasingly popular in colorectal surgery over the last decade. Robotic-assisted surgery has shown better outcomes than conventional laparoscopic surgery because of superior ergonomics, high-resolution three-dimensional cameras, and articulating instruments; however, issues like the long operative time and cost-effectiveness remain unresolved. This study compares the robotic and laparoscopic approach of abdominoperineal resection (APR) for low rectal cancer to evaluate the superiority of robotic surgery in short-term and oncological outcomes. This meta-analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and principles. We conducted a systematic search in the PubMed, Cochrane, Google Scholar, and ResearchGate databases, and seven studies were included after the standardized quality check. Inclusion criteria involved any patient at the age of 18 or above with low rectal cancer who underwent APR with the exclusion of studies that are not in English, patients who underwent open surgery, and patients with recurrent cancer. A total number of 10,331 participants from seven eligible studies were involved in this review and meta-analysis with 1499 in the robotic group and 8,895 in the laparoscopic group. The oncological outcome showed that the positive resection margin is significantly higher in the laparoscopic group with a mean difference (MD) of 0.35, 95% CI (0.14, 0.89), and P = 0.03. The difference in the number of harvested lymph nodes between the robotic and laparoscopic APR is not statistically significant with an OR of 0, 95% CI (-0.19, 0.19), and P = 0.98. The operative time was found to be higher in the robotic group with an MD of 11.25, 95% CI (9.25, 13.04), and P = 0.0001. A higher conversion rate was reported in the laparoscopic group with OR 0.38, 95% CI (0.28, 0.51), and P = 0.00001. The length of the hospital stay was less in the robotic group with an MD of 2, 95% CI (-2.08, -1.92), and P = 0.00001. A lower rate of postoperative ileus was found in the robotic group with an odd ratio of 0.74, 95% CI (0.61,0.89), and P = 0.001, which is statistically significant. The mortality rate and thromboembolic complication also showed a significantly higher rate in the laparoscopic group with an OR of 0.15, 95% CI (0.03, 0.84), and P = 0.03 and an OR of 0.14, 95% CI (0.03, 0.69), and P = 0.02, respectively. There is no statistically significant difference between the robotic and laparoscopic groups in the surgical site infection, urinary dysfunction, cardiac, and pulmonary complications. In conclusion, our study findings indicated that robotic APR has a better short-term outcome and negative circumferential resection margins compared to laparoscopic APR. However, more research and prospective randomized controlled trials are needed to determine the efficiency, cost effectiveness, recurrence, and survival rate in robotic APR.

Exploring mindfulness interventions across cultures: a comparative meta-analysis of mindfulness interventions for athletes in Western and Eastern contexts.

Applying mindfulness training across cultures can be challenging because its internal motivation depends on values, but there are differences between Western and Eastern contexts. This meta-analysis examines the comparative impacts of the Western Mindfulness-Acceptance-Commitment (MAC) approach and the culturally-adapted Chinese Mindfulness-Acceptance-Insight-Commitment (MAIC) mindfulness training for athletes, to explore the importance of cultural adaptation in cross-cultural psychology to psychological skills training. This meta-analysis was registered with Prospero (ID: CRD42023474474) and adhered to the PRISMA principles. The PICO search methodology was employed to identify pertinent Chinese and English literature across six databases (Web of Science, PubMed, Scopus, CNKI, Wanfang, and VIP) from 2003 to 2023. The evidence originated from randomized controlled trials. Effect sizes were evaluated across three primary domains: athletic performance, mindfulness, and psychological flexibility, and heterogeneity and publication bias. Both MAC and MAIC demonstrated positive effects across all outcome categories in 18 studies. MAIC exhibited substantially larger effect sizes compared to MAC. In mindfulness (MAIC: g = 1.273, p < 0.001; MAC: g = 0.521, p = 0.001), sports performance (MAIC: g = 0.945, p = 0.015; MAC: g = 0.550, p < 0.001), MAC did not provide evidence of improved psychological flexibility (g = 0.076, p = 0.747), while MAIC demonstrated significant benefits (g = 0.964, p < 0.001). While MAIC is based on MAC, it yields more significant outcomes. This may be the "Insight" component introduced by MAIC, which skillfully integrates Eastern context. The MAIC strategy not only becomes more appropriate for local athletes but also indirectly enhances their mindfulness, athletic performance, and psychological flexibility, resulting from cultural adaptation. The new idea not only solves the culture shock caused by the direct application of Western MAC approach on Chinese athletes, but also provides a new solution to the problem that there is insufficient evidence to support the effect of the MAC approach on "psychological flexibility." Investigating differential effects between MAC and MAIC contributes to understanding the significance of culturally adapting mindfulness training and transnational movement of practices. The findings will assist practitioners in selecting evidence-based protocols tailored to athlete needs and cultural contexts. Prospero (ID: CRD42023474474).

Effectiveness of gait analysis in management of osteoarthritis knee at primary care settings in Asia: a systematic review and meta-analysis protocol

Background: This systematic review will focus on the effectiveness of gait analysis on osteoarthritis knee management. The objectives of this systematic review and meta-analysis are to synthesize the clinical effectiveness and to compare the effectiveness of gait analysis in the osteoarthritis knee management in Asian population. Methods: This review will be conducted and reported according to PRISMA guidelines. To discover relevant papers, the search technique will use MeSH terms such as osteoarthritis knee, gait analysis, osteoarthritis knee management, primary healthcare, effectiveness, and Asia. Other synonymous words will be searched using the Boolean operator "and"/"or" on PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials assessing the efficacy of gait analysis in the therapy of osteoarthritis knee patients in primary care settings in Asia will be considered. A random effects meta-analysis will be carried out using the REVMAN software version 5.3.5. The STATA software version SE16 will be used for both cumulative and comparative meta-analysis. Conclusions: This review and meta-analysis will be among the first to give an extensive purview on the effectiveness of gait analysis in osteoarthritis knee management at primary care settings in Asian population. This study will also acknowledge the effects of different gait analysis strategies with an attempt to compare the same. Trial Registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42024540444).

Wheat genetic progress in biomass allocation and yield components: A global perspective

BackgroundWheat is an essential food source and is subjected to intense breeding efforts for increased grain yield, but stagnation in grain yield improvements has been reported in many regions. The identification of genetically linked factors impeding further progress in wheat grain yield improvement is therefore urgently required. MethodA comparative meta-analysis of data from 66 publicly available field experiments involving multiple wheat genotypes was performed to identify traits altered in breeding programs, their relationship with grain yield, and their past and current impact on grain yield increases. ResultsWheat grain yield can be increased by increasing either the aboveground biomass (ABM) or the harvest index (HI). However, there was no correlation between these traits since a reduction in plant height can occur with increases in the HI and overall grain yield, but with no reduction in the ABM. The combined data from 32 global datasets revealed a substantial increase in wheat grain yield from 1860 to 2017, accompanied by improvement in HI and yield components. When considering only the genotypes introduced from the 1960s to 2017, there was a linear increase observed in both grain yield and HI until the mid-1980s. However, genetic progress in HI and GY has slowed down since then. Before the mid-1980s, there was a decreasing trend observed in plant height which remained relatively static thereafter. While ABM did not exhibit significant increases during this period. After the mid-1980s, significant improvements have been observed in ABM; however, no obvious increase were observed in other yield components. ConclusionsSince the 1980s, there has been an increase in the aboveground biomass of wheat, while grain weigth and grains per m2 increases trending slowly, and both harvest index and grain yield have almost stagnated. Therefore, increasing grains per m2 and/or grain weight should be the major research direction to further improve the wheat harvest index and grain yield in the future. ImplicationsThe systematic study of changes in wheat traits in past breeding efforts for improved grain yields has provided useful indicators for the direction of wheat breeding in the future.

Efficacy of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Colorectal Surgery: A Meta-Analytical Comparison With Conventional Care in Terms of Outcomes and Complications.

The "Enhanced Recovery After Surgery" (ERAS) strategy, a patient-centered, evidence-based approach, aims to reduce surgical stress, maintain physiological function, and expedite recovery. Initially developed for elective surgeries, particularly colorectal procedures, ERAS protocols are now being explored for their potential benefits in the more challenging context of emergency surgeries. The current investigation aims to identify the most useful ERAS components in emergency surgery scenarios by comparing postoperative recovery times, possible health outcomes of patients, and complication rates. Through August 2023, extensive searches were conducted in the Cochrane Library, MEDLINE, EMBASE, and PubMed databases. Data were taken from nine RCTs, which were prospective and retrospective cohort studies and were used to derive important outcomes. The Cochrane Risk of Bias tool was employed to measure the caliber of research. Effect pooling estimates were estimated using random-effects models. For the investigations, STATA version 16.0 and Review Manager (RevMan) version 5.4 were used. Nine studies that addressed the range of ERAS components and outcomes were included. Compared to standard treatment, ERAS procedures generally showed faster postoperative recovery durations. Studies' success or adherence rates differed. Subgroup analyses were necessary due to significant heterogeneity in order to determine potential sources. For emergency colorectal procedures, ERAS methods shorten postoperative recovery periods when appropriately modified and put into practice. However, varying success rates throughout studies showed that, in order to maximize and standardize ERAS protocols for comprehensive advantages, significant thought and further study are required. The meta-analysis suggests that ERAS protocols offer substantial benefits in emergency colorectal surgeries, particularly in reducing postoperative recovery times and complication rates.

Ischemic stroke incidence in intermediate or high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement: a comparative systematic review and meta-analysis

Background and purposeThis comparative systematic review and meta-analysis investigated the incidence of ischemic stroke in intermediate-to-high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement.MethodsWe conducted a systematic review and meta-analysis following the PRISMA guidelines, searching PubMed, Google Scholar, Embase, Web of Science, and Cochrane CENTRAL databases from their inception to December 2023. The evaluated outcomes were primarily incidence of stroke and transient ischemic attack (TIA), along with other secondary safety end-points at 30 days and 1 year post-procedure. Odds ratios (ORs) with 95% confidence intervals (CIs) were utilized for each study, employing a random-effects model for data synthesis irrespective of heterogeneity. Statistical heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager.ResultsWe screened 8028 articles and included 8 studies consisting of 5 randomized controlled trials and 3 observational studies. The studies examining 30-day and 1-year stroke incidence found no significant difference between TAVR and SAVR patients (OR 0.83, 95% CI 0.59 to 1.17, p = 0.30, OR 0.92, 95% CI 0.64 to 1.33, p = 0.67, respectively). Both TAVR and SAVR also had a comparable risk of having a transient ischemic attack within 30 days (OR 0.93, 95% CI 0.24 to 3.63, p = 0.92, I2 52%) and 1 year (OR 1.15, 95% CI 0.72 to 1.82, p = 0.56, I2 0%) following the procedure. Regarding safety endpoints, TAVR had lower rates of all-cause mortality and acute kidney injury at 1 year post-procedure, but a higher incidence of major vascular complications at both 30 days and 1 year compared with SAVR.ConclusionThe results suggest that TAVR and SAVR have comparable outcomes for both TIA and stroke incidence at 30 days and 1 year post-procedure, but display varying safety profiles in intermediate-to-high surgical risk patients.

Artificial intelligence in commercial fracture detection products: a systematic review and meta-analysis of diagnostic test accuracy

Conventional radiography (CR) is primarily utilized for fracture diagnosis. Artificial intelligence (AI) for CR is a rapidly growing field aimed at enhancing efficiency and increasing diagnostic accuracy. However, the diagnostic performance of commercially available AI fracture detection solutions (CAAI-FDS) for CR in various anatomical regions, their synergy with human assessment, as well as the influence of industry funding on reported accuracy are unknown. Peer-reviewed diagnostic test accuracy (DTA) studies were identified through a systematic review on Pubmed and Embase. Diagnostic performance measures were extracted especially for different subgroups such as product, type of rater (stand-alone AI, human unaided, human aided), funding, and anatomical region. Pooled measures were obtained with a bivariate random effects model. The impact of rater was evaluated with comparative meta-analysis. Seventeen DTA studies of seven CAAI-FDS analyzing 38,978 x-rays with 8,150 fractures were included. Stand-alone AI studies (n = 15) evaluated five CAAI-FDS; four with good sensitivities (> 90%) and moderate specificities (80–90%) and one with very poor sensitivity (< 60%) and excellent specificity (> 95%). Pooled sensitivities were good to excellent, and specificities were moderate to good in all anatomical regions (n = 7) apart from ribs (n = 4; poor sensitivity / moderate specificity) and spine (n = 4; excellent sensitivity / poor specificity). Funded studies (n = 4) had higher sensitivity (+ 5%) and lower specificity (-4%) than non-funded studies (n = 11). Sensitivity did not differ significantly between stand-alone AI and human AI aided ratings (p = 0.316) but specificity was significantly higher the latter group (p < 0.001). Sensitivity was significant lower in human unaided compared to human AI aided respectively stand-alone AI ratings (both p ≤ 0.001); specificity was higher in human unaided ratings compared to stand-alone AI (p < 0.001) and showed no significant differences AI aided ratings (p = 0.316). The study demonstrates good diagnostic accuracy across most CAAI-FDS and anatomical regions, with the highest performance achieved when used in conjunction with human assessment. Diagnostic accuracy appears lower for spine and rib fractures. The impact of industry funding on reported performance is small.

Effect of pituitary stalk preservation during craniopharyngioma removal on pituitary function, extent of resection, and recurrence: systematic review and meta-analysis.

Optimal management of the pituitary stalk during craniopharyngioma resection remains a controversial subject. This meta-analysis aimed to evaluate the effect of pituitary stalk preservation on postoperative diabetes insipidus (DI), anterior pituitary function (PF), extent of resection, and recurrence. Medline was searched via Ovid for relevant articles from inception to September 2, 2022. Studies reporting the rates of DI or anterior PF postoperatively or at last follow-up, extent of resection, or tumor recurrence at last follow-up were eligible for inclusion. The risk ratio (RR) for each outcome was calculated. Random-effects meta-analyses were performed with additional stratification by age. To assess for risk of bias across studies, funnel plots and the Egger's test were utilized. In total, 3488 abstracts and 150 full-text articles were reviewed, resulting in 33 studies with a total of 2366 patients for inclusion. In the comparative meta-analysis, pituitary stalk preservation significantly decreased the risk of DI postoperatively (17 studies, RR 0.67, 95% CI 0.55-0.81, I2 = 75%), DI at last follow-up (6 studies, RR 0.54, 95% CI 0.41-0.72, I2 = 20%), and abnormal anterior PF postoperatively (15 studies, RR 0.78, 95% CI 0.69-0.89, I2 = 49%) but not abnormal anterior PF at last follow-up (4 studies, RR 0.38, 95% CI 0.09-1.63, I2 = 64%). There were no significant differences in the rates of incomplete resection (12 studies, RR 1.59, 95% CI 0.77-3.28, I2 = 68%) or tumor recurrence (9 studies, RR 1.18, 95% CI 0.92-1.51, I2 = 0%) between the preservation and sacrifice groups. However, subgroup analysis of pediatric patients revealed a higher risk of incomplete resection (RR 3.29, 95% CI 1.17-9.26, I2 = 70%) in the stalk preservation group. Pituitary stalk preservation was demonstrated to confer protective benefit on PF, although the benefit persisted on long-term follow-up for posterior PF only. Stalk preservation in pediatric patients should be given careful consideration, as it is associated with higher rates of incomplete resection. These results should be interpreted with caution due to inclusion of small studies and inadequate reporting of outcomes in the literature.

The Impact of Antidepressants on COVID-19 and Post-Acute COVID-19 Syndrome: A Scoping-Review Update

On May 20, 2024, this systematic scoping review in PUBMED identified 1016 articles related to AD and COVID-19, Long COVID and SARS-COV-2. These included 10 retrospective "large scale" studies (> 20000 chart reviews), 8 prospective clinical trials (plus 4 regarding Long COVID), 11 placebo-controlled randomized (RCT) (plus 2 regarding Long COVID) and 15 meta-analyses. COVID-19: Retrospective studies with cohorts taking AD primarily for psychiatric comorbidities or chronic pain conditions directly prior to SARS-COV-2 infection described that this substance class (most studied: Selective Serotonin Re-Uptake Inhibitors (SSRI) and Selective Serotonin Noradrenaline Re-Uptake Inhibitors (SSNRI)) were associated with (i) significantly fewer SARS-COV-2 infections and (ii) a milder course of COVID-19 ("COVID-19 protection"). Ten of the 11 RCTs found regarding COVID-19 tested fluvoxamine, as this old AD appeared suitable as a prophylactic agent against severe COVID-19, taking into account its in vitro potency against the progression of intracellular sepsis cascades. Therefore, most (12 out of 15) meta-analyses also referred to fluvoxamine. They found (iii) a significant (40-70% reduction) in mortality, intubation and hospitalization rates when fluvoxamine was used as an add-on to standard therapy for mild to moderate COVID-19. When this AD was used in the early stages of the disease, it was more successful than when it was given later in advanced, severe COVID-19 (e.g. severe pneumonia, final sepsis stages). A dose dependency was observed: 2x50 mg fluvoxamine over 15 days was less effective than 2x100 or even 3x100 mg with an adverse event profile still at the placebo level. Direct comparisons with drugs approved for COVID-19 do not yet exist. A first indirect meta-analytical comparison showed an advantage of paxlovid or molnupiravir versus fluvoxamine against the development of severe COVID-19: risk reduction of 95% (I2 = N/A, but only one study) or 78% (I2=0) versus 5+-5% (I2=48). However, an add-on of fluvoxamine was still significantly more efficacious than symptom-oriented standard therapy alone. Long COVID: A common Long COVID phenotype with dominant anxiety and depression symptoms, which responds to AD, relaxation therapy and/or psychotherapy, has now been identified. Casuistics report positive effects of AD on fatigue, cognitive and autonomic dysfunctions. A first large prospective open-label RCT has just shown significantly more favourable courses, less viral load and less pro-inflammatory cytokines in the treatment of mild to moderate COVID-19 with fluvoxamine versus standard treatment, also with regard to the subsequent development of neuropsychiatric and pulmonary Long COVID or fatigue. Overall, there is promising evidence of a preventive effect of AD (especially fluvoxamine) against progression to severe COVID-19 and against the development of Long COVID. It is likely, that the entire AD substance class could be effective here. This assumption is based on the results of retrospective large scale studies, but awaits verification by better controlled studies. The potential effectiveness/efficacy (currently low and moderate confidence of the evidence for the entire substance class and specifically fluvoxamine, respectively) of fluvoxamine as an add-on against COVID-19 and possibly also directly against Long COVID could stimulate similar projects in other infectious diseases that also have the potential to pose a lasting threat to the health of those affected. We consider the evidence to date to be sufficient to be able to emphasize a possible positive effect of these substances in the psychoeducation of patients with COVID-19 or Long COVID who are already receiving AD for other conditions - especially also against the symptoms associated with the viral disease or its consequences. In regions where neither vaccines nor antiviral agents currently approved for the prevention or treatment of COVID-19 are available, AD and in particular fluvoxamine would be a cost-effective alternative to protect against a severe course, even if this AD appears to have a smaller effect against COVID-19 than the currently approved antiviral agents, but with presumably better tolerability. A direct comparative clinical trial with approved antiviral agents is still pending and should be positive to further open the door for a guideline-based recommendation of fluvoxamine (or perhaps even AD) for COVID-19 or its aftermath.

Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis.

The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we conducted this investigation to compare between both procedures. Studies comparing flexible to rigid bronchoscopy (n = 14) were identified by searching PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We performed comparative meta-analyses of reported presentation characteristics and clinical outcomes, using fixed- and random-effects models. A diverse range of FB types and locations were identified. No difference was observed in the success rate of FB removal between flexible and rigid bronchoscopy (logOR = 0.27; 95%CI: -1.91:2.45). The rate of negative first bronchoscopy was higher in the flexible compared to the rigid group (logOR = 2.68; 95%CI: 1.68:3.67). Conversion rates to the alternative method were higher in the flexible bronchoscopy group. The overall complication rates were similar between both methods; however, the risk of desaturation was significantly lower with flexible bronchoscopy (logOR = -2.22; 95%CI: -3.36:-1.08). Flexible bronchoscopy was associated with a shorter length of hospital stay. The choice of bronchoscopy technique should be tailored to individual case characteristics.

Association of human papillomavirus 16 and 18 with ovarian cancer risk: Insights from a meta‑analysis.

Ovarian cancer (OC) presents a global health challenge, with well-documented genetic aspects. However, to the best of our knowledge, the role of human papillomavirus (HPV) types 16 and 18 in OC remains unclear. The present meta-analysis assessed the prevalence of HPV in OC across 43 studies and included a comparative meta-analysis of 19 case-control studies to determine the association of HPV with OC risk. Subgroup analyses were performed based on geographic regions and histopathological types to explore heterogeneity, and publication bias was evaluated using funnel plots and statistical tests of asymmetry. The pooled prevalence of HPV was found to be 10% (95% CI, 5-18) and 7% (95% CI, 3-15) specifically for HPV 16/18. Case-control studies indicated an odds ratio (OR) of 4.92 (95% CI, 1.96-12.53) for HPV 16/18, with higher pooled prevalence rates of 17% for all HPV genotypes and 13% for HPV 16/18. Notably, Asian countries exhibited the highest HPV prevalence and OR in OC. These findings support the involvement of HPV, particularly HPV 16 and 18, in increasing the risk of OC, emphasizing the need for further research to confirm these associations and explore potential mechanisms.

Shared and distinct patterns of default mode network dysfunction in major depressive disorder and bipolar disorder: A comparative meta-analysis

BackgroundWhile patients with major depressive disorder (MDD) and bipolar disorder (BD) exhibited default mode network (DMN) dysfunction revealed by aberrant resting-state functional connectivity (rsFC) patterns, previous findings have been inconsistent. Little is known about the similarities and differences in DMN rsFC between MDD and BD. MethodsA voxel-wise meta-analysis of seed-based DMN rsFC studies on MDD or BD was performed using the Seed-based d Mapping software with permutation of subject images (SDM-PSI). Aberrant DMN rsFC in both disorders was investigated separately, followed by conjunction and between-disorder comparison analyses. Functional decoding was performed to implicate the psychophysiological underpinnings of derived brain abnormalities. ResultsThirty-four studies comparing 1316 MDD patients with 1327 HC, and 22 studies comparing 1059 BD patients with 1396 HC were included. Compared to HC, MDD patients exhibited DMN hyperconnectivity with frontolimbic systems, and hypoconnectivity with temporal lobe and posterior cingulate cortex. BD patients displayed increased DMN connectivity with bilateral precuneus, and reduced connectivity with prefrontal cortex and middle temporal gyrus. No common patterns of DMN rsFC abnormalities were observed between MDD and BD. Compared to BD, MDD patients showed DMN hyperconnectivity with triangular part of the left inferior frontal gyrus and left fusiform gyrus. Functional decoding found that patterns of DMN rsFC alteration between MDD and BD were primarily related to action and perception domains. ConclusionDistinct DMN dysfunction patterns in MDD and BD enhance current understanding of the neural substrates of mood disorders and may provide a potential biomarker for differentiation.

Game Changer or More of the Same? A Comparative Meta-analysis of Rezafungin and Caspofungin in Treating Candidemia and Invasive Candidiasis.

This meta-analysis assesses the recent Food and Drug Administration (FDA)-approved antifungal, rezafungin, for treating candidemia and invasive candidiasis-both are significant health concerns with limited treatment options. Two randomized controlled trials comparing rezafungin to caspofungin were meta-analyzed, revealing no significant differences in global cure rates and 30-day all-cause mortality. While rezafungin's unique attributes, like a novel mechanism and once-weekly dosing, may enhance patient adherence, concerns arise about its clinical relevance given the substantial investment. The study emphasizes the need for ongoing research, post-marketing surveillance, and real-world data to determine rezafungin's true value in managing these life-threatening fungal infections. Despite FDA approval, further investigation is warranted for a comprehensive understanding of rezafungin's efficacy and safety.

Janus kinase inhibitors versus tumor necrosis factor inhibitors in rheumatoid arthritis: meta-analytical comparison of efficacy and safety.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by persistent inflammation leading to progressively worse disability. Janus kinase (JAK) inhibitors and tumor necrosis factor (TNF) inhibitors are pivotal in RA treatment, yet their comparative efficacy remains underexplored. This study aimed to compare the efficacy and safety of JAK inhibitors and TNF inhibitors in treating RA using data from randomized controlled trials (RCTs). A meta-analysis and outcomes analysis were based on results of the Health Assessment Questionnaire Disability Index (HAQ-DI), Clinical Disease Activity Index (CDAI), Visual Analogue Scale (VAS), and Patient Global Assessment Scale (PtGA) and other indices as incidences of venous thromboembolism (VTE) and malignancy. The JAK inhibitors caused a statistically significant improvement in the HAQ-DI score [MD = 0.08, 95% CI (0.03, 0.12), p = 0.0008] compared with the TNF inhibitors. However, no significant difference was observed between the two drug classes in the CDAI score [MD = -2.03, 95% CI (-9.27, 5.22), p = 0.58]. JAK inhibitors were associated with an increase in the VAS score [MD = 3.62, 95% CI (0.86, 6.38), p = 0.01], but there was no significant difference in the PtGA score [MD = 1.91, 95% CI (-3.25, 7.08), p = 0.47]. JAK inhibitors demonstrated superior efficacy in improving the functional status and reducing the disease activity in RA patients compared with TNF inhibitors. Both drug classes exhibited comparable safety profiles for VTE and malignancies, though JAK inhibitors had a higher risk for thromboembolism.

The diagnosis performance of [18F]FDG PET/CT, MRI, and CT in the diagnosis of mandibular invasion in oral/oropharyngeal carcinoma: a head-to-head comparative meta-analysis

The diagnosis performance of [18F]FDG PET/CT, MRI, and CT in the diagnosis of mandibular invasion in oral/oropharyngeal carcinoma: a head-to-head comparative meta-analysis

Comparative Meta-Analysis of Triplet vs. Quadruplet Induction Regimens in Newly Diagnosed, Treatment Naïve, Multiple Myeloma.

The use of 4-drug induction regimens for treatment naïve newly diagnosed multiple myeloma (NDMM) is associated with improved depth of response and progression-free survival (PFS). However, head-to-head trials of 4-drug combinations are lacking, and instead, these regimens are typically compared to 3-drug backbones; limiting the ability to discern whether any additional benefit (or toxicity) is simply additive or represents a synergy (or interaction). We conducted a meta-analysis of phase 2 and phase 3 clinical trials that randomized treatment naïve NDMM patients to either a 4-drug or 3-drug induction regimen. We included 11 trials which represented 6509 unique patients. PFS for all trials in the meta-analysis was 54 months with a 4-drug induction and 8.9 months with a 3-drug induction (HR: 0.49; 95% CI: 0.45; 0.54), but there was no benefit to using a 4-drug induction that did not include an anti-CD38 antibody (PFS 4-drug 8.1 months, PFS 3-drug 8.0 months; HR 0.95; 95% CI 0.86; 1.06). Adverse events were more frequent with the quadruplet regimens but were predominately mild. High-grade (≥3) adverse events (AEs) that were more common with 4-drug regimens were infections (RR: 1.34; 95% CI 1.17; 1.54) and thrombocytopenia (RR: 1.39; 95% CI 1.12; 1.74). This study suggests that 4-drug induction regimens which include an anti-CD38 antibody improve efficacy although with additional toxicity in NDMM patients.