Mean Difference Research Articles

Efficacy and safety of double-dose statin monotherapy versus moderate-intensity statin combined with ezetimibe dual therapy in diabetic patients: a systematic review and meta-analysis of randomized controlled trials.

Cardiovascular disease is a leading cause of mortality, especially in individuals with type 2 diabetes mellitus and dyslipidemia. Despite adequate statin therapy, some patients fail to achieve the target low-density lipoprotein-cholesterol levels. Trials have compared doubling the statin dose with the addition of ezetimibe. A systematic literature search was performed using various databases. Forest plots were constructed for pooled analysis with statistical significance set at P < 0.05. Seven trials were included. Monotherapy showed no significant difference compared with dual therapy for low-density lipoprotein-cholesterol levels [mean difference (MD): -5.03; P = 0.37], high-density lipoprotein-cholesterol levels (MD: 0.01; P = 0.95), total cholesterol (MD: -2.38; P = 0.66), and triglycerides (MD: 5.37; P = 0.67) at follow-up compared to baseline. Monotherapy significantly reduced serious clinical adverse events (risk ratio: 0.21; P = 0.04), with no difference in treatment-related adverse effects, discontinuation due to treatment-related or overall adverse events.

Effects of Unilateral, Bilateral and Combined Plyometric Jump Training on Asymmetry of Muscular Strength and Power, and Change-of-Direction in Youth Male Basketball Players

This study aimed to compare the effects of unilateral (UT), bilateral (BT), and combined (UBT) plyometric training on muscular strength, power, and change-of-direction performance in youth male basketball players. Sixty-six male youth basketball players (age: 16.1 ± 0.8 years) participated in this randomized experimental study, which lasted 8 weeks with a training frequency of 2 sessions per week. The UT group performed only single-leg plyometric exercises, while the BT group conducted similar plyometric drills using both feet. The UBT group combined both approaches, performing one session of UT and one session of BT each week. The players were evaluated at baseline and after the 8-week period using a force platform for the unilateral countermovement jump test (UCMJ), isometric squat test (IST), isometric knee flexor strength test (KFS), leg land and hold test (LHT), and 5-0-5 tests. The asymmetry between legs per outcome was measured using the symmetry angle. The UT, BT, and UBT all significantly improved outcomes in the IST, UCMJ, KFS, LHT, and 5-0-5 tests (p &lt; 0.05) following the intervention, with no significant differences among the three methods. However, while UT and UBT significantly reduced asymmetries in the tests (p &lt; 0.05), BT increased asymmetries. Only, the UT group showed significant improvements over the control group in asymmetry measures: IST asymmetry (mean difference: 1.2%, p = 0.049), KFS asymmetry (mean difference: 2.5%, p &lt; 0.001), and LHT asymmetry (mean difference: 1.1%, p = 0.013). While there are no substantial differences among UT, BT, and UBT in terms of improvements in unilateral tests and symmetry levels, UT stands out for its effectiveness in enhancing neuromuscular performance and reducing asymmetries among basketball players compared to the control condition. UT was the only method that showed significant benefits in this context. Strength and conditioning coaches might consider incorporating UT, either alone or alongside BT, to optimize individual limb strength and coordination.

Risk factors for incisional hernia after open abdominal aortic aneurysm repair: a systematic review and meta-analysis.

The incidence of incisional hernia (IH) after an open abdominal aortic aneurysm (AAA) repair can reach up to 35%, contributing to long-term morbidity. Individual studies have been limited in identifying modifiable risk factors for IH after an open AAA repair. This meta-analysis aims to review all the risk factors for IH after an open AAA repair. We searched Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science databases for original studies. Risk factors assessed were age, sex, comorbidities, surgical incision, blood loss, and surgical site infection (SSI). Data analysis was done using RStudio 4.1.2. We computed Relative Risk (RR) for dichotomous outcomes and Mean differences (MD) with 95% Confidence Interval (CI) for continuous outcomes. P-values less than 0.05 were considered statistically significant. Ten studies met the inclusion criteria among 1,795 screened articles. Among those ten studies, there were a total of 1,806 patients of which 341 patients developed IH. Older age (Mean 69.6-70.7 years, MD 1.39 years, CI [1.12-1.66], P < 0.01), midline vertical incision (RR 1.55, CI [1.06-2.25], P = 0.02) and increased intraoperative blood loss (MD 429.8ml, CI [234.8- 624.8], P < 0.01) were associated with an increased incidence of IH. Surgical site infection (SSI) was noted as a risk factor for IH after open AAA repair (RR 2.36, CI [1.31-4.24], P = 0.004). No statistically significant association was found between the incidence of IH and sex (RR 1.0, CI [0.8-1.14], P = 0.98), smoking (RR 1.01, CI [0.93-1.09], P = 0.88), diabetes (RR 1.38, CI [0.85-2.25], P = 0.19), and chronic kidney disease (RR 1.55, CI [0.47-5.09], P = 0.46). This meta-analysis shows that age, midline vertical incision, intraoperative blood loss, and SSI are risk factors for IH after open AAA repair.

Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.

The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40). UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

Interleukin-6 Inhibitors for Neuromyelitis Optica Spectrum Disorder (NMOSD): a Systematic Review and Meta-analysis

BackgroundInterleukin-6 (IL-6) inhibitors recently emerged as a promising therapy for neuromyelitis optica spectrum disorder (NMOSD). ObjectiveWe performed a systematic review and meta-analysis comparing IL-6 inhibitors to placebo or traditional immunosuppressants in NMOSD. MethodsWe searched PubMed, Embase, and Cochrane Central for eligible studies. Efficacy endpoints included hazard ratio (HR) for relapse, annualized relapse ratio (ARR) and Expanded Disability Status Scale (EDSS) change over time. Safety outcomes comprised any adverse event, serious adverse events and infections. Statistical analysis was performed using RevMan Web and R studio package meta. Heterogeneity was assessed with I² statistics. ResultsFour studies involving 361 patients (228 treated with IL-6 inhibitors) were included. IL-6 inhibitors significantly reduced HR for relapse (HR 0.35; 95% CI 0.23, 0.55); p<0.00001; I²=0%) and ARR (mean difference -0.79 relapses/year; 95% CI -1.54, -0.03; p=0.04; I²=96%) compared to placebo or traditional immunosuppressants. No significant differences were observed in EDSS change over 24 weeks of follow-up (mean difference -0.18; 95% CI 0.41, 0.05; p=0.93; I²=0%), adverse events (odds ratio (OR) 1.59; 95% CI 0.45, 5.63; p=0.48; I²=48%), serious adverse events (OR 0.76; 95% CI 0.40, 1.44; p=0.50; I²=0%) and infection rates (OR 1.10; 95% CI 0.67, 1.79; p=0.71; I²=0%). ConclusionIL-6 inhibitors demonstrate superior efficacy in preventing relapses in NMOSD compared to placebo or traditional immunosuppressants, without a notable increase in safety risks.

Yoga-based lifestyle intervention for healthy ageing in older adults: a two-armed, waitlist randomized controlled trial with multiple primary outcomes.

Yoga-based clinical research has shown considerable promise in varied ageing-related health outcomes in older adults. However, robust frameworks have yet to be used in intervention research to endorse yoga as a healthy ageing intervention to test the multidimensional construct of healthy ageing. This was an assessor-masked, randomized controlled trial conducted among 258 sedentary, community-dwelling older adults aged 60-80years, randomly allocated to 26-week yoga-based intervention (YBI) (n = 132) or waitlist control (WLC) (n = 126). The effectiveness of YBI was assessed through two separate global statistical tests, generalized estimating equations and rank sum-based test, against a comprehensive healthy aging panel comprised of ten markers representing the domains of physiological and metabolic, cognitive, physical capability, psychological, and social well-being. The secondary outcomes were individual primary marker scores, Klotho, inflammatory markers, and auxiliary blood markers. We could establish the healthy aging effect of the 26-week YBI over WLC using two models of global statistical test (GEE, β = 0.29; 95% CI = 0.20 to 0.38, p < 0.001), and rank sum-based test (β = 0.28, 95% CI = 0.19 to 0.36, p < 0.001). There were also significant improvements in direction of benefit at individual levels of all the aging markers. Exploratory evaluation with adopted indices from contemporary clinical trials also validated the potential of YBI for healthy aging; HATICE adapted composite score (mean difference = - 0.18; 95% CI = - 0.26 to - 0.09, p < 0.001) and healthy ageing index (mean difference = - 0.33; 95% CI = - 0.63 to - 0.02, p = 0.03). The global effect of YBI across multiple ageing-related outcomes provides a proof of concept for further large-scale validation. The findings hold a great translational value given the accelerated pace of population aging across the globe. Trial registration: CTRI/2021/02/031373.

Agreement between fat-free mass from bioelectrical impedance analysis and dual-energy X-ray absorptiometry and their use in estimating resting metabolic rate in resistance-trained men.

This study aimed to determine the agreement between fat-free mass (FFM) estimates from bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) and their use in estimating resting metabolic rate (RMR) in men undergoing resistance training. Thirty healthy resistance-trained men (22.7 ± 4.4 years, 70.0 ± 8.7 kg, 174.6 ± 6.7 cm, and 22.9 ± 2.3 kg/m2) were evaluated. The equation developed by Tinsley et al. (RMR = 25.9 × fat-free mass [FFM] + 284) was adopted to calculate the RMR. DXA was used as the reference method for FFM. Furthermore, FFM was also estimated by BIA using a spectral device. No significant difference (p > 0.05) was observed between DXA (1884.2 ± 145.5 kcal) and BIA (1849.4 ± 167.7 kcal) to estimate RMR. A positive and significant correlation (r = 0.89, p < 0.05) was observed between DXA and BIA estimates of RMR. The mean difference between methods indicated that BIA presented a bias of -34.8 kcal. These findings suggest that using FFM derived from DXA or BIA results in similar RMR estimates in resistance-trained men.

Photoangiolytic Lasers for Treatment of Benign Laryngeal Lesions: A Systematic Review and Meta-Analysis.

To compare the efficacy of the 445-nm blue laser to the 585-nm pulsed dye laser (PDL) and 532-nm potassium-titanyl-phosphate (KTP) laser in the treatment of benign laryngeal lesions. Cochrane Library, PubMed, Scopus, and CINAHL. Following PRISMA guidelines, databases were searched from inception through January 29, 2024, for studies reporting the use of photoangiolytic lasers for treatment of benign laryngeal lesions, including the 585-nm PDL, 532-nm KTP laser, and 445-nm blue laser. Outcome measures included lesion resolution (%), mean differences (Δ) in Voice Handicap Index (VHI-10), and summed dysphonia grade, roughness, and breathiness (GRB) scale. A total of 45 studies were included for meta-analysis, consisting of 348 patients treated with PDL, 550 patients with KTP laser, and 338 patients with blue laser. Treatment with blue laser resulted in the greatest lesion resolution (94.0%; 95% confidence interval [CI]: 90.2%-96.7%), followed by KTP laser (90.4%; 95% CI: 84.1%-95.2%), and PDL (86.9%; 95% CI: 62.9%-99.2%). VHI-10 improved significantly in patients following treatment with blue laser (Δ13.3; 95% CI: 10.7-16.0; p < 0.0001), KTP laser (Δ10.3; 95% CI: 7.4-13.3; p < 0.0001), and PDL (Δ7.4; 95% CI: 4.8-10.1; p < 0.0001). GRB improved significantly in patients following treatment with blue laser (Δ4.1; 95% CI: 2.9-5.2; p < 0.0001), KTP laser (Δ3.0; 95% CI: 2.0-4.0; p < 0.0001), and PDL (Δ2.5; 95% CI: 0.8-4.2; p = 0.005). Photoangiolytic lasers are effective in treating benign laryngeal lesions. Blue lasers are promising for laryngeal laser surgery. Laryngoscope, 134:4847-4857, 2024.

Circulating interleukin-33 levels in obesity and type 2 diabetes: a systematic review and meta-analysis.

Obesity and type 2 diabetes (T2D) are increasingly prevalent worldwide, and there is a critical need for novel interventions. Interleukin-33 (IL-33), an anti-inflammatory cytokine that regulates metabolism, is a promising biomarker for these conditions. The goal of this systematic review and meta-analysis is to examine the role of IL-33 in obesity and T2D, assessing its potential in predicting disease progression. A systematic search was performed on Scopus, Web of Science, and PubMed up until May 30, 2023. Each study was assessed for quality and sources of bias using the relevant critical appraisal checklists. Meta-analyses were conducted to compare IL-33 levels in individuals with obesity and T2D versus healthy controls (HC), and in obesity alone versus HC. Eighteen studies were included in the systematic review, and nine qualified for meta-analyses. The analyses showed insufficient evidence to suggest a significant difference in IL-33 levels between individuals with T2D and HC (mean difference, MD = -79.95, 95% CI [-241.38; 81.48]), with substantial heterogeneity across the studies observed (I2 = 97.1%, τ2 = 33,549.15). Similarly, there was insufficient evidence to suggest a significant difference between nondiabetic individuals with obesity and HC (MD = -7.31, 95% CI [-25.74; 11.13]), and heterogeneity was noted (I2 = 86.2%, τ2 = 342.45). There is insufficient evidence to indicate significant differences in IL-33 levels in individuals with T2D or obesity compared with HC. The results suggest a need for improved IL-33 measurement methods to reduce heterogeneity, enhancing understanding of the role of IL-33 in obesity and T2D, and informing future research and therapeutic strategies.NEW & NOTEWORTHY Our research finds an inconclusive relationship between IL-33 serum levels in individuals with type 2 diabetes (T2D) and nondiabetic individuals with obesity. In addition, we note a potential gender association with IL-33 serum levels. Further studies with larger cohorts are required to assess the significance of serum IL-33 in T2D and obesity. Urgent standardization is needed in IL-33 quantification and reporting methods for reliable comparisons.

The Effects of High-Intensity Interval Training on Cardiometabolic Health in Children and Adolescents: A Systematic Review and Meta-Analysis

High-intensity interval training (HIIT) interventions are typically prescribed according to several laboratory-based parameters and fixed reference intensities to accurately calibrate exercise intensity. Repeated all-out printing efforts, or sprint interval training, is another form of HIIT that is prescribed without individual reference intensity as it is performed in maximal intensities. No previous study has performed a systematic review and meta-analysis to investigate the effect of HIIT and SIT on cardiometabolic health markers in children and adolescents. Moreover, previous studies have focused on single risk factors and exercise modalities, which may restrict their ability to capture a complete picture of the factors that could be affected by different interval interventions. The present study aimed to conduct a novel meta-analysis on the effects of HIIT and SIT on multiple cardiometabolic health markers in children and adolescents. An electronic search was conducted in three main online databases including PubMed, Web of Science, and Scopus were searched from inception to July 2024 to identify randomized and non-randomized control trials comparing HIIT and SIT versus the non-exercise control group in children and adolescents with mean age ranges from 6 to 18 years old on cardiometabolic health markers including fasting glucose and insulin, insulin resistance, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), systolic blood (SBP) and diastolic blood (DBP) pressures. Standardized mean differences (SMD), weighted mean differences (WMD), and confidence were calculated using a random effect model. HIIT decreased insulin, insulin resistance, TG, TC, LDL, and SBP and increased HDL but did not decrease glucose and DBP. Furthermore, subgroup analyses show that insulin and insulin resistance were decreased by sprint interval training (SIT) and in those with obesity. Lipid profile mainly is improved by SIT and in those with obesity. Also, SBP was decreased by SIT and in those with obesity. Our results prove that HIIT is an effective intervention for improving cardiometabolic health in children and adolescents, mainly those with obesity. Specifically, SIT is an effective interval training mode in children and adolescents.

MELATONIN ON SLEEP IN PARKINSON’S DISEASE: A RANDOMIZED DOUBLE BLIND PLACEBO CONTROLLED TRIAL

BackgroundSleep disturbances are one of the most common non-motor symptoms in Idiopathic Parkinson’s Disease (IPD) patients. However, the effect of melatonin on sleep problems in Parkinson's disease patients is unclear. Aims and objectivesTo study the effect of melatonin on sleep in IPD patients through subjective and objective assessment. MethodsBetween August 2023 to February 2024, we conducted a randomized, double-blind, placebo-controlled trial on IPD patients. We randomized eligible subjects to melatonin (3mg) (n=43) or placebo (n=43) for 8 weeks. The primary endpoint was sleep quality assessed through the Pittsburgh sleep quality index and daytime sleepiness using Epworth sleepiness scale. Secondary endpoints were polysomnographic sleep parameters, quality of life, motor and non-motor symptoms. Assessments were done at baseline and at the end of 8 weeks. ResultsWe screened 107 IPD patients and 86 patients were included in the study. Seventy three patients (melatonin, 35 and placebo, 38) completed the study. The mean change in Pittsburgh Sleep Quality Index (PSQI) score between the two groups was 1.87 (95% CI: 1.5–2.1; p = 0.001) and Epworth Sleepiness Scale (ESS) score was 1.25 (95% CI: 0.80-1.71; p = 0.001) favoring melatonin. The mean difference between the two groups for Non-Motor Symptoms Scale (NMSS) was 6.11 (95% CI 5.27-6.92; p = 0.001), Parkinson's Disease Questionnaire (PDQ 39) 8.12 (95% CI 6.97-9.50; p = 0.001) & Polysomnography (PSG) parameters [sleep latency 8.36 (95% CI 4.38-12.34; p = 0.001) and total sleep time 14.51 (95% CI 5.00-24.41; p = 0.005)] favoring melatonin. Side effects attributable to melatonin were minimal. ConclusionMelatonin is an effective and safe treatment option for sleep problems in PD patients, and beneficial effects on sleep quality are associated with improved non-motor symptoms and quality of life. We need to emphasize the fact that though we had statistically significant changes in our outcomes, it is not clear whether such changes would have real-life impact (meaningfulness) that would be relevant to licensing authorities or management as patients in our study are young, have short disease duration, have high use of anticholinergics and on modest levodopa equivalent dose. So, we are doubtful if this could be generalized to the typical PD population who are older, have longer disease duration and are on potentially sedating medications or not.

Factor Structure of the CES-D-20 Scale in Young Adults in Singapore: An Examination of Six Alternative Structures and Measurement Invariance by Sex

Building on past research that has indicated cultural variations in the factor structure of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D-20), as well as several limitations validating the CES-D-20 within a Singapore context, this study investigated the CES-D-20’s factor structure and sex-based measurement invariance in Singapore. A large young adult sample in Singapore (N=1008) was utilised, and the original CES-D-20 was administered to all participants. The findings confirmed the four-factor model’s robustness over five other alternative models (RMSEA=.05, SRMR=.04), where each of the 20 items loaded significantly onto its respective factor (all loadings≥.42, all ps<.001). All four factors were also significantly inter-correlated to a medium to very large extent (all ps<.001). Configural and weak invariance were established across sexes; however, strong invariance required modification, where the release of a single intercept constraint resulted in strong partial invariance, implying sex differences in the expression of crying. Homogeneity tests suggested no significant sex differences in latent factor means, variances, and covariances. The importance of cultural- and sex-specific considerations when utilising the CES-D-20 are discussed.

Transfer graph feature alignment guided multi-source domain adaptation network for machinery fault diagnosis

In recent years, the application of unsupervised multi-source domain adaptation (MSDA) techniques for fault diagnosis has gained significant traction. Current research typically overlooks or fails to effectively capture critical data structure information during feature extraction. Another challenge is optimising the integration of information from multiple source domains to diagnose the target domain while avoiding negative transfer. To address these challenges, this study proposes a transfer graph feature alignment guided multi-source domain adaptation network (MDTGAL). In the proposed method, a transfer graph sample generator module (GSG) is constructed to model the data structure between source and target domains, and multiple graph feature extractors are employed to learn the data structure information from different domain combinations. A regularisation technique is introduced to extract the domain-invariant features by aligning the parameters across multiple independent graph feature extractors. In addition, a weighted soft-voting mechanism based on the polynomial kernel-induced maximum mean difference metric (PK-MMD) is designed to fuse the outputs from multiple classifiers, to comprehensively account for the influence of each source domain. The proposed method was tested on multi-source domain transfer tasks involving various operating conditions of rotating machinery. The experimental results demonstrate that the MDTGAL exhibits superior cross-domain diagnostic performance, outperforming existing mainstream methods. In addition, this study explored the impact of varying numbers of source domains on the diagnostic accuracy of the target domain, providing insights into selecting the correct number of source domains for specific MSDA tasks.

Effect of continuous positive airway pressure therapy on blood levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in obstructive sleep apnoea adults: A systematic review, meta-analysis and trial sequential analysis

Obstructive sleep apnoea (OSA) is a long-term disorder characterized by frequent blockages in the upper respiratory tract during sleep, often leading to abrupt awakenings, with or without a decrease in oxygen levels. The systematic review and meta-analysis aimed to assess the effect of continuous positive airway pressure therapy (CPAP) on blood interleukin (IL) levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in OSA adults. The published databases from PubMed, Scopus, Web of Science, and Cochrane Library were searched from 2003 to 2024, without any restrictions. The Review Manager software 5.3 was employed to compute effect sizes, which were presented as the standardized mean difference (SMD) along with a 95% confidence interval (CI). In total, 320 records were identified through database searching; ultimately, 42 articles were included in the qualitative synthesis and then the meta-analysis. The CPAP therapy significantly reduces IL-6 levels, as indicated SMD=0.64 [95% CI: 0.35, 0.93] and P<0.0001. CPAP therapy significantly reduced IL-18 and IL-1β levels in adults with OSA, but there is no significant difference in IL-10, IL-4, or IL-17 levels. Age, blood sample, body mass index, ethnicity, and treatment duration for IL-6 and apnoea-hypopnea index with IL-10 levels were effective factors in the pooled results. Experimentally, there was an interaction between IL-18 and IL-1β. CPAP therapy has a positive impact on inflammatory markers in OSA adults; remarkably, it reduces IL-6 and IL-1β levels. Nevertheless, more evidence (such as the role of ethnicity) and understanding of interactions are needed.

Meta-analysis of dietary supplementation with flavonoids in small ruminants: Growth performance, antioxidant status, nutrient digestibility, ruminal fermentation, and meat quality

This study aimed to evaluate the effects of dietary supplementation with flavonoids on growth performance, antioxidant status, nutrient digestibility, ruminal fermentation, and meat quality of small ruminants through a meta-analytic approach. The data used in the meta-analysis were extracted from 29 scientific articles identified through systematic searches following the PRISMA methodology. Der-Simonian and Laird, random effects models, were used to assess effect sizes using weighted mean differences. Dietary supplementation with flavonoids increased (P < 0.05) dry matter intake, average daily gain, hot carcass weight, hot carcass yield, Longissimus dorsi muscle area, and backfat thickness. In contrast, the feed conversion ratio decreased (P < 0.05) in response to dietary flavonoid supplementation. Dietary supplementation with flavonoids increased (P < 0.001) the serum concentration of superoxide dismutase, catalase, glutathione peroxidase, and total antioxidant capacity but decreased (P < 0.001) the serum concentration of malondialdehyde (MDA). The digestibility of dry matter, organic matter, crude protein, neutral detergent fiber, and acid detergent fiber increased (P < 0.05) in response to dietary flavonoid supplementation. Dietary supplementation with flavonoids decreased (P < 0.001) the ruminal concentration of ammonia nitrogen and increased (P < 0.001) the ruminal concentration of total volatile fatty acids and acetate. Dietary supplementation with flavonoids decreased (P < 0.001) cooking loss, shear force, and MDA in meat. In conclusion, dietary supplementation with flavonoids can be used as a nutritional strategy to improve growth performance, antioxidant status in blood serum, nutrient digestibility, ruminal fermentation, and meat quality in small ruminants.

Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials.

Orofacial pain (OFP) is an ache in the front part of the head and typically has musculoskeletal, dental, neural, or sinogenic origin. Dry needling (DN) is the insertion of a solid sterile fine needle through the skin aimed at deactivating the myofascial trigger points has extensively been studied in randomized clinical trials (RCTs). This systematic review was aimed at evaluating the evidence base for the effectiveness of DN for OFP. We searched Medline, Cochrane Central, and Web of Science (from their respective inceptions to February 2024) for RCTs evaluating the effectiveness of DN in patients with OFP. Studies with individuals suffering from cervicogenic or tension type headaches as well as observational studies were excluded. Primary outcomes were pain intensity and severity; secondary outcomes were disability, quality of life, and adverse effects. The review adhered to the methods described by in the Cochrane Handbook. Twenty-four RCTs with a total of 1,318 patients suffering from OFP were included. Most had an unclear or high risk of bias, and the quality of the evidence ranged from very low to low for all comparisons and outcomes. A meta-analysis suggested that, compared with usual care alone, DN + usual care had no effect on pain intensity (visual analogue scale) (standardized mean difference = -1.89, 95% confidence intervals -5.81 to 2.02, very low certainty evidence) at follow-ups of up to 6 weeks. There is little reliable evidence for the effectiveness of DN in reducing OFP. Future, larger, more rigorous studies might reduce the existing uncertainties.

Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis.

Despite the robust evidence demonstrating positive effects from creatine supplementation (primarily when associated with resistance training) on measures of body composition, there is a lack of a comprehensive evaluation regarding the influence of creatine protocol parameters (including dose and form) on body mass and estimates of fat-free and fat mass. Randomized controlled trials (RCTs) evaluating the effect of creatine supplementation on body composition were included. Electronic databases, including PubMed, Web of Science, and Scopus were searched up to July 2023. Heterogeneity tests were performed. Random effect models were assessed based on the heterogeneity tests, and pooled data were examined to determine the weighted mean difference (WMD) with a 95% confidence interval (CI). From 4831 initial records, a total of 143 studies met the inclusion criteria. Creatine supplementation increased body mass (WMD: 0.86 kg; 95% CI: 0.76 to 0.96, I2 = 0%) and fat-free mass (WMD: 0.82 kg; 95% CI: 0.57 to 1.06, I2 = 0%) while reducing body fat percentage (WMD: -0.28 %; 95% CI: -0.47 to -0.09; I2 = 0%). Studies that incorporated a maintenance dose of creatine or performed resistance training in conjunction with supplementation had greater effects on body composition. Creatine supplementation has a small effect on body mass and estimates of fat-free mass and body fat percentage. These findings were more robust when combined with resistance training.

Effect of Age at Liver Transplant on Anxiety, Depression, and Quality of Life Among Adolescents.

Introduction: Life expectancy for pediatric liver transplant patients has increased over the past decade. Different stages of the transplant process can impact patients' quality of life (QOL) and create psychological and physical stressors. This study explored whether age at transplant affected adolescents' feelings of anxiety, depression, and QOL. Design: In this cross-sectional quantitative study, data were collected on 22 adolescent patients aged 13-18 who received a transplant at least 12 months before enrollment. This cohort was divided into 2 groups based on their age at transplant: Group 1 (0-5 years) and Group 2 (6-18 years). To assess transplant-related anxiety, depression, and QOL, participants completed 3 surveys: the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Pediatric Quality of Life Inventory™ Transplant Module (PedsQL TM). Results: Group 1 experienced less anxiety and fewer problems based on GAD-7 scores but reported stronger feelings of depression based on PHQ-9 scores. Based on the PedsQL TM scale, Group 1 had higher mean scores compared to Group 2 across all components (mean difference range: 7.2- 27.3; Cohen's d range: 0.27 - 1.13). The largest difference between the 2 groups was observed on the PedsQL TM scale's How I Look (Group 1 mean 81.1 vs. Group 2 mean 53.8; Cohen's d: 1.13; P = 0.015), Conclusion: In this cohort, age at transplant affected adolescents' feelings of anxiety, depression, and QOL. Awareness of these findings can help clinicians screen for and address mental health issues.

Interplay Exploration of Problematic Internet Usage, Social Isolation and Attitudes: A Quantitative Study Among University Students In Malaysia

Internet overuse is a growing global concern, with addiction and social isolation becoming increasingly prevalent. This study aims to examine the problematic Internet usage and its link to social isolation among the students by assessing their attitudes towards Internet use, its purpose, social isolation, and Internet addiction. A quantitative approach utilizing a questionnaire survey was employed and 440 students from University Putra Malaysia was selected using a stratified random sampling method. The majority of participants (78.3%) fell within the younger age bracket of 18 to 23 years. The study sample predominantly comprised Malay (66.8%) and Muslim (68.9%) students. Chinese students constituted 25% of the sample, while Indians represented 3.9%. The largest religious minority were Buddhists (19.1%), followed by Christians (7.5%). 30% of respondents reported a monthly income between 2100 to 3000 Malaysian Ringgit. Significant associations were found between attitudes towards Internet use and both social isolation and Internet addiction. Similarly, statistically significant relationships were observed between the purpose of Internet use, social isolation, and Internet addiction. However, no significant correlations were found between age, income, Internet addiction, and social isolation. Additionally, ANOVA results indicated no significant mean differences between religion and Internet addiction, although a significant difference was noted for social isolation. This study provides valuable insights for educators, counselors, and policymakers to develop effective programs combating internet addiction among students. By understanding the link between internet use, attitudes, and social isolation, targeted interventions can be created to promote healthy online habits and student well-being. Keywords: Internet Addiction, Social isolation, Attitudes and Purpose of using Internet, Religion, Age and Income

RELATIONSHIP BETWEEN SOCIAL MEDIA SCREEN TIME AND QUALITY OF LIFE AMONG UNDERGRADUATE STUDENTS DURING PANDEMIC COVID19 IN KUALA LUMPUR

Social media can be used as a channel for communication with family members. A strong dependence on the Internet may result from excessive screen time, which can then affect people's mental health and well-being. It has been suggested that adolescent social media use is associated with decreased mental health. One of the key components that affects a person's quality of life is their mental health in the aspects of anxiety and depression levels. This cross-sectional study aimed to measure and analyse the relationship between social media screen time and quality of life among undergraduate biomedical sciences students. In Kuala Lumpur, this study's online survey was carried out. A validated questionnaire about social media use and quality of life was used to conduct this online survey. The study involved 182 respondents. WhatsApp was the most popular communication platform, with 62.6%, followed by Twitter with 12.6%. 52.7% use social media for social and entertainment purposes. There was no significant mean difference in social media usage and screen time between gender, year of study, income, and residency (p&gt;0.05). There was no significant interaction between gender and year of study for social media usage duration(F=1.465, p&gt;0.05). There was no significant correlation between the level of social media with quality of life(p&gt;0.05). Meanwhile, using binary logistic regression analysis, there was no significant relationship between level of screen time with all domains of quality of life. Meanwhile, there is a significant relationship between the level of screen time and the year of study OR=3.67(2nd year) and OR=3.14 (4th year) when compared to the first year (p&lt;0.05). In conclusion, the results suggested there was a significant relationship between social media usage and with year of study. The results suggest that higher education should consider promoting the effective usage of social media using the social media platform as most students nowadays find information on social media. Keywords: Anxiety; depression; social media; screen time; quality of life; undergraduates.