Weighted Mean Difference Research Articles

Comparative efficacy and acceptability of non-invasive neuromodulation technologies and botulinum toxin injections for post-stroke spasticity and motor function: a network meta-analysis of randomised controlled trials.

Non-invasive neuromodulation is a promising approach for improving spasticity and motor function after stroke. However, it is still unclear which type of non-invasive neuromodulation is effective and evidence of important differences between them and botulinum toxin (BoNT) injection is limited. We aimed to assess the comparative efficacy and acceptability of non-invasive neuromodulation technologies and BoNT for post-stroke spasticity and motor function. In this network meta-analysis, Cochrane Library, EMBASE, MEDLINE, Web of Science, Scopus, CNKI, and Wan Fang Data were searched from the earliest records to 8 October 2024. Randomised controlled trials that compared any type of non-invasive neuromodulation therapies, BoNT, and control treatments (including sham or no stimulation/injection) for post-stroke spasticity measured by modified Ashworth scale (MAS) were included. MAS, motor function, and acceptability were pooled using random-effects model with summary weighted mean difference (WMD) or risk ratios (RR) alongside 95% confidence interval (CI). Ranking probabilities of the treatments were estimated. Clinical importance was categorized as definite, probable, possible, or definitely not, considering the relationship between effect measures (95% CI) and minimal clinically important difference (1, 6, and 1.5 points for MAS, motor function, and acceptability, respectively). The quality of evidence was assessed using CINeMA online web. PROSPERO registration CRD42024543494. 6260 studies were identified and 185 trials (11,185 participants; 12 interventions) were included. Compared with control treatments, BoNT, high- and low-frequency repetitive transcranial magnetic stimulation (HFrTMS and LFrTMS), and anodal, cathodal, and dual transcranial direct current stimulation (atDCS, ctDCS, and dtDCS) significantly improved spasticity at short-term follow-up (WMD range-0.81 to-0.31), but did not achieve clinical importance. At mid-term, ctDCS (WMD=-2.00; 95% CI:-3.03,-0.97) and dtDCS (WMD=-1.62; 95% CI:-3.22,-0.02) were more efficacious than control treatments in reducing post-stroke spasticity with probable clinical importance. For motor function, atDCS, ctDCS, and dtDCS were more efficacious than control treatments (WMD range 6.29-13.00), with probable clinical importance, while BoNT, HFrTMS, and LFrTMS with possible clinical importance (WMD range 3.42-5.28). Various modalities have comparable acceptability to control treatments (RR range 0.48-1.46). Confidence in accordance with CINeMA ranged from high to low. Sensitivity and meta-regression analyses on limb measured, cointervention, and stroke stage confirmed the main findings of this study. Taken together with clinical importance, evidence available supports three forms of tDCS as effective treatments for post-stroke spasticity and/or motor impairments, whereas BoNT, HFrTMS, and LFrTMS for motor impairments. These modalities could be considered alongside rehabilitation interventions as core treatments for post-stroke spasticity and motor impairments. China Postdoctoral Science Foundation (2024M752230).

Systematic Review of Surgical Success, Complications, Revision Rates, Radiation Dosage, and Operative Time of 3D-Navigated versus Non-Navigated Spinal Procedures.

Three-dimensional (3D) navigation offers real-time guidance in surgery. However, there is limited and inconsistent data regarding the usability, safety, and efficacy. To address gaps in knowledge about 3D navigation in spinal surgery, we conducted a comprehensive review of success rates, complications, revisions, radiation exposure, and operative time associated with Federal and Drug Administration-approved 3D surgical navigation tools. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used a protocol registered on International Prospective Registration of Systematic Reviews (CRD42023404554). Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched using relevant keywords for 3D surgical navigation and spinal procedures from 1946 to March 02, 2023. Two independent reviewers assessed the studies using inclusion/exclusion criteria and risk of bias tools. Statistical analyses included one-way analysis of variance, weighted-mean difference, and unpaired t-tests with Welch's correction for associations and comparisons between groups, respectively. Of the total 11,324 studies identified and 7198 screened, 62 studies totaling 3170 adult patients were included in this comprehensive review. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.5% and 94.0%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r= 0.25, P= 0.68). The most commonly reported complication was pedicle screw malposition or breach. A subset of 20 studies, totaling 1554 patients, compared the performance of 3D navigation to two-dimensional fluoroscopy or freehand navigation. There was a significant difference of 6.53% between surgical success rates of the 3D-navigated and control groups (P= 0.03). However, there was no significant difference in radiation exposure or operative time. The 3D navigation in spinal procedures has higher surgical success rates than two-dimensional fluoroscopy and freehand navigation. Included studies exhibited varying limitations, including no patient follow-up (n= 1), less than 10 patients (n= 6), various types of spinal disorders (n= 1), and varying comorbidities among participants (n= 2). Improving 3D navigation tools remains imperative to decrease operative time and radiation exposure.

Effect of Vitamin D Supplementation on Lipid Profile in Overweight or Obese Women: A Meta-analysis and Systematic Review of Randomized Controlled Trials.

Previous studies have explored the relationship between vitamin D and lipid profile in individuals with obesity or overweight women, but the results have been inconsistent. This meta-analysis and systematic review of randomized controlled trials (RCTs) was conducted to assess the effect of vitamin D on lipid profile in women who are overweight or obese. A meticulous search strategy was used across the Scopus, PubMed/Medline, Web of Science, and Embase databases up to June 2024. RCT studies administering vitamin D to overweight or obese women were extracted. A random-effects model was applied to compute the weighted mean difference (WMD) and 95% CIs of the intervention on each variable. Thirteen eligible publications with 16 arms focused on low-density-lipoprotein cholesterol (LDL-C), 16 arms on high-density-lipoprotein cholesterol (HDL-C), 18 arms on total cholesterol (TC), and 18 arms on triglycerides (TG) were included in the final quantitative analysis. Vitamin D supplementation resulted in significant reductions in TG (WMD: -6.13 mg/dL; 95% CI: -8.99 to -3.28; P = .000) and TC (WMD: -4.45 mg/dL; 95% CI: -7.06 to -1.83; P = .001), as well as a significant increase in HDL-C concentrations (WMD: 1.54 mg/dL; 95% CI: 0.57 to 2.52; P = .002). Stratified analysis indicated a greater reduction in TG levels in studies with a mean baseline TG concentration ≥150 mg/dL (WMD: -23.58 mg/dL) and when vitamin D was administered for ≤26 weeks (WMD: -11.44 mg/dL). According to our findings, vitamin D has a significant effect on hypertriglyceridemia in individuals who are overweight or obese. However, vitamin D has no significant effect on LDL-C concentrations in this population.

Effects of Photobiomodulation on Burning Mouth Syndrome: A Systematic Review and Meta-Analysis.

The objective of this research is to evaluate the effectiveness and safety of photobiomodulation or low-level laser therapy on burning mouth syndrome compared to placebo, no-laser, clonazepam and alpha-lipoic acid. A systematic review of randomised clinical trials was performed. The databases consulted were MEDLINE, CENTRAL, LILACS, EMBASE and clinical trial registries ClincalTrial.org and WHO-ICTRP, to retrieve citations published until April 4, 2023. In addition, we consulted the grey literature for unpublished studies. There were no restrictions on language, publication status and publication date. Outcomes included pain relief, change in oral health quality of life, adverse effects and change in the quality of life concerning anxiety and depression. Two independent authors performed the study selection, and the risk of bias was assessed using the Cochrane collaboration tool. The random effect was calculated with a 95% confidence interval to calculate the relative risk. We performed heterogeneity by I2 and subgroup analysis. For all calculations, we used Review Manager 5.4.1 software. In total, 528 references were located, and 13 studies were included, with 503 participants. Seven studies were evaluated qualitatively, and six were grouped for data meta-analysis according to the type of laser used, red or infrared. The following comparisons were evaluated: laser versus placebo, laser versus clonazepam and laser versus alpha-lipoic acid. Less pain was reported with the use of a laser, with low quality of evidence, in the comparisons: red laser versus placebo with a weighted mean difference (WMD) of -1.18; 95% CI [-2.16 to -0.19]; I2 = 61%; N = 58; 2 RCTs; infrared laser versus placebo with WMD = -1.34; 95% CI [-1.86 to -0.82]; I2 = 14%; N = 87; 3 RCTs; laser versus clonazepam with mean difference (MD) of -1.66; 95% CI [-3.17 to -0.15]; I2 = 0%; N = 33; 1 RCT. Oral health quality of life was better with the use of the laser, with very low quality of evidence, in the comparisons: red laser versus placebo with WMD = -1.08; 95% CI [-1.49 to -0.66]; I2 = 0%; N = 105; 2 RCTs; infrared laser versus placebo with WMD = -0.46; 95% CI [-1.70 to 0.78]; I2 = 86%; N = 85; 3 RCTs; laser versus clonazepam with MD = -19.65; 95% CI [-45.97 to 6.67]; N = 33; 1 RCT. For anxiety and depression, there was no significant difference between the groups, with very low quality of evidence, in the comparisons: infrared laser versus placebo, for anxiety with MD = 0.11; 95% CI [-2.64 to 2.86]; N = 28; 1 RCT; and for depression with MD = -0.66; 95% CI [-3.56 to 3.44]; N = 28; 1 RCT. Likewise, the comparison of laser versus clonazepam for anxiety and depression with MD = 1.05; 95% CI [-2.83 to 4.93]; N = 33; 1 RCT. Pain was less common, and quality of life was better when using a low-level laser than placebo and clonazepam. The certainty of the evidence obtained was low and very low, respectively, meaning that the true effect may differ substantially from the effect estimate. Further well-conducted RCTs are needed to increase the degree of certainty of the evidence obtained.

The Effects of Exercise Training on Body Composition and Cardiometabolic Risk Factors in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Introduction and Aim: We performed a systematic review and meta-analysis to investigate the effects of exercise training on body composition and cardiometabolic health in patients with Type 1 diabetes (T1D). Method: A search in three main databases including PubMed, Web of Science, and Scopus was conducted from the inception of this review until June 2024 to identify randomized control trials investigating the effects of exercise training compared to a control on body composition and cardiometabolic risk factors in patients with T1D. The data were pooled using random effects models to calculate weighted mean differences (WMDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs). Results: Overall, 25 studies involving 1120 patients with T1D were included in the meta-analysis. Exercise training decreased body mass index (BMI) [WMD: −0.18 kg.m2, p = 0.02], fasting glucose [WMD: −14.97 mg/dl, p = 0.01], and HbA1c [WMD: −0.49%, p = 0.003], and increased VO2max/peak [WMD: 2.76 mL/kg/min, p = 0.001] as compared with controls. Exercise training had no effect on body fat percentage or lean body mass, lipid profiles, or blood pressure. Subgroup analysis indicated that age, exercise mode, and intervention duration were the main moderators for the beneficial effects of exercise training. Conclusions: In patients with T1D, exercise training is effective for decreasing body weight and cardiometabolic risk factors.

Treatment for anxiety, depression, and stress in pregnant people experiencing antepartum hospitalization: a systematic review and meta-analysis.

To systematically evaluate inpatient interventions to reduce symptoms of anxiety, depression, or stress in pregnant individuals during antepartum hospitalization. Searches were conducted in Ovid MEDLINE, Embase, CINAHL Plus, Cochrane CENTRAL, and PsycINFO from database inception through April 2023. Randomized controlled trials and cohort studies were eligible for inclusion if an intervention was compared to treatment as usual (TAU) to reduce symptoms of anxiety, depression, or stress among pregnant individuals admitted to a hospital's antepartum unit. Two authors independently screened all abstracts for eligibility and reviewed all potentially eligible full-text articles for inclusion. The primary outcome was the score on the assessment for symptoms of anxiety, depression, or stress after the intervention. The Hedges method was used to detect standardized mean difference (SMD) in studies using different psychometric scales, and weighted mean differences (WMD) were used in studies using the same psychometric scales. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Of 1185 articles originally identified, 19 full-text manuscripts were reviewed, and three studies (all randomized controlled studies)-corresponding to 226 patients randomized to an intervention and 263 patients randomized to TAU-were included. Compared to TAU, interventions significantly reduced mean scores on validated scales assessing symptoms of anxiety (SMD -0.65 [95% Confidence Interval (CI) -0.83, -0.46]), depression (WMD -0.52 [95% CI -0.76, -0.28]), and stress (WMD -0.57 [95% CI -0.82, -0.31]). Though data are limited, interventions given to birthing people who experience antepartum hospitalization modestly-but significantly-reduce symptoms of anxiety, depression, and stress. These data highlight a need for further high-quality trials to support the mental health needs of this high-risk population. This project was supported by the Department of Maternal Fetal Medicine at the Alpert School of Medicine of Brown University. AKL was supported by NICHD (K23HD103961). ESM was supported by NICHD (R01HD105499) and NINR (R01NR021126-01). LGW was supported by K23HD107296-01A1 and P20GM139767. PROSPERO, CRD42023444189.

The effect of propolis supplementation on blood pressure: a systematic review and meta-analysis of controlled trials.

The current meta-analysis aimed to determine the efficacy of propolis supplementation on hypertension. The systematic review and meta-analysis. were undertaken on five online databases to find clinical trials assessing the effects of propolis on systolic blood pressure (SBP) and diastolic blood pressure (DBP) markers up to October 2023. The pooled estimation of the weighted mean difference (WMD) and the corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model. Egger's regression test was used to assess publication bias. A significant decrease was observed in SBP levels following propolis supplementation (WMD=-5.58 mmHg, 95% CI: -7.74, -3.42; I2=42.99%, P=0.08). However, no significant change was found in the levels of DBP (WMD=-1.34 mmHg, 95% CI: -6.10, 3.41; I2=75.94%, P<0.01). Moreover, studies with an experimental design (-5.53, 95% CI: -13.24, 2.18) and trials with <30 individuals (-3.96, 95% CI: -7.98, 0.06) did not demonstrate a significant impact of propolis on SBP levels. In trials with an experimental design, a substantial decrease in DBP levels was seen in subgroup analyses after propolis supplementation (-9.29, 95% CI: -12.50, -6.08). The results of the study revealed the positive effects of propolis supplementation in the context of hypertension, as evidenced by a reduction in SBP levels.

Post-transplant cyclophosphamide versus anti-thymocyte globulin in haploidentical stem cell transplantation: a systematic review and meta-analysis.

Post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are mainstay prophylactic treatment options for graft-versus-host disease (GVHD), widely used in haploidentical stem cell transplantation. Due to a lack of prospective studies, a number of retrospective comparisons have yielded different conclusions as to which prophylaxis regimen is superior. We performed a meta-analysis of these studies to get more informed and comprehensive decisions from clinicians. Nine studies were eligible, and a total of 1674 patients were included. The combined hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) results demonstrated that, compared with ATG, PTCy demonstrated better overall survival (OS) (HR 0.7, 95% CI 0.51-0.97), leukemia-free survival (LFS) (HR 0.66, 95% CI 0.53-0.81), and GVHD-free/relapse-free survival (GRFS) (HR 0.79, 95% CI 0.65-0.97); faster lymphocyte reconstitution, lower risk of relapse (HR 0.69, 95% CI 0.53-0.9) and fungal infection (RR 0.23, 95% CI 0.07-0.79). However, neutrophil engraftment was delayed in the PTCy regimen group (WMD 3.29, 95% CI 2.49-4.10). No statistically significant differences were observed in the time to platelet engraftment, bacterial infection, or viral infection, including cytomegalovirus, polyomaviruses BK/JC and Epstein-Barr virus. Nor was any statistically significant difference observed in the incidences of II-IV acute-GVHD (aGVHD) (HR 0.81, 95% CI 0.62-1.05), III-IV aGVHD (HR 0.67, 95% CI 0.22-2.19) or severe chronic-GVHD (cGVHD) (RR 1.22, 95% CI 0.51-2.88), or non-relapse mortality (NRM) outcomes (HR 0.67, 95% CI 0.4-1.11). Therefore, in haploidentical transplantation, PTCy accelerates lymphocyte reconstitution, significantly reduces the risk of recurrence and fungal infection, and improves the OS, LFS and GRFS, compared with ATG, with no significant difference in the efficacy of preventing acute or severe cGVHD, or the risk of bacterial or viral infection.

Exploring utilities of [64Cu]Cu-DOTA-trastuzumab immunoPET in breast cancer: a systematic review and meta-analysis.

[64Cu]Cu-DOTA-trastuzumab represents a novel immunopositron emission tomography (immunoPET) agent with emerging diagnostic applications in human epidermal growth factor receptor-2 (HER2)-expressing breast cancer (BC). This systematic review and meta-analysis evaluates the current diagnostic utilities of [64Cu]Cu-DOTA-trastuzumab PET/computed tomography (CT) and explores tumor uptake metrics in HER2-positive BC lesions. A systematic literature search of PubMed, Scopus, and Ovid databases was conducted using relevant keywords to identify eligible studies. Of the 123 articles reviewed, six met the inclusion criteria. Qualitative data analysis was applied to all included studies. Several promising utilities were identified, including [64Cu]Cu-DOTA-trastuzumab's capacity to detect HER2-positive primary BC lesions, lymph nodes, and distant metastases. Additionally, [64Cu]Cu-DOTA-trastuzumab PET/CT demonstrated potential in predicting therapy response in HER2-positive lesions. The overall lesion detectability was 91% [95% confidence interval (CI), 81-98%] for HER2-positive BC. HER2-positive BC lesions exhibited significantly higher maximum standardized uptake values compared to HER2-negative lesions, with a weighted mean difference of 2.14 (95% CI, 0.18-4.09; P = 0.03). These findings underscore the need for further large-scale and prospective investigations of this promising radiotracer in the near future.

Different regimens of preoperative carbohydrate loading on insulin resistance: A network meta-analysis.

The effectiveness of preoperative carbohydrate loading(PCL) on postoperative insulin resistance(IR) is controversial. In addition, the effect of different doses of carbohydrates on postoperative IR is also controversial. Therefore, this study aimed to investigate the efficiency of PCL on postoperative IR and the optimal regimen for the effect on postoperative IR. A systematic search of clinical randomized controlled trials was performed to extract basic information about the included studies, specific regimens of PCL, and preoperative and postoperative IR. Network meta-analysis was performed using frequentist random effects. A total of 7 regimens were identified by categorizing them based on frequency, timing, control groups, and conducting subgroup analysis according to surgical procedure. High (>45g) and low (≤45g) doses were divided according to the standard definition of PCL. Dose analysis was performed on studies in the subgroups that met the optimal frequency and timing regimen. Reporting of results based on weighted mean differences(WMD), 95% confidence intervals(95%CrI), and the surface under the cumulative ranking(SUCRA). Carbohydrate loading given only 3h before surgery is more strongly associated with insulin resistance than fasting(WMD:-4.04,95%CrI:-5.67 to-2.40) and placebo(WMD:-4.00,95%CrI:-5.98 to-2.02). Single-dose preoperative 3h regimen has the highest probability of being the optimal regimen(SUCRA=90.9%). This is also true in open(SUCRA=93.7%) and laparoscopic surgery(SUCRA=99.9%). Analyzed using a fixed-effects model in open and laparoscopic surgery. In open surgery, high-dose and low-dose carbohydrates are associated with postoperative IR compared with fasting(high-dose: WMD:-1.75,95%CrI:-1.95 to-1.54; low-dose: WMD:-2.46,95%CrI:-3.70 to-1.23) and placebo(high-dose: WMD:-5.37,95%CrI:-6.99 to-3.76; low-dose: WMD:-6.09,95%CrI:-7.29 to-4.90). Low-dose carbohydrates(SUCRA=95.3%) have the highest probability of being the best option. In laparoscopic surgery, high-dose and low-dose carbohydrates are also associated with postoperative IR compared with fasting(high-dose (WMD:-5.70,95%, CrI:-7.63 to-3.77); low-dose (WMD:-3.69,95%CrI:-4.11 to-3.27))and placebo(high-dose (WMD:-5.73,95%CrI:-7.72 to-3.74); low-dose (WMD:-3.72,95%CrI:-4.14 to-3.30)). SUCRA for high-dose carbohydrates is 99.2%. Preoperative implementation of carbohydrate loading is more beneficial in alleviating postoperative insulin resistance than fasting and placebo. Conducting PCL on the morning of surgery is more effective in relieving postoperative IR. For both open and laparoscopic surgeries, administering carbohydrate loading 3h before the surgery may represent the optimal regimen. Further studies are needed to investigate the effect of different doses on postoperative IR.

A meta-analysis of intravitreal ranibizumab versus laser photocoagulation for the treatment of retinopathy of prematurity.

Laser photocoagulation (LPC) has been a traditional treatment for retinopathy of prematurity (ROP). However, intravitreal anti-VEGF agents such as bevacizumab and ranibizumab (IVR) have also been increasingly used. This meta-analysis aims to rigorously compare IVR to LPC in the treatment of ROP. Medline, Embase and Cochrane CENTRAL were used to identify studies comparing IVR monotherapy to LPC (PROSPERO ID: CRD42023390855). The primary outcome was ROP regression. Secondary outcomes included likelihood of additional treatment, time from treatment to reactivation or re-treatment, refractive outcomes and adverse events such as retinal detachment, cataract, macular dragging/ectopia, vitreous or retinal hemorrhage, glaucoma, and endophthalmitis. A random effects meta-analysis was designed. 2361 articles were identified. 1947 eyes from 7 cohort studies, 1 case-control study and 2 RCTs were included with a median follow-up of 21 months (range: 11-75 months). There was no significant difference in disease regression between IVR and LPC (risk ratio [RR]=0.96, 95% confidence interval [CI] [0.83, 1.10], p=0.52), however, eyes that underwent IVR were associated with a higher likelihood of requiring additional treatment (RR= 2.70, CI= [1.55, 4.68], p<0.001). Although less frequent, retreatment occurred earlier with LPC compared to IVR (weighted mean difference (WMD)= -4.29 weeks, CI= [-6.48, -2.10], p<0.001). Furthermore, eyes that received IVR had a lower refractive error, with a WMD of -0.93 diopters (CI= [-1.54, -0.32], p=0.003) at a median age of assessment of 5.0 years (range 1.5-6.3 years). There was no difference in the rate of adverse events between LPC and IVR (p>0.05 for RD, MDR, VH and cataract). Quality of evidence was rated moderate for likelihood and time of additional treatment, as well as refractive error, but was considered low for disease regression and adverse events. Compared to LPC, IVR was associated with a higher likelihood of requiring additional treatment but a lower risk of myopia. More studies are needed to evaluate dose-response relationships and temporal trends in ROP regression following these treatments.

Clinical efficacy and safety of sodium thiosulfate in the treatment of uremic pruritus: a meta-analysis of randomized controlled trials.

Uremic pruritus (UP) is a debilitating condition frequently associated with chronic kidney disease, severely impairing patients' quality of life and contributing to increased mortality. Recent studies have suggested that intravenous sodium thiosulfate (STS) may offer therapeutic relief for pruritus in patients undergoing hemodialysis. To assess its effectiveness, we conducted a systematic review and meta-analysis to explore the potential of intravenous STS in managing UP. A comprehensive search of electronic databases was performed up to September 2024 to identify randomized controlled trials evaluating the clinical efficacy of STS in treating UP. Eight studies, encompassing 520 participants, were included in the analysis. The findings indicated that the STS group achieved a significantly higher rate of pruritus suppression compared to control groups. The STS group showed a marked reduction in the Visual Analogue Scale (weighted mean difference = -5.023; 95% CI: -6.137 to -3.909; P < 0.001) and Pittsburgh Sleep Quality Index (weighted mean difference = -4.754; 95% CI: -5.432 to -4.075; P < 0.001). The STS group demonstrated a decrease in CRP levels compared to the non-treatment group in the context of treating UP (WMD = -1.269; 95% CI: -2.014 to -0.523; P = 0.007). No significant differences were observed between the STS and control groups regarding parathyroid hormone, serum calcium, or serum inorganic phosphorus. While this meta-analysis demonstrated a reduction in pruritus symptoms with STS administration, the evidence remains insufficient to conclusively support its therapeutic benefit in managing UP. Further well-designed studies with larger sample sizes are needed to confirm these findings.

Different treatment for humeral shaft fractures: A network meta-analysis.

The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures. We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The "Risk of Bias Assessment" tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis. A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8-7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = -4.4, 95% confidence intervals, -8.7 to -0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05). The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study's results, more high-quality randomized controlled trials are needed in the future to verify these findings.

The efficacy and safety of Baduanjin exercise as complementary therapy for pain reduction and functional improvement in knee osteoarthritis: A meta-analysis of randomized controlled trials.

To systematically evaluate the efficacy and safety of Baduanjin exercise in patients with knee osteoarthritis through meta-analysis. While Baduanjin exercise, a traditional Chinese exercise therapy, is part of complementary and alternative medicine, its therapeutic value for knee osteoarthritis remains uncertain due to limited supporting evidence. This study seeks to address this gap. The study protocol has been registered in PROSPERO(CRD42024501559). A systematic review and meta-analysis were conducted by searching six databases up to January 2024 (PubMed, Cochrane Library, EBSCO, Web of Science and CNKI, and Wanfang Medical), including RCTs that assessed Baduanjin exercise for KOA treatment. Two reviewers independently selected studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias tool (RoB2). Meta-analyses were performed using RevMan version 5.4.1 software. The outcome indicators included the WOMAC knee pain score, stiffness score, and physical function score, as well as the total score and adverse events. For summary results, weighted mean difference (MD) and 95 % confidence intervals (CI) were used. Twelve RCTs involving 846 participants were included. Baduanjin exercise significantly improved WOMAC pain score (MD=-2.59, 95 % CI: -4.20 to -0.97, P = 0.002), stiffness score (MD=-2.42, 95 % CI: -3.75 to - 1.08, P = 0.004), physical function score (MD=-4.42, 95 % CI: -5.67 to -3.17, P < 0.00001), and total score (MD=-11.27, 95 % CI: -14.26 to -8.28, P < 0.00001) compared to controls. Subgroup analyses revealed significant improvements regardless of intervention duration, frequency, or location. No adverse events were reported. However, high heterogeneity and methodological biases were observed. Baduanjin exercise appears to be an effective and safe complementary therapy for improving pain and function in patients with KOA. High-quality RCTs are needed to confirm these findings and explore optimal intervention parameters. Future research should address the identified methodological limitations.

Efficacy and safety of acupuncture with moxibustion for knee osteoarthritis: a meta-analysis of randomized controlled trials

BackgroundOsteoarthritis (OA) is prevalent, yet its management remains challenging. This meta-analysis aims to evaluate the efficacy of acupuncture combined with moxibustion versus other standard treatments in patients with knee osteoarthritis (KOA) based on randomized controlled trials (RCTs).MethodsSearches were conducted in Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to retrieve relevant RCTs. Data on baseline characteristics, treatment efficacy, and adverse events were extracted. The analysis utilized pooled weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CIs) to assess the superior treatment modality.ResultsA total of 18 RCTs were included. Acupuncture combined with moxibustion demonstrated significant improvement in the visual analog scale (VAS) for pain and the long-term (> 60 weeks) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function compared to other treatments. In contrast, short- (< 4 weeks) and mid-term (6–60 weeks) WOMAC outcomes for pain, stiffness, and physical function indicated varied results. The overall efficacy rate also favored the combined therapy significantly in the short- and mid-term evaluations. Notably, this therapy was associated with fewer adverse events.ConclusionThe meta-analysis reveals that acupuncture combined with moxibustion is notably more effective and safer than other treatment modalities for KOA, particularly during mid- and long-term follow-up periods.

Predictive value of lymphocyte-associated inflammation index in post-stroke cognitive impairment: a systematic review and meta-analysis

BackgroundThe predictive role of the lymphocyte-associated inflammation index in post-stroke cognitive impairment (PSCI) remains controversial. Therefore, we performed an updated meta-analysis to update the evidence.MethodsThis meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were systematically searched from their inception to May 5, 2024. Two investigators independently conducted literature screening and data extraction for the included studies. Two investigators independently assessed the quality of the included studies using the Newcastle-Ottawa Scale (NOS). Combined effect sizes were calculated using weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs). Heterogeneity was tested using the chi-square (χ2) test (Cochran’s Q) and index of inconsistency (I2), Publication bias was assessed using funnel plots and Egger’s regression test.ResultsThis systematic review included a total of 16 studies, encompassing 3,406 patients. Meta-analysis revealed that neutrophil-to-lymphocyte ratio (NLR) levels were significantly higher in the PSCI group compared to the non-PSCI group (WMD: 1.12; 95% CI: 0.85, 1.40; p &amp;lt; 0.00001). Similarly, the platelet-to-lymphocyte ratio (PLR) levels were significantly higher in the PSCI group compared to the non-PSCI group (WMD: 16.80; 95% CI: 4.30, 29.29; p = 0.008). However, there was no statistically significant difference between the two groups concerning hemoglobin, albumin, lymphocyte, and platelet (HALP) scores (WMD: -12.78; 95% CI: −25.95, 0.38; p = 0.06) and lymphocyte count (WMD: -0.13; 95% CI: −0.34, 0.07; p = 0.20).ConclusionIncreased levels of PLR and NLR are strongly associated with the PSCI, which may serve as an effective tool for predicting PSCI. However, there is insufficient evidence to support a direct relationship between HALP scores, lymphocyte count, and PSCI.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023462232.

Silent cerebral lesions after catheter ablation for atrial fibrillation using cryoballoon, hotballoon, laserballoon and radiofrequency catheters: a Bayesian network meta-analysis.

Catheter ablation (CA) is an effective therapeutic option for patients with symptomatic atrial fibrillation (AF). Previous studies have reported silent cerebral lesions (SCLs) detected by magnetic resonance imaging (MRI) after different CA techniques; however, the results were controversial. Therefore, we performed this network meta-analysis (NMA) to assess the incidence of SCLs after cryoballoon, hotballoon, laserballoon, and radiofrequency ablation (RFA). Databases such as PubMed, Embase, and the Cochrane Library were searched systematically. Both pairwise meta-analysis (PMA) and NMA were conducted. The primary outcome was the incidence of new SCLs on MRI after CA procedures. Nine studies were analyzed and 1,057 patients were enrolled. Laserballoon ablation (LBA) had a higher incidence of SCLs than cryoballoon ablation (CBA) [odds ratio [OR] = 1.86, 95% confidence interval [CI] 1.06-3.27, p = 0.032] in the PMA, while no significant difference was detected between the CA techniques according to the NMA. The surface under the cumulative ranking curve (SUCRA) values indicated that CBA may be the best therapeutic option (SUCRA = 81.1%). The NMA results demonstrated similar procedure-related complication rates and mean activated clotting time between CBA (SUCRA = 53.7%, 66.3%), hotballoon ablation (HBA) (SUCRA = 81.5%, 43.6%), LBA (SUCRA = 3.39%, 42.8%) and RFA (SUCRA = 61.3%, 47.3%). LBA therapy required significantly more procedure time than CBA [weighted mean difference (WMD) = 24.36 min, 95% CI 12.51-36.21 min, p = 0.00]. CBA treatment had lower incidence of post-procedural SCLs and took less procedure time compared with LBA for patients with AF. The procedure-related complications were comparable between CBA, LBA, HBA and RFA. PROSPERO, identifier (CRD42024511110).

Bone expansion as a horizontal alveolar ridge augmentation technique: a systematic review and meta-analysis.

Bone expansion is one of the quickest, simplest, and most reliable methods of alveolar ridge augmentation for implant placement. This systematic review is designed to investigate the outcomes of the bone expansion technique for horizontal ridge augmentation. The protocol of study has been prospectively registered into PROSPERO (CRD42023414686). Pubmed, Embase, Web of Science, and Scopus databases were searched. Human original articles utilizing different bone expansion procedures for horizontal ridge augmentation without the use of bone materials or combined with vertical ridge augmentation techniques were included in the study. Qualitative and quantitative synthesis have been conducted. I-squared was used to assess heterogeneity. Meta-regression, forest plots random-effect model, and weighted mean difference were used for analysis. Leave-one-out influence analysis for finding outliers. Egger's publication bias test and Funnel plots were used to address publication bias. 3291 records were identified. Ten articles were included in this study after screening. The survival and complication rates of implants placed simultaneously with bone expansion was 100% 100% (95% CI: 99-100%) and 0% (95% CI: 0-1%), respectively. The meta-regression revealed that by each month passing from the implant placement the survival probability would be decreased significantly by 0.08% (95% CI: 0.009-0.15%; P = 0.03). The weighted mean ridge width difference before and after the osseodensification was 1.55mm (95% CI: 0.92-2.17mm). Based on the study's limitations it can be concluded that the bone expansion procedure can be considered an efficient and safe method regarding the survival and complication rates of placed implants. N/A.

The Effect of Prebiotics, Alone or as Part of Synbiotics, on Cardiometabolic Parameters in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: This systematic review and meta-analysis aimed to investigate the effect of prebiotics, alone or as part of synbiotics, on cardiometabolic parameters in polycystic ovary syndrome (PCOS) women. Methods: Databases, including PubMed, Scopus, ISI Web of Science, Embase, and the Cochrane Central Register of Controlled Trials, were searched for relevant randomized-controlled trials (RCTs) until 12 December 2024. Changes in mean ± standard deviations were extracted and combined using a random-effects model. Bias was assessed using Cochrane risk of bias and evidence quality with GRADE. Results: Twenty RCTs with 1271 participants were included. Results showed high-quality evidence supporting prebiotics' effects, alone or as part of synbiotics, in reducing body-mass index [n = 853; weighted-mean difference (WMD): -0.510, 95%CI: -0.669, -0.351 kg/m2] and diastolic blood pressure (WMD: -2.218, 95%CI: -4.425, -0.010 mmHg), moderate-quality evidence for weight, waist-to-hip ratio, and triglycerides improvements, and low or very-low-quality evidence for waist circumference (WC), fat mass, fasting plasma glucose, fasting insulin, low-density lipoprotein (LDL), total cholesterol (TC), high sensitive-C reactive protein, total testosterone, follicle-stimulating hormone and free androgen index improvements. Subgroup analyses revealed possible reduction in LDL with prebiotics, as well as possible decreases in WC, TC, and total testosterone with synbiotics. Dietary approaches to stop hypertension diet improved insulin sensitivity. Conclusions: This study suggests that prebiotics may beneficially affect several cardiometabolic parameters in PCOS women. Approximately one-third of the results were based on moderate-to-high-quality evidence. This study highlights the need for future well-designed, larger RCTs with longer treatment duration to strengthen the evidence base and guide clinical decision-making.

Long-Term Effects of Sinus Floor Elevation with and Without Bone Graft: A Systematic Analysis of Randomized Clinical Trials.

Background and Objective: The aim of this systematic review was to assess clinical trials on the efficiency of sinus lift techniques with and without bone grafting in the atrophic posterior maxilla. Materials and Methods: This article was written under the PRISMA and the Cochrane Handbook for Systematic Reviews of Interventions guidelines. PubMed, Scopus, and Web of Science databases were electronically searched until December 2023. The risk of bias was assessed according to Cochrane Risk of Bias tool guidelines. Statistical analysis was performed for implant survival rate (ISR), marginal bone loss (MBL), and endo-sinus bone gain (ESBG). Results: At the end of the electronic search, 5 clinical trials were considered eligible. Statistical analysis was achieved for osteotome sinus floor elevation. The ISR at 3 years had a risk ratio (RR) of 0.98 [0.90, 1.07] (CI 95%), p = 0.7, and at 5 years, RR 1.02 [0.93, 1.11] (CI 95%), p = 0.68. The MBL, at 3 years, indicated a weighted mean difference (WMD) of 0.01 [-0.15, 0.16] (CI 95%), p = 0.93, and at 5 years, WMD of -0.08 [-0.53, 0.37] (CI 95%), p = 0.73. ESBG at 3 years had a WMD of -0.44 [-1.05, 0.17] (CI 95%), p = 0.16, and at 5 years, WMD of -0.61 [-1.63, 0.41] (CI 95%), p = 0.24. Conclusions: The available evidence underlines that the osteotome sinus floor elevation technique without bone graft may be used.