Mean Difference Research Articles

The effects of propolis supplementation on blood pressure in adults: a systematic review and meta-analysis of clinical trials

Purpose Recent trials have found that propolis supplementation can beneficially reduce blood pressure (BP) in adults, but there is no definitive consensus on this topic. The purpose of this study is to provide an overview and update the current documents regarding the effects of propolis supplementation on BP by presenting a systematic review and meta-analysis. Design/methodology/approach The systematic search was conducted, considering all studies published up to July 2024, in the following databases: PubMed, Scopus, Cochrane Library and ISI Web of Science. Data were pooled by using the random-effects model, and weighted mean difference (WMD) was considered as the summary effect size. Findings In this systematic review and meta-analysis, eight clinical trials were included. The obtained results show that propolis supplementation caused a significant decrease in systolic BP (WMD = −3.93 mmHg, 95% CI = −7.05 to −0.82, p = 0.01 and I2 = 45.2%). However, the meta-analysis results showed that propolis supplementation did not significantly change the levels of diastolic BP (WMD = −1.64 mmHg, 95% CI = −4.60 to 1.32, p = 0.27 and I2 = 74.0%). Originality/value The findings of this study suggest that propolis supplementation may be used as a dietary supplement to improve systolic BP, but further studies are needed to confirm these results.

Combined high-intensity interval and resistance training improves cardiorespiratory fitness more than high-intensity interval training in young women with overweight/obesity: a randomized controlled trial

ObjectiveThis study aimed to compare the effects of high-intensity interval training (HIIT) combined with resistance training (RT) versus HIIT alone on body composition, cardiorespiratory fitness and glycolipid metabolism in young women with overweight/obesity.MethodsThis randomized controlled trial divided 40 subjects into an experimental group (HIIT+RT) and a control group (HIIT). Both groups underwent training three times per week for eight weeks. Body composition, cardiorespiratory fitness and glycolipid levels were assessed before and after the intervention.ResultsThe results revealed that compared to baseline, both the experimental and control groups showed significant improvements in body weight, body mass index (BMI), Body fat, waist circumference (WC), waist-hip ratio (WHR), peak oxygen uptake (VO2peak), vital capacity (VC), oxygen pulse (VO2/HR), minute ventilation, resting heart rate, blood oxygen saturation, blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (p<0.05). Additionally, a significant increase in muscle mass and a significant reduction in 2-hour postprandial glucose were observed in the experimental group (p<0.05). Muscle mass (mean difference: 2.75%), VO2peak (mean difference: 1.61 mL/min/kg), VC (mean difference: 334mL), and VO2/HR (mean difference: 0.51mL/beat) showed greater improvement in the HIIT+RT group compared to the HIIT group (p<0.05).ConclusionIn conclusion, an 8-week regimen of either combined HIIT and RT or HIIT significantly improves body composition, cardiorespiratory fitness and glycolipid metabolism in women with overweight/obesity. However, the combined training appears to offer more benefits than HIIT alone. Further research is needed to evaluate the long-term effects and feasibility of combined training.Trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300075961.

Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure

BACKGROUND: Fewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy. METHODS: Utilizing the American Heart Association’s Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%–100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups. RESULTS: Among 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16–2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11–1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58–2.31]). Patients with no insurance (AMD, −4.90 percentage points [−5.62 to −4.17]), Medicaid (AMD, −0.45 percentage points [−0.89 to −0.01]), and Medicare (AMD, −1.64 percentage points [−2.10 to −1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, −3.40 percentage points [95% CI, −4.10 to −2.71]). CONCLUSIONS: Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.

Use of in situ simulation to improve team performance and utilization of a rapid sequence intubation checklist

AbstractBackgroundIntubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PEDs). This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve PED team performance during RSI scenarios through utilization of an RSI checklist.MethodsWe created a checklist modeled after previously published PED checklists. PED multidisciplinary teams participated in video‐recorded SIM training sessions involving a scenario requiring intubation three times, first without interruption then while receiving our intervention of rapid‐cycle deliberate practice (RCDP) debriefing focusing on checklist utilization and team dynamics. Learners went through the scenario once more uninterrupted to apply learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention along with pre‐ and postintervention surveys.ResultsA total of 483 learners participated in 64 SIM training sessions, 44 of whom met inclusion criteria and were included for data analysis. Scores increased postintervention for airway management, human factors and in total. Least‐squares mean differences for total, airway, and human factors scores were 9.55 (95% confidence interval [CI] 7.24–11.85), 4.22 (95% CI 2.91–5.52), and 5.33 (95% CI 3.86–6.8), respectively, which was statistically significant with p‐value of <0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort postintervention.ConclusionsThis study supports the benefit of multidisciplinary SIM training with RCDP‐style methodology as an educational method for improving airway management, teamwork skills, and RSI checklist utilization for PED staff. Incorporation of additional maintenance SIM sessions for ongoing education is likely to be further beneficial and would allow evaluation of degradation of skills over time following initial training.

Multisensory stimulation to reduce procedural pain in retinopathy of prematurity: A randomized controlled trial

AbstractBackgroundRetinopathy is frequently seen in the neonatal intensive care unit (NICU), and its examination is a painful procedure for infants.AimThis randomized active‐controlled trial aimed to investigate the impact of multisensory stimulation (MSS) on neonatal pain during retinopathy of prematurity (ROP) examinations, in comparison with a white noise (WN) and control group receiving standard care.Study DesignConducted as a three‐arm, randomized controlled trial, the study was implemented in the NICU of a local university hospital. Recruitment spanned from July 2023 to November 2023, with preterm infants (gestational age < 37 weeks) randomly assigned to either a MSS, WN or a control group. MSS components included visual, auditory, tactile, olfactory and gustatory stimuli, all designed to create a synergistic, comforting environment for the infant during the procedure. Procedural pain, heart rate and oxygen saturation were assessed at various stages before and after ROP examinations.ResultsAnalysis of 90 participants revealed that the MSS group exhibited lower Premature Infant Pain Profile (PIPP) scores than the WN and control groups (mean difference: −2.12, 95% confidence interval [CI]: −2.62 to −1.62; odds ratio [OR]: 0.004, 95% CI [0.001, 0.012], p < 0.001). Additionally, heart rates were significantly lower in the MSS group (mean difference: −15.3 beats/min, 95% CI: −20.5 to −10.1; OR: 0.025, 95% CI [0.008, 0.073], p < .001) and oxygen saturation levels were higher (mean difference: 3.2%, 95% CI: 1.8% to 4.6%; OR: 1.12, 95% CI [1.05, 1.20], p < .001) than in the other groups.ConclusionsMSS emerges as a favourable, safe and non‐pharmacological intervention for pain management in ROP and similar procedures.Relevance to Clinical PracticeMultisensory stimulation can be effectively integrated into the routine care provided by critical care nurses during retinopathy of prematurity examinations in preterm infants. This non‐pharmacological intervention offers a practical approach for critical care nurses to reduce procedural pain and improve physiological stability in this vulnerable population.

Social disorganization theory and the college campus periphery

AbstractObjectiveThis study tests the idea that neighborhoods on the periphery of large U.S. university campuses are socially disorganized and thus higher in crime relative to those that do not border university campuses. Social disorganization theory predicts that crime in these neighborhoods is elevated due to their high rate of residential mobility, relatively low socioeconomic status, and high levels of ethnic heterogeneity.MethodsTo test this hypothesis, data from the National Neighborhood Crime Study 2000 were analyzed. The data set contains a representative sample of U.S. neighborhoods with variables measured at the tract level. A series of t‐tests note the difference in crime rate means for campus and non‐campus areas, and ordinary least squares (OLS) regression analyses further test the hypothesis.ResultsWe find support for the main prediction using basic social disorganization models containing composite measures plus tract and city‐level controls.ConclusionThe theoretical and practical implications of this research are discussed along with the study's limitations and the potential for future research.

Assessing the impact of telemedicine interventions on systolic and diastolic blood pressure reduction: A systematic review and meta-analysis

Background Hypertension, characterized by high blood pressure, poses a significant risk for cardiovascular diseases, stroke, and heart attack. Managing it is particularly challenging in areas with limited healthcare access and for patients who cannot attend regular in-person visits. Telemedicine interventions offer a promising solution by improving patient adherence and facilitating timely treatment adjustments. This study aims to systematically evaluate the impact of these telemedicine interventions on reducing systolic and diastolic blood pressure. Methods A comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. Two independent reviewers screened and selected eligible articles, extracting key data using a standardized form. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool (MMAT). A random effects model was used to combine the results, with treatment effects measured using standardized mean differences (Hedges's g). Consistency of findings was evaluated through statistical tests, including the Q test and I² statistic, to assess heterogeneity. Data analysis was conducted using Stata statistical software version 17.0. Results Of the 2700 articles retrieved, 35 studies were selected for inclusion in the analysis. Using a random-effects model, the overall effect size was Hedges's g = −0.22 (95% CI: −0.30 to −0.15; p-value < 0.001), indicating a small but meaningful reduction in blood pressure (systolic and diastolic). Telemedicine interventions had a greater impact on systolic blood pressure (Hedges's g = −0.27, 95% CI: −0.39 to −0.15; p-value < 0.001) compared to diastolic blood pressure (Hedges's g = −0.17, 95% CI: −0.26 to −0.07; p-value < 0.001), though both reductions were clinically relevant. Conclusion This study demonstrates that telemedicine interventions significantly reduce both systolic and diastolic blood pressure, with a more pronounced effect on systolic pressure. The overall effect size indicates a small but meaningful improvement in hypertension management. These findings highlight the potential of telemedicine as an effective strategy for enhancing patient outcomes in hypertension care.

Alteplase in COVID-19 severe hypoxemic respiratory failure: the TRISTARDS multicenter randomized trial

BackgroundPulmonary intravascular thrombus formation has been widely observed in patients with respiratory failure, for example, in patients with SARS-CoV-2 infection (COVID-19). The aim of this study was to evaluate the efficacy/safety of alteplase thrombolysis in COVID-19 severe hypoxemic respiratory failure. In this multicenter, open-label study, patients were randomized to receive alteplase (low- or high-dose) over 5 days plus standard of care (SOC), or SOC alone. The primary endpoint was time to clinical improvement (≥ 2-point decrease on WHO Clinical Progression Scale, or hospital discharge) up to Day 28. Secondary endpoints included all-cause mortality at Day 28, treatment failure at Day 28 and change in arterial oxygen partial pressure/fractional inspired oxygen (PaO2/FiO2) ratio at Day 6 versus baseline.ResultsSixty-nine patients were randomized to alteplase (low- or high-dose) and 35 to SOC; 65% were on high-flow oxygen or non-invasive ventilation at baseline. Median time to clinical improvement was 25 days in the alteplase group and > 28 days (median not reached) in the SOC group. All-cause mortality was 8/69 (12%) versus 10/35 (29%) in the alteplase versus SOC groups, respectively (unadjusted risk difference [RD], − 17% [95% confidence interval (CI) − 34 to 0], p = 0.047; adjusted RD, − 16% [95% CI − 31 to 1], p = 0.058). The PaO2/FiO2 ratio (mean [standard deviation]) increased by + 30 (84) mmHg in the alteplase group and decreased by − 12 (59) mmHg in the SOC group (adjusted mean difference vs. SOC, p = 0.052). Differences were greater in patients receiving high-dose alteplase, and in those not receiving invasive ventilation. Eighteen patients (26.1%) in the alteplase group discontinued treatment due to adverse events. Major bleeding was more frequent with alteplase than with SOC (9 vs. 0 patients); no bleeding was fatal. The study closed early due to insufficient patient recruitment.ConclusionAlteplase was not associated with faster clinical recovery from COVID-19 severe hypoxemic respiratory failure. A numerical difference in survival and PaO2/FiO2 ratio was observed, particularly in patients not receiving invasive ventilation. These exploratory findings merit further investigation in larger patient cohorts that are adequately powered to confirm the hypotheses generated in this study regarding the impact of alteplase on treatment outcomes.Trial registration ClinicalTrials.gov: NCT04640194 (November 23, 2020); https://clinicaltrials.gov/study/NCT04640194 (early discontinuation due to insufficient patient recruitment).

Efficacy of Action Observation Therapy on Gait, Balance and Mobility Impairments: A Systematic Review and Meta‐Analysis

ABSTRACTBackground and purposeAction Observation Therapy (AOT) has been proposed to improve gait, balance and mobility in subjects with neurological and musculoskeletal disorders. The current review aimed to investigate AOT effects in subjects with gait, balance and mobility impairments.MethodsA systematic literature search was performed using PubMed/MEDLINE, EMBASE and Scopus databases from inception until May 2023. Randomized controlled trials investigating effects of AOT on gait, balance and mobility in subjects with any type of clinical condition were included. Two reviewers performed data extraction and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. The overall effects were reported as mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI).ResultsThirty‐one studies were included. Low evidence supported AOT to enhance walking speed (SMD: 0.40; 95% CI: 0.17, 0.62; I2 = 0%), stride length (SMD: 0.35; 95% CI 0.05, 0.66; I2 = 0%) and single limb support duration (MD: 4.1%; 95% CI: 1.0, 7.2, I2 = 0%) after stroke. Low evidence supported AOT to improve walking distance (MD: 56.8 m; 95% CI; 39.2, 74.4 m) and dynamic (SMD: 0.40; 95% CI: 0.04, 0.76; I2 = 0%) and static (SMD: 0.69; 95% CI: 0.32, 1.05; I2 = 0%) balance, while very low evidence supported AOT to enhance mobility (MD: −1.48 s; 95% CI; −2.2, −0.8 s; I2 = 0%) after stroke. Moderate evidence supported AOT to improve dynamic balance in subjects with Parkinson's disease (SMD: 0.44; 95% CI: 0.09, 0.79; I2 = 28%), while low evidence supported AOT to enhance dynamic balance (SMD: 0.61; 95% CI: 0.15, 1.08; I2 = 27%) and mobility (MD: −2.08 s; 95% CI; −3.5, −0.6 s; I2 = 0%) in patients with orthopedic conditions.ConclusionAOT improved gait, balance and mobility after stroke, dynamic balance in patients with Parkinson's disease and dynamic balance and mobility in patients with orthopedic conditions. However, evidence certainty was generally low and further high‐quality studies are needed.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews (n. CRD42021240626)

Goal‐Directed Rehabilitation Versus Standard Care for Individuals with Hereditary Cerebellar Ataxia: A Multicenter, Single‐Blind, Randomized Controlled Superiority Trial

ObjectiveRehabilitation is thought to reduce ataxia severity in individuals with hereditary cerebellar ataxia (HCA). This multicenter, randomized controlled superiority trial aimed to examine the efficacy of a 30‐week goal‐directed rehabilitation program compared with 30 weeks of standard care on function, ataxia, health‐related quality of life, and balance in individuals with an HCA.MethodsIndividuals with an autosomal dominant or recessive ataxia (aged ≥15 years) were enrolled at 5 sites in Australia. Participants were randomized (1:1) to receive rehabilitation (6 weeks of outpatient physiotherapy followed by a 24‐week home exercise program) (n = 39) or continued their usual activity (n = 37). The primary outcome measure was the motor domain of the Functional Independence Measure (mFIM) at 7 weeks. Secondary outcomes included the Scale for the Assessment and Rating of Ataxia (SARA) and the SF‐36v2, assessed at 7, 18, and 30 weeks. Outcome assessors were blinded to treatment allocation.ResultsSeventy‐one participants (rehabilitation, 37; standard‐care, 34) were included in the intention‐to‐treat analysis. At 7 weeks, mFIM (mean difference 2.26, 95% confidence interval [CI]: 0.26 to 4.26, p = 0.028) and SARA (−1.21, 95% CI: −2.32 to −0.11, p = 0.032) scores improved after rehabilitation compared with standard care. Compared with standard care, rehabilitation improved SARA scores at 30 weeks (mean difference −1.51, 95% CI: −2.76 to −0.27, p = 0.017), but not mFIM scores (1.74, 95% CI: −0.32 to 3.81, p = 0.098). Frequent adverse events in both groups were fatigue, pain, and falls.InterpretationGoal‐directed rehabilitation improved function at 7 weeks, with improvement in ataxia and health‐related quality of life maintained at 30 weeks in individuals with HCA, beyond that of standard care. ANN NEUROL 2024

The effects of laparoscopic sleeve gastrectomy on serum levels of growth hormone and insulin-like growth factor 1

Background. It is unclear exactly how bariatric surgery affects the body’s metabolic and physiological functions. The purpose of the study was to assess the activity of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels in obese individuals before and six months after laparoscopic sleeve gastrectomy. Materials and methods. This study included 52 patients with a body mass index (BMI) ranging from 35 to 56 kg/m2 who qualified for laparoscopic sleeve gastrectomy and had completed data at the 6-month postoperative follow-up. All patients were clinically examined by a team of surgeons and a physician before operation. The serum levels of GH and IGF-1 were assessed pre- and post-operatively. Results. The study included 52 patients with obesity who were undergoing laparoscopic gastric sleeve surgery. Their mean age was 32.04 ± 6.90 years. More than half of the patients, 27 (51.9 %), were aged 19 to 32 years, 32 (61.5 %) patients were females, and 38 (73.1 %) had a BMI of 35–49.9 kg/m2. There was a significant increase in the serum GH after the sleeve gastrectomy compared to the pre-operative level (0.95 ± 0.30 vs 0.62 ± 0.40 ng/ml, p = 0.0001). IGF-1 also significantly increased after the surgery: 117.13 ± 32.40 vs 102.63 ± 33.90 ng/ml (p = 0.0001). Concerning BMI, there was no significant difference in the GH mean for patients with a BMI of 35–49.9 and 50–56 kg/m2 pre- and post-operatively: 0.6 vs 0.8 (p = 0.07) and 0.9 vs 1 (p = 0.5), respectively. On the other hand, IGF-1 exhibited a significant difference before and after surgery: 107.7 vs 88.9 ng/ml (p = 0.02) and 123.2 vs 100.7 (p = 0.03). Conclusions. This study concludes that sleeve gastrectomy significantly increases the serum level of both GH and IGF-1 and, consequently, their effects on disturbed lipid and protein metabolism in morbidly obese patients.

Systematic review and meta-analysis assessing the status of carotid intima–media thickness and lipid profiles in type 2 diabetes mellitus

ObjectivesCarotid intima–media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the...

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Effects of percussive massage therapy on fascia echo intensity and fascia thickness in firefighters with chronic non-specific low back pain: a randomized controlled trial

BackgroundChronic non-specific low back pain (CNSLBP) is prevalent among firefighters and may negatively affect their job performance. Alterations in the thoracolumbar fascia (TLF) structure are associated with CNSLBP. Percussive massage therapy (PT) has demonstrated potential in modifying fascial properties and alleviating pain. However, its effects on TLF structure in CNSLBP patients have not been thoroughly investigated. This study evaluates the effects of 6 weeks of PT on TLF echo intensity, thickness, pain, and disability in firefighters with CNSLBP, utilizing ultrasound imaging as a primary assessment tool.MethodsThis six-week randomized controlled trial involved 38 firefighters with CNSLBP. Participants were randomly assigned 1:1 to either the PT group (receiving PT and core stability exercise) or the control group (receiving only core stability exercise). TLF echo intensity and thickness were measured using ultrasound imaging, and disability was assessed using the Roland-Morris Disability Questionnaire (RMQ) at baseline and post-intervention. Pain was measured using the Visual Analog Scale (VAS) at baseline, immediately after the first intervention, three weeks post-intervention, and post-intervention. Paired t-tests were conducted to analyze within-group changes in RMQ and ultrasound data, while ANCOVA was used to assess between-group differences, and repeated measures ANOVA for VAS scores.ResultsParticipants in the PT and control groups were aged 26.6±4.1 and 23.6±1.7 years, respectively, with BMI of 23.1±1.8 and 21.8±1.2 kg/m². The PT group showed significant reductions in bilateral TLF echo intensity post-intervention (left side: mean difference -6.4, 95% CI -9.7 to -3.1, p < 0.001, effect size 0.67; right side: mean difference -7.6, 95% CI -11.8 to -3.3, p < 0.01, effect size 0.60). Changes in TLF thickness were not statistically significant (p > 0.05). The PT group demonstrated significantly lower VAS scores than the control group (mean difference - 0.626, 95% CI -1.087 to -0.165, p = 0.009, effect size 0.63). RMQ scores decreased by -1.3 (95% CI -2.1 to -0.4, p < 0.01, effect size 0.5).ConclusionSix weeks of percussive massage therapy significantly reduced thoracolumbar fascia echo intensity, alleviated pain, and improved functional disability in firefighters with chronic non-specific low back pain, but was not effective in altering fascia thickness. Percussive massage therapy emerges as an effective and safe strategy for managing chronic non-specific low back pain in firefighters.Trial registrationRetrospectively registered in Thai Clinical Trials Registry (TCTR20221223001) on December 22, 2022.

Relative analgesic effectiveness of pharmacological interventions in knee osteoarthritis: a component network meta-analysis

Abstract Introduction Knee osteoarthritis (KNOA) is a chronic, burdensome, highly prevalent degenerative disease1. As there is no current cure for KNOA, treatments are primarily focused on pain management. While pharmacological interventions typically demonstrate superiority to placebo for pain relief, evidence regarding their relative effectiveness is lacking. Component Network Meta-Analysis (CNMA) is a relatively new technique that uses all available evidence to estimate effects of each treatment against all other treatments via its performance relative to a common comparator such as placebo. Aim To evaluate relative analgesic effectiveness of pharmacotherapies for KNOA using CNMA to provide comprehensive, evidence-based information for clinical decisions and inform future guidelines. Methods We performed a comprehensive search of major electronic databases (MEDLINE, EMBASE and CENTRAL) and trial registries from inception to January 2021 without language restriction for RCTs that compared treatment for adults with KNOA with another treatment or control listed in NICE guidelines: paracetamol, NSAIDs (with and without gastroprotection), COX2-inhibitors, opioids, duloxetine, capsaicin, hyaluronic acid (HA) and corticosteroids (CS), administered via oral, topical, transdermal or intra-articular (IA) routes2. Assessment at the following time windows: immediate (up to two weeks), short (closest to 3 months), medium (closest to 6 months) and long (closest to 12 months). A random-effects CNMA was used to estimate relative treatment effects; mean differences (MD) for a primary outcome of pain (0-10) within a frequentist framework3. Certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) with risk of bias (RoB) assessed using the revised Cochrane RoB2 tool. This study does not require ethical approval as it is a systematic review and CNMA of already approved trials and is registered with PROSPERO, CRD42020184192. Results Screening initially identified 33298 citations, reduced to 202 studies after a full-text review. In the immediate-term relative effectiveness ranged between -1.41 (95% confidence interval [CI] -2.23, -0.60) for transdermal NSAIDs and -0.25 (-0.48, -0.02) for IAHA. In the short term, we found evidence of significant effects for all interventions except topical capsaicin and transdermal opioids; effects ranged from -2.09 (-3.69, -0.49) for transdermal NSAIDs to -0.31 (-0.57, -0.04) for IACS. In the medium term, we only found a significant effect for IAHA with MD -0.36 (-0.62, -0.10). We did not find evidence of a significant effect in the long term. 137 (67.8%) of 202 studies included were rated at high risk of bias, 50 (24.7%) at some concerns, and 15 (7.5%) at low, and the certainty of evidence ranged from moderate to very low. Discussion/Conclusion This large-scale and first CNMA provides comprehensive evidence for KNOA pain management. We found evidence of significant effects for several single and multicomponent interventions for immediate and short-term effectiveness. However, their effect diminished over time. While we employed ranking metrics, we could not declare a clear winner among competing interventions due to the between-study heterogeneity, strength of evidence, and the complex nature of KNOA pain. Findings from this study should serve as a tool to inform future guideline developments and clinical decisions, emphasising a holistic approach towards managing KNOA pain with considerations to routes of administration, comorbidities, polypharmacy, and patient needs.

Deep vein thrombosis in response to stress induced by earthquakes in Japan: a meta-analysis of possible exacerbating factors

The principal goal of this study was to assess factors associated with deep vein thrombosis (DVT) in the aftermath of earthquakes in Japan. We searched PubMed, Google Scholar, Web of Science, and Cochrane Library for articles published in English or Japanese regarding indicators for DVT associated with Japanese earthquakes. We calculated pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) for patients with DVT (the DVT group) as compared with the non-DVT group for potential predictors. Ultimately, 7 articles were included in the analysis, comprising 6,637 subjects (DVT, 895; and non-DVT, 5,742). The following factors proved statistically significant: female gender (OR = 1.48, 95% CI; 1.20–1.81, p = 0.0002), greater age (MD = 4.44, 95% CI; 1.62–7.25, p = 0.002), hypertension (OR = 1.44, 95% CI; 1.18–1.75, p = 0.0003), heart disease (OR = 1.45, 95% CI; 1.07–1.97, p = 0.02), previous history of DVT (OR = 9.23, 95% CI; 2.94–28.91, p = 0.0001), sleeping pill use (OR = 1.81, 95% CI; 1.37–2.38, p = 0.0001), lower leg varix (OR = 1.63, 95% CI; 1.17–2.28, p = 0.004), and soleal vein dilatation ≥ 8 mm (OR = 2.13, 95% CI; 1.32–3.42, p = 0.002). Our findings furnish insights that can aid in making informed choices about healthcare and policy in the context of earthquake-induced stress.

Psychometric Validation of the CLN2 Quality of Life Questionnaire in Participants with CLN2 Disease Treated with Cerliponase Alfa

Objectives: This study evaluated the psychometric properties of the ceroid lipofuscinosis type 2 Quality of Life (CLN2 QoL) questionnaire. Methods: Data from children with CLN2 disease aged 3–16 years receiving cerliponase alfa in the BMN 190-201 and BMN 190-202 clinical studies, collected via purposive sampling, were used to assess convergent and divergent validity, internal consistency and reliability. The clinically important difference (CID) was estimated with distribution- and anchor-based methods. Descriptive and inferential statistical analyses were conducted using IBM SPSS. Results: CLN2 QoL data of 22 participants were analysed. Ceiling effects were observed in 22 items (35% threshold); no floor effects were observed. Internal consistency analysis showed good reliability (Cronbach’s alpha and Omega reliability &gt;0.7) for four domains at study completion; only one domain had good reliability at baseline. All domains had good test–retest reliability (correlation &gt;0.5) except Feeding With G-Tube and Seizures. Convergent and divergent correlation analysis showed moderate-strong correlations (&gt;0.4) between PedsQL and CLN2 QoL total scores, between the Pediatric Quality of Life Inventory (PedsQL) total score and most CLN2 QoL domains at baseline, and between CLN2 QoL total score and most PedsQL domains at week 97. Known groups validity showed a significant difference in means for the Behaviour domain (p = 0.05) for reasons that could not be clarified. CID was 6.79–12.94 for domains; total score CID was 6.91 using distribution-based and 6.13–13.05 using anchor-based methods. Conclusions: This study is the first to validate the CLN2 QoL and to estimate the CID of this instrument in CLN2 patients. Our results show good validity and reliability of this tool.

Determination of the Level of von Willebrand Factor, ADAMTS13, and Ratio of ADAMTS13:von Willebrand Factor in Sickle Cell Disease Patients

Abstract Background: Sickle cell anemia (SCA) is a hypercoagulable state characterized by a significant alteration in hemostatic parameters which may predispose an increased risk of vaso-occlusive crisis (VOC). Sickle cell disease (SCD) is the most common genetic disorder in sub-Saharan Africa. Nigeria bears a high disease burden with an estimated prevalence of 1%–3% of its population being affected by the disease. The study seeks to determine the role of von Willebrand factor (VWF), ADAMTS13, and the ratio of ADAMTS13:VWF antigen in the pathogenesis of VOC. Objective: The objective of this study is to evaluate the level of VWF, ADAMTS13, and their ratio in SCD subjects in Calabar and to determine their role in the pathogenesis of VOC. Methodology: This is a comparative study carried out at the University of Calabar Teaching Hospital (UCTH), Calabar. Sixty SCA patients were evaluated in VOC and steady states as well as five parented healthy controls. VWF: Ag and ADAMTS13:Ag were evaluated using Assaypro enzyme-linked immunosorbent assay kits with Lot nos. 01751728 and 04222167R, respectively. Data were analyzed by IBM SPSS Chicago software version 21. The study was approved by the UCTH Institution Ethical Review Board. Results: The mean ages of the SCA subjects and controls were 23.5 ± 7.2 years and 26.5 ± 5.6 years, respectively (P = 0.706). There were 23 (38.3%) males in the SCA group and 21 (42.0%) females in the controls. There was no significant difference in their sex distribution (P = 0.063). The mean (standard deviation [SD]) of VWF in VOC, steady state, and controls were 2.52 ± 0.34, 1.34 ± 0.23, and 1.41 ± 0.23 IU/mL, respectively. The differences in mean were significantly higher in VOC state (P = 0.003). The mean ± SD of ADAMTS13 in VOC, steady state, and controls were 0.61 ± 0.10, 0.44 ± 0.06, and 0.62 ± 0.10 μg/L, respectively. ADAMTS13 levels did not differ significantly across the groups (P = 0.270). Similarly, there was no significant difference between ADAMTS13:VWF ratios across the groups (P = 0.318). Conclusion: VWF level is elevated in VOC state and thus may be implicated in the pathogenesis of VOC. ADAMTS13 and the ratio of ADAMTS13:VWF are not significantly affected in VOC.

First‐choice hormonal therapies for children with infantile epileptic spasms syndrome in South Asia: A network meta‐analysis of randomized controlled trials

AbstractConsidering the peculiar challenges with infantile epileptic spasms syndrome (IESS) in South Asia and a wide variation in the usage of hormonal therapies, we compared the efficacy and safety of various hormonal therapies for children with IESS in South Asia. We searched PubMed, Embase, Scopus, and Web of Science databases from the inception until April 2024. We included only randomized clinical trials (RCTs) evaluating the efficacy and safety of hormonal therapies for IESS in the South Asian region. Complete cessation of epileptic spasms (ES), electro‐clinical response, and time taken to be spasm‐free at 2 or 6 weeks of therapy were efficacy outcomes, while the occurrence of adverse events was the safety outcome. Effect estimates were reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI) and Cochrane risk of bias 2.0 (ROB 2.0) used for quality assessment of each study. The surface under the cumulative ranking curve (SUCRA) was used to rank the different therapies and reported as a p‐score ranging from 0 to 1. Of 747 citations, nine RCTs comprising 566 children with IESS were included. After 2‐week treatment, dexamethasone (OR: 6.72; 95% CI: 1.47, 30.72), adrenocorticotropic hormone therapy (ACTH) high dose (HD) (OR: 5.30; 95% CI: 1.05, 26.91), and prednisolone HD (OR: 2.41; 95% CI:1.07, 5.46) had shown significantly greater efficacy for cessation of EScompared with ACTH low dose (LD). Similarly, for electroclinical response, dexamethasone (OR: 9.63; 95% CI: 1.99, 46.70) and prednisolone HD (OR: 3.46; 95% CI: 1.38, 8.68) had greater efficacy compared with ACTH LD. Safety outcomes revealed that hypertension was significantly less common with ACTH LD and prednisolone HD as compared with ACTH HD. This study provides quality evidence on preferred first‐choice hormonal therapy for managing IESS in South Asia. ACTH HD, dexamethasone, and prednisolone HD are the most effective hormonal therapy options with dose‐dependent therapeutic efficacy.Plain Language SummaryThis study provides insights into the selection of first‐line hormonal therapies among the various treatments for managing infantile epileptic spasms syndrome (IESS) in South Asia. The study findings suggested that the effectiveness of these therapies is dose‐dependent, with high doses of ACTH, dexamethasone, and prednisolone being the most effective for achieving cessation of epileptic spasms.

Acupuncture for uremic pruritus: A systematic review and meta-analysis protocol

Background Uremic pruritus (UP) or chronic kidney disease-associated pruritus (CKD-aP) is one of the most intractable dermatologic symptom in patients with chronic kidney disease. Several randomized controlled trials (RCTs) have been conducted to investigate the antipruritic effects of acupuncture on UP/CKD-aP and suggested a significant therapeutic effect, while the evidence supporting the application of acupuncture is limited. Objectives This study will assess the efficacy and safety of acupuncture for patients with UP/CKD-aP. Methods Data Sources: RCTs will be searched in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database, the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov from inception to 31st August 2024. Study eligibility criteria: RCTs in English and Chinese conducted on UP/CKD-aP patients will be included. Participants: Adult patients diagnosed with UP/CKD-aP will be included. Interventions: All acupuncture interventions in the management of UP/CKD-aP will be included, compared with no treatment, placebo or sham acupuncture, or other treatment agents. Outcome measures: The primary outcome will be the change in the severity of itching evaluated by validated scales. Study appraisal and svnthesis methods: If necessary, a meta-analysis will be performed for the pooled therapeutic effect by Review Manager 5.3, or a qualitative descriptive analysis will be presented. The data will be transformed into the risk ratio (RR) for binary data and the mean difference (MD) or standardized MD for continuous data for analysis. Results This review will update evidence of RCTs evaluating acupuncture for UP/CKD-aP. Limitations Anticipated challenges contain the methodological and clinical heterogeneity in terms of evaluation tools and acupuncture interventions within included studies. Conclusion and implications It will benefit patients and impact health-care decision-making regarding the models of care that are feasible for patients. Trial registration PROSPERO CRD42021257001.