High-quality Clinical Trials Research Articles

The efficacy and safety of tyrosine kinase inhibitors in the treatment of advanced or metastatic chordoma: a single-arm meta-analysis.

Chordoma is a rare malignant tumor with a higher incidence in males than in females. There is an increasing number of clinical studies related to tyrosine kinase inhibitors (TKIs), yet the efficacy and safety of different drugs vary. In this single-arm meta-analysis evaluating the efficacy and safety of TKIs for chordoma treatment, 12 studies involving 365 patients were analyzed. The findings suggest that TKIs can improve outcomes, with an objective response rate of 1.7% and 29% based on RECIST and Choi criteria, a median progression-free survival (mPFS) of 8.41 months and a median overall survival (mOS) of 36.6 months. Imatinib, in particular, showed a longer mOS of 39.3 months compared to 25.0 months for other TKIs. However, high toxicity was noted, with a 95% overall incidence of adverse events (AEs), including hypertension, nausea and vomiting, and edema. Serious AEs occurred at a rate of 55%. In subgroup analysis, Imatinib showed a lower incidence of AEs compared to other TKIs. Combination therapy reduced the risk of severe adverse events compared to monotherapy. The study underscores the potential of TKIs to extend survival in chordoma patients but also highlights the need for careful management of treatment-related toxicity. Combining TKIs, especially imatinib, with other treatments may avoid serious adverse events. Further high-quality clinical trials are needed to confirm these findings and optimize treatment protocols.

Bibliometric analysis on the top one hundred cited studies on gastrointestinal endoscopy.

Gastrointestinal endoscopy has been widely used in the diagnosis and treatment of gastrointestinal diseases. A great many of studies on gastrointestinal endoscopy have been done. To analyze the characteristics of top 100 cited articles on gastrointestinal endoscopy. A bibliometric analysis was conducted. The publications and their features were extracted from the Web of Science Core Collection, Science Citation Index-Expanded database. Excel, Web of Science database and SPSS software were used to perform the statistical description and analysis. VOSviewer software and MapChart were responsible for the visualizations. The top 100 cited articles were published between 1976 and 2022. The guidelines (52%) and clinical trials (37%) are the main article types, and average publication year of the guidelines is much later than that of the clinical trials (2015 vs 1998). Among the clinical trials, diagnostic study (27.0%), cohort study (21.6%), case series (13.5%) and cross-sectional study (10.8%) account for a large proportion. Average citations of different study types and designs of the enrolled studies are of no significant differences. Most of the 100 articles were published by European authors and recorded by the endoscopic journals (65%). Top journals in medicine, such as the Lancet, New England Journal of Medicine and JAMA, also reported studies in this field. The hot spots of involved diseases include neoplasm or cancer-related diseases, inflammatory diseases, obstructive diseases, gastrointestinal hemorrhage and ulcer. Endoscopic surgery, endoscopic therapy and stent placement are frequently studied. Our research contributes to delineating the field and identifying the characteristics of the most highly cited articles. It is noteworthy that there is a significantly smaller number of clinical trials included compared to guidelines, indicating potential areas for future high-quality clinical trials.

Covered Versus Bare Metal Stents in Chronic Mesenteric Ischaemia Treatment: A Systematic Review and Meta-analysis.

The main treatment for Chronic Mesenteric Ischemia (CMI) is revascularization, typically achieved through stent angioplasty of the superior mesenteric artery, and in certain cases, the celiac trunk. However, long-term outcomes using bare-metal stents have been less than satisfactory. Therefore, we aimed to compare the performance of covered stents (CS) versus bare-metal stents (BMS) in patients treated for CMI. Pubmed, Embase and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of patients with CMI who underwent stenting procedures using BMS or CS. The main outcomes were primary patency and freedom from reintervention. Statistical analysis was performed using R version 3.6. One randomized clinical trial and five observational studies were included. In the pooled analysis, patients undergoing the covered stenting approach haOd a higher primary patency (HR 0.40; 95%CI 0.23-0.68; p<0.01). Additionally, CS also demonstrated significantly superior freedom from reintervention when compared to BMS patients (HR 0.30; 95% CI 0.13-0.71; p<0.01). In patients undergoing transluminal angioplasty with stent placement both in the celiac trunk and superior mesenteric artery, the use of CS indicated superior primary patency and a higher rate of freedom from reintervention compared to BMS. These findings indicate superior outcomes with CS and may suggest their use as the preferred stent option in patients with CMI. However, these findings should be interpreted cautiously due to the limited number of studies, the moderate to serious risk of bias in the included data, and the significant heterogeneity observed. Further high-quality clinical trials are necessary to validate these results and strengthen the evidence base for clinical practice.

Expert consensus on nasal anticholinergics in the treatment of allergic rhinitis

Background: Allergic rhinitis (AR) is a common hyperreactive nasal disease in otolaryngology, mainly manifested as rhinorrhea, nasal obstruction, nasal itching, and sneezing. Despite medication and immunotherapy, a large proportion of patients do not completely eliminate rhinorrhea. In recent years, the use of nasal anticholinergics in the treatment of AR has gained attention. However, there is currently no consensus on the timing and selection of nasal anticholinergics for AR treatment. Summary: We reviewed previous studies on nasal anticholinergic drugs in AR and summarized the pathogenesis of AR, the role of anticholinergic drugs, cholinergic neural pathways, the mechanisms of nasal anticholinergic drugs, common types and clinical efficacy of nasal anticholinergic drugs, and precautions for their use. We also provided some suggestions for their clinical application. Key Messages: At present, the main drugs of nasal anticholinergics are ipratropium bromide and phencyquine bromide. The cholinergic nervous system is the main neural pathway mediating nasal secretion. Anticholinergic drugs work by blocking the interaction between Ach and the high density of M receptors in the nasal cavity. The clinical effect of nasal anticholinergics is generally good, and there are almost no major or systemic adverse reactions. Nasal anticholinergics provide a more complete treatment for AR patients with poorly controlled rhinorrhea. In the future, nasal anticholinergics will be assessed in high-quality clinical trials and applied clinically.

Rituximab-associated adverse events in nephrotic syndrome: A systematic review and meta-analysis.

Rituximab (RTX) has been recommended to treat nephrotic syndrome (NS), but its safety has not been quantitatively analyzed. PubMed, Embase, and the Cochrane Register of Controlled Trials databases were searched from inception to December 31, 2023, for randomized control trials (RCTs) and retrospective studies reporting the adverse events (AEs) related to RTX for treating NS. Data were expressed as odds ratios (OR) and risk difference (RD) with 95% confidence interval (CI). Heterogeneity was identified using the Cochrane Q test and quantified by the I 2 statistic. Ten RCTs and five retrospective studies with 1231 patients were enrolled. RTX significantly reduced the risk of total AEs (OR=0.32, 95% CI [0.13, 0.78]) compared to the non-RTX group in retrospective studies but was not in RCTs. The pooled rate of infusion reactions was 32% (95% CI=[19%, 45%]) in RCTs and 8% (95% CI=[3%, 13%]) in retrospective studies. Subgroup analyses demonstrated a lower risk of hematological events in adult NS patients (OR=0.21, 95% CI [0.09, 0.51]) and the 1000mg RTX intervention (OR=0.21, 95% CI [0.09, 0.51]). There is no significant difference in serious AEs, infection, gastrointestinal, renal, cardiovascular, and cancer events between the two groups. RTX reveals great potential in terms of safety compared to non-RTX treatments due to the relatively few AEs in our results. However, the interaction of other drugs needs to be monitored. The safety of RTX in NS patients needs to be further confirmed in high-quality clinical trials.

Wearable devices, ischemic heart disease and cardiovascular outcomes: A systematic review and meta-analysis.

To evaluate the impact of wearable devices when associated with usual care on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic heart disease compared with usual care alone. Randomised clinical trials with patients aged 18years and above with ischemic heart disease, using wearable devices and assessing at least one of the primary outcomes (myocardial infarction, stroke, cardiovascular mortality, or major adverse cardiovascular events) or secondary outcomes (all-cause mortality, hospitalisation, all arrhythmias, heart failure, unstable angina or revascularisation procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL, INAHTA and the Web of Science Core Collection were searched in April 2024. Studies were also identified via citation searching. Cochrane Risk of Bias version 1 was applied as provided in Covidence. Meta-analyses were performed when possible. Six studies of moderate quality were included. Wearables showed positive effects in reducing major adverse cardiovascular events (RR 0.75, 95% CI 0.57-0.98, two studies) and all-cause mortality (RR 0.64, 95% CI 0.43-0.96, three studies); no significant effects were found on myocardial infarction (RR 0.89, 95% CI 0.59-1.34, four studies), cardiovascular mortality (RR 0.35, 95% CI 0.07-1.73, three studies), hospitalisations (RR 0.77, 95% CI 0.56-1.07, five studies), all arrhythmias (RR 1.10, 95% CI 0.49-2.48, two studies), and heart failure (RR 0.85, 95% CI 0.61-1.18, two studies). Meta-analysis could not be performed for stroke, unstable angina, and revascularisation procedures. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence was deemed low or very low. While wearables seem to have some positive effects for patients with ischemic heart disease, only weak recommendations for use are possible. More large-scale, high-quality randomised clinical trials are needed to recommend the routine use of wearables in combination with usual care. CRD42024586137.

Efficacy and safety of low-intensity ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis.

Myofascial Pain Syndrome (MPS) is a common pain disorder characterized by the presence of trigger points within the muscles or fascia. Low-intensity ultrasound therapy, as a noninvasive modality, has indeed found application in the management of MPS, but its efficacy for myofascial pain syndrome has still been controversial. The objective of this systematic review was to assess the safety and efficacy of low-intensity ultrasound therapy for MPS. We searched PubMed, Embase, PEDro, Web of Science, and CENTRAL for RCTs on ultrasound therapy in MPS patients. We included RCTs comparing ultrasound with other therapies or placebo-sham ultrasound. Clinical outcomes included pain scores and physical functional performance. Risk of bias and heterogeneity were assessed. Two authors of the review independently evaluated the risk of bias of each trial and extracted the data. This systematic review included sixteen RCTs involving a total of 1063 participants with MPS. None of the included studies reported adverse events. Comparing with sham or no treatment, the application of low-intensity ultrasound yielded additional benefits for pain (SMD [CI] = - 1.04 [- 1.72, - 0.36], P < 0.0003), with high heterogeneity (χ2 = 116.63, P < 0.00001, I2 = 91%). Patients receiving low-intensity ultrasound had improved on pressure pain threshold. Compared with other treatments, there were no differences in outcomes functional scores. The current study indicates that low-intensity ultrasound effectively reduces pain intensity in MPS patients. The heterogeneity regarding the parameters of ultrasound, including frequency, intensity, time was found to be high among the included studies. Each therapeutic modality works differently in various situations and may lead to multitudinous effects. The positive impact of low-intensity ultrasound on functional improvement needs to be further analyzed through more high-quality clinical trials with large sample sizes in the future. This study was registered on the following website: https://www.crd.york.ac.uk/PROSPERO/ . The PROSPERO registered ID is CRD42023472032.

Infrastructure, capabilities, and capacities required for clinical trials design and delivery: A rapid scoping review of recommendations and regulations

Objective Synthesise the published literature and national regulations on infrastructure, capabilities and capacities required to manage and quality assure clinical research. Introduction The World Health Assembly (WHA) resolution 75.8 (2022) called “for a strengthened global architecture for coordinated and high-quality clinical trials”. For this remit, infrastructure, capabilities, and capacities needed to design and deliver high-quality clinical trials must be understood and advanced. This rapid scoping review aims to identify the breadth of requirements and recommendations for effective management of clinical trials in regulations, national legislation and the published literature. The findings will be summarised into themes. It will inform a framework for the assessment and development of units undertaking observational studies and interventional clinical trials. Inclusion criteria Peer-reviewed literature, grey literature, and national legislation that recommends infrastructure, capabilities, and/or capacities needed to manage and quality assure clinical trials. Publications authored by those who design, manage, fund, sponsor, regulate or oversee clinical trials. Methods Peer-reviewed and grey literature will be identified through Medline, Embase, PsycINFO, and Global Health via Ovid; SCOPUS; the Web of Science Core Collection; and the WHO Global Index Medicus using specific field codes to increase the specificity of the search strings. No date, language, or geographic limits will be applied. Deduplicated titles and abstracts will be screened by two blinded reviewers with discrepancies resolved by a third reviewer. Grey literature may be identified through the peer reviewed literature, supplemented with structured searches of Google and DynaMed. National regulations will be sourced online and from available summaries. Full text literature and regulations will be screened by a single reviewer, with proportionate verification by a second reviewer. Data will be extracted and coded for patterns in NVivo software. All items and codes will be summarised using a thematic framework analysis and identify core constructs within each theme.

Evidence-based recommendations for the prophylactic use of antiseizure medications (ASMs) in neurosurgery: a systematic review of guidelines.

This study aims to evaluate the methodological quality of guidelines concerning the prophylactic use of antiseizure medications (ASMs) in neurosurgery and to summarize relevant recommendations. PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), and other guideline repositories and official organizations were searched from 2004 to 2023 (20years). The extracted information consisted of the guideline characteristics, relevant recommendations, levels of evidence, and strength of recommendations. Using the Guideline Research and Evaluation Tool II (AGREE II), five reviewers assessed the methodological quality of the guidelines, and the intraclass correlation coefficient (ICC) is used to assess the inter-reviewer consistency. Of 27 eligible guidelines, AGREE II scores varied with higher scores in Clarity of Presentation (88.89%), Scope and Purpose (83.33%), and Editorial Independence (72.92%), but lower in Rigor of Development (59.17%), Stakeholder Involvement (46.67%), and Applicability (41.67%). ICC ranged from 0.51 to 0.92. Nine guidelines were recommended, eight with modifications, and ten not recommended. ASMs prophylaxis are recommended for patients with a seizure history, which means secondary prophylaxis, and specific high-risk groups, but not recommended for primary prophylaxis routinely for those without a history of seizure. Guidelines in neurosurgical perioperative prophylactic use of ASMs are of moderate quality with domains for enhancement. Guidelines lack detailed guidance on medication initiation, dosage, and duration, highlighting the need for more high-quality clinical trials comparing newer and classical ASMs.

Role of Flavonoids in Mitigating the Pathological Complexities and Treatment Hurdles in Alzheimer's Disease.

With the passage of time, people step toward old age and become more prone to several diseases associated with the age. One such is Alzheimer's disease (AD) which results into neuronal damage and dementia with the progression of age. The existing therapeutics has been hindered by various enkindles like less eminent between remote populations, affordability issues and toxicity profiles. Moreover, lack of suitable therapeutic option further worsens the quality of life in older population. Developing an efficient therapeutic intervention to cure AD is still a challenge for medical fraternity. Recently, alternative approaches attain the attention of researchers to focus on plant-based therapy in mitigating AD. In this context, flavonoids gained centrality as a feasible treatment in modifying various neurological deficits. This review mainly focuses on the pathological facets and economic burden of AD. Furthermore, we have explored the possible mechanism of flavonoids with the preclinical and clinical aspects for curing AD. Flavonoids being potential therapeutic, target the pathogenic factors of AD such as oxidative stress, inflammation, metal toxicity, Aβ accumulation, modulate neurotransmission and insulin signaling. In this review, we emphasized on potential neuroprotective effects of flavonoids in AD pathology, with focus on both experimental and clinical findings. While preclinical studies suggest promising therapeutic benefits, clinical data remains limited and inconclusive. Thus, further high-quality clinical trials are necessary to validate the efficacy of flavonoids in AD. The study aim is to promote the plant-based therapies and encourage people to add flavonoids to regular diet to avail the beneficial effects in preventive therapy for AD.

Safety and effectiveness of Salvia miltiorrhiza and ligustrazine injection for acute cerebral infarction in Chinese population: a PRISMA-compliant meta-analysis.

Salvia miltiorrhiza and ligustrazine injection (SML) is a type of traditional Chinese medicine injection, which has been considered a promising adjunctive therapy treatment for acute cerebral infarction (ACI). Although there have been positive reports on the treatment of SML, there is still controversy over its exact efficacy and safety in ACI patients. In this study, a systematic review was conducted on randomized controlled trials (RCTs) of SML for the treatment of ACI to evaluate its clinical efficacy and safety. From the establishment of the database until May 2023, all randomized controlled trials related to SML and ACI were collected from the Cochrane Library, Web of Science, Embase, Medline, PubMed, CSJD, Wanfang database, CBM and CNKI. This systematic review and meta-analysis were strictly conducted in accordance with the PRISMA statement. The reported outcomes including overall response (ORR), National Institutes of Health Stroke Scale (NIHSS), hemorrheology indexes, activity of daily living (ADL) and adverse events were in detail investigated. An analysis was conducted on the relevant data of 3869 ACI patients from 38 trials. The results indicated that the combination of conventional treatment and SML can significantly improve the ORR of patients (RR = 1.23, 95% CI = 1.20-1.27, P < 0.00001), neurological status (NIHSS, MD = -4.35, 95% CI = -5.15-3.54, P < 0.00001) and ADL (Barthel Index score, MD = 10.27, 95% CI = 7.75-12.79, P < 0.00001) compared with regular treatment alone. After the combined therapy, the hemorheology of ACI patients also significantly improved (P < 0.05). There is no significant difference in the frequency of adverse events between the two groups (RR = 1.49, 95% CI = 0.91-2.46, P = 0.11). The evidence from the meta-analysis suggested that the combination of conventional therapy and SML is safer and more effective than conventional therapy alone in treating ACI. However, due to the limitations of this analysis, such as regional bias and publication bias, the above conclusions need to be further verified by prospective, high-quality and multicenter clinical trials.

FcRn inhibitors: Transformative advances and significant impacts on IgG-mediated autoimmune diseases.

Pathogenic IgG autoantibodies play a crucial role in the pathogenesis of autoimmune diseases, and removal of pathogenic IgG autoantibodies is an important therapeutic approach and tool for such diseases. The neonatal Fc receptor (FcRn) interacts with IgG and protects it from lysosomal degradation. FcRn inhibitors accelerate the clearance of IgG antibodies, including pathogenic IgG autoantibodies, by targeting and blocking the binding of FcRn to IgG. Theoretically, FcRn inhibitors can be applied for the treatment of IgG-mediated autoimmune diseases. With successful completion of multiple relevant clinical trials, key evidence-based data have been provided for FcRn inhibitors in the treatment of IgG-mediated autoimmune diseases, and several FcRn inhibitors have been approved for these indications. Additional trials are being planned or conducted. This review examines all available high-quality clinical trials of FcRn inhibitors assessing IgG-mediated autoimmune diseases.

Influence of the Physiological Pacifier on the Development of Malocclusions in Children: A Scoping Review.

As a result of the dental alterations pacifiers can cause, several designs have been described, differing in the shape and size of the teat. The aim of this review was to compare the influence of the physiological pacifier on the development of malocclusions in children with other types of pacifier. The research question was: does the use of physiological pacifiers cause less dentomaxillary alterations than other designs? A scoping review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, and Scopus. The ROBINS-I risk of bias tool was used for the methodology assessment of the included studies. Of the 122 articles identified in the initial search, 5 articles met all the inclusion criteria. In all of them, in general, the use of the pacifier caused malocclusions such as an anterior open bite, a posterior crossbite, an increased overjet, and an involvement of the overbite. Children who began using the physiological pacifier very early, between 0 and 3 months, were less likely to develop finger sucking/thumb sucking compared to children who started after 3 months. In the prevalence of open anterior bite and overjet, there was a significant difference between the use of conventional pacifiers and anatomical pacifiers compared to the use of physiological pacifiers. the physiological pacifier can cause fewer oral alterations and could be the best option as a pacifier, however, more well-designed and high-quality randomised clinical trials are required.

Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application-a review.

Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.

Disseminated Superficial Actinic Porokeratosis: A Systematic Treatment Review.

Disseminated superficial actinic porokeratosis (DSAP) is a disorder of keratinization characterised by small, brown plaques with elevated keratotic rims, typically occurring on sun exposed areas. DSAP poses a risk for malignant transformation, emphasising the need for effective management strategies. The aim of this study was to review the current reported management options for DSAP. This systematic review was based on a comprehensive search of databases (Cochrane, PubMed, Medline, Embase, Emcare, ProQuest, Web of Science, CINAHL) from inception to 15 March 2024. Studies reporting management of DSAP were included irrespective of study design. Of 923 citations, 61 studies were included, predominantly comprising case reports and retrospective case series. A limited number of randomized and open-label trials were identified. Various treatment modalities were reported, including topical and systemic agents, photodynamic therapy, and laser therapy. Multiple management options are available for DSAP, including topical and systemic agents, photodynamic therapy and laser treatments. However, these approaches vary in their balance between efficacy and toxicity. Currently, there is a paucity of high-quality clinical trial data to guide treatment decisions. Further studies are required to determine the most effective and safe management strategies for DSAP. PROSPEROREGISTRATION: CRD42024514558.

Establishing Clinical Research Networks for Future Infectious Disease Outbreak Responses in Southeast-Asia: Report of a workshop on Challenges and Opportunities

The COVID-19 pandemic highlighted the critical need for well-established clinical research networks capable of rapid response during infectious disease outbreaks. In Southeast Asia, the absence of active research networks at the onset of the COVID-19 contributed to gaps in regional preparedness. This manuscript discusses the challenges and opportunities identified during a regional workshop held in Singapore (26 February – 1 March 2024), which brought together 130 stakeholders from across the region. The workshop aimed to build consensus on strategies to strengthen existing networks by developing human capacity, overcoming resource limitations, and sustaining collaborative research during inter-pandemic periods. Key challenges identified included the variability in research infrastructure across countries, complex regulatory requirements, and insufficient funding during non-outbreak periods. Recommendations include the development of standardised research protocols, the creation of a regional data-sharing platform, and fostering sustained collaboration to ensure these networks remain functional and responsive. Addressing these gaps is critical for enhancing Southeast Asia's capacity to conduct high-quality clinical trials and effectively respond to future infectious disease outbreaks.

Evidence-Based Review on Symptomatic Management of Huntington's Disease.

Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, behavioral, and cognitive impairments and significant impacts on patient quality of life. This evidence-based review, conducted by the Korean Huntington Disease Society task force, systematically examines current pharmacological and nonpharmacological interventions for symptomatic management of HD. Following PRISMA guidelines, databases were searched for studies up to August 2022 that focused on 23 symptoms across four domains: motor, neuropsychological, cognition, and others. This review provides a comprehensive and systematic approach to the management of HD, highlighting the need for more high-quality clinical trials to develop robust evidence-based guidelines.

Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage: Meta-Analysis of High-Quality Randomized Clinical Trials.

Spontaneous intracerebral hemorrhage (ICH) poses high mortality and morbidity rates with limited evidence-based therapeutic approaches. We aimed to evaluate the current evidence for the role of minimally invasive surgery (MIS) in the management of ICH. This systematic review and meta-analysis followed recommended guidelines and protocols. Medline, Embase, Scopus, and the Cochrane Library were searched from inception up to April 12, 2024. The inclusion was restricted to randomized clinical trials (RCTs) of high quality, ensuring they were not deemed to have a high risk of bias in any of the Cochrane risk of bias tool (RoB2) domains. Primary outcomes were good functional outcome (modified Rankin scale, 0-3) and mortality beyond 90 days. Secondary outcomes were early mortality within 30 days and rebleeding rates. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using random-effects models. Fourteen high-quality RCTs were included. There were 3,027 patients with ICH (1,475 randomized to MIS, and 1,452 randomized to medical management or craniotomy). Of included patients, 1,899 (62.7%) were males. MIS resulted in higher odds of achieving long-term good functional outcome (OR, 1.51 [95% CI, 1.25-1.82]), lower odds of long-term mortality (OR, 0.72 [95% CI, 0.57-0.90]) and lower odds of early mortality (OR, 0.73 [95% CI, 0.56-0.95]). Rebleeding rates were similar (OR, 1.10 [95% CI, 0.55-2.19]). The treatment effect of MIS was consistent across multiple sensitivity and subgroup analyses, including individuals with deep ICH. This meta-analysis provides high-quality clinical trial evidence supporting the use of MIS as a primary treatment strategy in the management of ICH. ANN NEUROL 2024.

Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review.

Greater trochanteric pain syndrome (GTPS) is one of the most prevalent causes of lateral hip pain. The incidence rate is as high as 1.8 patients per 1000 annually, with females predominantly affected. We compared and analysed the effectiveness of platelet-rich plasma (PRP) injections in treating GTPS. Literature search was carried out on PubMed, Embase and Cochrane by two independent reviewers using the terms: 'Greater Trochanteric Pain syndrome' and 'Platelet-rich plasma'. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Cochrane risk of bias tool andMethodological Index for Non-Randomized Studies (MINORS) tool were used to assess bias. Nine studies were shortlisted and reviewed for patient sample size, diagnostic modalities, the presence of tendinopathy or bursitis, the number of PRP injections administered, and the length of symptom relief achieved. We analysed nine studies between 2013 to 2024 comprising of a total of 508 patients who received treatment with PRP injections for lateral hip pain. There was an improvementand sustained relief in symptoms in eight studies, while one reported no change. Many studies indicated PRP injections to be more effective than corticosteroid injections (CSI) in treating GTPS. PRP appears to be an effective injectable treatment option for GTPS, which does not respond to conservative therapy. However, due to the limitations of the current literature, there is a need for more large-scale, high-quality randomized clinical trials to assess further the effectiveness of PRP for treating GTPS.

Effects of Chicken Egg Powder, Bovine Colostrum, and Combination Therapy for the Treatment of Gastrointestinal Disorders.

Natural-based products are of interest to the pharmaceutical industry as potential sources of novel medicinal compounds. They are also used by consumers/patients as standalone therapies or as an adjunct to Western medicines. Two natural-based products of interest are chicken egg and bovine colostrum (the milk produced in the first few days following calving). Both products are rich in immunoglobulins, antimicrobial peptides, growth factors, and macro- and micro-nutrients. In vitro, in vivo, and a limited number of clinical studies suggest therapeutic benefits of both components given alone and together. Combination therapy is of particular interest, as preclinical studies suggest synergistic effects on growth, repair, and gut protection, including microbiome-induced damage. This article describes the main constituents of egg and bovine colostrum, studies of their use alone and together for a wide range of conditions, highlights areas requiring further research, and describes novel indications such as GLP-1-associated gut symptoms. While well placed in the food supplement arena, additional high-quality clinical trials are required to establish their benefits in clinical practice.