Library Science Research Articles

THE IMPACT OF VASCULAR RISK FACTORS ON CEREBRAL AMYLOID ANGIOPATHY: A COHORT STUDY IN HEREDITARY CAA AND A SYSTEMATIC REVIEW IN SPORADIC CAA

Background: Cerebral amyloid angiopathy (CAA) has a remarkably variable disease course, even in monogenetic hereditary forms. Our aim was to investigate the prevalence of vascular risk factors and their effect on disease onset and course in Dutch-type hereditary (D-)CAA and sporadic CAA. Methods: We performed a cohort study in D-CAA to investigate the association between vascular risk factors (hypertension, hypercholesterolemia, smoking and alcohol use) and age of intracerebral hemorrhage (ICH) onset and time of ICH recurrence with survival analyses. In addition, we performed a systematic review to assess the prevalence of vascular risk factors and their effect on clinical outcome in sporadic CAA. We searched PubMed, Embase, Web of Science and COCHRANE Library, from 1987-2022 and included cohorts with ≥10 patients. We created forest plots, calculated pooled estimates and reported variability (heterogeneity plus sampling variability) and risk of bias. Results: We included 70 participants with D-CAA (47% women, mean age 53y). Sixteen (23%) had hypertension, 15 (21%) hypercholesterolemia, 45 (64%) were smokers and 61 (87%) used alcohol. We found no clear effect of vascular risk factors on age of first ICH (log-rank test hypertension: p=0.35, hypercholesterolemia: p=0.41, smoking: p=0.61 and alcohol use: p=0.55) or time until ICH recurrence (log-rank test hypertension: p=0.71, hypercholesterolemia: p=0.20 and smoking: p=0.71). We identified 25 out of 1234 screened papers that assessed the prevalence of risk factors in CAA and 6 that reported clinical outcomes. The pooled prevalence estimates of hypertension was 62% (95%CI:55%-69%), diabetes 17% (95%CI:14%-20%), dyslipidemia 32% (95%CI:23%-41%), and tobacco use 27% (95%CI:18%-36%). One study reported study diabetes and hypertension to be associated with a lower risk of recurrent ICH, whereas another study reported hypertension to be associated with an increased risk. All other studies showed no association between vascular risk factors and clinical outcome. High quality studies focusing on vascular risk factors were lacking. Conclusions: In patients with D-CAA and sporadic CAA the prevalence of vascular risk factors is high. Although this suggests an opportunity for prevention, there is no clear association between these risk factors and CAA-related ICH onset and recurrence.

O PROTAGONISMO DA ENFERMAGEM NA ASSISTÊNCIA AO PARTO HUMANIZADO: UMA REVISÃO INTEGRATIVA DA LITERATURA

The puerperal pregnancy process requires dignified and qualified care, not limited to the expulsion or extraction of the fetus. The implementation of good practices in labor and birth care is essential to guarantee the rights of the parturient. It is up to the care team to provide security in the partutive process, through evidence-based methods. The present research aims to understand the actions of the nursing team involved in the humanization of childbirth, highlighting the main determining factors for maternal satisfaction and dissatisfaction in the experience of labor. This is a systematic bibliographic survey, with a qualitative approach, of the integrative literature review type. The search for research material was carried out through electronic access to the digital databases Virtual Health Library, Latin American and Caribbean Literature in Health Sciences and Scientific Electronic Library. The inclusion criteria adopted were: national articles, available free of charge, with full texts, published between 2014 and 2024. The selection process allowed eight scientific studies to be obtained. Regarding the humanization of the parturition process associated with the direct action of nursing, it can be seen that the adoption of non-invasive practices results in maternal satisfaction and reduction of fetal impairment. It was noted that the incorporation of obstetric nurses in childbirth sectors contributed to the reduction of proscribed or invasive practices. It was concluded that humanized childbirth is closely associated with the use of good practices by professionals, which will directly impact the care for the mother-child binomial. Therefore, labor and birth care policies should be constantly reinforced, providing greater dissemination of knowledge.

Effect of different training modalities on lipid metabolism in patients with type ii diabetes mellitus: a network meta-analysis.

This study to evaluate the effects of different training modalities on blood lipids in type II diabetic patients by Network Meta-analysis, and provide a relevant basis for patients to develop exercise prescriptions to regulate blood lipids. Randomized controlled trials (RCTs) were retrieved from Zhiwang, Wanfang, Wipu, PubMed, EBSCO, Cochrane Library, and Web of Science that were published from the establishment to February 2023. Relevant statistical analyses were performed using Stata 17.0 software and Revman 5.4. A total of 35 randomized controlled trials with 2771 patients with type II diabetes were finally included. The results of Network Meta-analysis showed that, compared with the control group, Chinese traditional fitness exercise (CTF), resistance training (RT), and aerobic training (AT) could reduce total cholesterol (TC) levels; CTF, RT, whole body vibration training (WBV), and AT could reduce triacylglycerol (TG) levels; CTF, WBV and AT could increase High-density lipoprotein cholesterol (HDL) levels; CTF, RT and AT could reduce Low-density lipoprotein cholesterol (LDL) levels. SUCRA probability ranking results showed that CTF was the most effective in reducing TC[SMD= -0.57, 95% CI (-0.83, -0.31), p < 0.001], TG[SMD= -0.24, 95% CI (-0.36, -0.12), p < 0.001], LDL[SMD= -0.52, 95% CI (-0.70, -0.35), p < 0.001]; RT was the most effective in increasing HDL[SMD = 0.14, 95% CI (0.03, 0.26), p < 0.05]. CTF is more effective in improving TC, TG and LDL levels, while RT is most effective in improving HDL levels.

Early Palliative Care in Advanced Non-Small Cell Lung Cancer Patients: A Meta-Analysis.

This study aims to assess the efficacy of Early Palliative Care (EPC) in non-small cell lung cancer (NSCLC) through a meta-analysis approach. A computerized search was conducted in databases such as PubMed, Cochrane Library, Scopus, Embase, and Web of Science for prospective randomized controlled trials (RCTs) investigating the application of EPC in advanced NSCLC. Outcome measures including Overall Survival (OS), quality of life, and psychological status were extracted and subjected to pooled analysis. After the computerized search, a total of 7 studies comprising 1185 participants were included, with 597 patients receiving EPC intervention and 588 patients receiving Standard Care (SC) intervention. Three studies reported OS after the intervention, demonstrating a significant improvement in OS for patients receiving EPC (pooled HR = 1.60, 95% CI: 1.22, 1.98). Five studies analyzed the Functional Assessment of Cancer Therapy (FACT) scores after the intervention, revealing a significant improvement in FACT scores for patients receiving EPC (pooled SMD = 1.18, 95% CI: 1.04, 1.31). No significant differences were found in anxiety and depression scores between the 2 interventions in the 5 studies. In advanced NSCLC, EPC provides benefits in terms of increased survival rates and improved quality of life. EPC should be considered as part of multidisciplinary treatment for patients with advanced NSCLC.

Machine Learning Algorithms to Predict the Risk of Rupture of Intracranial Aneurysms: aSystematic Review.

Subarachnoid haemorrhage is apotentially fatal consequence of intracranial aneurysm rupture, however, it is difficult to predict if aneurysms will rupture. Prophylactic treatment of an intracranial aneurysm also involves risk, hence identifying rupture-prone aneurysms is of substantial clinical importance. This systematic review aims to evaluate the performance of machine learning algorithms for predicting intracranial aneurysm rupture risk. MEDLINE, Embase, Cochrane Library and Web of Science were searched until December 2023. Studies incorporating any machine learning algorithm to predict the risk of rupture of an intracranial aneurysm were included. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). PROSPERO registration: CRD42023452509. Out of 10,307 records screened, 20studies met the eligibility criteria for this review incorporating atotal of 20,286 aneurysm cases. The machine learning models gave a0.66-0.90 range for performance accuracy. The models were compared to current clinical standards in six studies and gave mixed results. Most studies posed high or unclear risks of bias and concerns for applicability, limiting the inferences that can be drawn from them. There was insufficient homogenous data for ameta-analysis. Machine learning can be applied to predict the risk of rupture for intracranial aneurysms. However, the evidence does not comprehensively demonstrate superiority to existing practice, limiting its role as aclinical adjunct. Further prospective multicentre studies of recent machine learning tools are needed to prove clinical validation before they are implemented in the clinic.

Proton beam therapy for craniopharyngioma: a systematic review and meta-analysis.

Craniopharyngioma is a rare and slow-growing benign sellar or parasellar epithelial tumor. The number of patients receiving proton beam therapy (PBT) has increased. This study aimed to systematically evaluate and analyze the comprehensive evidence regarding the safety and efficacy of PBT for craniopharyngioma. We searched four databases: the Cochrane Library, PubMed, Embase, and Web of Science. The period was from their inception to February 16, 2024. Two researchers independently screened the literature and extracted data. Among 486 candidate articles, eight studies were included in our study. Exactly 393 patients with craniopharyngioma underwent PBT in these studies. These studies reported data on survival and toxicity. The median sample size was 42.5 patients. The median age was9.1-37years; the female proportion was 48.9%, and the median follow-up time was 29-91.4months. All patients were treated once daily, five times a week, with a fraction of 1.8Gy (RBE) per session. The median total dose was 54.0Gy (RBE). The local control rates at 3 and 5years in these studies were 99% and 93%, respectively. The overall survival rates at 3 and 5years in these studies were both 100%. The incidence of acute and late toxicities was mainly grade 1-2. The main late toxicities included vascular and visual toxicities, hypothalamic obesity, endocrinopathy, and panhypopituitarism. PBT for craniopharyngioma, especially in children and adolescents, has shown impressive local control and acceptable acute and late toxicities.

Prognostic impact of the newly revised IASLC proposed grading system for invasive lung adenocarcinoma: a systematic review and meta-analysis.

This study aimed to evaluate the prognostic value of the newly revised International Association for the Study of Lung Cancer (IASLC) grading system (2020) on the 5-year overall survival (OS) and recurrence-free survival (RFS) in patients with lung adenocarcinoma (LADC). Clinical studies that investigated the prognostic value of revised IASLC staging system in patients with LADC were retrieved from the PubMed, Web of Science, ScienceDirect, and Cochrane Library databases. This study was conducted in accordance to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklists. Based on inclusion and exclusion criteria, we included 12 studies for analysis. The grade of LADC was assessed by revised IASLC system, which included three grades. Compared to Grade 3 LADC, grade 1 (total [95% CI]: 1.38 [1.19, 1.60]) and grade 2 (total [95% CI]: 1.29 [1.15, 1.44]) LADC had higher 5-year OS rates. Similarly, Grade 1 (total [95% CI]: 1.76 [1.42, 2.18]) and Grade 2 (total [95% CI]: 1.51 [1.28, 1.77]) had higher 5-year RFS rates Grade 3 LADC. However, 5-year OS and RFS had no significant difference between Grade 1 and Grade 2 patients. This systematic review and meta-analysis provides evidence that the newly revised IASLC grading system is significantly associated with the prognosis of patients with LADC, where Grade 3 indicated unfavorable prognosis.

BN SO22 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: A systematic review and meta-analysis

Abstract Background Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life and safety in patients that underwent MSA, with a comparison to fundoplication. Method A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study Results Thirty-nine studies with 8,075 patients were included: 6,983 patients underwent MSA and 1,092 a fundoplication procedure. More individuals discontinued proton-pump inhibitors (P&amp;lt;0.001; WMD 0.83) and had higher rates of satisfaction (P&amp;lt;0.001; WMD 0.85) following MSA compared to fundoplication. Functional outcomes including ability to belch (P&amp;lt;0.001; WMD 0.96) and emesis (P&amp;lt;0.001; WMD 0.92), and bloating (P=0.003; WMD 0.20) were better after MSA than after fundoplication, although MSA had higher rates of dysphagia (P=0.001; WMD 0.41). The overall erosion and removal rate following MSA was 0.24% and 3.9% respectively, indicating no difference in re-intervention rates between MSA and fundoplication (P=0.446; WMD 0.001). Conclusion MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.

Propuesta de lineamientos generales para la gestión del conocimiento en bibliotecas infantiles

The objective of this research is to present a proposal for general guidelines for knowledge management in children’s libraries, taking as reference the experience of the academic activity of the School of Library Science, Documentation and Information (EBDI) of the National University (UNA) of Costa Rica with the name of the Miriam Álvarez Brenes Children’s Library (BIMAB) in the period between January 2018 and June 2020. This study had a qualitative approach and was explanatory; data collection was done primarily through bibliographic review and experiences obtained in the management of this academic activity. As main results and conclusions, it is possible to highlight the definition of a series of general guidelines for knowledge management that can be related and adjusted to the context of any children’s library; so, general guidance is provided for the continuous improvement of management processes of the information unit and to facilitate access and democratization of information products and services for its community of users.

Abstract 4137019: Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Despite the effectiveness of drug-eluting stents (DES) in preventing restenosis, many patients still experience DES restenosis. Neointimal hyperplasia and neoatherosclerosis can develop within these stents, leading to recurrent coronary syndromes. Hypothesis: Repeated stenting with DES is limited by additional metal layers, the need for prolonged dual antiplatelet therapy, and heightened risks of stent thrombosis. Locally acting drugs with sustained efficacy may prevent this progression. Paclitaxel delivery via contrast medium or drug-coated balloon catheters could exert antiproliferative effects, reducing neointimal proliferation. Aims: To synthesize existing evidence on the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated Balloons in coronary in-stent restenosis. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to March 23, 2024. Using R version 4.4.0, we reported outcomes as risk ratios (RRs) or mean differences (MD) and confidence intervals (CIs). This review has been registered and published in PROSPERO (CRD42024527412). Results: The meta-analysis included a total of six trials with 1,541 patients. PCB significantly reduced the incidence of myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P &lt; 0.001), target lesion revascularization (RR 0.34, 95% CI [0.14, 0.84], p &lt; 0.001). No significant differences were observed between PCB and UCB regarding cardiac-related mortality, target vessel revascularization, percutaneous coronary intervention, all-cause death, Q wave and non-Q wave myocardial infarction, coronary artery bypass grafting, and target vessel failure. Conclusion: PCB for ISR significantly reduced the incidence of myocardial infarction, MACE, and stent thrombosis compared to UCB.

Advancements in breast cancer management: a comprehensive review of ribociclib combined with endocrine therapy

Background: In this review, the complicated landscape of breast cancer management is explored with a focus on the promising synergies between ribociclib and endocrine therapy. Ribociclib mainly acts as a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, which disrupts cell cycle progression necessary for tumor growth. This, in combination with endocrine therapy, aims to produce hormone receptor-positive breast cancers, which is a very relevant subtype with challenging therapeutics. Methods: A comprehensive review was conducted using multiple databases, PubMed, Embase, Scopus, Cochrane Library, and Web of Science, covering the period from January 1990 to May 2024. Results: Pharmacokinetic studies underscore the efficacy and tolerability of ribociclib, thus providing vital information for dose adjustments, particularly among patients with renal and hepatic impairments. Ribociclib’s value in extending progression-free survival and improving overall survival has been shown by clinical trials such as the MONALEESA series. Quality of life considerations and patient-reported outcomes from these trials indicate that ribociclib has a broader effect on the well-being of the patients. However, despite the success experienced by this drug in clinical practice, it still has some side effects, including hematologic toxicity, hepatotoxicity, and thromboembolism associated with it. Ribociclib resistance mechanisms are multifaceted mixtures comprising genetic variations or mutations, compensatory signaling pathways, and epigenomic changes. While overcoming resistance remains challenging, ongoing research seeks to reconcile. Conclusion: Ribociclib combined with endocrine therapy represents a significant advancement in breast cancer treatment, albeit with challenges that necessitate ongoing research and holistic patient care approaches.

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.

Abstract 4137350: Temporal Trends and Effect of Superior Vena Cava Isolation Plus Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Ablation: A Systematic Meta-Analysis with Trial Sequential Analysis

Objectives: To assess the efficacy and safety of Superior Vena Cava Isolation (SVCI) plus Pulmonary Vein Isolation (PVI) compared to PVI alone in patients with drug-refractory paroxysmal atrial fibrillation (PAF). Methods: We utilized PubMed, EMBASE, Cochrane Library (CENTRAL) and Web of Science to identify the published randomized controlled trials (RCTs) involving patients undergoing SVCI+PVI ablation compared to PVI alone therapy. The search, conducted until February 17, 2024, used the terms "Superior Vena Cava," "Pulmonary Vein," "Radiofrequency Ablation," and "Atrial Fibrillation." Two reviewers screened records, extracted outcomes, and evaluated risk bias. The analysis employed Revman 5.4 and Trial Sequential Analysis (TSA 0.9.5.10 Beta). Results: The results included 4 RCTs involving 532 patients. Recurrence of atrial fibrillation significantly reduced in the SVCI+PVI group compared to the PVI alone group (RR 0.42, 95% CI 0.26–0.69, P = 0.0005; I 2 = 16%, P heterogeneity = 0.04) during a mean 12-month follow-up. Trial Sequential Analysis (TSA) supported these findings. Procedural complications did not show significant differences (RR 1.72, 95% CI 0.52–5.75, P = 0.38; I 2 = 0%, P heterogeneity = 0.56). Conclusion: In conclusion, the meta-analysis of RCTs suggests that SVCI in addition to PVI is superior to PVI alone for PAF, with no increase in procedural complications. TSA demonstrated consistent results with an adequate sample size, indicating no need for further RCTs on this matter.

Obstructive Sleep Apnea in Pediatrics and Adolescent Women: A Systematic Review of Sex-Based Differences Between Girls and Boys

Background/Objectives: Obstructive sleep apnea (OSA) is marked by repetitive occurrences of upper airway (UA) obstruction during sleep. Morbidities impacting the metabolic, cardiovascular (CV) and neurological systems are correlated with OSA. Only a few studies have described the existence of different characteristics depending on sex and, to date, the girl phenotype in OSA pediatrics is not well known. The objective of this systematic review is to identify the specific phenotype of OSA in pediatric and adolescent females compared to males. Methods: A systematic review was performed. The terms “pediatric sleep apnea” and “sex differences” were used to look for publications using PubMed, the Cochrane Library and Web of Science. Inclusion criteria: (1) peer-reviewed journal articles written in English; (2) investigations conducted on individuals diagnosed with OSA; and (3) investigations providing information about sex differences. Exclusion criteria: (1) studies carried out with individuals aged 18 years and older; (2) studies involving a sample size of fewer than 10 patients; and (3) editorials, letters and case reports. Results: Fifteen studies were included and classified in sections related to sex-based differences. Conclusions: Limited information related to sex-based OSA differences in the pediatric population exists. These differences are conditioned by hormonal status, and are minimal in the premenarcheal period. Moreover, adolescent women present a lower prevalence of obesity and craniofacial alterations, lower OSA severity related to higher UA area and earlier tonsil regression. Hyperactivity is more frequent in boys. Some studies pointed to a higher risk of high diastolic blood pressure in girls than in boys.

Machine learning-based infection diagnostic and prognostic models in post-acute care settings: a systematic review.

This study aims to (1) review machine learning (ML)-based models for early infection diagnostic and prognosis prediction in post-acute care (PAC) settings, (2) identify key risk predictors influencing infection-related outcomes, and (3) examine the quality and limitations of these models. PubMed, Web of Science, Scopus, IEEE Xplore, CINAHL, and ACM digital library were searched in February 2024. Eligible studies leveraged PAC data to develop and evaluate ML models for infection-related risks. Data extraction followed the CHARMS checklist. Quality appraisal followed the PROBAST tool. Data synthesis was guided by the socio-ecological conceptual framework. Thirteen studies were included, mainly focusing on respiratory infections and nursing homes. Most used regression models with structured electronic health record data. Since 2020, there has been a shift toward advanced ML algorithms and multimodal data, biosensors, and clinical notes being significant sources of unstructured data. Despite these advances, there is insufficient evidence to support performance improvements over traditional models. Individual-level risk predictors, like impaired cognition, declined function, and tachycardia, were commonly used, while contextual-level predictors were barely utilized, consequently limiting model fairness. Major sources of bias included lack of external validation, inadequate model calibration, and insufficient consideration of data complexity. Despite the growth of advanced modeling approaches in infection-related models in PAC settings, evidence supporting their superiority remains limited. Future research should leverage a socio-ecological lens for predictor selection and model construction, exploring optimal data modalities and ML model usage in PAC, while ensuring rigorous methodologies and fairness considerations.

Abstract 4136159: Determinants of Exercise Intolerance in Postural Orthostatic Tachycardia Syndrome: a Systematic Review

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a syndrome of an exaggerated heart rate (HR) response with standing, disproportionately affecting young women associated with exercise intolerance due to dizziness, palpitations, and/or chest pain. Research question: How does the exaggerated increase in HR with standing translate into impaired exercise tolerance in subjects with POTS? Aims: To systematically analyze determinants of exercise intolerance in subjects with POTS. Methods: We searched the National Library of Science and identifed 11 cohorts with a diagnosis of POTS and an assessment of exercise capacity. We abstracted the information including type of exercise testing, hemodynamics and gas exchange parameters (peak oxygen consumption [VO 2 ]) with exercise, and effect of interventions (if present). Results: We identified 849 subjects with POTS, female:male ratio of 8.5:1, 25±8 years, and 365 age-and sex-matched controls. A cycle ergometer was used in 8 studies (574 subjects, 68%) and a treadmill in 3 (275 subjects, 32%). Peak VO 2 was measured in 10 studies (836 subjects, 98%), and exercise hemodynamics in 9 (593 subjects, 70%). All 11 (100%) studies described a higher HR at rest and during submaximal exercise in subjects with POTS, with a similar slope of HR/load, and shorter time to peak HR. Of the 9 studies with hemodynamics, 6 (67%) reported a reduction in stroke volume (SV) with standing and with exercise, but only 1 (11%) documented a reduction in cardiac output (CO). Two studies (22%) enrolling teenagers showed a variable increase in SV and CO in POTS. Peak VO 2 was reduced in 8 (80%) studies when compared with predicted values, but only in 4 (40%) when compared with controls matched for deconditioning. Intravenous fluid administration in two studies did not affect HR, SV, CO or peak VO 2 . Exercise training in one study (19 subjects) and propranolol 20 mg in another study (11 subjects) led to improving peak VO 2 . Conclusions: An exaggerated HR response with standing and with exercise is a hallmark of POTS, a mechanism by which subjects reach a higher HR at lower workloads. While the increase in HR is associated with a reduction in SV, CO is typically maintained and occasionally increased, therefore making it an unlikely mechanism responsible for the peculiar exertional symptoms of POTS. Strategies that result in a reduction in HR may, on the other hand, translate in improved exercise capacity in subjects with POTS.

University Dropout: A Systematic Review of the Main Determinant Factors(2020-2024).

This research is a systematic review aimed at synthesizing scientific evidence on the causes of university dropout, focusing on the subcategories of vocational guidance, academic performance, socioeconomic status, and institutional aspects between 2020 and June 2024. Only articles addressing university dropout were considered, analyzing dimensions such as vocational guidance, academic performance, socioeconomic status, and institutional aspects. Articles published in indexed scientific journals with double-blind, double-blind peer, or open reviews between 2020 and June 2024 were included. The main databases used were Scopus, Web of Science, and Google Scholar. To assess the risk of bias in qualitative studies, the criteria from the article "Validity criteria for qualitative research: three epistemological strands for the same purpose" were used. For quantitative studies, the criteria from the article "Evaluating survey research in articles published in Library Science journals" were followed. For mixed-method studies, both sets of criteria were combined. A total of 23 studies were included: 15 quantitative (65.22%), 3 qualitative (13.04%), and 5 mixed-method (21.74%). All studies (100%) addressed the subcategories of socioeconomic status and institutional aspects. Regarding the academic performance subcategory, 86% of the studies addressed it, while the vocational guidance subcategory was covered by 73.91% of the studies. Vocational guidance, academic performance, socioeconomic status, and institutional aspects are crucial for reducing university dropout. Providing adequate professional guidance, academic support, financial assistance, and strong institutional support is fundamental to improving student retention and academic success.

Comparative Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Phase Angle and Bioelectrical Impedance Analysis Measures: A Systematic Review and Meta-Analysis

Background/Objectives: The objective of this meta-analysis was to determine the impact of bariatric surgery on phase angle (PhA) and other bioimpedance measures among adults with obesity, comparing the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, including studies up to May 2024 from MEDLINE, Scopus, Cochrane Library, and Web of Science. Eligible studies assessed PhA changes pre- and post-bariatric surgery in adults with BMI ≥ 30 kg/m2. Data on PhA, fat mass (FM), fat-free mass (FFM), body cell mass (BCM), weight, and BMI were extracted and analyzed. Results: Thirteen studies with a total of 1124 patients were included. Significant PhA reductions were observed at 6 months post-surgery (effect size: −1.00; 95% CI: −1.11 to −0.89; p &lt; 0.001), with a more substantial reduction in RYGB patients compared to SG. FM and FFM decreased significantly at 12 months (FM: −27.58; 95% CI: −32.58 to −22.57; p &lt; 0.001; FFM: −10.51; 95% CI: −12.81 to −8.94; p &lt; 0.001). Weight and BMI showed marked reductions at 6 months (Weight: −31.42 kg; 95% CI: −37.28 to −25.26; p &lt; 0.001; BMI: −11.39; 95% CI: −12.60 to −10.18; p &lt; 0.001), with sustained decreases at 12 and 24 months. Conclusions: Bariatric surgery significantly reduces PhA, FM, FFM, weight, and BMI, with initial greater impacts observed in RYGB compared to SG. PhA shows potential as a marker for monitoring post-surgical recovery and nutritional status. Further long-term studies and standardized measurement protocols are recommended to optimize patient management.

Transcranial direct current stimulation in the management of epilepsy: a meta-analysis and systematic review

BackgroundTranscranial direct current stimulation (tDCS) has recently become a novel and non-invasive treatment option for refractory epilepsy. Previous systematic reviews have suggested that tDCS may be effective in treating epilepsy, this study presents the first meta-analysis on its effectiveness.MethodsWe searched PubMed, Embase, Cochrane Library, and Web of Science for relevant randomized controlled trials (RCTs) from database inception to May 2024. The Cochrane risk of bias tool RoB2.0 was used to assess the risk of bias. Primary outcomes included changes in seizure frequency from baseline and the proportion of patients with a ≥50% reduction in seizure frequency.ResultsOf the 608 studies initially identified, 14 were finally included. The pooled results from the random-effects model indicated that tDCS significantly reduced seizure frequency (WMD 0.41, 95% CI 0.24, 0.59). Further subgroup analysis revealed that tDCS significantly reduced seizure frequency in temporal lobe epilepsy, and seizure frequency was more alleviated in studies that had treatment sessions of fewer than 5 times, and followed up within 2 months' post-treatment. Only four studies provided data on patients with a ≥50% reduction in seizure frequency, showing no significant difference (RR 2.96, 95% CI 0.85, 10.32). In the systematic review, three studies analyzed cognitive function changes after tDCS treatment, but none reported significant improvements. The most common side effect during tDCS treatment was transient tingling, and no patients required additional life-support measures due to side effects.ConclusionThe current meta-analysis on available trials indicates that tDCS can effectively reduce seizure frequency in the short term and is well-tolerated. However, its impact on cognitive improvement in epilepsy patients requires further investigation.Systematic review registrationhttps://inplasy.com/inplasy-2024-6-0033/, identifier INPLASY202460033.

Routine antibiotic prophylaxis and early implant failure: is there a link?

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30-1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.