Mean Difference Research Articles

Pathophysiological Significance of α-Synuclein in Sympathetic Nerves: In Vivo Observations.

Lewy body diseases (LBDs) such as Parkinson disease (PD) feature increased deposition of α-synuclein (α-syn) in cutaneous sympathetic noradrenergic nerves. The pathophysiologic significance of sympathetic intraneuronal α-syn is unclear. We reviewed data about immunoreactive α-syn, tyrosine hydroxylase (TH, a marker of catecholaminergic fibers), and the sympathetic neurotransmitter norepinephrine (NE) in skin biopsies from control participants and patients with PD, the related LBD pure autonomic failure (PAF), the non-LBD synucleinopathy multiple system atrophy (MSA), or neurologic postacute sequelae of severe acute respiratory syndrome coronavirus 2 (neuro-PASC). In a retrospective observational study, we reviewed data about α-syn-TH colocalization indexes and immunoreactive α-syn and TH signal intensities in arrector pili muscles, blood vessels, and sweat glands from neck skin biopsies and NE concentrations in simultaneously obtained thigh skin biopsies from participants studied at the NIH Clinical Center. LBD, MSA, and control group data were assessed by analyses of variance with the Tukey post hoc test for multiple comparisons. Similar analyses were performed for patients with PD or neuro-PASC vs control. Dermal α-syn-TH colocalization indexes and α-syn signal intensities from neck skin biopsies were examined in 18 controls (mean age 58 years, 50% female) and 53 LBD (66, 34%), 15 MSA (61, 33%), and 11 neuro-PASC (52, 82%) patients. The LBD group had higher α-syn-TH colocalization indexes than the controls (mean difference = 1.495, 95% CI 1.081-1.909, p < 0.0001) and increased α-syn signal intensities in all 3 skin constituents (arrector pili: mean difference = 2.743, 95% CI 1.608-3.879, p < 0.0001; blood vessels: mean difference = 2.157, 95% CI 1.095-3.219, p < 0.0001; sweat glands: mean difference = 4.136, 95% CI 1.704-6.567, p < 0.0001). The groups did not differ in either immunoreactive TH or NE. The neuro-PASC and PD groups had elevated α-syn-TH colocalization indexes compared with the controls, also with no group differences in immunoreactive TH or NE contents. LBDs and neuro-PASC entail increased α-syn-TH colocalization indexes in skin biopsies, without evidence of local denervation or noradrenergic deficiency. The results fail to support toxicity of intraneuronal α-syn in cutaneous sympathetic noradrenergic nerves in either LBDs or neuro-PASC. The neuro-PASC data raise the possibility of sympathetic intraneuronal α-syn deposition as part of postinfectious immune or inflammatory processes.

Internal limiting membrane peel size and macular hole surgery outcome: a systematic review and individual participant data study of randomized controlled trials.

There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH). A systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into "small" (1-disc diameter [DD] in radius or less) and "large" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence. Five RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)). Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. ILM peel size probably has no significant effect on postoperative VA.

Impact of exercise on musculoskeletal pain and disability in the postpartum period: a systematic review and meta-analysis

ObjectiveTo examine the impact of exercise on musculoskeletal pain (low back pain (LBP), pelvic girdle pain (PGP), lumbopelvic pain (LBPP) and bodily pain) and kinesiophobia during the postpartum period.DesignSystematic review...

Patterns and predictors of postoperative complications and recurrence after ileocecal resection for Crohn's disease: a national multicenter longitudinal study.

Crohn's disease (CD) negatively impacts quality of life, and a high percentage of patients will need surgery. Ileocecal resection (ICR) is the most common abdominal procedure performed in CD. Postoperative complications are frequent, and recurrence is common. The main objectives of this study were to analyze risk factors (RF) for anastomotic leakage (AL) and recurrence after ICR, as well as quality of life (QoL) in CD in a sample of the Spanish population. A prospective, multicenter, observational study was designed, including all types of hospitals in Spain from 2018 to 2021. Demographic and medical-surgical characteristics, postoperative complications, hospital types by annual ICR volume, and quality of life (IBDQ-9) up to 1year follow-up (OYF) were recorded and analyzed. A total of 386 ICRs were recorded. At 60days, there were 134 (36.4%) complications, 46 (11.91%) of which were major. A total of 23 (5.9%) AL were registered, and RF were Montreal A3 [OR 14.2, 95% CI (2.70-126), p = 0.005], Montreal p [OR 7.29, 95% CI (1.14-44.4), p = 0.029], and intensified adalimumab treatment [3.8, 95% CI (1.2-13.1), p = 0.026]. Recurrences at OYF were 67 (19%), and RF were history of neoplasia [OR 7.14, p = 0.01], Montreal B3 [OR 2.12, p = 0.02], and minimally invasive surgery (MIS) [OR 2.63, p = 0.02]. The mean difference in IBDQ-9 from baseline to 60days was +1.72 (n = 177, p < 0.001) and to OYF +2.12 (n = 140, p < 0.001). The AL rate was 5.9%. Montreal A3, perianal disease, and intensified adalimumab were associated with a higher rate of AL. The recurrence rate was 17.6% (OYF). Prior neoplasia, Montreal B3, and MIS were associated with higher risk of recurrence. ICR improves quality of life at 60days and is maintained 1year after surgery.

Addressing Intervention Fit When Developing Services for Adolescents Leaving Care - An Empirical Assessment of Measurement Invariance and Latent Mean Differences in Theoretically Defined Mediators.

A good fit between program theory and the needs of the target population is essential to the success of an intervention. Still, empirical investigation of fit is a rare activity in theoretical frameworks for intervention development. The study objective was to inform the development of relevant support for youth transitioning from out-of-home care (OHC) in Sweden in light of intervention fit. Self-efficacy, mental health, resilience, and self-determination have been identified as potentially important malleable mediators that can be targeted by independent living services (ILS). This study aimed to establish the extent to which measurement instruments used to capture these mediators measure similarly across youth that belong to a potential target population for ILS and those who do not. A cross-sectional survey design was used to compare youth with and without experience of OHC on the four study outcomes using a multi-group measurement invariance analysis and latent mean comparison. All scales demonstrated scalar invariance or partial scalar invariance. Contrary to initial hypothesis, no differences in latent means were found. Four potential interpretations of the results were discussed. Conclusion: The study identified a potential discrepancy between theoretical assumptions and empirical characteristics relevant to development of ILS for youth with experience of OHC in Sweden. Moreover, it highlighted the importance of exploring theoretical core mediators empirically in the target population in the process of intervention development and evaluation.

Efficacy and safety of microfocused ultrasound for temporary eyebrow lift and glabellar wrinkle reduction.

Microfocused ultrasound (MFU) is a noninvasive treatment method that is widely used for skin tightening. In this study, we investigated the efficacy and safety of a novel MFU device for temporary eyebrow lifting and glabellar wrinkle reduction. In this prospective, single-center, single-arm, and open-label study, 38 patients were enrolled. Each patient was treated with MFU at the forehead and lateral eye areas. The treatment efficacy was measured at weeks 4, 8, 12, and 16 by calculating the average eyebrow height (AEH), maximal eyebrow height (MEH), patient satisfaction score, and glabellar Line Scale (GLS) score. Moreover, adverse events were recorded. The AEH was elevated with a mean difference of 1.99mm at week 4 and remained elevated at week 16 with a mean difference of 1.57mm. (P < 0.0001, respectively). In addition, the mean MEH increased by 2.21mm at week 4 and by 1.63mm at week 16 (P < 0.0001, respectively). Glabellar wrinkles were temporarily alleviated in some patients, with 71.05% of patients showing an improvement of one point or more in their GLS score at week 4. No serious adverse events were reported. MFU is an effective and safe treatment for temporary eyebrow lifting and glabellar wrinkle reduction.

A systematic review and meta-analysis of neuromuscular electrical stimulation post-botulinum toxin injection in children with cerebral palsy

The aim of our study is to investigate whether adjunct neuromuscular electrical stimulation (NMES) therapy improves functional performance outcomes in children with cerebral palsy (CP) who have received botulinum toxin (BTX) injections. We searched the PubMed, Cochrane Library, CINAHL, EMBASE, and Scopus databases for randomized controlled trials studying the effects of NMES after BTX injection in children with CP from database inception to July 3, 2024. Two independent reviewers extracted data, and risks of bias were assessed using the PEDro scale for randomized controlled trials. We included 5 randomized controlled trials in this meta-analysis. NMES treatment following BTX injection resulted in greater functional performance outcomes compared with BTX injections alone (standardized mean difference = 0.57; 95% CI = 0.22 to 0.92). However, NMES following BTX injections did not significantly improve spasticity outcomes (standardized mean difference = 0.28; 95% CI = − 0.21 to 0.76). Despite including only a small number of trials, the present analysis demonstrated that NMES is an effective adjunct to BTX injections for managing CP in children. Further research must be conducted to refine these therapies, ensure better outcomes, and alleviate the burdens faced by individuals with CP.

Unveiling neurogenic biomarkers for the differentiation between sepsis patients with or without encephalopathy: an updated meta-analysis

BackgroundSepsis-associated encephalopathy (SAE) is characterized by brain dysfunction in the context of sepsis and frequently leads to significant cognitive and neurological impairments, as well as an elevated risk of mortality. Accurate diagnosis of SAE is crucial for the timely initiation of optimal treatment and appropriate patient management. Neurogenic biomarkers hold promise as reliable serum diagnostic tools for the detection and longitudinal monitoring of SAE. This meta-analysis seeks to evaluate the diagnostic and prognostic utility of serum neurogenic biomarkers in patients with SAE.MethodsThe study protocol was registered in the PROSPERO database (CRD42023408312) and conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was conducted to comprehensively and critically evaluate the existing body of evidence regarding the use of serum neurogenic biomarkers: neuron-specific enolase (NSE), ubiquitin C-terminal hydrolase-L1 (UCH-L1), Tau, S100 calcium-binding protein β (S100β), and glial fibrillary acidic protein (GFAP) for the diagnosis and risk assessment of fatality in SAE. We conducted a systematic search of electronic bibliographic databases, including PubMed, Web of Science, Embase, Cochrane databases, CNKI, CQVIP, and WFSD. The quality and risk of bias of the selected studies were assessed using the QUADAS-2 tool. For biomarkers reported in two or more studies, pooled standardized mean differences and 95% confidence intervals were calculated. Heterogeneity among the included studies was examined using the I2 statistic and random-effects model was applied owing to large heterogeneity.ResultsForty-two studies were included in our meta-analysis. The levels of serum neurogenic biomarkers were significantly higher in patients with SAE as compared to septic patients with no-encephalopathy (NE): NSE (standardized mean difference (SMD) 1.98 (95% CI 1.55–2.42), P < 0.00001); UCH-L1 (SMD 1.75 (95% CI 0.90–2.59), P < 0.0001); Tau (SMD 1.14 (95% CI 1.01–1.28), P < 0.00001); S100β (SMD 1.82 (95% CI 1.45–2.19), P < 0.00001); and GFAP (SMD 3.63 (95% CI 1.85–5.41), P < 0.0001). In addition, significantly lower serum neurogenic biomarkers levels were noted in septic patients with survivors as compared to non-survivors: NSE (SMD − 1.87 (95% CI − 2.43 to − 1.32), P < 0.00001); UCH-L1 (SMD − 1. 71 (95% CI − 2.24 to − 1.19), P < 0.00001); Tau (SMD − 0.57 (95% CI − 0.79 to − 0.35), P < 0.00001); S100β (SMD − 1.34 (95% CI − 1.88 to − 0.80), P < 0.00001). However, no significant differences in serum GFAP levels [SMD -7.98 (95% CI − 22.23–6.27), P = 0.27) were found between the surviving and non-surviving groups.ConclusionThe increased serum neurogenic biomarkers may be predictive of SAE and mortality for septic patients, which are expected to be applied as a reliable blood-based diagnostic tool for detection and longitudinal monitoring in SAE patients. However, results should be interpreted with caution due to the high heterogeneity among studies.

The effect of autologous platelet concentrates as solely grafting material or with bone graft materials in maxillary sinus augmentation: a meta-analysis of randomized controlled trials.

This study compared the effectiveness of adding autologous platelet concentrates (APCs(+)) and sole bone grafting procedures (APCs(-)) in maxillary sinus augmentation (MSA). A systematic search was performed to identify randomized controlled trials (RCTs) from electronic database and clinical registers published up to June 1, 2024. Six evaluation indices comprising percentage of new bone formation (NBF%), percentage of residual bone substitute (RBS%), percentage of fibrous tissue (FT%), implant stability quotient (ISQ), bone height (BH) and bone density (BD) were identified. We analyzed 14 studies involving 268 lifted sinuses and 119 implants. Compared with the APCs(-) group, the APCs(+) group demonstrated a significant advantage regarding NBF% (weight mean difference (MD)= 4.80, 95% confidence interval (CI) (1.82,8.32), p=0.007) and RBS% (MD=-4.48, 95% CI (-6.01,2.96), p<0.01), with no evident superiority in FT% (MD=-0.11, 95% CI (-0.56,0.35), p=0.64), ISQ (MD=-1.68, 95% CI (-6.77,3.40), p=0.52) and BH (standard mean difference (SMD) =-0.11, 95% CI (-3.04,2.83), p=0.94). While APCs(-) group showed a significant benefit in BD compared to the APCs(+) group (MD=-28.34, 95% CI (-48.98,-7.71), p=0.01). Compared with APCs(-), APCs(+) could be a better option for promoting NBF% and reducing RBS%, whereas we found no evident influence in FT% and ISQ under MSA. Concerning BD and BH results, there were no additional effects with the addition of APCs, which needs to be treated with caution due to the limited number of studies. APCs(+) procedures show promising results, with a higher NBF% and lower RBS%, making them a potential routine MSA strategy.

Preoperative peripheral nerve blocks are not independently associated with improved functional outcome, patient satisfaction, or risk of chronic pain at one year following knee arthroplasty.

Control of acute pain following knee arthroplasty (KA) with a perioperative peripheral nerve block (PNB) may improve functional outcomes and reduce the risk of chronic postoperative knee pain (CPKP). The aims of this study were to assess whether a PNB influences patient-reported outcomes and risk of CPKP at one year following KA. A retrospective study was conducted over a two-year period and included 3,338 patients who underwent KA, of whom 1,434 (43.0%) had a lower limb PNB. A total of 2,588 patients (77.6%) completed and returned their one-year follow-up questionnaire. The Oxford Knee Score (OKS) and pain component (OKS-PS), EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (VAS) were collected preoperatively and at one year postoperatively. Patient satisfaction was also recorded at one year. The OKS-PS was used to define CPKP at one year. The PNB group were younger (mean difference (MD) 0.7 years, 95% CI 0.0 to 1.3; p = 0.039), had a worse OKS (MD 0.7, 95% CI 0.1 to 1.3; p = 0.027), and were more likely to have had a spinal anaesthesia relative to a general anaesthetic (odds ratio 4.2, 95% CI 3.23 to 5.45; p < 0.001). When adjusting for confounding factors, patients in the PNB group had a significantly reduced improvement in their OKS (MD -0.9, 95% CI -1.6 to -0.1; p = 0.022), which may not be clinically meaningful. There were no significant differences in the OKS-PS (p = 0.068), EQ-5D (p = 0.313), or EQ-VAS (0.855) between the groups when adjusting for confounding factors. When adjusting for confounding factors using binary regression analysis, there were no differences in patient satisfaction (p = 0.132) or in the risk of CPKP (p = 0.794) according to PNB group. PNBs were independently associated with worse knee-specific outcomes, but whether these are clinically meaningful is not clear, as the difference was less than the minimal clinically important difference. Furthermore, PNBs were not independently associated with differences in health-related quality of life, patient satisfaction, or risk of CPKP.

Beneficial and harmful effects of duloxetine versus placebo, ‘active placebo’ or no intervention for adults with major depressive disorder: a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials

ObjectivesTo assess the beneficial and harmful effects of duloxetine versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder.DesignSystematic review with meta-analysis and trial sequential analysis of...

Effectiveness of cardiometabolic health education interventions in populations with lower educational attainment: A systematic review and meta-analysis.

Health education is integral to cardiometabolic disease (CMD) management. Certain populations, such as people with lower educational attainment have higher risk of CMD and worse outcomes. They are also known to have differing preferences for health education formats and delivery compared with the general population. This study assessed the efficacy of CMD educational interventions in populations with lower educational attainment. Four databases (Medline, Proquest, CINAHL, and Google Scholar) were systematically searched to identify studies using an educational intervention, targeting CMD-related outcomes, in a population with low educational attainment, in a community or primary care setting. A random-effects meta-analysis was conducted to calculate pooled mean differences. Educational interventions were associated with statistically significant improvements at approximately 3 months, compared with baseline, in terms of BMI (mean difference [95 % confidence interval] = -0.27 [-0.42, -0.12] kg/m2; p < 0.001), weight (-0.20 [-0.35, -0.06] kg; p = 0.007), % fat in diet (-2.45 [-3.08, -1.81]; p < 0.001), systolic blood pressure (-0.51 [-0.98, -0.05] mmHg; p = 0.031), total cholesterol (-0.54 [-0.70, -0.38] mg/dL; p < 0.001), HbA1c (-0.46 [-0.74, -0.17] %; p = 0.002), physical activity (1.04 [0.43, 1.66] hours/week; p < 0.001), and CES depression score (-0.72 [-1.16, -0.27]; 0.002). However, where 12 or 24 month follow-up data were available, there were no statistically significant differences compared with baseline. CMD education interventions can improve multiple outcomes in the short term in people with lower educational attainment. Further work is needed around how such benefits may be maintained.

Early Sedation with Dexmedetomidine in Patients with Acute Myocardial Infarction Requiring Mechanical Ventilation.

Patients with acute myocardial infarction (AMI) who require invasive mechanical ventilation (IMV) represent a critically ill population with limited data on optimal sedative and analgesic use. Clinical trials assessing dexmedetomidine use exclude or poorly represent patients with AMI. This study aimed to compare the use of early sedation with dexmedetomidine to usual-care sedation in patients with AMI requiring IMV. We utilized the Vizient® Clinical Data Base to identify patients aged ≥18 years admitted between 2015 and 2019 with a primary diagnosis of AMI who required IMV. Patients receiving dexmedetomidine on the first day of IMV were included in the early dexmedetomidine group while the remaining patients were assigned to the usual care group. Inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk differences between groups. We identified 15,928 patients, of which 1,620 (10.2%) received early dexmedetomidine. Patients who received early dexmedetomidine were more likely to present with cardiogenic shock (52.0% vs. 47.7%, P=0.001). In unadjusted analyses, patients receiving early dexmedetomidine had lower in-hospital mortality (33.0% vs 42.1%) and more ventilator-free days (13.6 vs 12.1) compared to usual care (both, P<0.05). After IPTW, patients receiving early dexmedetomidine had a 11.0% (95% confidence interval [CI]: 8.6% to 13.5%) lower mortality and more ventilator-free days (mean difference: +2.2 days, 95% CI: 1.6-2.8 days). Early sedation with dexmedetomidine was associated with lower mortality compared to usual care in patients with AMI requiring IMV. A randomized controlled trial of sedative agents in this population is warranted.

Effect of nutrition education on hemoglobin level of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BackgroundMaternal hemoglobin (Hgb) is considered an essential, modifiable risk factor for adverse pregnancy outcomes (APOs). Evidence for the effect of nutrition education on the Hgb levels of pregnant women in low-income countries, including Ethiopia, is inconclusive. This study aimed to assess the effect of nutrition education on the Hgb levels of pregnant women in urban settings in the Bale Zone, Southeast Ethiopia.MethodsA community-based two-arm parallel cluster randomized controlled trial was carried out among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control groups) at health facilities from February to December 2021. A multistage cluster sampling technique followed by systematic sampling was used to select the pregnant women. Pregnant women who took part in the intervention arm received six nutrition education sessions, whereas pregnant women in the control group received routine standard care. We used a pretested, interviewer-administered, structured questionnaire to collect the data. The Hgb level of pregnant women was measured by collecting a finger-prick blood sample using a HemoCue Hb 301. A generalized estimating equation (GEE) model was used to isolate the net effect of the intervention on Hgb, accounting for the clustering. Beta coefficients (β) along with a 95% confidence interval (CI) were used for interpretations.ResultsThe mean difference in Hgb levels between the intervention and control groups was 0.12 ± 0.04 (P value < 0.002). The multivariable GEE linear model revealed that nutrition education significantly improved the Hgb levels of pregnant women [β = 0.36, 95% CI: (0.30, 0.43)]. An increase in the consumption of a cup of coffee or tea decreased Hgb levels by 0.14 g/dL [β = -0.14, 95% CI: (-0.23, -0.06)].ConclusionThe findings showed that a comprehensive nutrition education intervention using the health belief model (HBM) and theory of planned behaviour (TPB) designed to improve dietary diversity substantially improved hemoglobin (Hgb) levels among pregnant women. While we found no single dietary factor to be significant, in this group of pregnant women in Ethiopia, an increase in the daily consumption of a cup of coffee or tea decreased Hgb levels. As a consequence, pregnant women should be advised to limit their coffee or tea consumption. The study was registered on Clinicaltrials.gov retrospectively with the registration number PACTR202201731802989 on 24/01/2022.

The association between insomnia (related symptoms) and glycaemic control: a systematic review and meta-analysis.

Insomnia characterised by difficulties in falling asleep and maintaining sleep, and early awaking, is a prevalent worldwide sleep disorder. While previous studies have suggested an association between insomnia and adverse glycaemic control, the evidence remains inconclusive. Therefore, this meta-analysis aims to explore this association. Insomnia was assessed based on defined criteria, including related symptoms such as poor sleep quality and low sleep efficiency. Glycaemic control was evaluated using indicators such as fasting plasma glucose, haemoglobin A1c, and the presence of diabetes. A literature search was performed in PubMed, Web of Science, and Scopus. The quality of the included studied was assessed using The Newcastle-Ottawa Scale. Effect sizes, including odds ratio, relative risk, mean difference, and standard mean difference, were chosen based on data type. Forest plots visually displayed pooled effect sizes and corresponding 95% confidence intervals, while the I2 test calculated heterogeneity. Meta-regression and subgroup analysis explored potential sources of heterogeneity. Leave-one-out sensitivity analysis assessed result robustness, and Begg's and Egger's tests evaluated publication bias. Ninety-one articles, comprising 84 are cross-sectional studies, (five are case-control studies, and two are cohort studies) with 2 217 521 participants, were included. Ten separate meta-analyses were conducted based on variable type (binary/continuous), study design (cross-sectional, case-control, or cohort), and measurement of exposures/outcomes. All meta-analyses indicated a positive association between insomnia (related symptoms) and adverse glycaemic control. However, three meta-analyses showed significant heterogeneity, and three lacked robustness. No publication bias was detected across any of the analyses. Insomnia is likely associated with adverse glycaemic control. As the included studies are observational, future research should prioritise diverse methodologies and robust study designs to further explore this complex relationship. insomnia, insomnia related symptoms, glycaemic control, systematic review, meta-analysis. PROSPERO CRD42024491688.

Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis

Spinal deformities characterized by malalignment of the spinal column, including scoliosis, hyper kyphosis, and lordosis, can significantly impact lower limb kinematics, potentially leading to altered gait patterns. We aimed to synthesize existing literature investigating the effect of spinal deformities on lower limb kinematics during walking. We searched Four databases including PubMed, Web of Science, Scopus and Embase from their inception through 29th December 2024. The Newcastle-Ottawa Scale was applied to assess quality of included studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE system) was employed to assess the overall quality of the evidence in the meta-analysis. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. The review included 35 studies with 1941 participants. Regarding scoliosis, strong evidence suggested a significant increase in right leg stance% and non-significant changes in left leg cadence, right and left leg speed and ankle transverse ROM in individuals with scoliosis compared to controls. Sensitivity analysis showed strong evidence of decrease in right leg stride length and ankle sagittal ROM, decrease in left leg single support and non-significant change in left leg step length. Individuals with sagittal malalignment showed strong evidence of significant reduction in velocity; moderate evidence suggested a significant increase in double support and a decrease in stride length, knee and hip sagittal ROM. Sensitivity analysis revealed strong evidence of a significant decrease in cadence during walking in individuals with sagittal trunk malalignment compared to controls. Participants with adult spinal deformity exhibited strong evidence of increased double support and decreased cadence during walking compared to controls. Spinal deformities significantly alter lower limb kinematics during gait. Our findings highlight the essential need for clinicians to take gait alterations into account when developing targeted interventions for individuals with spinal deformity.

Clinical efficacy of adjunctive use of coenzyme Q10 in non-surgical periodontal treatment: A systematic review.

This systematic review evaluated the effects of coenzyme Q10 (CoQ10) in non-surgical periodontal treatment (PROSPERO: CRD42022311286). Five databases were screened (up to May/2024). It included only randomized controlled trials (RCTs) of subgingival scaling root planing (SRP) with or without adjunct use of the antioxidant CoQ10 in adults with periodontitis. The risk of bias and the certainty of the evidence were assessed. Meta-analyses were conducted to estimate mean differences for probing depth (PD) and clinical attachment level (CAL) between baseline and follow-up. Ten studies were included, of which four administered CoQ10 locally (topical [n=1]; intra-pocket [n=3] modalities), and six used oral supplementation. There was no significant effect of local use of CoQ10 on reduction of PD and gain in CAL. Daily oral supplementation (120mg/day) with CoQ10 resulted in a greater mean reduction of PD by 0.41mm (95% CI: 0.02-0.80) and a greater mean CAL gain by 0.52mm (95% CI: 0.26-0.78) than seen in controls. Based on very low certainty of evidence, there was no significant effect of locally delivered Q10 gel on PD/CAL, but daily oral supplementation with CoQ10 resulted in better periodontal health after 12weeks.

Validation of a Noninvasive Approach for Cerebrospinal Compliance Monitoring.

Intracranial pressure (ICP) monitoring is a cornerstone of neurointensive care. However, some limitations of invasive techniques for ICP monitoring to acknowledge are the risk for complications and the lack of robust evidence supporting individualized ICP safety thresholds. Cerebrospinal compliance (CSC) may serve as a more reliable indicator of brain health than ICP alone. Previously, intracranial compliance (Ci), was described as a mathematical model from invasive ICP to assess CSC, using ICP waveform amplitudes and cerebral arterial blood volume (CaBV) waveform amplitudes via transcranial Doppler (TCD). This study aimed to compare Ci with a surrogate parameter based on CaBV waveform amplitudes and pulsatile micrometric skull waveforms (Skw) amplitudes. This noninvasive parameter was named Bcomp. Neurocritical patients undergoing ICP monitoring were evaluated using TCD and the skull micrometric deformation sensor (B4C). ICP waveform (from invasive ICP probes) and Skw (from noninvasive B4C) were analyzed to extract pulse amplitudes, whereas TCD provided cerebral blood velocities from the middle cerebral arteries for CaBV calculation. CSC was measured using the volume/pressure relationship, with CaBV amplitude serving as the volume surrogate, and ICP and B4C pulse amplitudes as surrogates for ICP values. Agreement and correlation analysis was calculated between Ci and Bcomp. Data from 71 patients were analyzed, with 68% of the sample having suffered traumatic brain injury. Maximum CaBV was significantly delayed in patients with poor CSC (p < 0.001). Ci and Bcomp showed strong agreement and linear correlation (mean difference of - 0.28 and Spearman correlation of 0.88, p < 0.001). Using CaBV, which reflects changes in arterial blood volume during the cardiac cycle and Skw pulse amplitudes, Bcomp demonstrated high agreement and correlation with Ci, defined as the product of CaBV and ICP pulse amplitude. The observed shift in CaBV among patients with poor CSC suggests that this vascular marker is influenced by intracranial resistance. These findings are promising for the real-time, noninvasive assessment of CSC in clinical settings and warrant further research.

Systematic review and meta-analysis of peripheral blood inflammatory markers in hidradenitis Suppurativa.

Despite the systemic inflammatory implications of hidradenitis suppurativa (HS), the relationship between systemic inflammatory markers and HS has not been definitively established in the existing literature. This review aimed to evaluate the relationship of peripheral blood inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) with the presence and severity of HS. A comprehensive search of the PubMed, Embase and Cochrane databases was conducted. Studies with data on these peripheral blood inflammatory markers in HS patients were included. A meta-analysis was performed using standardized mean differences to evaluate the association between these inflammatory markers and HS. Our study included 23 research articles that included 2623 cases and 22 015 controls. The results demonstrated that (1) CRP, ESR, NLR, and SII levels were significantly higher in HS patients than controls, and (2) CRP, ESR, PIV, and SII positively correlated with HS severity between Hurley stages I and II and II and III. NLR and PLR also correlated with severity between stages II and III. CRP, ESR, NLR and SII are significantly associated with the presence of HS, while CRP, ESR, SII, and PIV are important indicators of HS severity. NLR and PLR become particularly significant in groups with severe HS. Our results underscore the systemic inflammatory involvement in HS and suggest that these inflammatory markers could be valuable in clinical practice for screening and monitoring the progression of HS.

Effects of combined protein and exercise interventions on bone health in middle-aged and older adults - A systematic literature review and meta-analysis of randomized controlled trials.

Osteoporosis has become a global public health concern making prevention and treatment essential to reduce severe consequences for individuals and health systems. This systematic review with meta-analysis aimed to determine the effects of combined protein and exercise interventions compared to (a) exercise alone and (b) protein alone on bone mineral content (BMC) or density (BMD) in middle-aged and older adults. We systematically searched Medline, CINAHL, CENTRAL, Web of Science, and SPORTDiscus until 24th January 2023. Pairwise random-effects meta-analyses were performed to calculate weighted mean differences (WMD) with 95% confidence intervals (95% CI). We evaluated risk of bias (Cochrane RoB2) and certainty of evidence (CoE; GRADE). If pooling was not possible, the results were summarized descriptively. For the comparison of combined protein supplementation and exercise vs. exercise alone, no meta-analysis for BMD (2 RCTs) was possible. For BMC, little to no intervention effect was found (WMD 0.03 kg; 95% CI - 0.00 to 0.05; 4 RCTs; IG = 97/CG = 98; I2 = 58.4%). In a sensitivity analysis, restricted to combined milk-protein supplementation and exercise, the result remained similar (0.01 kg; 95% CI - 0.01 to 0.03; 4 RCTs; IG = 71/CG = 71; I2 = 0.0%; low CoE). For the comparison of combined protein and exercise interventions vs. protein alone, no RCT on BMC was identified; the results on total or regional BMD (2 RCTs) were inconclusive. Based on our findings, no robust conclusions can be drawn on whether combining protein and exercise interventions is more beneficial for bone health than one component alone. Sufficiently powered studies with longer duration are required to clarify these questions (CRD42022334026).