Random-effects Model Meta-analysis Research Articles

Efficacy and safety of premixed versus basal-bolus regimens as intensification of insulin therapy in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized clinical trials.

To estimate the efficacy and safety of the basal-bolus and premixed insulin as intensification regimens in patients with type 2 diabetes mellitus (T2DM). A comprehensive search of online databases was performed until December 2022 to identify randomized controlled trials (RCTs) comparing premixed insulin versus basal-bolus regimen with treat-to-target intention. The Cochrane ROB-2 tool and GRADE approach were used for quality assessment and certainty of the evidence, respectively. Pooled weighted mean difference (WMD) and odds ratio (OR) were calculated using random-effects meta-analysis models. Eighteen RCTs were included in the meta-analysis, and 66% had a low risk of bias. We found no significant difference between the two regimens regarding HbA1c reduction (WMD: 0.03% [-0.05%, 0.10%]). The basal-bolus regimen improved fasting plasma glucose (FPG) more than the premixed regimen (WMD: 6.35 mg/dL [0.31, 12.39]). Both had similar effects on weight gain. The odds of developing overall, nocturnal, and severe hypoglycemia were comparable (pooled OR: 0.9, 1.02, and 1.00, respectively) with no heterogeneity. Findings of the model were robust. The certainty of the evidence was moderate to high for all outcomes except FPG. Two regimens are clinically comparable. Patient preference should be considered when adopting an individualized approach in a real-world setting.

The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis.

Hypoxaemia (low oxygen saturation in blood) is a key predictor of in-hospital mortality, affecting people of all ages with many different conditions. Early detection and treatment of hypoxaemia are critical, but there are few data to quantify hypoxaemia burden outside the child pneumonia population. We aimed to estimate hypoxaemia prevalence for adults and children with acute illness attending health facilities in low-income and middle-income countries (LMICs). We conducted a systematic review and meta-analysis, searching MEDLINE, PubMed, Embase, Cumulated Index in Nursing and Allied Health Literature, Index Medicus, and Google Scholar for studies reporting hypoxaemia prevalence among patients attending health facilities. We included articles with original data on peripheral blood oxygen saturation (SpO2), from an LMIC, published between Jan 1, 1998, and Jan 10, 2023. We included studies in acutely unwell people of any age and with any condition, but excluded those admitted to intensive care units, receiving perioperative care, or attending hospital for preventive or chronic care. We assessed study quality using Joanna Briggs Institute's Checklist for Prevalence Studies. Two reviewers independently conducted title and abstract screening, full-text review, data extraction, and quality assessment, requesting summary data from authors. We reported pooled prevalence of hypoxaemia (typically defined as SpO2 <90%) overall and by condition, using a random-effects meta-analysis model. This study is registered with PROSPERO, CRD42019136622. We identified 9173 unique records from searches and included 213 in meta-analyses involving 601 757 participants. The majority of studies were from the World Bank regions of sub-Saharan Africa (108 [51%] of 213) or south Asia (58 [27%]). The pooled prevalence of hypoxaemia among admitted patients was 24·5% (95% CI 19·9-29·4) for neonates (aged 0-28 days), 12·1% (10·0-14·4) for children (aged 1 month-17 years), and 10·8% (4·9-18·7) for adults (aged ≥18 years). Hypoxaemia prevalence was highest in neonatal and primary respiratory conditions but still common in many other conditions. Hypoxaemia was associated with 4·84 (95% CI 4·11-5·69) times higher odds of death than no hypoxaemia. Hypoxaemia is common across all age groups and a range of primary respiratory and other critical illnesses and is strongly associated with death. These estimates will inform oxygen-related strategies and programmes, and integration of pulse oximetry and oxygen into clinical guidelines, service structures, and strategies for maternal, neonatal, child, adolescent, and adult health. Bill & Melinda Gates Foundation, the ELMA Foundation, and Unitaid.

The effects of balance training on cognitive function in persons with multiple sclerosis: A systematic review and meta-analysis.

There is growing literature examining the effects of balance training on cognitive function in individuals with multiple sclerosis (MS), yet the findings remain inconsistent. This study aimed to investigate methodological characteristics of balance training studies and examine the effects of this modality on cognitive function. This study performed literature search using MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL databases from inception to April 2024. Randomized and non-randomized controlled trials of balance training studies that assessed cognitive function were included. The Tool for the Assessment of Study Quality and Reporting in Exercise was used to evaluate methodological quality of included studies. We calculated effect sizes as standardized mean differences (SMD) using Hedge's g and employed multi-level random-effects model for meta-analysis. Fourteen articles with 1,020 participants were included in this review, and a subset of seven studies with 26 effect sizes were further used for meta-analysis. Balance training indicated medium effects on global cognition (SMD [95 % CI] = 0.39 [0.13, 0.64]), processing speed (SMD [95 % CI] = 0.36 [0.00, 0.73]), and visuospatial memory (SMD [95 % CI] = 0.53 [0.12, 0.93]) and large effect on verbal memory (SMD [95 % CI] = 0.66 [0.25, 1.06]). We found that intervention characteristics and exercise doses significantly moderated the effects on cognition. Balance training may effectively improve overall and specific domains of cognitive function in persons with MS. Exercise doses of at least 120 min per week and a total duration of 720 min or more were significant moderators for greater cognitive improvement.

What Computed Tomography Findings Are Predictive of Posttraumatic Enophthalmos in Orbital Fractures?

Enophthalmos is a surgical indication for orbital fracture repair. However, guidelines to predict enophthalmos in orbital fractures are ambiguous. The authors systematically reviewed the existing literature on using computed tomographic findings to establish objective metrics to predict enophthalmos in asymptomatic patients during initial trauma work-up. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed and Embase were used to identify studies of interest. The Quality in Prognosis Studies tool was used for risk of bias assessment. Random-effects model meta-analyses of orbital volume change and fracture area values were completed. Regression analyses were performed to determine thresholds that predicted 2 mm of enophthalmos. Of the initial 2236 abstracts, 36 met inclusion criteria. Thirty retrospective studies evaluated a total of 2851 patients, and 6 prospective studies evaluated 211 patients. All 36 studies had predominantly low risk of bias. Predictors of enophthalmos assessed were orbital volume change (21 articles), fracture surface area (13 articles), inferior rectus muscle displacements (7 articles), and fracture location (4 articles). Studies reporting on orbital volume change offered values ranging from 0.69 to 4.26 cm 3 . Fracture area predictor values ranged from 1.50 to 3.38 cm 2 . Meta-analyses confirmed the validity of both predictors. Pooled regression analyses demonstrated that 3.33 cm 3 of orbital volume increase or fracture area of 3.12 cm 2 were predictors of 2 mm of enophthalmos. Both orbital volume change and fracture area measured on computed tomographic scan are good predictors of late posttraumatic enophthalmos. Pooled data indicate that 3.12 cm 2 of fracture area or 3.33 cm 3 of orbital volume increase is predictive of enophthalmos.

Racial residential segregation is associated with ambient air pollution exposure after adjustment for multilevel sociodemographic factors: Evidence from eight US-based cohorts.

We examined if racial residential segregation (RRS) - a fundamental cause of disease - is independently associated with air pollution after accounting for other neighborhood and individual-level sociodemographic factors, to better understand its potential role as a confounder of air pollution-health studies. We compiled data from eight large cohorts, restricting to non-Hispanic Black and White urban-residing participants observed at least once between 1999 and 2005. We used 2000 decennial census data to derive a spatial RRS measure (divergence index) and neighborhood socioeconomic status (NSES) index for participants' residing Census tracts, in addition to participant baseline data, to examine associations between RRS and sociodemographic factors (NSES, education, race) and residential exposure to spatiotemporal model-predicted PM2.5 and NO2 levels. We fit random-effects meta-analysis models to pool estimates across adjusted cohort-specific multilevel models. Analytic sample included eligible participants in CHS (N = 3,605), MESA (4,785), REGARDS (22,649), NHS (90,415), NHSII (91,654), HPFS (32,625), WHI-OS (77,680), and WHI-CT (56,639). In adjusted univariate models, a quartile higher RRS was associated with 3.73% higher PM2.5 exposure (95% CI: 2.14%, 5.32%), and an 11.53% higher (95% CI: 10.83%, 12.22%) NO2 exposure on average. In fully adjusted models, higher RRS was associated with 3.25% higher PM2.5 exposure (95% CI: 1.45%, 5.05%; P < 0.05) and 10.22% higher NO2 exposure (95% CI: 6.69%, 13.74%; P < 0.001) on average. Our findings indicate that RRS is associated with the differential distribution of poor air quality independent of NSES or individual race, suggesting it may be a relevant confounder to be considered in future air pollution epidemiology studies.

Hyponatremia Incidence After Subarachnoid Hemorrhage and Association with Outcomes: Systematic Review and Meta-Analysis.

Hyponatremia after aneurysmal subarachnoid hemorrhage (aSAH) is common; however, the incidence, and association with vasospasm, morbidity, and mortality, has yet to be defined. We aimed to identify incidence of hyponatremia after aSAH, and quantify its association with measurable outcomes. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was conducted (international prospective register of systematic reviews ID CRD42022363472). Articles published in MEDLINE, Embase, and Cochrane Library between January 1990 and January 2024 were included. Hyponatremia definitions, incidence during admission, and association among vasospasm, length of hospital stay, and poor outcome (Glasgow Outcome Scale 3 or less) were identified. Pooled incidence rates and binary and continuous outcomes were calculated using random effects meta-analysis models. In total, 52 studies (10,512 patients) were included. Most studies included patients admitted to tertiary neuroscience centers (61.5%, N= 32), or critical care units (23.1%, N= 11). Sodium of less than 135 mmol/L was the most commonly used hyponatremia definition (84.6%, N= 44). The pooled incidence of hyponatremia was 37.0% (95% confidence interval [CI]: 31.7%-42.4%). Hyponatremia increased the risk of vasospasm (15 studies; odds ratio: 2.93; 95% CI: 1.77-4.84), and length of hospital stay (3studies, 16.4 days vs. 8.0 days, mean difference 8.5 [95% CI: 4.6-12.4]), but was not associated with poor outcome (10 studies; odds ratio 1.15; 95% CI 0.44-3.02). These findings remained when carrying out sensitivity analysis for different hyponatremia and outcome definitions, bias, and aSAH populations. Hyponatremia is common in aSAH, may increase the likelihood of vasospasm, but in isolation does not appear to affect overall outcomes. Managing hyponatremia effectively should be a priority for treating clinicians.

Quantification of Legionella pneumophila in building potable water systems: A meta-analysis comparing qPCR and culture-based detection methods

Quantitative polymerase chain reaction (qPCR) offers a rapid, automated, and potentially on-site method for quantifying L. pneumophila in building potable water systems, complementing and potentially replacing traditional culture-based techniques. However, its application in assessing human health risks is complicated by a tendency to overestimate risks due to the detection of genomic copies unassociated with viable, infectious bacteria. This study examines the relationship between L. pneumophila measurements via qPCR and culture-based methods, aiming to establish qPCR-to-culture concentration ratios needed to inform associated health risks. Eligible studies collected quantitative data on L. pneumophila concentrations using molecular and culture-based methods within paired water samples. We developed a Poisson lognormal ratio model and a random-effects meta-analysis model to analyze variations in qPCR-to-culture ratios within and across sites. Of the 17 studies in the systematic review, seven, including 23 site-specific data sets, were used for meta-analysis. Our findings indicate these ratios typically vary from 1:1 to 100:1, with ratios close to 1:1 predicted at all sites. Consequently, adopting a default 1:1 conversion factor appears necessary as a cautious approach to convert qPCR concentrations to culturable concentrations for use in health risk models, such as quantitative microbial risk assessment (QMRA). Where this approach may be too conservative, viability-qPCR could improve the accuracy of qPCR-based QMRA. Standardizing qPCR and culture-based methods and reporting site-specific environmental factors affecting L. pneumophila culturability would improve understanding of the relationship between the two methods. The ratio model introduced here advances beyond simple correlation analyses, facilitating investigations of temporal and spatial heterogeneities in the relationship. This analysis is a step forward in the integration of QMRA and molecular biology, and the framework demonstrated for L. pneumophila is applicable to other pathogens monitored in the environment.

Age of detection of congenital hearing loss in South Africa: A systematic review

Background: Newborn hearing screening is the most important step towards early intervention of congenital or early-onset hearing loss (HL) and has the potential to optimise patient outcomes. Yet, literature on the age of identification of this HL in South Africa (SA) is sparse.Aim: To determine the age of identification of congenital HL from published studies in SA.Setting: The study was conducted in SA.Methods: This was a systematic review conducted during April 2024 – June 2024 across the following databases: PubMed, EBSCO, Web of Science and Scopus. A random effects (RE) model meta-analysis was conducted using STATA version 18. Statistical tests conducted include meta-summary statistics and RE meta-analysis.Results: Ten studies, with a total of 1501 children, were included in this review. The computed Q-test of homogeneity was 5870.97 and the pooled mean age of identification was 30 months (95% confidence intervals [CI]: 19.3–41.3).Conclusion: These findings show that congenital or early-onset HL in SA is identified later than the national and international standards, that is, 1 month of age. These findings are important for future research, priority setting and implementation of strategies to reduce the burden and impact of HL. Future research investigating the barriers to early detection of HL in SA is recommended. Furthermore, the implementation of evidence-based interventions to lower the age of identification of congenital HL to enable its early detection and intervention in this age group is recommended.Contribution: This study highlights the need to strengthen preventative programmes for paediatric HL in SA.

P0496 Upadacitinib for Patients with Crohn’s Disease and Previous Biologic Failure: A Systematic Review and Meta-Analysis

Abstract Background Upadacitinib is an oral Janus kinase 1 (JAK1) inhibitor that has demonstrated potential as a therapeutic agent for Crohn’s disease (CD). This systematic review and meta-analysis aim to evaluate the efficacy of Upadacitinib in treating CD patients with prior biologic failure. Methods A comprehensive literature search was conducted in October 2024 across PubMed, Embase, Cochrane, and ClinicalTrials.gov to identify clinical trials comparing Upadacitinib to placebo in CD patients with prior biologic failure. The inclusion criteria were studies that assessed clinical and endoscopic outcomes in CD patients. A random-effects model meta-analysis was performed using RStudio software to determine the pooled efficacy of Upadacitinib. Results Three clinical trials1,2 involving a total of 807 patients were included in the meta-analysis. The analysis revealed that Upadacitinib significantly outperformed placebo in achieving both clinical remission and endoscopic response in this population. Specifically, Upadacitinib was associated with a relative risk (RR) of 2.89 (95% confidence interval [CI]: 2.12–3.95, Figure 1) for clinical remission compared to placebo. Additionally, Upadacitinib demonstrated a significantly higher likelihood of achieving endoscopic response (RR 6.9; 95%CI: 3.36–14.16, Figure 2). These results suggest that Upadacitinib can be a promising treatment option for CD patients who have failed prior biologic therapies. Conclusion Upadacitinib is an effective therapeutic option for patients with Crohn’s disease and prior biologic failure, with significant improvements in both clinical remission and endoscopic response compared to placebo.

Macular Atrophy in Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.

Macular atrophy incidence in neovascular age-related macular degeneration (AMD) patients undergoing anti-vascular endothelial growth factor (VEGF) treatment. Macular atrophy is a significant event that may occur in eyes with neovascular AMD treated with anti-VEGF therapy. We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO, CRD42024474924). A comprehensive literature search of MEDLINE, EMBASE, and Web of Science was performed up to November 1, 2023. Randomized and non-randomized studies of treatment-naïve neovascular AMD patients reporting macular atrophy incidence at 24±3 months after anti-VEGF therapy were eligible for inclusion in this review. Two independent reviewers conducted screening, data extraction, and quality assessment. For randomized controlled trials, the Cochrane Risk of Bias 2 tool was employed, while non-randomized studies were evaluated using the ROBINS-I tool. Random-effects meta-analysis models were used for quantitative synthesis, accounting for study variability. Heterogeneity was assessed with the I2 statistic, and publication bias by funnel plots and Egger's test. The primary outcome was the incidence of new macular atrophy at 24 months post-anti-VEGF therapy, with secondary outcomes at 12 months. Atrophy was diagnosed using color fundus photograph (CFP), fluorescein angiography (FA), fundus autofluorescence (FAF), optical coherence tomography (OCT), or multimodal imaging. Twenty-three studies met the inclusion criteria for qualitative analysis, with 11 included in the meta-analysis (N=3,013 eyes). The pooled 24-month incidence of macular atrophy was 29% (95% confidence interval [CI]:20%-38%,I2=93%). Subgroup analysis revealed incidence rates of 26% (95% CI:15%-37%,I2=88%) for 814 eyes with Type 1/2 macular neovascularization (MNV), 49% (95% CI:18%-80%,I2=92%) for Type 3 MNV (N=230 eyes), and 29% (95% CI:18%-40%,I2=96%) for all MNV types (N=2,131 eyes). The pooled 12-month incidence among 2,214 eyes was 11% (95% CI:4%-18%,I2=93%). The certainty of evidence regarding the incidence of macular atrophy after anti-VEGF treatment, as assessed by GRADE, was low. While this meta-analysis has limitations, including a moderate risk of bias in non-randomized studies, inconsistencies in the results indicated by high heterogeneity, and imprecision due to the different imaging modalities used to diagnose macular atrophy, our results suggest that macular atrophy could be a common complication in neovascular AMD patients receiving anti-VEGF therapy.

Financing the future: insights into sustainable energy investments through scientific mapping and meta-analysis

This study presents a detailed literature review on financing for renewable and sustainable energy through bibliometric analysis and scientific mapping, utilizing the Scopus database from 2000 to 2023. Using network analysis techniques, it identifies eight main clusters, each focusing on different aspects of financing renewable energy and their geographic and technical contexts. The study highlights the most frequently cited articles, notable authors, key institutions, affiliations, and journals in sustainable energy finance. A random effects model meta-analysis was also conducted to assess the overall effect size of each research stream. Findings indicate that the literature on renewable energy finance has expanded since 2000 and exhibits considerable diversity. The study pinpoints five major themes suitable for discussion and exploration of new research questions: (i) the role of Fintech in renewable energy finance, (ii) the regulatory framework governing renewable energy finance, (iii) the economic feasibility of renewable energy in emerging markets, (iv) the influence of private and public finance on renewable energy development, and (v) the relationship between renewable energy finance and sustainable development goals. The insights from this study aim to inspire and equip readers as they embark on their inquiries into the connections between energy investment, policy, finance, and behavioral sciences. Following identifying research gaps, this paper outlines potential future research directions. It serves as a thorough resource on current trends in sustainable energy investments and recommends viable research topics, thus benefiting researchers, professionals, and policymakers alike.

Improving large language model applications in biomedicine with retrieval-augmented generation: a systematic review, meta-analysis, and clinical development guidelines.

The objectives of this study are to synthesize findings from recent research of retrieval-augmented generation (RAG) and large language models (LLMs) in biomedicine and provide clinical development guidelines to improve effectiveness. We conducted a systematic literature review and a meta-analysis. The report was created in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 analysis. Searches were performed in 3 databases (PubMed, Embase, PsycINFO) using terms related to "retrieval augmented generation" and "large language model," for articles published in 2023 and 2024. We selected studies that compared baseline LLM performance with RAG performance. We developed a random-effect meta-analysis model, using odds ratio as the effect size. Among 335 studies, 20 were included in this literature review. The pooled effect size was 1.35, with a 95% confidence interval of 1.19-1.53, indicating a statistically significant effect (P = .001). We reported clinical tasks, baseline LLMs, retrieval sources and strategies, as well as evaluation methods. Building on our literature review, we developed Guidelines for Unified Implementation and Development of Enhanced LLM Applications with RAG in Clinical Settings to inform clinical applications using RAG. Overall, RAG implementation showed a 1.35 odds ratio increase in performance compared to baseline LLMs. Future research should focus on (1) system-level enhancement: the combination of RAG and agent, (2) knowledge-level enhancement: deep integration of knowledge into LLM, and (3) integration-level enhancement: integrating RAG systems within electronic health records.

Breastfeeding and Lung Function of Children: A Systematic Review and Meta-Analysis.

To evaluate the associations between breastfeeding and lung function among children without known respiratory diseases and to determine the effects of breastfeeding on spirometry. A systematic search of PubMed, Embase and Cochrane was performed from their inception to 11 Oct 2023 (PROSPERO identifier: CRD42023471664). Observational studies (cohort or cross-sectional or case-control design) and randomised controlled trials (RCTs) were searched. A random-effects model meta-analysis was used to estimate the effect size if significant heterogeneity was detected (p < 0.05 or I2 > 50%); Otherwise, the fixed-effects model was applied. In total, 13 observational studies with 18 152 children were included in the qualitative synthesis, and five studies with 5305 children were included in the meta-analysis. Compared to children who were never breastfed, those who were breastfed had better FEV1 (β: 19.34 mL; 95% CI: 6.05, 32.64; p = 0.004) and PEF (β: 87.50 mL/s; 95% CI: 27.43, 147.58; p = 0.004). A similar trend was observed for FVC (β: 17.45 mL; 95% CI: -0.43, 35.33; p = 0.06). Furthermore, compared to children breastfed for less than three to four months, those breastfed for three to four months or more had better FEV1 (β: 19.86 mL; 95% CI: 4.21, 35.51; p = 0.01), FVC (β: 31.90 mL; 95% CI: 7.87, 55.93; p = 0.009) and PEF (β: 75.68 mL/s; 95% CI: 24.40, 126.97; p = 0.004). This systematic review and meta-analysis revealed associations between breastfeeding and improved lung function in children aged 6-16 years. Further high-quality evidence is needed.

Body composition differences in older adults with and without Alzheimer's disease: A systematic review and meta-analysis of observational studies.

Research on body composition and fat distribution in Alzheimer's disease (AD) has presented conflicting findings. Compare body composition and anthropometric measurements in older adults with and without AD. A systematic review and meta-analysis were conducted following Cochrane guidelines and PRISMA standards. MEDLINE, Embase, Scopus, LILACS, WPRIM, and the Spanish Bibliographic Index of Health Sciences were searched up to September 2024, considering observational studies that compared body composition between AD groups and controls. Outcomes included body fat percentage, body mass index (BMI), impedance, resistance, and reactance. The methodological quality and level of evidence were assessed using the Joanna Briggs Institute scale and GRADE, respectively. A random-effects meta-analysis model was used to calculate mean differences (MD). Fourteen studies involving 2761 older adults were included. Older adult women with AD showed a lower body fat percentage (p < 0.01; MD = -5.07) and BMI (p = 0.05; MD = -1.28) compared to controls. Older adult men with AD had higher impedance (p = 0.01; MD = 2.05), resistance (p = 0.02; MD = 45.10), and lower reactance (p = 0.03; MD = -2.05) compared to controls. No significant differences in body fat percentage or BMI were found between older adults with and without AD, regardless of gender. Women with AD showed lower body fat percentage and BMI, while men with AD had higher impedance, resistance, and lower reactance. These factors should be included in geriatric assessments for AD patients, though further research is needed to understand their link to cognitive outcomes in AD.

Milling has superior mechanical properties to other fabrication methods for PMMA denture bases: A systematic review and network meta-analysis.

This systematic review and network meta-analysis aimed to compare different PMMA (polymethyl methacrylate) complete denture base manufacturing techniques by evaluating their mechanical properties. The objective was to determine which method-compression molding, injection molding, milling, or 3D printing-offers the best performance. In vitro studies investigating mechanical properties of PMMA denture base resins. Four electronic databases such as PubMed, Embase, Web of Science, and the Cochrane Library were screened for English language articles. Two independent researchers selected studies, extracted data, assessed risk of bias, and evaluated evidence certainty. A total of 17152 articles were found by electronic databases. Finally, 63 studies were analyzed, using random-effects model for network meta-analysis. The outcomes investigated were flexural strength, flexural modulus, surface roughness, impact strength, and Vickers hardness. Milling consistently ranked first or second across outcomes, excelling in flexural strength, modulus, and surface roughness. In contrast, 3D-printed denture bases demonstrated the lowest mechanical performance, highlighting the limitations of this technique at present. Milling is generally recommended for PMMA denture bases due to its superior mechanical properties across most outcomes, supporting its use in clinical settings. However, while promising, 3D-printed PMMA denture bases require further improvement to meet clinical performance standards.

Fixed-effect versus random-effect model in meta-analysis: How to decide?

Interpretation of meta-analysis requires an appropriate understanding of its statistical methods. Data synthesis methods are the basis of the meta-analytic process, and a thorough knowledge of the models used is essential. The two most widely used methods for data synthesis are the ‘fixed-effect method’ and the ‘random-effect method’. The latter is commonly used when a ‘significant heterogeneity’ exists. This narrative review explains fixed- and random-effect models, the two most commonly used data synthesis models.

An upward trend of dyslipidemia among adult population in Vietnam: Evidence from a systematic review and meta-analysis.

It is critical to assess the progress toward achieving the national goal of reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030 in Vietnam. This study aimed to examine the pooled prevalence of dyslipidemia among the Vietnamese adult population. Five databases, PubMed, Web of Science, Embase, CINAHL, Google Scholar, and local peer-reviewed journals were searched from inception to May 2024 without language restrictions. Pooled percentages of all dyslipidemia indicators were derived by random-effect model meta-analysis. We also estimated the pooled crude odds ratio and confidence interval (CI) for factors associated with dyslipidemia and calculated Hedges's g standardized mean for each dyslipidemia component. Sixty-nine studies were identified as relevant for systematic review, with 41 studies included in the meta-analysis. The overall prevalence of having at least one component of dyslipidemia was 49% (95%CI=38%-60%), and figures for high total cholesterol, elevated triglycerides, increased low-density lipoprotein-cholesterol and low high-density lipoprotein-cholesterol were 31% (95%CI=25%; 37%), 38% (95%CI=31%; 44%), 21% (95%CI=12%; 32%), 23% (95%CI=16%; 30%), respectively. The pooled percentage of overall dyslipidemia was higher in males, in the Southeast region and in studies reported in Vietnamese than those in English. Having diabetes, hypertension, abdominal obesity and overweight/obesity were significantly positively associated with dyslipidemia. The prevalence of dyslipidemia was substantially high and increased in the Vietnamese adult population. Findings from this up-to-date review reinforce the necessity of effective implementation of NCDs prevention to achieve the national goal.

Global Prevalence of Neospora caninum in Domestic Pigs (Sus domesticus) and Wild Boars (Sus scrofa): A Systematic Review and Meta-Analysis.

Neospora caninum (Apicomplexa, Sarcocystidae) is a protozoan parasite regarded as a major cause of reproductive failure in cattle. Swine are susceptible to N. caninum infection; however, the role of these animals in the circulation, maintenance, and transmission of N. caninum remains unclear. Therefore, we aimed to estimate the global seroprevalence of N. caninum in domestic pigs (Sus domesticus) and wild boars (Sus scrofa). Online databases including PubMed, Web of Science, Scopus, and Google Scholar were systematically searched to identify relevant studies up to 30 April 2024. A random-effects meta-analysis model was used to estimate the overall and subgroup-pooled prevalence of N. caninum across studies. The Cochrane test (Q) and the I2 index were employed to heterogeneity. Funnel plots and Egger's regression test were used to evaluate publication bias, year of publication, and sample size. A total of 11,124 animals from 26 eligible studies were included. The pooled seroprevalence of N. caninum in swine was 17% (95% CI: 7%-26%) with a prevalence of 17% in domestic pigs and 16% in wild boars. In the subgroup analysis, the highest prevalence was observed among female animals, with a pooled seroprevalence of 17% (95% CI: 7%-26%). The pooled seroprevalence of N. caninum was nearly equal in adult and sub-adult swine (18% and 14%, respectively). The overall seroprevalence of N. caninum in swine, based on sample size and year of publication, showed no statistically significant correlations. The present study showed that domestic swine are suitable intermediate hosts of N. caninum based on serological findings. However, further studies are needed to describe the epidemiology of the N. caninum and to isolate the parasite from swine to confirm this hypothesis.

Meta-Analysis of MINIject vs. Two iStents as Standalone Treatment for Glaucoma with 24 Months of Follow-Up.

Background: This study compares the long-term intraocular pressure (IOP)-lowering efficacy of standalone MINIject (iSTAR Medical, Belgium) suprachoroidal implantation and two iStent (Glaukos, CA, USA) trabecular bypass implantation using a systematic review and meta-analysis. Methods: Systematic review of standalone implantation of MINIject or iStent inject with at least 24 months of follow up. The mean and standard deviation of IOP and the number of IOP-lowering medications at baseline and at 24 months were extracted. Weighted estimates of the outcome variables were calculated using random-effects meta-analysis models. Heterogeneity in the outcome measures among the studies was quantified using I². Results: Seven studies (three studies for MINIject and four for iStent) comprising 280 eyes were included. At 24 months, there was a greater reduction in IOP from baseline in the MINIject vs. two iStent cohorts (-9.57 vs. -4.92 mmHg, p = 0.03). The change from baseline in mean medication use was -1.00 with MINIject and -0.56 medications with iStent (p = 0.26). The mean percentage IOP reduction at 24 months ranged from 36.3-42.2% with MINIject compared to 5.2-40.7% with iStent, with greater variability in mean change from baseline in IOP observed in the iStent group (I2 = 96.5% vs. 0%). The most frequent adverse events for MINIject were anterior chamber inflammation, best-corrected visual acuity (BCVA) loss, hyphema, and conjunctival hemorrhage, and for iStent, these were device obstruction, BCVA loss, IOP spike, and cataract progression. Conclusions: While both MINIject and iStent inject devices resulted in significant reductions in IOP and IOP medication use, standalone MINIject may provide a greater and more consistent reduction in IOP.

Is nivolumab alone or in combination with ipilimumab more effective for treating lung cancer? a meta-analysis.

Nivolumab and ipilimumab combination immunotherapy has become a standard treatment option for certain cancers. However, the benefits of combination therapy compared to nivolumab monotherapy in lung cancer patients are not entirely clear. We aimed to evaluate whether nivolumab plus ipilimumab improves clinical outcomes in lung cancer patients compared to nivolumab monotherapy. A literature search was performed on PubMed, Web of Science, and Scopus from inception until November 2024 to identify relevant randomized controlled trials. The Cochrane risk of bias tool was used to assess the risk of bias, the hazard ratio (HR) was calculated for survival, risk ratios (RRs) were calculated for response rate and safety outcomes, and a random effects model meta-analysis was performed to estimate the safety and efficacy of the treatments. Seven trials comprising 2134 patients were included. Compared with patients receiving nivolumab monotherapy, non-small cell lung cancer patients who received combination therapy had better progression-free survival (HR = 0.82, 95% CI 0.71; 0.93, P < 0.01, low certainty), and there were no significant differences in overall survival (HR = 0.95, 95% CI 0.86; 1.0, P = 0.31, moderate certainty), or objective response rate (RR = 1.36, 95% CI 0.91; 2.02, P = 0.14 very low certainty). The combination group had a significantly greater risk of grade 3-4 adverse events (RR = 2.77, 95% CI 1.38; 5.56, P < 0.01, low certainty). Although combination treatment significantly improved progression-free survival in NSCLC patients, it was also associated with a greater risk of adverse events and treatment-related mortality than nivolumab monotherapy. The current evidence is insufficient for choosing combination treatment over nivolumab monotherapy.