Network Meta-analysis Research Articles

Different exercise interventions on quality of sleep in breast cancer survivors—a network meta-analysis of randomized controlled trials

IntroductionBreast cancer is currently the most prevalent cancer globally; however, it generally has a favorable prognosis and is linked to a high survival rate. While effective treatments can extend survival and mitigate associated side effects, not all survivors are exempt from complications. Notably, a significant proportion of survivors experience sleep disorders following surgery, which can severely impact their quality of life. Exercise is frequently recommended as a non-pharmacological intervention to enhance sleep quality among breast cancer survivors and may also play a role in reducing recurrence rates. Recognizing that various forms of exercise may yield different outcomes in addressing sleep disorders in this population, we conducted a network review meta-analysis to assess the effectiveness of diverse exercise modalities for breast cancer survivors suffering from sleep disturbances.MethodsWe searched four electronic databases for randomized controlled trials of individuals diagnosed breast cancer with sleep disorders by different exercise therapy. The primary outcomes included Yoga, Pilates, Qigong, Tai Chi, Walking, Dance, Resistance training, Football, Virtual reality therapy, Activity change exercise, Software-guided exercises. The methodological quality of the included studies was assessed using the Cochrane Bias risk Assessment tool, and network meta-analysis was performed using Stata15 software. The review was pre-registered (PROSPERO ID: CRD42023442892).ResultsData on 3083 breast cancer survivors with sleep disturbances from 34 eligible randomized controlled trials were analyzed, with 23 classified as medium risk and 2 as high risk. Network meta-analysis showed that walking exercise [Standard Median Different (SMD) =3.06, 95% Confidence Interval (95%CI)=(-5.89,-0.23)] significantly improved sleep disorder (Surface Under the Cumulative Ranking curve, SUCRA: 84.5%) and reduced Pittsburgh sleep quality index (PSQI) score.DiscussionBased on the network ranking table, we can conclude that walking exercise offers greater benefits compared to other exercise interventions for improving sleep quality in breast cancer patients. This finding presents a novel perspective on exercise interventions for breast cancer survivors experiencing sleep disorders.Systematic review registrationPROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442892, identifier CRD42023442892.

Implications of five endoscopic and conventional open surgery on lateral neck dissection outcomes in patients with papillary thyroid carcinoma: a network meta-analysis and systematic review

Implications of five endoscopic and conventional open surgery on lateral neck dissection outcomes in patients with papillary thyroid carcinoma: a network meta-analysis and systematic review

Comparison of the efficacy and safety of GLP-1 receptor agonists on cardiovascular events and risk factors: A review and network meta-analysis.

This study aims to systematically evaluate and perform a systematic review and network meta-analysis comparing the comprehensive cardiovascular protective effects of various glucagon-like peptide-1 receptor agonists (GLP-1RAs), focusing on cardiovascular events and risk factors. We searched PubMed, Embase, Cochrane Library and Web of Science from inception to December 15, 2024. Included studies were published randomized controlled trials (RCTs) comparing GLP-1RAs to placebo or other GLP-1RAs. Missing data were standardized, and network meta-analysis was performed using Stata 17.0. Study heterogeneity, publication bias and evidence quality were assessed using the Cochrane Risk of Bias tool and Confidence in Network Meta-Analysis (CINeMA). As of December 15, 2024, a total of 18 313 articles were retrieved. Based on the inclusion and exclusion criteria, 156 high-quality studies were included, incorporating 144 782 patients and 14 different GLP-1RAs. The network meta-analysis demonstrated low heterogeneity, ensuring the reliability of the results. Comprehensive analysis revealed the following: Efpeglenatide was the most effective in reducing major adverse cardiovascular events. Oral semaglutide shows more significant advantages in reducing all-cause mortality and cardiovascular mortality. Orforglipron excelled in glycaemic control and weight reduction. SC-Semaglutide showed the greatest efficacy in lowering both systolic blood pressure and diastolic blood pressure, Liraglutide showed the greatest efficacy in lowering total cholesterol, Noiiglutide in triglycerides and Taspoglutide in low-density lipoprotein cholesterol, but no GLP-1RAs in high-density lipoprotein cholesterol. GLP-1RAs did not significantly increase the incidence of adverse events, but Orforglipron and Taspoglutide significantly increased the incidence of gastrointestinal adverse events compared with placebo. This study compared the cardiovascular benefits of different GLP-1RAs, including reductions in cardiovascular events and improvements in multiple cardiovascular risk factors. However, due to limitations in the quantity and quality of the included studies, the conclusions should be interpreted with caution. Future large-scale, high-quality clinical trials are needed to validate these findings and further optimize comprehensive cardiovascular management strategies for patients.

Effects of plant active substances in rheumatoid arthritis—a systematic review and network meta-analysis

BackgroundPlant active substances are extensively utilized in treating rheumatoid arthritis (RA). Despite numerous experimental and clinical studies on plant active substances their efficacy remains largely unsubstantiated. The widespread use of these extracts as therapeutic measures for RA is problematic due to the lack of compelling evidence.ObjectiveOur research aims to assess the impact of plant active substances on RA by conducting a network meta-analysis.MethodsWe systematically searched four electronic databases—PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science—from their inception to August 2024. The main focus was on assessing primary outcomes, including the Visual Analogue Scale (VAS), inflammatory markers, Swollen Joint Count (SJC), Tender Joint Count (TJC), and Disease Activity Score on 28 joints (DAS28). We performed data analysis using StataMP 15.1 software and ranked the therapeutic effects based on the Surface Under the Cumulative Ranking Curve (SUCRA) probability values.ResultsBased on screening procedures, 18 eligible studies were incorporated into the analysis. These studies encompassed a total of 1,674 RA patients and investigated 10 different plant active substance therapies. Specifically, 10 studies included VAS indicators, 17 studies included inflammatory marker indicators, 14 studies included DAS28 indicators, 13 studies included SJC indicators, and 13 studies included TJC indicators. Based on SUCRA values, quercetin appeared to be the most effective treatment for decreasing serum VAS levels (67.3%). Furthermore, curcumin emerged as the most promising option for reducing inflammatory marker levels (72.3%), SJC (75.6%), and TJC (76.2%). Lastly, with respect to DAS28, resveratrol emerged as the optimal choice (74.3%).ConclusionAccording to the network meta-analysis (NMA), curcumin exhibited superior efficacy compared to placebo in decreasing SJC and TJC. Additionally, curcumin demonstrated greater effectiveness in reducing inflammatory markers. Quercetin was more effective in reducing VAS, and resveratrol was more effective in reducing DAS28. Patients with RA may benefit from these findings. Insightful information from this study is helpful for RA patients to consider using plant active substance therapies. For their efficacy and safety to be confirmed, more proof is needed.

Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis

BackgroundThe objective of this study is to assess the relative efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran, in conjunction with potent statins like atorvastatin and rosuvastatin, in patients presenting with hyperlipidemia or heightened cardiovascular risk attributable to elevated low-density lipoprotein cholesterol (LDL-C).MethodsA systematic search was conducted across databases including PubMed, Embase, and the Cochrane Library to explore lipid-lowering therapies in hyperlipidemia from their inception to 7 November 2023. A network meta-analysis (NMA) was conducted via Stata 17 software, with two authors independently conducting the search, screening, and data abstraction.ResultsA total of 68 clinical studies involving 21,288 patients with hyperlipidemia were incorporated into the NMA. PSCK9 inhibitors and potent statins significantly reduced LDL-C levels from baseline vs. placebo regardless of background therapy. Regarding the efficacy of lipid reduction, four principal medications were evaluated: evolocumab and atorvastatin [mean standard deviation (MD) −3.41, 95% CI −4.81 to −2.00] and evolocumab with rosuvastatin (MD −3.44, 95% CI −5.10 to −1.78) vs. placebo; alirocumab combined with rosuvastatin (MD −2.91, 95% CI −3.95 to −1.88) and alirocumab with atorvastatin (MD −2.90, 95% CI −3.97 to −1.84) vs. placebo. Meanwhile, compared with placebo, evolocumab (MD −1.89, 95% CI −2.27 to −1.50), alirocumab (MD −1.83, 95% CI −2.09 to −1.57), rosuvastatin (MD −1.93, 95% CI −2.30 to −1.56), inclisiran (MD −1.68, 95% CI −2.10 to −1.27), and atorvastatin (MD −1.68, 95% CI −2.04 to −1.31) could also play a role in the treatment of LDL-C reduction. Moreover, the incidence of adverse events (AEs) was similar to that observed in the control group, which included both placebo and potent statin groups, with no significant differences identified in our study (P > 0.05).ConclusionsThe combination of PCSK9 inhibitors with robust statins like rosuvastatin and atorvastatin markedly decreases LDL-C levels in patients with hyperlipidemia when compared to placebo or monotherapy. Notably, the pairing of evolocumab and atorvastatin exhibited exceptional efficacy in this investigation. In the interim, the combination of PCSK9 inhibitors and potent statins demonstrates a notable safety profile when contrasted with the control group.

Injectables in preventing intraoperative bleeding and postoperative ecchymosis in surgical rhinoplasty: a systematic review and network meta-analysis

Injectables in preventing intraoperative bleeding and postoperative ecchymosis in surgical rhinoplasty: a systematic review and network meta-analysis

Comparison of the efficacy of different protocols of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on motor function, activities of daily living, and neurological function in patients with early stroke: a systematic review and network meta-analysis.

The application of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in patients with early stroke has recently received considerable attention, but the optimal protocol remains inconclusive. This study intends to evaluate and compare the effects of different protocols of tDCS and rTMS on improving motor function, activities of daily living (ADL), and neurological function in patients with early stroke, and to comprehensively assess their efficacy and safety. MEDLINE, Embase, Cochrane Library, and Web of Science were searched. Risk of bias (RoB) was assessed using the Cochrane Risk of Bias 2.0 tool, and Bayesian NMA was conducted using R4.3.1 and Stata16. The results of NMA showed that after early intervention, bilateral application of high- and low-frequency rTMS (BL-rTMS) performed best in improving the upper extremity motor function at the end of intervention (SUCRA: 92.8%) and 3 months (SUCRA: 95.4%). Besides, low-frequency rTMS (LF-rTMS) performed best in improving the lower extremity motor function (SUCRA: 67.7%). BL-rTMS was the most effective in ameliorating the ADL at the end of intervention (SUCRA: 100%) and 3 months (SUCRA: 85.6%). In terms of the NIHSS scores, BL-rTMS had the highest probability of being the most effective measure at the end of intervention (SUCRA: 99.7%) and 3 months (SUCRA: 97.05%). Besides, LF-rTMS (0%), 5Hz-rTMS (0%), and intermittent theta-burst stimulation (iTBS) (0%) all exhibited a good safety profile. BL-rTMS is the optimal stimulation protocol for improving upper extremity motor function, ADL, and neurological function in early stroke, with long-term efficacy.

A Markov model assessing the cost-effectiveness of various anti-vascular endothelial growth factor drugs and panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) may lead to vision loss and blindness. The cost-effectiveness of various anti-vascular endothelial growth factor (anti-VEGF) drugs and panretinal photocoagulation (PRP) was assessed to supplement the NICE guideline for treating PDR. A Markov model including eight levels of visual acuity (ranged between >85 and ≤25 letters) was developed to compare the cost-effectiveness of ranibizumab, aflibercept and bevacizumab with PRP (alone or in combination). Clinical inputs in the model were based on literature, while a published network meta-analysis (NMA) informed visual outcomes. Costs were estimated from a UK NHS perspective. Assuming initial treatment effects from the NMA continued to be applied for the remainder of lifetime, the probabilistic analysis resulted in bevacizumab plus PRP producing the highest net monetary benefit (NMB [95% CI]) of £221,374 [£203,941-£238,388] at £20,000 per quality-adjusted life-year. However, assuming initial treatment effects stabilised over time resulted in PRP alone producing the highest NMB of £223,416 [£209,318-£236,866]. Results were associated with large uncertainty due to wide confidence intervals around vision-based treatment effects of anti-VEGFs versus PRP, particularly for bevacizumab as data were drawn from trials with small sample size and high risk of bias. Using confidential prices for aflibercept and ranibizumab did not change the overall findings. PRP is likely to be more cost-effective than anti-VEGFs for PDR. However, the results should be interpreted with caution given the scarcity of long-term visual outcomes with anti-VEGFs in this population. Further research on long-term visual outcomes may resolve these uncertainties.

Comparative efficacy of incretin drugs on glycemic control, body weight, and blood pressure in adults with overweight or obesity and with/without type 2 diabetes: a systematic review and network meta-analysis

BackgroundThe rapid development of multi-receptor drugs targeting glucagon-like peptide-1 receptor (GLP-1R) is driving significant advancements in the treatment of individuals with type 2 diabetes and obesity. This systematic review and network meta-analysis aims to compare the efficacy and safety of multi-receptor drugs in adults with overweight or obesity, with or without type 2 diabetes.MethodsA systematic search was conducted in PubMed, Cochrane, Web of Science, Embase, CNKI, and WanFang databases up to May 12, 2024. Randomized controlled trials (RCTs) with an intervention duration of at least 12 weeks were included. The population of interest consisted of individuals with overweight or obesity, with or without type 2 diabetes. Eligible studies compared multi-receptor drugs with placebo or other multi-receptor drugs. The primary outcomes were weight reduction, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), blood pressure changes, and adverse events. Risk of bias was assessed using the version 2 of the Cochrane risk-of-bias tool (ROB2), and a random-effects network meta-analysis was performed using the frequentist approach. Confidence in effect estimates was evaluated using the Confidence In Network Meta-Analysis (CINeMA) framework.ResultsA total of 24 trials, involving 9165 participants, were included. Retatrutide (mean difference (MD): -11.91 kg, 95% CI: -19.00 to -4.82, P-score: 0.80, p: 0.0003) and Tirzepatide (MD: -12.78 kg, 95% CI: -16.10 to -9.46, P-score: 0.89, p < 0.0001) exhibited superior efficacy in reducing body weight, with all other agents except Mazdutide (MD: -5.31 kg, 95% CI: -9.78 to -0.84, P-score: 0.37, p: 0.0189) achieving reductions of over 8 kg. In patients with type 2 diabetes, all agents reduced HbA1c by over 1%, with Tirzepatide (MD: -1.87%, 95% CI: -2.15 to -1.59, P-score: 0.87, p < 0.0001) and Mazdutide (MD: -1.89%, 95% CI: -2.43 to -1.35, P-score: 0.88, p < 0.0001) showing the greatest effects on glycemic control. For blood pressure management, Tirzepatide significantly reduced systolic blood pressure (MD: -6.69 mmHg, 95% CI: -7.62 to -5.75, P-score: 0.84, p < 0.0001) and diastolic blood pressure (MD: -3.73 mmHg, 95% CI: -4.75 to -2.71, P-score: 0.92, p < 0.0001), with nearly all agents lowering systolic blood pressure by more than 5 mmHg. Non-diabetic participants showed more pronounced improvements in both weight and blood pressure. Safety analysis revealed that Tirzepatide had a favorable safety profile and all agents showed no significant impact on serious adverse events compared to placebo.ConclusionsMulti-receptor drugs demonstrated substantial therapeutic potential in weight management, glycemic control, and blood pressure regulation in adults with overweight or obesity, with or without diabetes, with a generally favorable safety profile.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024554005.

Comparison of pharmacological therapies in metabolic dysfunction-associated steatohepatitis for fibrosis regression and MASH resolution: Systematic review and network meta-analysis.

Metabolic dysfunction-associated steatohepatitis (MASH) is a leading cause of liver disease. With the advent of multiple therapeutic targets in late-phase clinical drug development for MASH, there is a knowledge gap to better understand the comparative efficacy of various pharmacological agents. We conducted an updated network meta-analysis to evaluate the relative rank-order of the different pharmacological agents for both fibrosis regression and MASH resolution. We searched PubMed and Embase databases from 2020 to December 1, 2024, for published randomized-controlled trials (RCTs) comparing pharmacological interventions in patients with biopsy-proven MASH. The co-primary endpoints were fibrosis improvement ≥1 stage without MASH worsening and MASH resolution without worsening fibrosis. We conducted surface under the cumulative ranking (SUCRA) curve analysis. A total of 29 RCTs (n=9324) were included. Pegozafermin, cilofexor + firsocostat, denifanstat, survodutide, obeticholic acid, tirzepatide, resmetirom, and semaglutide were significantly better than placebo in achieving fibrosis regression without worsening MASH. Pegozafermin (SUCRA: 79.92), cilofexor + firsocostat (SUCRA: 71.38), and cilofexor + selonsertib (SUCRA: 69.11) were ranked the most effective interventions. Pegozafermin, survodutide, tirzepatide, efruxifermin, liraglutide, vitamin E + pioglitazone, resmetirom, semaglutide, pioglitazone, denifanstat, semaglutide and lanifibranor were significantly better than placebo in achieving MASH resolution without worsening fibrosis. Pegozafermin (SUCRA: 91.75), survodutide (SUCRA: 90.87), and tirzepatide (SUCRA: 84.70) were ranked the most effective interventions for achieving MASH resolution without worsening fibrosis. This study provides updated rank-order efficacy of MASH pharmacological therapies for fibrosis regression and MASH resolution. These data are helpful to inform practice and clinical trial design.

Alcohol Consumption Modulates the Development of Chronic Pain in COVID-19 Patients: A Network Meta-Analysis

Alcohol Consumption Modulates the Development of Chronic Pain in COVID-19 Patients: A Network Meta-Analysis

Comparative Effectiveness of Pharmacologic Treatments for the Prevention of Episodic Migraine Headache: A Systematic Review and Network Meta-analysis for the American College of Physicians.

Various treatments for preventing episodic migraine are available. To evaluate the comparative effectiveness and harms of pharmacologic prevention of episodic migraine, focusing on treatments already determined to be superior to placebo. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception until April 2024. Randomized trials evaluating selected efficacious pharmacologic treatments in adults with episodic migraine. Selection was done independently by 2 reviewers. Data were extracted by 1 reviewer and checked by a second. Risk of bias and certainty of the evidence were assessed using the Cochrane Risk of Bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, respectively. Sixty-one studies (20 680 patients) evaluating 16 treatments were included. Nineteen studies had low risk of bias. All selected treatments were deemed efficacious against placebo on the basis of previous systematic reviews. In network meta-analyses, calcitonin gene-related peptide antagonist monoclonal antibodies (CGRP-mAbs) probably resulted in fewer discontinuations due to adverse events than topiramate (risk difference, -16.2% [95% CI, -18.4% to -12.8%]; moderate-certainty evidence), and CGRP-mAbs may result in less migraine-related disability and improved quality of life compared with gepants (mean differences, -4.12 [CI, -9.30 to 1.05] and 2.25 [CI, -0.85 to 5.34], respectively; low-certainty evidence). For other outcomes and comparisons, there was moderate- or low-certainty evidence of no clinically important differences, uncertain evidence, or no evidence. Limited literature was available to determine the minimal important differences. The number of head-to-head comparisons of treatments was limited. No high-certainty evidence favored one pharmacologic treatment for prevention of episodic migraine over another. Evidence was mostly insufficient or of low certainty. American College of Physicians. (PROSPERO: CRD42023414305).

Iatrogenic nerve injury following pelvic ring injury: a network meta-analysis.

Pelvic ring injuries are common in multi-trauma patients and can be life-threatening, necessitating prompt surgical intervention to improve outcomes. However, surgery can lead to complications such as iatrogenic nerve injury. This network meta-analysis aimed to improve outcomes in multi-trauma patients with pelvic ring injuries by evaluating the incidence of iatrogenic nerve injuries, identifying vulnerable nerves, and comparing different fixation methods. A systematic search of MEDLINE, EMBASE, and Scopus from inception to 5 December 2023, revealed 29 comparative studies on the incidence of iatrogenic nerve injury in 1561 adult patients with pelvic ring injuries. Data were extracted on study and patient characteristics, iatrogenic nerve injury incidences, and specific nerve injuries. A random-effects model assessed treatment effects, with subgroup analysis and meta-regression. The main outcomes included odds ratios (ORs) and confidence intervals (CIs) for iatrogenic nerve injuries. Compared with closed reduction internal fixation, robotic-assisted techniques had the highest, and open reduction internal fixation had the lowest ORs for iatrogenic nerve injuries. The robotic-assisted approach ranked best with an OR of 0.22 (95%CI: 0.02-2.16), while closed reduction internal fixation with the anterior approach (OR: 0.71; 95%CI: 0.21-2.48) and open reduction internal fixation with the anterior approach performed the worst. The lateral femoral cutaneous nerve was injured in all open reduction internal fixation with anterior approach procedures and in 66.7% of open reduction internal fixation with posterior approach procedures. Meta-regression showed a significantly lower OR for iatrogenic nerve injuries in patients aged >41.4years in the open reduction internal fixation with anterior approach group (OR: 0.02; 95%CI: 0.001-0.63; p=0.026) compared with younger patients. The robotic-assisted technique may result in the fewest iatrogenic nerve injuries during the treatment of pelvic ring injuries. The posterior approach may also reduce the risk of iatrogenic nerve injuries.

ESPGHAN and NASPGHAN 2024 protocol for paediatric functional constipation treatment guidelines (standard operating procedure)

IntroductionFunctional constipation is common in childhood, with chronicity leading to a significant impact on patients and their families. There is a significant range of therapies available to healthcare professionals for...

Single inhaler with beclometasone, formoterol, and glycopyrronium versus triple therapies in adults with uncontrolled asthma: a systematic review and meta-analysis

Recent literature has shown that triple therapy is more effective than dual therapy for individuals with uncontrolled asthma. However, the comparative efficacy between different triple therapies remains unclear. The objective of this study was to determine the comparative efficacy of extra-fine single-inhaler medium-dose (MD) or high-dose (HD) of beclometasone/formoterol/glycopyrronium bromide (BDP/FOR/GLY) compared to other triple therapies in patients whose asthma remains uncontrolled with MD or HD inhaled corticosteroids and long-acting β2-agonists. A systematic literature review identified randomized control trials on adult patients with uncontrolled asthma. Two separate networks were constructed according to patients’ previous inhaled-corticosteroid dosage. Network meta-analyses evaluated severe and moderate-to-severe exacerbations, pre-dose forced expiratory volume, and asthma control questionnaire responses at 52 (± 3) weeks. Among single-inhaler triple therapies, MD BDP/FOR/GLY significantly reduced the risk of severe exacerbations (RR [95% CrI] compared to MD fluticasone/umeclidinium/vilanterol: 0.65 [0.49, 0.89]), while HD BDP/FOR/GLY demonstrated an improved trend in reducing severe and moderate-to-severe exacerbations versus HD indacaterol acetate/glycopyrronium bromide/mometasone, fluticasone/umeclidinium/vilanterol, and salmeterol/fluticasone + tiotropium. HD BDP/FOR/GLY and HD BDP/FOR + tiotropium did not differ significantly. Compared to relevant single-inhaler triple therapies, MD and HD BDP/FOR/GLY are associated with a significant benefit or trend for improvement in terms of reducing the rate of severe and moderate-to-severe exacerbations.

Clinical efficacy of different methods for treatment of granulomatous lobular mastitis: A systematic review and network meta-analysis.

This network meta-analysis aims to evaluate the recurrence rates of various treatment options for granulomatous lobular mastitis. We systematically searched and identified eligible studies in PubMed, EMBASE, Cochrane Library, and Web of Science databases until September 30, 2023. Original studies reporting the recurrence rates of various treatments were included. Subsequently, literature screening, data extraction, and network meta-analysis were conducted. This study was registered with PROSPERO (registration number CRD 42023434773). Nineteen articles involving 1,095 patients were included in this study. The network meta-analysis revealed that several treatment combinations reduced the recurrence rate compared to observation: Surgery + Local steroid injection + Systemic steroids therapy (OR: 0.23, 95% CI 0.01 to 4.53), Local steroid injection (OR: 0.34, 95% CI 0.02 to 6.81), Surgery + Systemic steroids therapy (OR: 0.36, 95% CI 0.02 to 5.29), Surgery + Traditional Chinese Medicine (OR: 0.33, 95% CI 0.01 to 9.11), Systemic steroids therapy + MTX (OR: 0.62, 95% CI 0.01 to 34.59), and Systemic steroids therapy + drainage (OR: 0.76, 95% CI 0.05 to 10.67). Among these, Surgery + Local steroid injection + Systemic steroids therapy demonstrated superior efficacy. The surface under cumulative ranking curve (SUCRA) values were highest for Surgery + Local steroid injection + Systemic steroids therapy (0.85), followed by Local steroid injection (0.78) and Surgery + Systemic steroids therapy (0.77). Steroid-based combination therapy may be the first choice for IGM patients, with a comprehensive strategy of local and systemic steroids combined with surgery having the best effect on IGM.

Comparative efficacy of topical commercial Chinese polyherbal preparation for vulvovaginal candidiasis: a network meta-analysis

ObjectiveTo systematically evaluate the differences in the efficacy of commonly used topical commercial Chinese polyherbal preparations (CCPPs) for vulvovaginal candidiasis (VVC), and to provide evidence-based reference for clinical drug regimens.MethodsComputer searched major Chinese and English literature databases, and collected randomized controlled trials (RCTs) of external use of CCPPs combined with conventional treatment (CT, test group) versus CT alone (control group) in patients with VVC. After screening the literature, the quality of the included studies was assessed using the risk of bias assessment tool recommended in 5.3 of the Cochrane Handbook. Outcome data for each outcome measure were extracted and a network meta-analysis was performed using Stata 15.0.ResultsA total of 74 RCTs with a total of 8,151 patients were included, nine interventions were involved. The results of network meta-analysis showed that, Fufang Shajiziyou suppository combined with CT was more effective in improving the negative conversion rate and controlling the recurrence rate of Candida albicans. Kangfu gel combined with CT had the better effect in relieving pruritus. Baofukang suppository combined with CT was the most effective in reducing leukorrhea. Fufukang spray combined with CT had fewer adverse reactions.ConclusionThe addition of CCPPs to CT may acquire a better curative effect in patients with VVC and external does not significantly increase the occurrence of adverse reactions. However, due to the low quality of the included literature, larger-scale, higher-quality clinical studies are still needed.Systematic Review RegistrationPROSPERO, NO: CRD42023410244.

Pharmacologic Management of Acute Pain in Children: A Systematic Review and Network Meta-Analysis.

Several pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain. To assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials. Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023. Trials that enrolled children (aged <18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included. Pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events. A total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], -1.29; 95% CI, -1.89 to -0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, -1.12; 95% CI, -2.09 to -0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, -1.19; 95% CI, -1.83 to -0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low-certainty evidence. Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.

Comparison of the Outcomes of Endoscopic Posterolateral Interbody Fusion and Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis.

Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD). A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies. Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF. Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.

Comparative outcomes of corticosteroids, neuromuscular blocking agents, and inhaled nitric oxide in ARDS: a systematic review and network meta-analysis

ObjectivesAcute respiratory distress syndrome (ARDS) is associated with high rates of morbidity and mortality. However, the evidence regarding the effectiveness of commonly used treatments, including corticosteroids, neuromuscular blocking agents (NMBAs), and inhaled nitric oxide (iNO), remains uncertain. Therefore, this study aimed to compare and rank these three treatments to identify the most effective option.Data sourcesWe searched PubMed, Embase, Cochrane Library, and Web of Science for clinical trials from the earliest records to 1 May 2024.Study selection and data extractionClinical trials evaluating three interventions compared with the control group for ARDS were included, with restrictions on any language. Data were extracted by two independent reviewers. Frequentist network meta-analysis (NMA) was performed to identify the most effective intervention, and treatments were ranked using the surface under the cumulative ranking (SUCRA) curve. The primary outcome was 28-day mortality, while secondary outcomes included ventilator-free days up to 28 days, ICU mortality, in-hospital mortality, and the incidence of new infection events.Data synthesisData from 26 clinical trials encompassing 5,071 patients were analyzed. Vecuronium bromide was the most effective strategy for reducing 28-day mortality compared to conventional treatment, iNO, methylprednisolone, and placebo (OR 0.38, 95% CI 0.15–1.00, and OR 0.30, 95% CI 0.10–0.85 and OR 0.25, 95% CI 0.08–0.74 and OR 0.23, 95% CI 0.08–0.65; SUCRA: 96.6%). Dexamethasone was identified as the most effective treatment option for increasing ventilator-free days at 28 days compared to conventional therapy and cisatracurium (MD 3.60, 95% CI 1.77–5.43, and MD 3.40, 95% CI 0.87–5.92; SUCRA: 93.2%). Methylprednisolone demonstrated the highest effectiveness for preventing ICU mortality (SUCRA: 88.5%). Although dexamethasone, cisatracurium, conventional therapy, methylprednisolone, and iNO treatment did not show significant superiority in reducing in-hospital mortality, dexamethasone showed the highest probability of being the most effective treatment option (SUCRA: 79.7%). Furthermore, dexamethasone treatment showed the highest safety in reducing the incidence of new infection events compared with placebo and iNO (OR 0.61, 95% CI 0.42–0.88, and OR 0.33, 95% CI 0.19–0.58; SUCRA: 91.8%).ConclusionThis NMA suggests that corticosteroids may provide benefits to patients with ARDS. While the application of NMBAs may reduce 28-day mortality, iNO did not demonstrate a significant beneficial effect as a therapeutic measure.Systematic review registrationPROSPERO, CRD42022333165 https://www.crd.york.ac.uk/PROSPERO/.