Non-significant Heterogeneity Research Articles

Multivariable prognostic prediction of efficacy and safety outcomes and response to fingolimod in people with relapsing-remitting multiple sclerosis.

The individual treatment response in people with relapsing-remitting multiple sclerosis (RRMS) remain unpredictable. In order to support medical decisions, we aimed to predict response to fingolimod compared to placebo, by developing and validating prognostic multivariable models. We included two-year follow-up from intention-to-treat populations of two multi-country placebo-controlled randomized controlled trials (RCT) of daily fingolimod 0.5 mg. The data was accessed via ClinicalStudyDataRequest.com (Proposal Number: 11223) The RCTs were in adult RRMS patients with active disease. We used four Cox proportional hazards based penalized (elastic net and grouped lasso) and tree methods (transformation tree and forest) to predict time-to relapse and other relevant efficacy and safety endpoints in data from the RCT FREEDOMS. Treatment arm, 80 baseline variables and their interaction with treatment were considered as candidate predictors in the models. A nested cross-validation scheme ensured independent tuning parameter optimization and internal model performance evaluation. The generalizability of the models with the highest cross-validated time-dependent area under the receiver operating curve (AUC) was further evaluated in terms of discrimination (AUC), calibration (plots, intercept, slope), clinical utility (decision curve analysis), and treatment response plots by external validation in data from the RCT FREEDOMS II. The best performing model predicting relapse risk (331 events) in the development sample (n=843) was an elastic net regression with main terms for four predictors alongside treatment: EDSS score, volume of Gadolinium enhanced T1 lesions, number of relapses in the last 2 years, and number of prior MS treatments. In external validation (n=713), it had an AUC of 0.68 (95% CI 0.63-0.72), but the predictions were overestimating the actual risk (358 events) with a calibration-in-the-large of -0.17 (-0.3 - -0.04) and a slope of 1.06 (0.78-1.35). Almost no heterogeneity (variability 0.001) was detected in the predicted relapse risk change in response to fingolimod. FREEDOMS II participants were predicted to have 0.21 to 0.31 absolute relapse risk reduction with fingolimod compared to placebo. The selected model predicting new or enlarging T2 magnetic resonance imaging (MRI) lesions had an AUC of 0.74 (0.70-0.78), moderate calibration, but no treatment response variability. The final model predicting confirmed disability progression had an AUC of 0.59 (0.54-0.64) and the predicted treatment response heterogeneity was not significant. The overall safety outcome could not be predicted with sufficient discrimination. However, the final model predicting infections or neoplasms had an AUC of 0.69 (0.63-0.74) and non-significant treatment response heterogeneity. For the efficacy outcomes, important predictors were related to (para)clinical disease activity or disability. Unexpected influential predictors included concomitant disorders. Relapse and new or enlarging T2 MRI lesions were moderately predictable in an independent sample with the developed prognostic models. Fingolimod was expected to decrease the risk of these events for all patients, with no predictable heterogeneity. Disability and safety outcomes could not be well-predicted and it is yet unresolved whether the change in their risk as response to fingolimod is heterogeneous or not.

Methodological issues in radiomics: impact on accuracy of MRI for predicting response to neoadjuvant chemotherapy in breast cancer.

To investigate whether methodological aspects may influence the performance of MRI-radiomic models to predict response to neoadjuvant treatment (NAT) in breast cancer (BC) patients. We conducted a systematic review until March 2023. A random-effects meta-analysis was performed to combine the area under the receiver operating characteristic curve (AUC) values. Publication bias was assessed using Egger's test and heterogeneity was estimated by I2. A meta-regression was conducted to investigate the impact of various factors, including scanner, features' number/transformation/type, pixel/voxel scaling, etc. RESULTS: Forty-two studies were included. The summary AUC was 0.77 (95% CI: 0.74-0.81). Substantial heterogeneity was observed (I2 = 81%) with no publication bias (p = 0.35). Radiomic model accuracy was influenced by the scanner vendor, with lower AUCs in studies using mixed scanner vendors (AUC; 95% CI: 0.70; 0.61-0.78) compared to studies including images obtained from the same scanner (AUC (95% CI): 0.83 (0.77-0.88), 0.74 (0.67-0.82), 0.83 (0.78-0.89) for three different vendors; vendors 1, 2, and 3, respectively; p-value = 0.03 for comparison with vendor 1). Feature type also seemed to have an impact on the AUC, with higher prediction accuracy observed for studies using 3D than 2D/2.5D images (AUC; 95% CI: 0.81; 0.78-0.85 and 0.73; 0.65-0.81, respectively, p-value = 0.03). Non-significant between-study heterogeneity was observed in the studies including 3D images (I2 = 33%) and Vendor 1 scanners (I2 = 40%). MRI-radiomics has emerged as a potential method for predicting the response to NAT in BC patients, showing promising outcomes. Nevertheless, it is important to acknowledge the diversity among the methodological choices applied. Further investigations should prioritize achieving standardized protocols, and enhancing methodological rigor in MRI-radiomics. Question Do methodological aspects influence the performance of MRI-radiomic models in predicting response to NAT in BC patients? Findings Radiomic model accuracy was influenced by the scanner vendor and feature type. Clinical relevance Methodological discrepancies affect the performance of MRI-radiomic models. Developing standardized protocols and enhancing methodological rigor in these studies should be prioritized.

Efficacy and Safety of Platelet-rich Plasma in the Management of Lumbar Disc Herniation: A Systematic Review and Meta-analysis

Background Lumbar radicular discomfort is often induced by mechanical compression of the nerve root and inflammatory reactions. Platelet-rich plasma (PRP) is an efficacious therapy modality, albeit ongoing controversies regarding its effectiveness, and it possesses the advantage of minimal side effects. Therefore, we conducted the current systematic review and meta-analysis to investigate the efficacy and safety of PRP in the treatment of lumbar disc herniation (LDH). Methods We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on three main keywords: “Platelet-rich plasma” AND “Lumbar” AND “Hernia*”. We conducted the pooled analysis of continuous variables using mean difference (MD) and we used pooled odds ratio (OR) for dichotomous variables with 95% confidence intervals (CI). Results The use of PRP was statistically significant associated with reduced visual analogue scale (VAS) compared with no PRP with MD of -0.44 (95%CI:-0.76, -0.11, p=0.008), and Oswestry Disability Index (ODI) with MD of -5.36 (95%CI: -8.25, -2.48, p=0.0003). However, no significant difference was observed regarding Japanese Orthopedic Association (JOA) with MD of 2.52 (95%CI:-0.8, 5.84, p=0.14) with non-significant heterogeneity. PRP was also associated with reduced risk of complications with OR of 0.22 (95%CI:0.07, 0.68, p=0.009) and non-significant heterogeneity. Conclusion PRP use in patients with LDH is associated with positive outcomes presented in reduction of pain, and disability (decrease in ODI scale) in addition to being safe with less incidence of complications compared with patients not receiving PRP.

Safety and Efficacy of Chyawanprash as a Prophylaxis Treatment for COVID-19: A Systematic Review and Meta-Analysis of Randomized Control Trials.

Amidst the multifaceted challenges posed by COVID-19, interest in complementary and alternative medicine (CAM) has risen. Chyawanprash (CP), an Ayurvedic formulation, is recognized for its multifunctional properties. This systematic review aims to evaluate its safety and effectiveness as a COVID-19 prophylactic.A literature search was conducted for articles published within the past three years from databases such as Cochrane Library, PubMed, and Google Scholar. A total of 1008 articles were identified, and 34 were included for full-text screening, resulting in five randomized controlled trials (RCTs) meeting the eligibility criteria. Meta-analysis was performed using a random effects model, with results represented in odds ratio (95% confidence intervals (CIs)), and publication bias presented through funnel plots.The five clinical trials conducted in India analyzed 153,343 participants. In the meta-analysis, the odds ratios for COVID-19-positive patients, COVID-19-positive in symptomatic patients, healthcare resource utilization (HCRU), and adverse events were 0.45 (95% CI 0.06-3.08, p = 0.41), 0.37 (95% CI 0.01-12.86, p = 0.58), 0.95 (95% CI 0.18-5.04, p = 0.95), and 0.94 (95% CI 0.63-1.40, p = 0.75) respectively. Notably, significant heterogeneity was observed among studies including both COVID-19-positive cases (I2= 80%, p = 0.007) and symptomatic COVID-19 cases (I2= 83%, p = 0.01), whereas non-significant zero heterogeneity was observed in HCRU (I2=0%, p = 0.74) and adverse events (I2= 0%, p = 1.00). The meta-analysis reveals a trendin the efficacy of CP as prophylaxis for COVID-19 treatments. However, owing to high heterogeneity and bias, further research is recommended.

Prognostic and clinicopathological value of the controlling nutritional status (CONUT) score in patients with head and neck cancer: a meta-analysis

BackgroundThe efficiency of controlling nutritional status (CONUT) score in detecting the prognosis of head and neck cancer (HNC) patients has been investigated in some works, but no consistent findings are obtained. Therefore, this work focused on evaluating the precise prognostic role of CONUT for HNC patients through meta-analysis.MethodsThe effect of CONUT on predicting the prognosis of HNC patients was evaluated through calculating combined hazard ratios (HRs) as well as 95% confidence intervals (CIs). The correlations of CONUT with clinicopathological features of HNC patients were investigated through combined odds ratios (ORs) and 95%CIs. This study used the random-effects model in the case of significant heterogeneity; or else, we selected the fixed-effects model.ResultsThere were eight articles involving 1,478 patients enrolled for the current meta-analysis. We adopted the fixed-effects model for OS and DFS analysis because of the non-significant heterogeneity. As demonstrated by our combined findings, high CONUT score could significantly predict the poor overall survival (OS) (HR = 1.94, 95%CI = 1.55–2.44, p < 0.001) and disease-free survival (DFS) (HR = 1.93, 95%CI = 1.45–2.56, p < 0.001) of HNC. In addition, higher CONUT score was significantly connected to T3-T4 stage (OR = 3.21, 95%CI = 1.94–5.31, p < 0.001) and N1-N3 stage (OR = 3.10, 95%CI = 1.74–5.53, p < 0.001).ConclusionAccording to findings in the present meta-analysis, high CONUT score significantly predicted the prognosis of OS and DFS for HNC patients. Higher CONUT score was also correlated to larger tumor size and LN metastasis in HNC. Due to it is a cost-effective and easily available parameter, CONUT could serve as promising prognostic biomarker for HNC.

Effectiveness of cognitive rehearsal programs for the prevention of workplace bullying among hospital nurses: a systematic review and meta-analysis

BackgroundTo solve the problem of workplace bullying among nurses, it is necessary to review the effects of interventions and generalize the findings. We conducted a systematic literature review and meta-analysis to evaluate the effects of cognitive rehearsal programs on workplace bullying among hospital nurses.MethodsData were collected from March 30 to April 11, 2021, and 11,048 journal articles published in South Korea and internationally were examined across eight databases. Nine articles were selected for inclusion in the systematic literature review; five of the nine studies were included in the meta-analysis. For randomized controlled trials, the risk of bias was evaluated, and for non-randomized controlled trials, the study quality was evaluated using the Risk of Bias for Non-randomized Studies version 2.0. Egger’s regression test was performed to determine publication bias.ResultsOf the nine articles selected for this study, two were randomized controlled trials and seven were non-randomized controlled trials. The I2 value was 18.9%, indicating non-significant heterogeneity. The overall effect size of the cognitive rehearsal programs was -0.40 (95% confidence interval: -0.604 to -0.196; Z = -3.85; p = .0001) in a random-effects model, indicating a large effect size with statistical significance.ConclusionsTherefore, cognitive rehearsal programs that address workplace bullying among hospital nurses are effective. Health policymakers must implement cognitive rehearsal programs in a policy manner to address the problems of bullying in the workplace.

Survival Outcomes in Stage IV Gastric Cancer Patients with Krukenberg Tumors: A Systematic Review and Meta Analysis.

Stage IV gastric cancer patients with Krukenberg tumors typically exhibit poor survival outcomes, often less than 2years. The management of this tumor subgroup remains non-standardized, and the impact of oophorectomy on survival remains uncertain. In this study, we systematically analyzed survival outcomes among gastric cancer patients with ovarian metastases who underwent standard chemotherapy, surgical resection of ovarian metastases, or combined chemotherapy and surgery. We conducted a systematic reviewand meta-analysis of randomized controlled trials and observational studies retrieved from MEDLINE (PubMed), Embase, and the Cochrane Library until January 25, 2024,applying the Boolean logic. Participants included individuals with pathologically and radiologically confirmed ovarian metastasis or clinically symptomatic cases with imaging evidence. Statistical analyses were performed using R (v.4.3.2., Vienna). The study was registered with PROSPERO(ID-CRD42023488373). A total of 1502 patients from 17 retrospective studies were pooled for analysis of overall survival (OS) outcomes. The OS in the standard chemotherapy cohort, as determined by the random effects model, was 6.708months (95% CI 3.867 to 9.548; P<0.0001), with non-significant heterogeneity (I2 = 5.5%). In the surgical resection cohort, OS was 12.786months (95% CI 6.9 to 18.671; P<0.0001), with low heterogeneity (I2 = 0%). In the combined chemotherapy and surgical resection cohort, OS was 16.228months (95% CI 12.254 to 20.202), with insignificant heterogeneity (I2 = 0%). This meta-analysis offerskey insights into survival outcomes associated with different therapeutic modalities in gastric cancer with Krukenberg metastases. It provides valuable evidence for clinical decision-making and future research directions. While the combined approach of chemotherapy and surgery demonstrates the highest effect size for OS, careful consideration of patient-centric approaches is essential in the oncological care landscape.

Efficacy of COVID-19 Treatments in Intensive Care Unit: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: Examining the cumulative evidence from randomized controlled trials (RCTs), evaluating the use of pharmacological agents for the treatment of COVID-19 infections in patients with critical illness. Data Sources: Databases Medline, Embase, Web of Science, Scopus, CINAHL, and Cochrane. Study Selection: Inclusion criteria were RCTs that enrolled patients with confirmed or suspected COVID-19 infection who are critically ill. Only RCTs that examined therapeutic agents against one another or no intervention, placebo, or standard of care, were included. Data Extraction: Pairs of reviewers extracted data independently. Outcomes of interest included the overall reported mortality defined as either the ICU mortality, hospital mortality, mortality within 28 days or mortality within 90 days. Data Synthesis: A total of 40 studies (11,613 patients) evaluated 50 therapeutic intervention arms divided into five main therapy categories; steroids, antiviral medications, immunomodulators, plasma therapies [intravenous immunoglobulins (IVIG), convalescent plasma and/or, therapeutic plasma exchange], and therapeutic anticoagulation. Immunomodulators was the only group with possible mortality benefit, risk ratio (RR) 0.83 (95% CI 0.73; 0.95), with nonsignificant heterogeneity (I 2 = 8%, p=0.36). In contrast, the other therapy groups showed no significant impact on mortality, as indicated by their respective pooled RRs: steroids [RR 0.91 (95% CI 0.82; 1.01), I 2 = 31%], antiviral medications [RR 1.11 (95% CI 0.82; 1.49), I 2 = 57%], plasma therapies [RR 0.77 (95% CI 0.58; 1.01), I 2 = 36%], and anticoagulation [RR 1.06 (95% CI 0.95; 1.18), I 2 = 0%]. Conclusions: This meta-analysis highlights both the heterogeneity and a lack of benefit from therapies evaluated during the COVID-19 pandemic. Many of the RCTs were developed based on limited observational data. Future RCTs investigating pharmaceutical interventions in critically ill patients during pandemics need to be designed based on better evidence.

Efficacy and Safety Assessment of LVIS Jr Device in Treating Wide-Neck Aneurysms: A Comprehensive Systematic Review and Single-Arm Meta-Analysis.

To evaluate the usage and the effectiveness of LVIS Jr device technology in managing wide-neck intracranial aneurysms. PubMed, Embase, and Web of Science databases, comprising studies with outcomes related to LVIS Jr use in wide-neck intracranial aneurysms were searched systematically. Data was extracted from the selected articles and subjected to statistical analysis. Among 886 initially identified articles, 20 studies met our inclusion criteria, comprising a total of 557 patients. Our analysis revealed a 96% final occlusion rate under common effects and 93% under random effects, with substantial heterogeneity (I² = 69%). Good clinical outcomes were observed in 99% of cases with low heterogeneity (I² = 27%). Mortality rates were extremely low, with only one reported death out of 499 patients across 18 studies, resulting in a 0% mortality rate for common and random effects and no heterogeneity (I² = 0). Complications occurred in 44 of 482 patients, yielding a 6% rate in the common effect model and 6% in the random effects model, with nonsignificant heterogeneity (I² = 25%). LVIS Jr observed a favorable rate of final occlusion and good clinical outcomes, and the low mortality and complication rates highlight its safety in the treatment of wide-neck aneurysms.

Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis.

Esophageal stenting is an important intervention for managing malignant and benign dysphagia, with stent migration representing a common drawback. This systematic review with meta-analysis aimed to assess the benefit of stent fixation over nonfixation. A systematic search was performed in MEDLINE, Cochrane, Scopus, and ClinicalTrials.gov databases until January 2023 for comparative studies evaluating the migration rates of esophageal stents with versus without (control) fixation. The primary outcome was migration rate. Secondary outcomes included adverse event rate. A subgroup analysis stratified the results based on different fixation techniques: suturing, over-the-scope (OTS) clipping, and through-the-scope (TTS) clipping. Meta-analysis was based on a random effects model and the results were reported as odds ratios (ORs) with 95 %CIs. 10 studies (1014 patients) were included. The rate of stent migration was significantly lower after fixation (OR 0.20, 95 %CI 0.11-0.37; I2 = 59 %, P = 0.01). The adverse event rate was similar between fixation and control groups (OR 0.65, 95 %CI 0.28-1.52; I2 = 55 %, P = 0.06). In the subgroup analysis, all fixation techniques remained superior to nonfixation of stents (suturing OR 0.23, 95 %CI 0.10-0.53; OTS clips OR 0.31, 95 %CI 0.17-0.58; TTS clips OR 0.10, 95 %CI 0.03-0.38); however, only the OTS and TTS clip groups achieved nonsignificant heterogeneity (I2 = 0 %, P = 0.67 and P = 0.73, respectively). No difference between techniques was recorded for migration rates. Esophageal stent fixation was associated with significantly lower migration rates compared with nonfixation of stents, regardless of fixation technique and stenting indication.

URINARY DIVERSION AFTER RADICAL CYSTECTOMY, ORTHOTOPIC NEOBLADDER VS ILEAL CONDUIT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF POSTOPERATIVE COMPLICATION

ABSTRACT&#x0D; Objective: The purpose of this study is to compare orthotopic neobladder (ONB) and ileal conduit (IC) formation in terms of surgical outcome and complication. Material &amp; Methods: Computerized bibliographic search on different databases related to this study. The PICO criteria method was applied to define research eligibility, per PRISMA recommendations and conducted a systematic review of the literature with meta-analysis. Weighted mean differences with 95 percent confidence intervals were used to compare continuous outcomes. Results: There were 479 publications were discovered and only 6 studies fulfilled the criteria included. The random-effect model's pooled result for urinary leakage complication revealed a significant difference of 1.62 between ONB and IC with higher incidence in neobladder group (95 percent CI, 1.85, 8.69, P = 0.0004) with non-significant heterogeneity (Chi2 = 0.65, df = 3 (P = 0.89), I2 = 0%). Other complications (ileus complication, anastomosis site stenosis, sepsis, urinary infection) showed non-significant difference. Conclusion: Because of the heterogeneity in several aspects of the analyzed papers, further study comparing Orthotopic Neobladder and Ileal conduit in terms of complication following urinary diversion are needed to confirm superiority of ONB or IC as the urinary diversion of choice.&#x0D; Keywords: Orthotopic neobladder, ileal conduit, urinary diversion, radical cystectomy

Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis.

To conduct a systematic review and meta-analysis assessing whether vision and/or eye disorders are associated with Autism Spectrum Disorder (ASD). Based on a pre-registered protocol (PROSPERO: CRD42022328485), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 5th February 2022, with no language/type of document restrictions. We included observational studies 1) reporting at least one measure of vision in people of any age with a diagnosis of ASD based on DSM or ICD criteria, or ADOS; or 2) reporting the prevalence of ASD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random-effects meta-analyses were used for data synthesis. We included 49 studies in the narrative synthesis and 46 studies in the meta-analyses (15,629,159 individuals distributed across multiple different measures). We found meta-analytic evidence of increased prevalence of strabismus (OR = 4.72 [95% CI: 4.60, 4.85]) in people with versus those without ASD (non-significant heterogeneity: Q = 1.0545, p = 0.7881). We also found evidence of increased accommodation deficits (Hedge's g = 0.68 [CI: 0.28, 1.08]) (non-significant heterogeneity: Q = 6.9331, p = 0.0741), reduced peripheral vision (-0.82 [CI: -1.32, -0.33]) (non-significant heterogeneity: Q = 4.8075, p = 0.4398), reduced stereoacuity (0.73 [CI: -1.14, -0.31]) (non-significant heterogeneity: Q = 0.8974, p = 0.3435), increased color discrimination difficulties (0.69 [CI: 0.27,1.10]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890), reduced contrast sensitivity (0.45 [CI: -0.60, -0.30]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890) and increased retinal thickness (=0.29 [CI: 0.07, 0.51]) (non-significant heterogeneity: Q = 0.8113, p = 0.9918) in ASD. ASD is associated with some self-reported and objectively measured functional vision problems, and structural alterations of the eye, even though we observed several methodological limitations in the individual studies included in our meta-analyses. Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life. CRD42022328485.

Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy.

There is no clear consensus as to which intervention to prioritize for midportion Achilles tendinopathy (AT), although recent clinical practice guidelines have recommended eccentric exercises. The purpose of this study was to (1) compare exercise loading protocols with passive treatment modalities for the management of midportion AT and (2) compare different exercise loading protocols. We hypothesized that loading exercises would be associated with a greater decrease in pain and symptoms compared with passive treatment modalities but that no loading protocols would be associated with improved results. Systematic review; Level of evidence, 1. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE, EMBASE, CINHAL, and Web of Science databases for randomized controlled trials (RCTs) and compared eccentric loading protocols with passive treatment modalities or different eccentric loading protocols as an intervention for midportion AT. A total of 5126 articles were identified after the initial search. After selection, the risk of bias (RoB) and the Grading of Recommendations, Assessment, Development and Evaluation approach were applied to pooled studies for quantitative analysis. The outcomes of interest were pain and function, which were measured using the visual analog scale and the Victorian Institute of Sport Assessment-Achilles scale. Mean differences (MDs) and 95% CIs were calculated using random effects (significant heterogeneity) or fixed effects (nonsignificant heterogeneity) inverse variance models. In this study, 12 RCTs (N = 543 participants) were included, of which 2 had a high RoB and 10 showed some concerns of bias. Passive interventions resulted in greater pain reduction in the short term compared with eccentric loading protocols (n = 4 studies; n = 212 participants; pooled MD, 10.22 [95% CI, 2.18 to 18.25]; P = .01). For function, there was a nonsignificant trend in favor of eccentric loading in the short- (n = 3 studies; n = 144 participants; pooled MD, -7.91 [95% CI, -16 to 0.19]; P = .06) and midterm follow-up (n = 5 studies; n = 258 participants; pooled MD, -6.78 [95% CI, -14.23 to 0.68]; P = .07). Meta-analyses of RCTs comparing different types of exercise loading protocols showed no significant differences in the short, mid-, and long term with regard to pain and function. Our meta-analyses did not highlight the superiority of one treatment over another for midportion AT.

Strength-based methods – a narrative review and comparative multilevel meta-analysis of positive interventions in clinical settings

ABSTRACT Objective In psychotherapy, strength-based methods (SBM) represent efforts to build on patients’ strengths while addressing the deficits and challenges that led them to come to therapy. SBM are incorporated to some extent in all major psychotherapy approaches, but data on their unique contribution to psychotherapy efficacy is scarce. Methods First, we conducted a systematic review and narrative synthesis of eight process-outcome psychotherapy studies that investigated in-session SBM and their relation to immediate outcomes. Second, we conducted a systematic review and multilevel comparative meta-analysis contrasting strength-based bona fide psychotherapy vs. other bona fide psychotherapy at post-treatment (57 effect sizes nested in 9 trials). Results Despite their methodological variability, the pattern of results in the process-outcome studies was generally positive, such that SBM were linked with more favorable immediate, session-level patient outcomes. The comparative meta-analysis found an overall weighted average effect size of g = 0.17 (95% CIs [0.03, 0.31], p < .01) indicating a small but significant effect in favor of strength-based bona fide psychotherapies. There was non-significant heterogeneity among the effect sizes (Q(56) = 69.1, p = .11; I2 = 19%, CI [16%, 22%]). Conclusion Our findings suggest that SBMs may not be a trivial by-product of treatment progress and may provide a unique contribution to psychotherapy outcomes. Thus, we recommend integration of SBM to clinical training and practice across treatment models.

Effects of Cognitively Stimulating Activities on the Cognitive Functioning of Older People with Mild Cognitive Impairment: A Meta-Analysis

Background. The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings.Objectives. This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, “In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?”Methods. A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA onolder people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot.Results. This meta-analysis which compared studies that employed similar methodologies, found that CSA has asignificant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMDof 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitivefunction was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran’s Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment.Conclusion. Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study’s significant, large effect, and non-significant heterogeneity warrants caution. &nbsp

Plasma Concentrations of Gut Hormones Acyl Ghrelin and Peptide YY and Subsequent Risk of Colorectal Cancer and Molecular Tumor Subtypes.

The findings of this study do not support a major role for the metabolic gut hormones ghrelin and PYY in colorectal cancer development but suggest the possibility of an involvement for ghrelin in specific tumor subtypes. Elucidating subtype-specific risk factors and mechanisms of carcinogenesis may have implications for precision prevention.

A meta-analysis of the genetic contribution to greenhouse gas emission in sheep.

The objective of this study was to use a random-effects model of meta-analysis to merge various heritability estimates of different gas emission traits (methane yield [METY], methane production [METP], carbon dioxide production [CO2 ], the sum of carbon dioxide and methane production [METP + CO2 ], ratio, and oxygen consumption [O2 ]) and their genetic association with growth and partial efficiency traits in sheep. A total of 53 genetic correlations and 47 heritability estimates from 13 scientific articles were used in the meta-analysis. The included papers were published between 2010 and 2022. To measure heterogeneity, Chi-square (Q) test was performed, and the I2 statistic was determined. The average heritability estimates for the studied traits were low to moderate and ranged from 0.137 (for METY) to 0.250 (for METP + CO2 ). The heterogeneity test of heritability estimates indicated that heritability estimates for METY, O2 consumption, and had low Q values and non-significant heterogeneity (p > 0.10). However, the average heritability estimates for other traits experienced significant heterogeneities (p < 0.10). The genetic correlation estimate between METP with O2 was -0.597 (p< 0.05), but its genetic correlations with other gas traits ranged from 0.593 (with METP + CO2 ) to 0.653 (CO2 ; p < 0.05). Also, mean estimates of genetic correlation between METP with live weight (LW), feed intake (FI), and residual feed intake (RFI) were 0.719, 0.598, and 0.408, respectively. The genetic correlations of CO2 with performance traits varied from 0.641 (with RFI) to 0.833 (with FI; p< 0.05). This meta-analysis showed gas emission traits in sheep are under low-to-moderate genetic control. The average genetic parameter estimates obtained in this study could be considered in the genetic selection programmes for sheep, especially when there is no access to accurate phenotypic records or genetic parameter estimates for gas emission traits.

Normal Ranges of Right Atrial Strain: A Systematic Review and Meta-Analysis

BackgroundStandard measures for the clinical assessment of right atrial (RA) function are lacking. ObjectivesIn this systematic review and meta-analysis, the authors sought to report a reference range for RA deformation parameters in healthy subjects and to identify factors that contribute to reported variations. MethodsThe authors conducted a comprehensive search of MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase; Scopus; and the Cochrane Central Register of Controlled Trials from database inception through October 2021. Studies were included if they reported RA strain or strain rate (SR) using 2-dimensional speckle-tracking echocardiography in healthy volunteers or apparently healthy control patients. Data were extracted by 1 reviewer and then reviewed by 2 independent reviewers. Conflicts were resolved through consensus. Data were combined using the method developed by Siegel and adjusted using the restricted maximum likelihood random-effects model. The normal range was defined as the 95% CI of the mean. Heterogeneity was assessed by the Cochran Q-statistic and the inconsistency index (I2). The quality of the included studies and publication bias were assessed. Effects of clinical variables were sought in a metaregression. ResultsThe search identified 4,111 subjects from 21 studies. The average RA reservoir strain was 44% (95% CI: 25%-63%), contractile strain was 17% (95% CI: 2%-32%), and conduit strain was 18% (95% CI: 7%-28%), with significant between-study heterogeneity and inconsistency. The systolic SR was 2.1 s-1 (95% CI: 0.9-3.4 s-1), early-diastolic SR was −2.0 s-1 (95% CI: −3.3 to −0.8 s-1), and late-diastolic SR was −1.9 s-1 (95% CI: −2.4 to −1.3 s-1), with nonsignificant heterogeneity and inconsistency. Ranges remained wide in healthy volunteers. The metaregression identified only age as significantly associated with systolic SR and no other significant determinants of variation among normal ranges of strain. ConclusionsThere are wide reference ranges for RA deformation, and these may limit the utility of this test in clinical practice.

Towards personalized treatment of T2N0 rectal cancer: A systematic review of long-term oncological outcomes of neoadjuvant therapy followed by local excision.

Background and AimTotal mesorectal excision (TME) remains the treatment of choice in T2N0 tumors. However, evidence suggest that one‐size‐fits‐all approach is not always beneficial for this group of patients. The aim of this study is to synthesize data on long‐term outcomes after neoadjuvant therapy (NAT) followed by local excision (LE) in T2N0 rectal cancer patients in the perspective of a rectal‐preserving strategy.MethodsA systematic search of PubMed/MEDLINE, SCOPUS, and Web of Science databases was conducted until October 2021 to identify studies comparing LE after NAT and TME or reporting oncologic outcomes after conservative approach. A pooled analysis was conducted using a fixed‐effect model in the case of non‐significant heterogeneity (P > 0.1), and a random effect model (DerSimonian–Laird method) when significant heterogeneity was present (P < 0.1) CRD42022300344.ResultsNine studies were included in the analysis. Three of them were comparative studies. The pooled 3‐year DFS, 5‐year DFS, 3‐year OS, 5‐year OS, local and distant recurrence rates were 92.8% (95% CI 81.6–99.5%), 91.3% (95% CI 88.3–94.3%), 96.1% (95% CI 90.5–100%), 72.6% (95% CI 57.5–87.7%), 4% (95% CI 18–63%), and 4.9% (95% CI 2–7.8%), respectively, in subjects treated with NAT followed by LE. No heterogeneity was found for all these analyses, except for the 5‐year OS sub‐analysis (I 2 95.5%, P < 0.001). Complete pathological response (ypT0) rate after NAT and LE ranges from 26.7% to 59%.ConclusionLE following neoadjuvant CRT may provide comparable survival benefit to radical surgery for patients with clinical stage T2N0 in selected patients although the evidence is still limited to provide solid recommendations. A personalized therapeutic approach taking into account tumor and patient‐related factors should be considered.

Do Bulk-Fill Resin Composites Present More Susceptibility to Marginal Degradation in Different Clinical Scenarios? A Systematic Review and Meta-Analysis

Objective: To compare the marginal degradation (susceptibility to marginal adaptation and marginal discoloration) of composite restorations placed in class II and V cavities using conventional and bulk-fill resin composites. Material and Methods: This study was approved by PROSPERO database (#42020201596). PubMed, Scopus, Embase, Web of Science, Lilacs, Cochrane, Open Grey, Clinical Trials, and Rebec databases were searched by three independent investigators using MeSH terms, supplementary concepts, synonyms, and free keywords, based on the PICOS strategy (P, population: restoration in permanent teeth; I, intervention: bulk-fill resin composite; C, comparison: conventional resin composite; O, outcome: marginal discoloration and adaptation; and S, study design: randomized and non-randomized clinical trials). The risk of bias was evaluated according to the Cochrane Collaboration’s tool, the meta-analyses by RevMan software, the certainty of evidence by the Grading of Recommendations Assessment, Development, and Evaluation, and the leave-one-out sensitivity test. The prevalence of successful events and the total number of restorations were used to calculate the risk difference at a confidence interval of 95%, according to a fixed-effect model. The heterogeneity was evaluated using the I2 index. Results: 16 from 10,780 studies were selected and included for qualitative and quantitative analysis. Two studies were considered as high risk of bias, one showing some concerns, and 13 as low risk of bias. Four meta-analyses evaluated the marginal adaptation and marginal discoloration in class II and V cavities, with a nonsignificant heterogeneity (I2 = 0%, p>0.05). The certainty of evidence was considered high, except for two subgroups of each outcome. Conclusion: There is evidence that composite restorations using conventional and bulk-fill resin composites present similar clinical performance related to marginal degradation.