Original Clinical Studies Research Articles

Rapamycin’s Impact on Age-Related Macular Degeneration—A Systematic Review and Hormesis Perspective

Background: Pre-clinical studies related to the use of rapamycin (Sirolimus®), a mammalian target of rapamycin (mTOR) inhibitors, for age-related macular degeneration (AMD) have shown improved therapeutic outcomes. However, knowledge of its dose–effect relationship in humans with AMD has been limited and requires further investigation. Objective: The aim of this study is to assess the safety and efficacy of Sirolimus® for treatment of AMD in humans and determine the dose range for its application in the eye. Methods: A systematic literature review was conducted following the PRISMA guidelines. The MEDLINE, Embase, CINAHL, Scopus and Cochrane Central Registry of Controlled Trials databases were searched for original clinical studies examining the effects of Sirolimus® on outcomes linked to AMD in humans. This review has been registered in the PROSPERO database. Results: Only four studies were found to satisfy the inclusion and exclusion criteria and were analyzed in this systematic review in a narrative way. The dose range of rapamycin in the limited number of studies appears to be toxic to the retina. Conclusion: Future studies should focus on establishing the optimal low-dose range of Sirolimus® that effectively induces autophagy without causing retinal toxicity, as current data indicate a potential therapeutic window that remains underexplored. Specifically, longitudinal, controlled studies with larger, heterogeneous patient populations are necessary to determine the precise dosing that balances efficacy and safety in treating AMD.

Detection and Stabilisation of Vulnerable Plaques in the Coronary Arteries

Vulnerable atherosclerotic plaques (AP) can be assessed by coronary artery imaging techniques. Intravascular ultrasound allows real-time assessment of the longitudinal and transverse dimensions of the vessel, the severity of its remodelling, and the size and structure of the AP. The resolution of optical coherent tomography makes it possible to accurately identify vulnerable APs according to the following characteristic parameters: a large necrotic nucleus, a thin fibrous capsule, neoangiogenesis and inflammatory changes in the AP cap. Percent atheroma volume, total atheroma volume, maximum lipid core burden index within 4 mm, minimal fibrous cap thickness, maximum lipid arc, lipid length and macrophage grade are the main characteristics of vulnerable AP. Lipid-lowering therapy (LLT) has a stabilising effect on AP. Databases searched were PubMed and Web of Science up to April 2023. In total, eight relevant articles (original clinical studies) were selected. In the ODISSEY J-IVUS study, there was a decrease of total AP volume by 3.1% in the monotherapy group and 4.8% in the combined LLT group (p=0.23). In the GLAGOV trial, atheroma volume decreased by 0.9 mm3 in the placebo group and 5.8 mm3 in the evolocumab group (p<0.001). Plaque regression was observed in 64.3% of patients in the evolocumab group and 47.3% in the placebo group. The dynamics of the minimum thickness of the fibrous cap varied within 18.0–62.67 µm on combined LLT and 13.2–33.19 µm on monotherapy (PACMAN-AMI). Regression of the lipid arc was also observed in the HUYGENS study. The development of cardiovascular imaging has made it possible to expand understanding of the morphology of vulnerable AP.

Diagnostic and Prognostic Ability of Pancreatic Stone Protein: A Scoping Review.

Pancreatic stone protein (PSP) is an acute-phase reactant mainly produced in response to stress. Its diagnostic and prognostic accuracy for several types of infection has been studied in several clinical settings. The aim of the current review was to assess all studies examining a possible connection of pancreatic stone protein levels with the severity and possible complications of patients diagnosed with infection. We performed a systematic search in PubMed, Scopus, the Cochrane Library and Clinicaltrials.gov to identify original clinical studies assessing the role of pancreatic stone protein in the diagnosis and prognosis of infectious diseases. We identified 22 eligible studies. Ten of them provided diagnostic aspects, ten studies provided prognostic aspects, and another two studies provided both diagnostic and prognostic information. The majority of the studies were performed in an intensive care unit (ICU) setting, five studies were on patients who visited the emergency department (ED), and three studies were on burn-injury patients. According to the literature, pancreatic stone protein has been utilized in patients with different sites of infection, including pneumonia, soft tissue infections, intra-abdominal infections, urinary tract infections, and sepsis. In conclusion, PSP appears to be a useful point-of-care biomarker for the ED and ICU due to its ability to recognize bacterial infections and sepsis early. Further studies are required to examine PSP's kinetics and utility in specific populations and conditions.

Efficacy of Homeopathic Higher Dilutions in management of Sleep Disorders: A Review

Background: Sleep disorders, including insomnia, have diverse causes and can significantly impact physical and mental health. Homeopathy is explored as an alternative treatment for these disorders, but its efficacy remains uncertain. Aim/Objective: This study reviews clinical research on the efficacy of homeopathic higher dilutions remedies for sleep disorders. The goal is to provide insights into the progress in clinical and preclinical investigations on homeopathy for sleep disorders. Methodology: We conducted a comprehensive database search for original clinical studies on homeopathy and sleep disorders and its related terminology published until September 2023, applying exclusion criteria to select relevant studies. Results: We identified 11 studies meeting our criteria. These studies explored the use of homeopathic remedies for managing sleep disorders with the help of various assessment tools, like Hamilton Anxiety Rating Scale (HAM-A), STAI questionnaire, Jenkins Sleep Scale (JSS), Insomnia Severity Index (ISI), Sleep Diary (SD), Sleep Impairment Index (SII), Visual Analogic Scale (VAS), and Trait of Anxiety Scale (TAS). Findings included reduced anxiety and improved sleep quality with Passiflora Compose, potential benefits of individualized homeopathic treatment for insomnia, and positive outcomes in children and young adults with sleep issues. Homeopathy also showed potential effects on sleep patterns in a rat study. Conclusion: The reviewed studies suggest the potential benefits of homeopathic treatments for sleep-related conditions. Passiflora Compose, individualized homeopathic treatment, and homeopathic similimum demonstrated promise in improving sleep quality and reducing anxiety. More research and larger trials are needed for wider acceptance, but these findings highlight their value for diverse populations.

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis.

This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA). This review was registered in PROSPERO (CRD42023450988). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of serum CA-125 in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (CA-125 OR CA125). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS-2 index. A synthesis of the results, standardization of the metrics, and three random-effect meta-analyses were performed. Five studies with data from 533 participants (including 219 patients with a confirmed diagnosis of AA and 107 controls) were included in this review. The random-effect meta-analysis of serum CA-125 (AA vs controls) included 3 articles (125 AA and 70 controls) and resulted in a non-significant mean difference [95% CI] of -6.80 [-20.51, 6.92] U/mL (p = 0.33). The meta-analysis by subgroups that included only male patients resulted in a significant mean difference [95% CI] of 3.48 [0.46, 6.49] U/mL (p = 0.02). Although serum CA-125 does not appear to be a good overall marker for the diagnosis of AA, our subgroup analyses show that this marker could be useful for diagnosing AA in males. It also appears to be a potentially useful tool for discriminating complicated and uncomplicated AA. However, the limited number of included studies precludes drawing generalizable conclusions. Future prospective studies focused on males and in its potential ability to discriminate between complicated and uncomplicatedAAare required.Registration. PROSPERO (CRD42023450988).

What Is the Association Between Agency and Levels of Capability and Comfort in Musculoskeletal Care? A Systematic Review.

People who take active responsibility for their health demonstrate agency. Agency in the context of chronic illness management with disease-modifying treatments is commonly linked to adherence and confidence in care seeking. In musculoskeletal health, agency is commonly observed in the accommodation of conditions related to aging and reflected in studies of people not seeking care. The development of agency measures originates from the realm of medical management of chronic illness rather than that of musculoskeletal disease, which is often optional or discretionary. With growing interest in the universal adoption of agency as a performance measure for quality payment programs, there is a need to better understand how agency is measured across musculoskeletal conditions, and how agency may be a modifiable correlate of capability, comfort, mindset, and circumstances. We systematically reviewed the evidence regarding agency among people seeking musculoskeletal specialty care and asked: (1) Are greater levels of agency associated with greater levels of comfort and capability? (2) Are greater levels of agency associated with better mental and social health? Following the PRISMA guidelines, we performed searches on May 22, 2023, with searches spanning September 1988 (in PubMed and Web of Science) and September 1946 (in Ovid Medline) to May 2023. We included original clinical studies addressing the relationship between agency and levels of comfort, capability, mindset, and circumstances (by utilizing patient-reported agency measures [PRAMs], patient-reported outcome measures [PROMs], and mental and social health measures) involving adult patients 18 years or older receiving specialist care for musculoskeletal conditions. We identified 11 studies involving 3537 patients that addressed the primary research question and three studies involving 822 patients that addressed the secondary question. We conducted an evidence quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) and found the overall evidence quality to be relatively high, with loss to follow-up and lack of reporting of sample size calculation the most consistent study shortcomings. The measures of capability varied by anatomical region. The Patient Activation Measure (a validated 10- or 13-item survey originally designed to assess a patient's level of understanding and confidence in managing their health and ability to engage in healthcare related to chronic medical illness) was used as a measure of agency in 10 studies (one of which also used the Effective Consumer Scale) and attitudes regarding one's management of musculoskeletal disorders in one study. We registered this systematic review on PROSPERO (Reg CRD42023426893). In general, the relationships between PRAMs and PROMs are weak to moderate in strength using the Cohen criteria, with 10 of 11 studies demonstrating an association between levels of agency and levels of comfort and capability. The three studies addressing mental health found a weak correlation (where reported) between levels of agency and levels of symptoms of depression and anxiety. The finding that agency in patients seeking care for musculoskeletal conditions is associated with greater comfort, capability, and mental health supports the prioritization of agency modification during musculoskeletal specialty care. This might include behavioral health and cognitive debiasing strategies along with strategies and services promoting self-management. Our work also points to an opportunity to develop agency measures better suited for discretionary care that more directly assess the cultivation of healthy mindsets, behaviors, and accommodative attitudes toward the discomfort and incapability experienced during aging. Level II, prognostic study.

Association Between Temporomandibular Joint Disorders and Metastatic Breast Cancer—A Mapping Review

Aim: The authors of the present study speculate that metastasis of breast cancer cells to the temporomandibular joint (TMJ) region mimics classical signs and symptoms of temporomandibular disorders (TMD). The aim of this mapping review was to investigate the association between metastatic breast cancer (MBC) and TMD. Materials and Methods: The focused question was, “Is there an association between MBC and TMD?” Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, Google Scholar, and Web of Science) were electronically searched up to and including March 2022. These databases were searched using different combinations of the following keywords: cancer, carcinoma, temporomandibular disorders, temporomandibular joint, disc displacement disorder, nociception, and tumor. Original clinical studies that meet the inclusion criteria were included. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. The structure of this current evidence-based review was tailored to primarily condense the relevant information. Results: Fifteen case reports were selected after screening the retrieved records from the electronic search. Fifteen out of 16 patients were women aged between 32 and 78 years. All patients were diagnosed with MBC, and most presented with adenocarcinoma. The symptoms identified in patients with TMD included: (a) preauricular pain; (b) preauricular swelling; (c) limited mouth opening; and (d) malocclusion. Fourteen of the included studies had a low RoB, while one had a moderate RoB. Conclusion: Based on the currently available evidence, a direct association between TMD and MBC or vice versa cannot be established. Routine visits to medical and oro-dental healthcare providers can contribute toward early diagnosis and management of TMD and MBC.

FAPi-Based Agents in Thyroid Cancer: A New Step towards Diagnosis and Therapy? A Systematic Review of the Literature.

(1) Background: Thyroid cancer (TC) is often treated with surgery followed by iodine-131. Up to 50% of the instances of TC lose their avidity to 131I, becoming more aggressive. In this scenario, [18F]FDG PET/CT imaging is used for evaluating the widespread nature of the disease, despite its low sensitivity and a false negative rate of 8-21.1%. A novel class of PET agents targeting the fibroblast activation protein inhibitor (FAPi) has emerged, studied particularly for their potential application to theranostics. (2) Methods: A search of the literature was performed by two independent authors (P.G. and L.E.) using the PubMed, Scopus, Web of Science, Cochrane Library, and EMBASE databases. The following terms were used: "FAP" or "FAPi" or "Fibroblast activating protein" and "thyroid" or "thyroid cancer", in different combinations. The included papers were original articles, clinical studies, and case reports in the English language. No time limits were used. Editorials, conference papers, reviews, and preclinical studies were excluded. (3) Results: There were 31 papers that were selected. Some studies reported a low or absent FAPi uptake in TC lesions; others reported promising findings for the detection of metastases. (4) Conclusions: The preliminary results are encouraging. FAPI agents are an alternative to [18F]FDG and a promising theranostic tool. However, further studies with a larger population are needed.

Artificial Intelligence in Ultrasound Diagnoses of Ovarian Cancer: A Systematic Review and Meta-Analysis.

Ovarian cancer is the sixth most common malignancy, with a 35% survival rate across all stages at 10 years. Ultrasound is widely used for ovarian tumour diagnosis, and accurate pre-operative diagnosis is essential for appropriate patient management. Artificial intelligence is an emerging field within gynaecology and has been shown to aid in the ultrasound diagnosis of ovarian cancers. For this study, Embase and MEDLINE databases were searched, and all original clinical studies that used artificial intelligence in ultrasound examinations for the diagnosis of ovarian malignancies were screened. Studies using histopathological findings as the standard were included. The diagnostic performance of each study was analysed, and all the diagnostic performances were pooled and assessed. The initial search identified 3726 papers, of which 63 were suitable for abstract screening. Fourteen studies that used artificial intelligence in ultrasound diagnoses of ovarian malignancies and had histopathological findings as a standard were included in the final analysis, each of which had different sample sizes and used different methods; these studies examined a combined total of 15,358 ultrasound images. The overall sensitivity was 81% (95% CI, 0.80-0.82), and specificity was 92% (95% CI, 0.92-0.93), indicating that artificial intelligence demonstrates good performance in ultrasound diagnoses of ovarian cancer. Further prospective work is required to further validate AI for its use in clinical practice.

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies.

In this narrative review, we aimed to overview the interplay between lichen planus (LP) and thyroid conditions (TCs) from a dual perspective (dermatologic and endocrine), since a current gap in understanding LP-TC connections is found so far and the topic is still a matter of debate. We searched PubMed from Inception to October 2023 by using the key terms "lichen planus" and "thyroid", (alternatively, "endocrine" or "hormone"). We included original clinical studies in humans according to three sections: LP and TC in terms of dysfunction, autoimmunity, and neoplasia. Six studies confirmed an association between the thyroid dysfunction (exclusively hypothyroidism) and LP/OL (oral LP); of note, only one study addressed cutaneous LP. The sample size of LP/OLP groups varied from 12-14 to 1500 individuals. Hypothyroidism prevalence in OLP was of 30-50%. A higher rate of levothyroxine replacement was identified among OLP patients, at 10% versus 2.5% in controls. The highest OR (odd ratio) of treated hypothyroidism amid OLP was of 2.99 (p < 0.005). Hypothyroidism was confirmed to be associated with a milder OLP phenotype in two studies. A single cohort revealed a similar prevalence of hypothyroidism in LP versus non-LP. Non-confirmatory studies (only on OLP, not cutaneous LP) included five cohorts: a similar prevalence of hypothyroidism among OLP versus controls, and a single cohort showed that the subjects with OLP actually had a lower prevalence of hypothyroidism versus controls (1% versus 4%). Positive autoimmunity in LP/OLP was confirmed in eight studies; the size of the cohorts varied, for instance, with 619 persons with LP and with 76, 92, 105, 108, 192, 247, and 585 patients (a total of 1405) with OLP, respectively; notably, the largest control group was of 10,441 individuals. Four clusters of approaches with respect to the autoimmunity in LP/OLP were found: an analysis of HT/ATD (Hashimoto's thyroiditis/autoimmune thyroid diseases) prevalence; considerations over the specific antibody levels; sex-related features since females are more prone to autoimmunity; and associations (if any) with the clinical aspects of LP/OLP. HT prevalence in OLP versus controls was statistically significantly higher, as follows: 19% versus 5%; 12% versus 6%; and 20% versus 9.8%. A single study addressing LP found a 12% rate of ATDs. One study did not confirm a correlation between OLP-associated clinical elements (and OLP severity) and antibody values against the thyroid, and another showed that positive TPOAb (anti-thyroperoxidase antibodies) was more often found in erosive than non-erosive OLP (68% versus 33%). Just the reverse, one cohort found that OLP subjects had a statistically significantly lower rate of positive TPOAb versus controls (9% versus 15%). Five case-control studies addressed the issue of levothyroxine replacement for prior hypothyroidism in patients that were diagnosed with OLP (no study on LP was identified); three of them confirmed a higher rate of this treatment in OLP (at 8.9%, 9.7%, and 10.6%) versus controls. In conclusion, with regard to LP/OLP-TC, we note several main aspects as practical points for multidisciplinary practitioners: OLP rather than LP requires thyroid awareness; when it comes to the type of thyroid dysfunction, mostly, hypothyroidism should be expected; female patients are more prone to be associated with ATDs; a potential higher ratio of OLP subjects taking levothyroxine was found, thus a good collaboration with an endocrinology team is mandatory; and so far, OLP individuals have not been confirmed to be associated with a higher risk of thyroid nodules/cancer.

Anastomotic Leak and Perioperative Outcomes of Esophagectomy for Esophageal Cancer during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background and Objectives: The coronavirus disease-2019 (COVID-19) pandemic influenced the healthcare system tremendously, as well as the number of elective surgical procedures worldwide. The aim of this study is to investigate the COVID-19 pandemic's impact on esophagectomies. Materials and Methods: The MEDLINE (via PubMed), Cochrane Library, and Google Scholar bibliographical databases were systematically searched. Original clinical studies investigating the outcomes of esophageal cancer surgery during the COVID-19 pandemic were deemed eligible. After exclusion criteria were applied, eight studies were considered eligible for inclusion. Results: Eight studies with non-overlapping populations, reporting on patients undergoing esophagectomy for resectable esophageal cancer during the COVID-19 pandemic, were included in our analysis, with a total of 18548 patients. Background characteristics for age, lung disease, smoking history as well as Body Mass Index and age were equal among the groups. The background of diabetes presented a statistically significant difference among the groups. Perioperative outcomes like reoperation rates, the length of intensive care unit stay, or readmission rates were not significantly increased during the pandemic. The 30-day readmission, and 30- and 90-day mortality were not affected either. The length of hospital stay was significantly lower in the non-pandemic period. Conclusions: The results of our study support the evidence that in the context of the COVID-19 pandemic, esophageal cancer operations took place safely and effectively, similarly to the standards of the non-COVID-19 era.

Metabolic and Other Endocrine Elements with Regard to Lifestyle Choices: Focus on E-Cigarettes.

Our objective was to overview recent data on metabolic/endocrine disorders with respect to e-cigarette (e-cig) use. This is a narrative review; we researched English, full-length, original articles on PubMed (between January 2020 and August 2023) by using different keywords in the area of metabolic/endocrine issues. We only included original clinical studies (n = 22) and excluded case reports and experimental studies. 3 studies (N1 = 22,385; N2 = 600,046; N3 = 5101) addressed prediabetes risk; N1 showed a 1.57-fold increased risk of dual vs. never smokers, a higher risk that was not confirmed in N2 (based on self-reported assessments). Current non-smokers (N1) who were dual smokers still have an increased odd of prediabetes (a 1.27-fold risk increase). N3 and another 2 studies addressed type 2 diabetes mellitus (DM): a lower prevalence of DM among dual users (3.3%) vs. cigarette smoking (5.9%) was identified. 6 studies investigated obesity profile (4 of them found positive correlations with e-cig use). One study (N4 = 373,781) showed that e-cig use was associated with obesity in the general population (OR = 1.6, 95%CI: 1.3-2.1, p < 0.05); another (N5 = 7505, 0.82% were e-cig-only) showed that obesity had a higher prevalence in dual smokers (51%) vs. cig-only (41.2%, p < 0.05), while another (N6 = 3055) found that female (not male) e-cig smokers had higher body mass index vs. non-smokers. Data on metabolic syndrome (MS) are provided for dual smokers (n = 2): one case-control study found that female dual smokers had higher odds of MS than non-smokers. The need for awareness with respect to potential e-cig--associated medical issues should be part of modern medicine, including daily anamnesis. Whether the metabolic/endocrine frame is part of the general picture is yet to be determined. Surveillance protocols should help clinicians to easily access the medical background of one subject, including this specific matter of e-cig with/without conventional cigarettes smoking and other habits/lifestyle elements, especially when taking into consideration metabolism anomalies.

The role ovariectomies and/or the administration of artificial female sex hormones play in orthodontic tooth movement: A systematic review.

The objective was to assess how ovariectomy or the administration of artificial female sex hormones affects orthodontic tooth movement (OTM) with fixed appliances. An electronic search of indexed databases was completed without language or time restrictions up to June 2022. The following eligibility criteria were utilized: (i) prospective original controlled clinical studies; (ii) experimental studies on animal models; (iii) subjects undergoing orthodontic therapy with fixed appliances; (iv) clearly defined control groups not undergoing ovariectomy or administration of artificial female sex hormone; and (v) studies with experimental groups receiving the intervention of interest (ovariectomy or artificial female sex hormone administration). Review articles, letters to the editor, case reports, case series, commentaries, cross-sectional studies, retrospective studies, and studies with no well-defined control group were excluded. The quality of the available evidence and the risk of bias within the studies were assessed. All disagreements were resolved via discussion. Seven animal studies were included in the systematic review. Five studies reported that ovariectomy increased the rate of orthodontic tooth movement. Two studies reported that the administration of artificial female sex hormones decreased the rate of orthodontic tooth movement. There is an association between ovariectomies and OTM and between the administration of artificial female sex hormones and OTM. The full extent of the association remains unclear due to the biases that are present and the length of time of orthodontic therapy.

Utilization of Mirror Visual Feedback for Upper Limb Function in Poststroke Patients: A Systematic Review and Meta-Analysis.

Mirror visual feedback (MVF), a noninvasive treatment method, is attracting attention as a possibility to promote the recovery of upper limb function in stroke patients. However, the cognitive effects of this therapy have received limited attention in the existing literature. To address this gap, we conducted a systematic review and meta-analysis to investigate the relationship between upper limb function and cognition in stroke patients and to evaluate the effect of MVF on improving upper limb function. A comprehensive search was performed on the Embase, MEDLINE, and PubMed databases to identify original articles and clinical studies published between 2013 and 2022. Qualitative analysis was performed using the Cochrane Risk of Bias tool, and in the quantitative analysis, a random-effects model was used as the effect model, and standard mean difference (SMD) was used as the effect measure. Eight studies that met the inclusion criteria were entered in the analysis. Data extraction included an assessment tool for upper extremity function. Results of the quantitative analysis demonstrate that MVF was effective in improving upper extremity function in stroke patients (SMD = 0.94, 95% CI 0.69 to 1.20). In conclusion, this systematic review and meta-analysis provides evidence supporting the effectiveness of MVF in improving upper limb function in stroke patients. However, further studies are needed to investigate the cognitive effects of MVF and elucidate the underlying mechanisms.

Patient diversity and author representation in clinical studies supporting the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock 2021: a systematic review of citations

BackgroundThe generalizability of the Surviving Sepsis Campaign (SSC) guidelines to various patient populations and hospital settings has been debated. A quantitative assessment of the diversity and representation in the clinical evidence supporting the guidelines would help evaluate the generalizability of the recommendations and identify strategic research goals and priorities. In this study, we evaluated the diversity of patients in the original studies, in terms of sex, race/ethnicity, and geographical location. We also assessed diversity in sex and geographical representation among study first and last authors.MethodsAll clinical studies cited in support of the 2021 SSC adult guideline recommendations were identified. Original clinical studies were included, while editorials, reviews, non-clinical studies, and meta-analyses were excluded. For eligible studies, we recorded the proportion of male patients, percentage of each represented racial/ethnic subgroup (when available), and countries in which they were conducted. We also recorded the sex and location of the first and last authors. The World Bank classification was used to categorize countries.ResultsThe SSC guidelines included six sections, with 85 recommendations based on 351 clinical studies. The proportion of male patients ranged from 47 to 62%. Most studies did not report the racial/ ethnic distribution of the included patients; when they did so, most were White patients (68–77%). Most studies were conducted in high-income countries (77–99%), which included Europe/Central Asia (33–66%) and North America (36–55%). Moreover, most first/last authors were males (55–93%) and from high-income countries (77–99%).ConclusionsTo enhance the generalizability of the SCC guidelines, stakeholders should define strategies to enhance the diversity and representation in clinical studies. Though there was reasonable representation in sex among patients included in clinical studies, the evidence did not reflect diversity in the race/ethnicity and geographical locations. There was also lack of diversity among the first and last authors contributing to the evidence.

Comparative Evaluation of Postoperative Facial Swelling and Occlusion in Orthognathic Treatment with Clear Aligners versus Fixed Orthodontic Appliances: A Systematic Review

The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was “Is there a difference in postoperative FS and occlusion attained with CAT and fixed OT after OS?” Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion attained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was better in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS.

Assessment of Most Definite Reference Point on Tragus to Mark the Ala Tragus Line for Orientation of Occlusal Plane: A Systematic Review and Meta Analysis

Objective: This systematic review and meta-analysis aimed to establish the most appropriate posterior reference point on the tragus of the ear for orienting the occlusal plane in complete denture prosthesis, addressing the existing confusion regarding this crucial anatomical landmark. Methods: A comprehensive literature search identified 20 relevant articles, with 12 meeting the inclusion criteria as original clinical experimental studies. Statistical analysis was performed to assess the preferred location on the tragus for aligning with the Fox plane. Results: Among the reviewed studies, 72.72% favored the inferior or lower border of the tragus as the optimal posterior reference point for aligning with the Fox plane. This choice was in contrast to the tip or middle point (18.18%) and the superior border (9.09%) of the tragus, which showed less tendency to parallel with the occlusal plane. Conclusion: Based on the findings of this systematic review and meta-analysis, it is concluded that the inferior border of the tragus is the most definitive posterior reference point for establishing the Ala-Tragus line during complete denture prosthesis. This consensus can guide clinicians in achieving accurate occlusal plane orientation and enhance the quality of complete denture prostheses. Update Dent. Coll. j: 2023; 13(2): 38-41

Comparisons of procedural characteristics and clinical outcomes between SMARTTOUCH SURROUNDFLOW catheter and other catheters for atrial fibrillation radiofrequency catheter ablation: a systematic literature review

BackgroundSMARTTOUCH SURROUNDFLOW (STSF) catheter is the new generation of SMARTTOUCH (ST) catheter with an upgraded irrigation system for radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF).MethodsThis systematic literature...

Influence of sealer type on treatment outcome of teeth with apical periodontitis: a systematic review.

The purpose of this article was to Evaluate the influence of sealer on the outcome of non-surgical endodontic treatment or retreatment of permanent teeth with apical periodontitis (PROSPERO registration: CRD42020205951). A systematic review of original clinical studies was carried out following PRISMA guidelines to answer whether the type of sealer used in endodontic treatment or retreatment influences the repair of apical periodontitis determined by clinical and radiographic parameters. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library database, until May 2023. Gray literature and a hand search of reference lists were also performed. The risk of bias was assessed using Cochrane RoB2 for randomized trials and the Newcastle-Ottawa Scale (NOS) for prospective and retrospective cohort and case-control studies. Among 1046 studies, a total of 819 were selected by title and abstract, resulting in 23 for full-text review. In total, 11 studies met the inclusion criteria (1467 patients/teeth with apical periodontitis). The quality assessment using RoB2 included five randomized control trials, of which four had medium risk and one had a low risk of bias. According to the NOS scale, five studies were classified as low risk and one study was considered as medium risk of bias. The sealer type and obturation techniques varied, and the mean follow-up time was 3.7 years. Most studies used two-dimensional radiographic criteria to assess the treatment outcome sealers and not cements. Eight studies did not find significant differences when comparing cements. The healing rates ranged from 56.7% to 90%. The results of this review support that the current endodontic sealers do not seem to influence the treatment outcome of permanent teeth with apical periodontitis. Although the studies had medium and low risk of bias, the results should be interpreted with caution. More randomized studies of long-term outcomes comparing filling materials are needed to strengthen this claim and allow for a meta-analysis.

A plain language summary on assessing the long-term effectiveness of cladribine tablets in people living with relapsing multiple sclerosis: The CLASSIC-MS study.

Previous studies have shown that people living with multiple sclerosis (MS) treated with cladribine tablets have fewer relapses (where new symptoms occur or existing symptoms get worse for 24hours or more) and delayed disability progression (slowing down of the disease getting worse). The CLASSIC-MS study looked at the long-term effectiveness of treatment with cladribine tablets in people living with MS who had taken part in the original CLARITY and CLARITY Extension clinical studies. Results showed that people treated with cladribine tablets maintained their mobility (the ability to move freely) for longer and experienced other positive effects long after their treatment ended, including being less likely to need further treatment for their MS. The results obtained from CLASSIC-MS show that the benefits of taking cladribine tablets carry on even when patients stop taking the treatment. Clinical Trial Registration: NCT03961204 (CLASSIC-MS) (ClinicalTrials.gov).