PRISMA-compliant Meta-analysis Research Articles

Safety and effectiveness of Salvia miltiorrhiza and ligustrazine injection for acute cerebral infarction in Chinese population: a PRISMA-compliant meta-analysis.

Salvia miltiorrhiza and ligustrazine injection (SML) is a type of traditional Chinese medicine injection, which has been considered a promising adjunctive therapy treatment for acute cerebral infarction (ACI). Although there have been positive reports on the treatment of SML, there is still controversy over its exact efficacy and safety in ACI patients. In this study, a systematic review was conducted on randomized controlled trials (RCTs) of SML for the treatment of ACI to evaluate its clinical efficacy and safety. From the establishment of the database until May 2023, all randomized controlled trials related to SML and ACI were collected from the Cochrane Library, Web of Science, Embase, Medline, PubMed, CSJD, Wanfang database, CBM and CNKI. This systematic review and meta-analysis were strictly conducted in accordance with the PRISMA statement. The reported outcomes including overall response (ORR), National Institutes of Health Stroke Scale (NIHSS), hemorrheology indexes, activity of daily living (ADL) and adverse events were in detail investigated. An analysis was conducted on the relevant data of 3869 ACI patients from 38 trials. The results indicated that the combination of conventional treatment and SML can significantly improve the ORR of patients (RR = 1.23, 95% CI = 1.20-1.27, P < 0.00001), neurological status (NIHSS, MD = -4.35, 95% CI = -5.15-3.54, P < 0.00001) and ADL (Barthel Index score, MD = 10.27, 95% CI = 7.75-12.79, P < 0.00001) compared with regular treatment alone. After the combined therapy, the hemorheology of ACI patients also significantly improved (P < 0.05). There is no significant difference in the frequency of adverse events between the two groups (RR = 1.49, 95% CI = 0.91-2.46, P = 0.11). The evidence from the meta-analysis suggested that the combination of conventional therapy and SML is safer and more effective than conventional therapy alone in treating ACI. However, due to the limitations of this analysis, such as regional bias and publication bias, the above conclusions need to be further verified by prospective, high-quality and multicenter clinical trials.

Predictive value of MRI for identifying symptomatic neurovascular compressions in classical trigeminal neuralgia: a PRISMA-compliant meta-analysis

BackgroundPatients with trigeminal neuralgia frequently undergo magnetic resonance imaging (MRI) prior to surgery. In patients without the signs and symptoms of face discomfort, MRI has shown the presence of neurovascular contact (NVC) in humans. Therefore, its capacity to accurately exclude NVC of the trigeminal nerve is not properly understood. A meta-analysis of the literature satisfied the criteria to further explore the value of MRI for the diagnosis of classical trigeminal neuralgia (CTN).Study designThe association between the symptomatic and asymptomatic trigeminal nerves, NVC, root entry zone (REZ), non-REZ, and anatomical variation was measured by a comprehensive review and meta-analysis of 13 observational studies using MRI for CTN neurovascular compression diagnosis.ObjectivesThis study aimed to evaluate the effectiveness of MRI in detecting the neurovascular compression that causes symptoms in individuals with classic trigeminal neuralgia.SettingThis study was conducted at the Department of Neurosurgery, Yantai Yuhuangding Hospital, Qingdao University.MethodsDigital searches of PubMed, Embase, and the Cochrane Library were performed to identify studies published until December 31, 2023. The following were evaluated: (1) MRI evidence of NVC in symptomatic and asymptomatic trigeminal nerves; (2) MRI indication of NVC at the REZ in symptomatic and asymptomatic trigeminal nerves; (3) MRI substantiation of non-REZ neurovascular contact in patients with CTN; and (4) asymptomatic and symptomatic anatomical changes at the NVC site of the trigeminal nerves. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed effects models.ResultsWe identified 13 observational studies (1 prospective and 12 retrospective studies) with data collected from 1770 nerves (728 symptomatic and 1042 asymptomatic) were meta-analyzed. First, MRI of 649/728 (88.2%) symptomatic versus 378/1042 (36.3%) asymptomatic trigeminal nerves revealed marked differences in NVC in the REZ (OR = 16.3; CI 95%=12.2–21.8; p < 0.00001). Second, pooled data showed that REZ NVC was detected in 206/262 (78.6%) symptomatic and in 129/340 (37.9%) asymptomatic nerves (OR = 5.0; CI 95% = 3.4–7.3; p < 0.00001); Third, no significant differences were detected between 44/267 (16.5%) symptomatic and 23/189 (12.1%) asymptomatic nerves on MRI examination of NVC in the NON-REZ (OR = 0.9; CI 95% 0.5–1.6) (p = 0.77); Finally, MRI revealed marked differences in 302/567 (53.2%) symptomatic and 73/919 (7.9%) asymptomatic anatomic changes (atrophy, dislocation, distorsion, flattening or indentation) at the NVC site of the trigeminal segments (OR = 11.9; CI 95% = 8.8–16.2; p < 0.00001).LimitationsDespite the systematic evaluation of 13 observational studies, large-scale randomized controlled trials should be conducted, focusing on the specificity of MRI for the diagnosis of trigeminal neuralgia and evaluating the specificity of the imaging findings and the impact of the patient’s postoperative treatment.ConclusionsA previous meta-analysis showed that patients with CTN were more likely to have NVC-specific anatomical changes. MRI of patients with CTN can detect anatomical changes in the REZ NVC with higher sensitivity.

Silver Nanoparticles (AgNPs) Incorporation into Polymethyl Methacrylate (PMMA) for Dental Appliance Fabrication: A Systematic Review and Meta-Analysis of Mechanical Properties.

Polymethyl methacrylate (PMMA), widely used in orthodontics and dentures, exhibits suboptimal mechanical properties, including flexural strength (FS), impact strength (IS), and tensile strength (TS), which are critical for ensuring durability, resistance to fracture, and overall functionality of dental appliances. Silver nanoparticles (AgNPs) are a promising filler due to their antimicrobial properties. This pre-registered (osf.io/yqftx) PRISMA-compliant meta-analysis compared the mechanical properties of PMMA/AgNP composites to pure PMMA, considering mean particle size and concentration. Of 360 records from ACM, BASE, PubMed, and Scopus, 35 studies were included (κ = 0.91), covering 88, 38, and 11 tests on FS, IS, and TS, respectively. FS increased only between 30-70 nm (r = 0.00; ρ = 0.03; R2deg2 = 0.13). IS remained higher for <80 nm and increased between 15 and 25 nm (r = -0.41; ρ = -0.28; R2deg2 = 0.59). TS favored 55 nm but had limited data (r = -0.24; ρ = 0.63; R2deg2 = 0.99). FS decreased with increasing wt%, showing no discernible trend (r = -0.22; ρ = -0.34). IS increased within 0.0-4.0 wt%, particularly 0.5-2.0 wt% (r = -0.15; ρ = -0.35; R2deg2 = 0.54). TS peaked at 0.5-2.0 wt% (r = -0.20; ρ = -0.24; R2deg2 = 0.91). Optimal mechanical properties of PMMA/AgNP likely fall within 15-70 nm mean nanoparticle size and 0.5-4.0 wt% concentration.

The diagnostic performance of the one-step nucleic acid amplification assay for the detection of sentinel lymph node metastases in cytokeratin 19-positive breast cancer: a PRISMA-compliant meta-analysis.

The status of the sentinel lymph nodes (SLNs) is an important prognostic factor for many different types of cancer. The one-step nucleic acid amplification (OSNA) assay has emerged as a rapid intraoperative molecular diagnostic tool for LN metastasis detection. We aimed to evaluate and summarize the value of the OSNA assay for the diagnosis of SLN metastasis in cytokeratin 19 (CK19)-positive breast cancer. To evaluate the diagnostic value, the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were pooled. The threshold effect, followed by subgroup analysis, was performed to explore the source of heterogeneity. A sensitivity analysis was performed to assess the stability of this meta-analysis model. Fagan plots and likelihood ratio scattergrams were used to explore the potential clinical significance. A total of 29 eligible studies, which consisted of 5,331 patients with 10,343 SLNs, were included in this meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.86 (95% CI: 0.85-0.88), 0.94 (95% CI, 0.94-0.95), 18.00 (95% CI, 13.54-23.92), 0.13 (95% CI, 0.10-0.17), and 138.99 (95% CI, 86.66-222.92), respectively. The AUC was 0.97 (95% CI, 0.95-0.98). Sensitivity analysis showed that four studies had an impact on the pooled results and mainly contributed to the heterogeneity. Fagan's nomogram revealed that the prior probability was 50%, the post-probability positive was 95%, and the post-probability negative was 11%. Our results suggested that OSNA can predict the occurrence of SLN metastasis in CK19-positive breast cancer. However, more well-designed and multicenter diagnostic tests are needed to validate our results.

Rituximab Therapy for Adult Refractory Systemic Lupus Erythematosus with Neurological and/or Psychiatric Presentations: A PRISMACompliant Meta-Analysis

Rituximab (RTX) is used off-label for refractory cases of systemic lupus erythematosus (SLE) with extrarenal activity, including neurological and/or psychiatric (N/P) presentations. However, evidence from randomized controlled trials is limited. This study aimed to conduct a pooled analysis of the effectiveness and safety of RTX therapy for adult refractory SLE with N/P manifestations. Electronic searches in PubMed, Epistemonikos, and ICTRP databases and statistical analysis were conducted in May 2023. Electronic searches identified 20 studies (25 reports). A total of 59 patients (53 females; 90%) were included, with a mean age of 33.5±10.6 years and a median disease duration of 3.5 years (range, 0.08 to 25.0) who were followed up post-RTX therapy for a median time of 12 months (range, 3.0 to 46.2). The rate of clinical response (partial or major) was 90% (95% CI, 83 to 96) (n = 57 patients). A third of responders relapsed after a median time of 9.5 months (range, 3.0 to 33.0). Pooled pre-RTX/post-RTX scores for Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (n = 13) were 19±15/7±5 and for neurological British Isles Lupus Assessment Group (BILAG) (n = 29) were A/D (13), A/C (5), B/D (7), B/C (2), and A/A (2). Patients without mood disorder had a higher chance of clinical response {relative risk (RR) 1.4 (1.03 to 1.48)}. Patients who benefited the most from RTX therapy were those with psychosis (a higher chance of major clinical response; RR 1.9 (1.02 to 2.34)), without acute confusional state (a lower chance of relapse; RR 0.08 (0.006 to 0.791)), and with disease duration <3 years (a lower chance of relapse; RR 0.18 (0.014 to 0.992)). Infection rate during treatment was 33% (7/21). RTX therapy had good effectiveness. The pooled evidence for safety outcomes was limited and of low certainty.

Efficacy and safety of tranexamic acid in patients undergoing thoracic surgery: a systematic review and PRISMA-compliant meta-analysis

ObjectivesPerioperative bleeding poses a significant issue during thoracic surgery. Tranexamic acid (TXA) is one of the most commonly used antifibrinolytic agents for surgical patients. The purpose of the current study was designed to investigate the efficacy and safety of TXA in patients undergoing thoracic surgery.MethodsAn extensive search of PubMed, Web of Science (WOS), Cochrane Library (trials), Embase, OVID, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP electronic databases was performed to identify studies published between the inception of these databases and March 2023. The primary outcomes included perioperative blood loss and blood transfusions. Secondary outcomes of interest included the length of stay (LOS) in hospital and the incidence of thromboembolic events. Weighted mean differences (WMDs) or odds ratios (OR) with 95% confidence intervals (CI) were used to determine treatment effects for continuous and dichotomous variables, respectively.ResultsFive qualified studies including 307 thoracic surgical patients were included in the current study. Among them, 65 patients were randomly allocated to the group receiving TXA administration (the TXA group); the other 142 patients were assigned to the group not receiving TXA administration (the control group). TXA significantly reduced the quantity of hemorrhage in the postoperative period (postoperative 12h: WMD = -81.90 ml; 95% CI: -139.55 to -24.26; P = 0.005; postoperative 24h: WMD = -97.44 ml; 95% CI: -121.44 to -73.44; P< 0.00001); The intraoperative blood transfusion volume (WMD = -0.54 units; 95% CI: -1.06 to -0.03; P = 0.04); LOS in hospital (WMD = -0.6 days; 95% CI: -1.04 to -0.16; P = 0.008); And there was no postoperative thromboembolic event reported in the included studies.ConclusionsThe present study demonstrated that TXA significantly decreased blood loss within 12 and 24 hours postoperatively. A qualitative review did not identify elevated risks of safety outcomes such as thromboembolic events. It also suggested that TXA administration was associated with shorter LOS in hospital as compared to control. To validate this further, additional well-planned and adequately powered randomized studies are necessary.

Martius flaps for low rectovaginal fistulae: a systematic review and proportional meta-analysis.

Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various others, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition. A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, whilst secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible. Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF were included. The mean age of the study population was 42.4 (±15.7), years. There were 44 primary and 93 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45-98.46; I2 = 32.1%; P = 0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24-89.67; I2 = 58.1%; P = 0.008). The weighted mean complication rate was 29% (95% CI: 8.98-54.68; I2 = 85.4%; P < 0.0001) and the overall recurrence rate was 12.0% (95% CI: 5.03-21.93; I2 = 52.3%; P = 0.021). When purely radiotherapy-induced RVF were evaluated, the mean overall success rate was 94.6% (95% CI: 83.33-99.75; I2 = 0%; P = 0.350). MF interposition appears to be more effective for primary than recurrent RVF. However, the poor quality of the data limits definitive conclusions being drawn and demands further assessment with randomized studies.

The efficacy and safety of compound kushen injection for adults with esophageal cancer: A meta-analysis of randomized controlled trials

Ethnopharmacological relevanceCompound Kushen injection (CKI), derived from the traditional Chinese medicine Sophora flavescens, has been widely prescribed to treat a variety of cancers including esophageal cancer (ESCA) in China. Aim of the studyThis study aimed to evaluate the efficacy and safety of CKI for ESCA systematically. MethodsThe protocol was registered in the PROSPERO database with No. CRD42022320503. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang Database, Clinicaltrials, and Chi-CTR were searched to select RCTs that compared CKI with other interventions for ESCA with outcome measures including clinical efficacy, complete response, quality of life (QoL), adverse events (AEs), and serious AEs (SAEs). The Cochrane Risk of Bias 2 (RoB2) tool was used to assess the quality of RCT. The overall effect sizes were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) on binary outcome data. Meta-analyses were conducted to estimate effect sizes. Subgroup and sensitivity analyses on characteristics of RCTs were performed to test the robustness. Publication bias was also detected with different methods. The evidence strength was assessed with the Grading of Recommendation, Assessment, Development, and Evaluation method. ResultsThis study finally included 35 RCTs with 2491 ESCA patients. The RoB of RCTs was some concern. The effect size of OR was 2.92 (95% CI [2.39, 3.57]) on clinical efficacy, 2.27 (95% CI [1.84, 2.81]) on complete response, 3.71 (95% CI [2.86, 4.80]) on QoL, 0.39 (95% CI [0.30, 0.50]) on AEs, and 0.13 (95% CI [0.07, 0.27]) on SAEs where the statistical significances (P < 0.00001) were found for all outcome measures. These overall effect sizes showed that CKI was more efficacious and safety for ESCA. Moreover, subgroup and sensitivity analyses found consistent results. Most publication bias analyses showed insignificant differences. The evidence strengths were moderate. ConclusionThe moderate evidence from this comprehensive PRISMA-compliant meta-analysis suggested that CKI may be a valuable alternative for adult patients with ESCA on its significant efficacy and safety. However, more RCTs of high quality with low RoB, large sample sizes, and long follow-up periods are still warranted to update the ESCA clinical guideline for physicians and policymakers in further study.

Methotrexate therapy for adult and paediatric moderate-to-severe atopic dermatitis: A PRISMA-compliant meta-analysis of data from daily practice.

Of the 15 eligible studies identified via electronic searches in MEDLINE, EMBASE and CENTRAL in November 2022 for methotrexate therapy of moderate-to-severe atopic dermatitis, 12 were non-randomized controlled trial (non-RCT) studies with data from 437 patients (235 adults and 202 children). The response rates for short-term therapy were 77% [95% CI 55-99] (four studies; adults) - comparable to 81% [54-100] of RCTs (two studies; adults) (p = 0.63) - and 61% [43-79] (two studies; children), and for medium/long-term therapy were 88.9% [74.3-100.0] (four studies; adults) and 77.7% [61.5-94.0] (three studies; children). Children had a markedly lower rate of treatment discontinuation due to side effects [2.0% (five studies; children) vs. 14.9% (six studies; adults)], but were more likely to experience gastrointestinal disorders {relative risk (RR) 2.0 [1.44-2.71]}, fatigue (RR 2.3 [1.35-3.72]), headache (RR 2.8 [1.23-5.61]), and infections (RR 2.9 [2.18-3.58]). Other adverse events (children vs. adults) included hepatic disorders (32/176 vs. 35/305) and blood and lymphatic system/bone marrow disorders (25/148 vs. 19/184). Four serious adverse events were reported (children). Evidence from daily practice was limited by bias in the selection of participants in the study.

Effects of perioperative intravenous glucocorticoids on perioperative neurocognitive disorders in adults after surgery: A PRISMA-compliant meta-analysis of randomized controlled trials.

Randomized controlled trials (RCTs) have shown uncertain clinical benefits from perioperative intravenous glucocorticoids for perioperative neurocognitive disorders (PND). Thus, this meta-analysis was performed to evaluate whether perioperative intravenous glucocorticoids can decrease the occurrence of PND among adults undergoing surgery. We searched 4 databases (MEDLINE, Embase, CENTRAL and Web of Science) for RCTs that assessed the incidence of PND in adults (aged ≥ 18 years old) after surgery. Two reviewers independently assessed the studies for eligibility, extracted data, and assessed the risk of bias in each study. We assessed the certainty of evidence using GRADEpro software. A total of 10 studies (N = 14,967) were eligible. Compared with controls, glucocorticoids were not associated with reducing the risk of postoperative cognitive dysfunction (POCD) (risk ratio [RR]: 0.79 95% confidence interval [CI]: 0.41-1.55, P = .50, I2 = 85%), risk of postoperative delirium (POD) (RR: 0.87 95% CI: 0.74-1.03, P = .10, I2 = 36%), the length of stay in intensive care unit (ICU) (mean difference [MD] -0.21 95% CI: -1.20 to 0.79, P = .68, I2 = 84%), 30-day mortality (RR: 0.92 95% CI: 0.59-1.46, P = .73, I2 = 0%), or postoperative atrial fibrillation (RR: 0.94 95% CI: 0.86-1.01, P = .11, I2 = 25%). However, there was significant difference between glucocorticoids and control group in the length of hospital stay (LOS) (MD: -0.39 95% CI: -0.62 to -0.16, P = .001, I2 = 0%), and postoperative infections (RR: 0.65 95% CI: 0.56-0.76, P < .00001, I2 = 0%). Perioperative intravenous glucocorticoids did not reduce the risk of PND in adults after surgery but might be associated with shorter the LOS and lower the incidence of postoperative infections. More, larger, higher-quality RCTs including neurological surgery or hip fracture surgery and different doses of glucocorticoids compared with placebos are needed to explore the intervention effects.

How autologous platelet-rich plasma affects pregnancy and birth outcomes in women with repeated embryo implantation failure: A prisma-compliant meta-analysis.

Repeated implantation failure refer to failure to conceive after three or more embryo transfer attempts. Several interventions were offered to improve maternal and fetal outcomes. Our objective was to investigate the impact of platelet-rich plasma (PRP) as a promising intervention to improve both pregnancy and birth outcomes. We searched PubMed, Scopus, Web of Science, and Cochrane Central, in addition to other relevant resources of grey literature. Only clinical trials were eligible to be included. We performed the meta-analysis using a random effects model. Eight randomized clinical trials, enrolling 1038 women with more than 3 implantation failure attempts, were included. We found a significant increase regarding all our prespecified primary outcomes. Chemical pregnancy rate [relative ratio (RR): 1.96, 95% confidence interval (CI): 1.61, 2.39; p<0.001], clinical pregnancy rate (RR: 4.35, 95% CI: 1.92, 2.88; p<0.001), and live birth rate (RR: 4.03, 95% CI: 1.29, 12.63; p=0.02) were found to be statistically significant and increased in patients who received PRP compared with the control group. Implantation rate (RR: 1.98, 95% CI: 1.34, 2.75; p<0.001), miscarriage rate (RR: 0.44, 95% CI: 0.23, 0.83, p=0.01), and multiple pregnancy rate (RR: 2.56, 95% CI: 1.02, 6.42, p=0.04) were also found to be significantly increased in the PRP group. We provide strong evidence on how intrauterine PRP can improve implantation, pregnancy, and birth outcomes in RIF women, which should direct clinicians to consider this intervention as a very effective tool in assisted reproductive techniques.

O135 Efferent limb stimulation prior to loop ileostomy closure- a meta-analysis

Abstract Introduction Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. We aimed to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced the incidence of POI. Methods A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases from inception until Oct 2022, was performed. All studies comparing PPS versus no stimulation were included. The primary objective was the incidence of POI whilst secondary objectives included time to resume oral diet, nasogastric tube (NGT) placement postoperatively, time to first passage of flatus/stool, length of stay (LOS) and other complications. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Results Four studies (3 randomized, 1 prospective) capturing 293 patients (140 PPS, 153 no-stimulation) were included. The PPS group was associated with a lower POI incidence (10.7 vs. 26.8%, OR 0.27, 95%CI=0.09-0.86, p=0.03), quicker time to resume oral diet (MD -1.34 days, p=0.02), shorter LOS (MD -1.43 days, p=0.001) and fewer complications (OR 0.37, p=0.008). However, there was no difference in the requirement for NGT placement (OR 0.50, p=0.12) or time to first passage of flatus/stool (MD -0.71 days, p=0.24). On sensitivity analysis, focusing on randomized data only, the difference observed in POI rates was lost (OR 0.35, p=0.10) whereas the results of the secondary objectives prevailed. Conclusion Efferent limb stimulation prior to surgery appears to result in a quicker time to resume oral diet, shorter LOS but similar POI rates. Further studies are needed to confirm those findings.

O131 Martius flaps for rectovaginal fistulae – a systematic review and metanalysis

Abstract Introduction Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various other procedures, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition. Methods A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible. Results Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF procedures were included. The mean age of the study population was 42.2 +/- 15.7 years. There were 45 primary and 92 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45- 98.46; I2= 32.1%; p=0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24- 89.67; I2= 58.1%; p=0.008). The weighted mean complication rate was 29% (95% CI: 8.98- 54.68; I2= 85.4%; p&amp;lt;0.0001) and the overall recurrence rate was 12.0% (95% CI: 5.03- 21.93; I2= 52.3%; p=0.021). When purely radiotherapy-induced RVF were evaluated, the mean overall success rate was 94.6% (95% CI: 83.33- 99.75; I2= 0%; p=0.350). Conclusion MF interposition appears to be an effective treatment modality for RVF. Future randomized studies should be conducted to confirm these findings and to compare MF with other surgical techniques.

Association of osteoporosis risk and polymorphisms of osteoprotegerin gene T950C in postmenopausal Chinese women: A PRISMA-compliant meta-analysis.

This study aimed to assess the association between the T950C polymorphism and osteoporosis in postmenopausal Chinese women to further reduce the influence of different genetic backgrounds by meta-analysis and subgroup analysis. Through November 2022, a systematic online investigation was performed with the aid of the Cochrane Library, EMBASE, PubMed, Web of Science and the Chinese National Knowledge Infrastructure to find case-control studies looking into the correlation between the osteoprotegerin gene (OPG) T950C polymorphism and postmenopausal osteoporosis susceptibility. This study included 6 studies with a total of 1669 postmenopausal osteoporosis cases and 2992 controls. In the recessive model, postmenopausal women with the CC genotype (mutant homozygote at the T950C locus) had a lower risk of osteoporosis, indicating that the CC genotype of OPG T950C might show a preventive effect on osteoporosis after menopause. In a stratified analysis by geographic area, the population from South China had a significantly higher risk under the dominant model [CC + TC (heterozygote at the T950C locus) vs TT (wild-type homozygotes at the T950C locus): odds ratio = 1.34, 95% confidence interval = 1.17-1.54, P < .01], while the population from South China had a significantly lower risk under the recessive model (CC vs TC + TT: odds ratio = 0.79, 95% confidence interval = 0.69-0.95, P = .02). Together, the OPG T950C polymorphism may be associated with osteoporosis risk in postmenopausal Chinese women, according to this meta-analysis. Because of the study's limitations, more large-scale research is needed to corroborate these findings.

Investigation of the efficacy and pharmacological mechanism of Danhong injections for treating chronic obstructive pulmonary disease: A PRISMA-compliant meta-analysis and network pharmacology analysis.

Accumulating evidence supported the clinical efficacy of Danhong injection (DHI) on chronic obstructive pulmonary disease (COPD). It is urgent to summarize the effects of DHI on various outcomes in COPD patients and to elucidate the molecular mechanisms of DHI in treating COPD. Eligible studies were retrieved from 6 databases including China national knowledge infrastructure, Wangfang, VIP, web of science, PubMed, and Embase. The heterogeneity across studies was tested using the I2 statistic and the quality of studies was assessed. The pooled evaluation of outcomes was calculated using a fix- or random-effect model according to the heterogeneity. The underlying mechanism of DHI in treating COPD was analyzed using network pharmacology. A total of 34 eligible studies with a general medium quality were included in the meta-analysis. The pooled data showed that DHI intervention significantly increased clinical efficacy as compared to routine treatment. Meanwhile, our data also revealed that the addition of DHI markedly improved hemorheological indicators, lung function index, arterial blood gas index, and as well as blood coagulation functions. However, the current meta-analysis lacked sufficient data to support the significant effect of DHI on prothrombin time and activated partial thromboplastin time. Network pharmacology found 59 candidate targets of DHI in treating COPD, and enrichment analysis found these targets were associated with lymphocyte proliferation and activation, glucocorticoid receptor signaling, TREM1 signaling, IL-12 signaling and production in macrophages, and aryl hydrocarbon receptor signaling. Multiple core targets including AKT1, TNF, and IL1B, etc. Were identified and might play an important role in the action of DHI against COPD. Taken together, this study suggested that DHI could ameliorate hemorheological indicators, lung function, arterial blood gas, and as well as coagulation functions of COPD patients and elucidate the underlying mechanism of DHI against COPD.

Comparison of intramedullary versus extramedullary alignment technique in total knee arthroplasty: A PRISMA-compliant meta-analysis.

This meta-analysis aimed to compare the efficacy of intramedullary and extramedullary femoral alignment technique in treating total knee arthroplasty (TKA) patients. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure, and Weipu databases were electronically searched. Potential clinical studies that investigated the effect and safety of intramedullary versus extramedullary femoral alignment technique in TKA patients were searched. The primary outcome was lower limb coronal alignment. Stata 12.0 was used for meta-analysis. This meta-analysis included 12 prospective randomized controlled studies that reported data on 935 TKA patients. No significant difference was noted in lower limb coronal alignment, coronal alignment of femoral component, sagittal alignment of femoral component and tibial slope between intramedullary and extramedullary alignment techniques ( P > .05). Further, extramedullary alignment technique significantly decrease the total blood loss than intramedullary alignment technique (weighted mean difference: -86.52; 95% confidence interval: -115.05--57.99; P = .000) and subsequently transfusion rate (risk ratio: 0.57; 95% confidence interval: 0.41-0.79; P = .000). Finally, there was no significant difference between intramedullary and extramedullary alignment techniques in terms of the total complications ( P > .05). The present meta-analysis showed that intramedullary and extramedullary femoral alignment technique had comparable precise profiles. And extramedullary femoral alignment technique could reduce blood loss and blood transfusion. Total complications were comparable between the groups. More randomized controlled trials with large samples are required to verify the comparison of intramedullary and extramedullary femoral alignment technique in TKA patients.

Solving the ambiguity of microfinance and intimate partner violence: a PRISMA-compliant meta-analysis study

Solving the ambiguity of microfinance and intimate partner violence: a PRISMA-compliant meta-analysis study

The risks of hematological toxicities of nivolumab in cancer patients: A PRISMA-compliant meta-analysis.

Nivolumab is the human programmed cell death-1 (PD-1)-blocking antibody showing significant effect in many refractory cancers. However, little is known about its risks of hematological toxicities, rare but clinically serious and potentially life-threatening adverse events. We want to explore whether nivolumab can increase the risks of hematological toxicities compared with other immunotherapy or chemotherapy drugs. The databases of PubMed, Embase, Web of science, and CNKI were searched. We used the medical subject heading terms "Nivolumab" plus keyword "Nivolumab" to search studies published from August 1990 to October 2021. For the included articles, we calculated the relative risks and the corresponding 95% confidence intervals (CIs) for the risks of anemia, neutropenia, and leukopenia in patients treated with nivolumab versus control drugs. Five original articles on the nivolumab trials were identified with 2399 patients enrolled in this meta-analysis. The relative risks of anemia, neutropenia, and leukopenia were 0.343 (95% CI: 0.177-0.663; P = .001), 0.020 (95% CI: 0.008-0.053; P = .000), and 0.054 (95% CI: 0.015-0.191; P = .000), respectively. The PD-1 inhibitor-nivolumab did not increase the risk of anemia, neutropenia and leukopenia. It may enhance awareness about lower risks of hematological toxicities when choosing nivolumab as PD-1 inhibitor among clinicians.

Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients: A PRISMA-compliant meta-analysis of randomized controlled trials: Erratum

Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients: A PRISMA-compliant meta-analysis of randomized controlled trials: Erratum

The efficacy of acupuncture with Lingguibafa acupoint selection in the treatment of insomnia: A PRISMA-compliant meta-analysis.

As a major public health problem, insomnia has garnered much attention. Acupuncture, with dialectical acupoint selection (DAS), has been proved to be effective for insomnia, but there is no evidence of evidence-based medicine to prove the efficacy of Lingguibafa acupoint selection (LAS) for insomnia. This study is to evaluate the clinical efficacy of acupuncture with LAS in patient with insomnia. The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Weipu Database for Chinese Technical Periodicals, Chinese Biomedical Database, and Wanfang Database were systematically searched from the inception dates to December 18, 2021. Randomized controlled trials of acupuncture with LAS versus acupuncture with DAS or acupuncture with LAS plus DAS versus acupuncture with DAS in patient with insomnia were included. Two review authors independently performed the data extraction and assessed study quality. A meta-analysis was performed using random-effects models to calculate relative risk and weighted mean difference for categorical and continuous variables, respectively. The primary efficacy outcome was improvement on Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included insomnia severity index, Epworth sleepiness scale, Hamilton anxiety scale, Hamilton Depression Scale (HAMD), and total effective rate. A total of 7 trials with 468 patients fulfilled the selection criteria. The pooled results indicated that acupuncture with LAS plus DAS could reduce PSQI score by 2.08 (1.60 after excluding heterogeneity) compared to acupuncture with DAS. Acupuncture with LAS plus DAS had high reliability in sleep quality, sleep latency, sleep time and daytime function, but showed no significant effect on sleep disorder and hypnotic drug. For total effective rate, acupuncture with LAS plus DAS or acupuncture with LAS was better than acupuncture with DAS, but the conclusion was less credible. Acupuncture with LAS is significantly associated with improvements in several sleep parameters, primarily evident on the PSQI score. Nevertheless, considering the poor methodological quality, trials employing appropriate randomization concealment and blinding based on a larger sample size are needed in the future.