Random-effects Model Meta-analysis Research Articles

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

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

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

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

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

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

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

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

Human rights violations are associated with forcibly displaced population’s mental health—a systematic review and meta-analysis

BackgroundLittle is known about the mental health consequences of human rights violations in forcibly displaced populations. Objective: The objectives of this systematic review are to examine: (1) the prevalence of mental health conditions among forcibly displaced persons; (2) to investigate methodological factors contributing to mental health conditions; and (3) associations between mental health conditions and human rights violations.MethodsWe conducted a systematic review with meta-analyses on the prevalence of anxiety, depression, and posttraumatic stress disorder among forcibly displaced populations and factors contributing to it by searching in databases MEDLINE (Ovid), Embase, Web of Science Core Collection (Clarivate), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), and PTSDPubs (ProQuest). Additionally, we assessed the Global Peace Index. Pooled associations were calculated using a random-effects meta-analysis model. Subgroup analyses were performed for the Global Peace Index, sampling methodology, also we assessed risk of bias.ResultsOf the 4,175 records screened, 55 with n = 31,573 participants met the inclusion criteria (n = 15,714 males, females, n = 15,859 females). Most studies were cross-sectional (n = 49). The pooled prevalence rates were 38.90% (95% CI: 29.63; 48.17) for anxiety, 38.16% (95% CI: 32.16; 44.15) for depression and 39.62% (95% CI: 32.87; 46.36) for posttraumatic stress disorder. Analyses by level of human rights violations show anxiety, and depression prevalence rates were higher in countries with low Global Peace Index than countries with high, moderate and low Global Peace Index (39.84% vs. 16.09%; 41.07% vs. 26.67%). Analyses by risk of bias indicate that the prevalence rate of PTSD was higher in studies with a high risk of bias compared to those with a very high risk of bias (49.27% vs. 29.79%). For anxiety, the prevalence rate was greater with random sampling compared to convenience sampling (44.71% vs. 36.87%). Depression and PTSD prevalence rates were higher with convenience sampling than with random sampling (38.67% vs. 37.70%; 42.83% vs. 35.50%).ConclusionOur review suggests that systematic continuous human rights violations are associated with mental health conditions in forcibly displaced persons. To prevent mental health conditions, it is necessary to reduce exposure to human rights violations in the countries forcibly displaced persons come from.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017076535, PROSPERO registration: CRD42017076535.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hyponatremia incidence after subarachnoid hemorrhage and association with outcomes: systematic review and meta-analysis.

Hyponatremia after aneurysmal subarachnoid hemorrhage (aSAH) is common, however the incidence, and association with vasospasm, morbidity, and mortality, has yet to be defined. We aimed to identify incidence of hyponatremia after aSAH, and quantify its association with measurable outcomes. A PRISMA-compliant systematic review and meta-analysis was conducted (PROSPERO ID CRD42022363472). Articles published in MEDLINE, EMBASE, and Cochrane Library between January 1990-January 2024 were included. Hyponatremia definitions, incidence during admission, and association between vasospasm, length of hospital stay, and poor outcome (Glasgow Outcome Scale three or less) were identified. Pooled incidence rates, binary and continuous outcomes were calculated using random effects meta-analysis models. In total, 52 studies (10512 patients) were included. Most studies included patients admitted to tertiary neuroscience centers (61.5%, N=32), or critical care units (23.1%, N=11). Sodium of less than 135 mmol/l was the most commonly utilized hyponatremia definition (84.6%, N=44). The pooled incidence of hyponatremia was 37.0% (95% CI 31.7-42.4%). Hyponatremia increased the risk of vasospasm (15 studies, Odds Ratio [OR] 2.93, 95% CI 1.77-4.84), and length of hospital stay (3 studies, 16.4 days vs 8.0 days, Mean Difference [MD] 8.5 [95% CI 4.6-12.4]), but was not associated with poor outcome (10 studies, OR 1.15, 95% CI 0.44-3.02). These findings remained when carrying out sensitivity analysis for different hyponatremia and outcome definitions, bias, and aSAH populations. Hyponatremia is common in aSAH, may increase the likelihood of vasospasm, but in isolation does not appear to affect overall outcomes. Managing hyponatremia effectively should be a priority for treating clinicians.

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

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

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

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

The Role of Lymphadenectomy in the Surgical Treatment of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Background: Lymphadenectomy in the operative management of hepatocellular carcinoma (HCC) remains controversial, with no recommendation for routine practice. Our study aimed to assess the effects of lymphadenectomy in addition to hepatic resection (HR) compared to HR alone for adults with HCC. Methods: This systematic review was conducted according to PRISMA guidelines until March 2023, searching and selecting the relevant literature comparing lymph node dissection or sampling, combined with HR, and with no lymph node removal. Critical appraisal of the included studies was performed using the ROBINS-I tool. Fixed- or random-effect meta-analysis models were carried out, and inter-studies were assessed for heterogeneity. Results: Fourteen studies were selected during the screening process. Data from eight studies containing 32,041 HCC patients were included in the quantitative synthesis. In total, 12,694 patients underwent lymph node dissection (LND), either selectively for preoperatively diagnosed or intraoperatively suspected lymph node metastasis (LNM) or unselectively (i.e., regardless of suspected LNM). According to LN status, 1-, 3- and 5-year mortality rates were higher in the LNM group with respect to both clinically negative LN (OR 3.25, 95% CI 2.52-4.21; p < 0.001; OR 3.79, 95% CI 2.74-5.24; p < 0.001; OR 3.92, 95% CI 2.61-5.88; p < 0.001) and proven LN0 (OR 1.75, 95% CI 1.0-3.04; p = 0.05; OR 2.88, 95% CI 1.79-4.63; p < 0.001; OR 2.54, 95% CI 1.33-4.84; p < 0.001). Moreover, the summary estimates of two controlled trials showed no significant difference in overall survival between LND groups and those without LND for negative LN patients. Conclusions: Lymph node dissection does not appear to improve overall survival, according to the available literature; thus, this does not support its routine adoption as part of standard liver resection for HCC. A case-by-case decision remains advisable.

Magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in low- and middle-income countries: An umbrella review of systematic review and meta-analysis.

To date, findings from systematic reviews and meta-analyses on unintended pregnancies in low-income and middle-income countries (LMICs) are inconsistent, posing challenges for preventive efforts. Therefore, the aim of this study is to determine the magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in LMICs: an umbrella review of systematic review and meta-analysis. PubMed, Scopus, Science Direct, Web of Science, as well as databases specific to systematic reviews, such as the Cochrane Database, have investigated the magnitude, risk factors, and adverse outcomes of unintended pregnancy in LMICs. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates from the included studies regarding the magnitude and predictors of unintended pregnancy were then pooled and summarised using random-effects meta-analysis models. We included 13 systematic review and meta-analysis (SRM) studies involving 1 446 122 women. The summary estimate for the magnitude of unintended pregnancy was 28.38% (95% CI = 23.06-33.7%, I2 = 100%). From the umbrella review, the reported factors and complications of statistical significance were as follows: maternal illiteracy (AOR = 3.79; 95% CI = 1.36-8.94), being unmarried (AOR = 12.98; 95% CI = 1.88-27.85), lack of communication with the husband about family planning (AOR = 3.43; 95% CI = 1.68-5.19), inability to attend antenatal care (AOR = 1.4; 95% CI = 0.62-2.17), never using family planning (AOR = 1.4; 95% CI = 0.62-2.17), maternal depression (AOR = 1.72; 95% CI = 0.81-2.64), stunting (AOR = 1.76; 95% CI = 1.25-2.48), and parity 3.83 (AOR = 1.3; 95% CI = 1.3-11.3). The pooled magnitude of unintended pregnancies in LMICs was high. Therefore, it is crucial to integrate family planning and maternal health care services to prevent unintended pregnancy. Additionally, interventions targeting rural, unmarried, less-educated, and adolescent women are important for preventing unintended pregnancies in LMICs.

Risk of congenital malformations and miscarriages following maternal use of oral fluconazole during the first trimester of pregnancy: a systematic review and meta-analysis.

The risks related to fluconazole use during the first trimester of pregnancy (T1) remain controversial. The aims of this systematic review and meta-analysis were to assess the association between oral fluconazole during T1 and major congenital malformations (MCM) overall and by subtype, minor malformations and miscarriages.We searched MEDLINE, EMBASE, Cochrane, ICTRP and ClinicalTrials.gov from inception to 02/12/24. Randomized controlled trials and observational studies were included. ROBINS-I was used for risk of bias assessment. Both fixed- and random-effects models meta-analyses were performed. GRADE was used to assess the certainty of the evidence.Among 1403 references, nine observational studies were included (3,764,897 pregnancies, including 116,425 exposed to fluconazole). The association between any fluconazole use during T1 and overall MCM was significant when combining crude estimates (ORc 1.18, 95%CI (1.08-1.29), I2 23%, seven studies), but not when combining adjusted estimates (ORa 1.02, 95%CI (0.98-1.07), I2 0%, six studies). Results were consistent for cumulative dose of fluconazole. In sensitivity analyses considering only studies with a valid definition of MCM, the association between fluconazole > 150mg and overall MCM remained significant when combining adjusted estimates. For the subtypes of MCM (cardiac, genito-urinary, musculoskeletal) we found no significant association. A significant association was found between fluconazole use and miscarriages (ORa 1.60, 95% CI (1.06-2.42).Fluconazole use during T1 does not significantly increase the risk of MCM overall or by subtype when considering adjusted estimates. However, potential risks, particularly at cumulative doses greater than 150mg which show a potential association with MCM, deserve much attention.PROSPERO Registration The protocol was registered on the 23rd September 2021 (registration number: CRD42021274003).

Biomarkers in paediatric bacterial meningitis: a systematic review and meta-analysis of diagnostic test accuracy.

Biomarkers for paediatric bacterial meningitis are essential for accurate diagnosis. To perform a systematic review of diagnostic accuracy on cerebrospinal fluid (CSF) and blood biomarkers for paediatric bacterial meningitis. Databases Medline, Excerpta Medica Database, Scopus and Web of Science were used. Eligible studies were those on novel diagnostic CSF and blood biomarkers from which data on biomarker concentration or diagnostic accuracy could be abstracted. Paediatric patients (0-18years) suspected of a central nervous system (CNS) infection. The QUADAS-2 tool was used to assess risk of bias. Difference in biomarker concentrations were assessed by calculating standardised and weighted mean differences. A random-effects meta-analysis model was used. Hierarchical summary receiver-operating characteristic curves were constructed. We identified 3,435 studies, of which 112 articles on 113 individual biomarkers (CSF n=90, blood n=23) were included. In CSF, CRP, IL-6, TNF-α and IL-8 showed the largest mean differences between bacterial meningitis and viral meningitis and IL-6, TNF- α and IL-8 between bacterial meningitis and no CNS infection/inflammation. CSF CRP and ferritin showed excellent discrimination for bacterial versus viral meningitis (summary area-under-the-curve [sAUC] 0.94, 95% CI 0.92-0.97, sAUC 0.94, 95% CI 0.90-1.0). CSF IL-6 and procalcitonin showed excellent discrimination for bacterial versus non-bacterial meningitis and versus no CNS infection/inflammation (sAUC IL-6: 0.98; 95% CI 0.96-1.00, sAUC procalcitonin: 0.96; 95% CI 0.94-0.99). Procalcitonin in blood showed good discrimination (AUC 0.89; 95% CI 0.68-1.00). We identified several CSF biomarkers with high diagnostic accuracy for the diagnosis of bacterial meningitis, including IL-6, procalcitonin, CRP and ferritin. None of the blood biomarkers exhibited excellent discrimination for paediatric bacterial meningitis. Validation of these biomarkers in prospective well-designed studies of diagnostic accuracy performed in children with suspected meningitis is needed. CRD42022361785.

Effectiveness of expressive writing therapy for postpartum women with psychological distress: Meta-analysis and narrative review.

The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings. The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women. For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress. Data was collected using a random effect model for meta-analysis. A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I2 above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty. Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.