Random-effects Model Research Articles

Toxicity spectrum of taxanes: A safety analysis from pre-marketing to post-marketing

ABSTRACT Background As fundamental chemotherapy drugs, paclitaxel and its derivatives are essential for cancer treatment. This analysis comprehensively evalutaed the toxicity spectrum of taxanes from the perspective of clinical trials and the real-world. Research design and methods Pooled-analyses were performed to estimate incidences of adverse events (AEs) with random-effect models after searching databases. Reports of AEs were retrospectively obtained from the US Food and Drug Administration’s (FDA’s) Adverse Event Reporting System (FAERS) database and positive signals were quantified by employing three algorithms. Results A total of 36 studies involving 10,828 patients were analyzed in pooled-analysis and 58,835 case reports were retrieved. Leukopenia (59.69, 95% confidence interval 41.34-75.69) and neutropenia (29.69, 23.31-36.99) ranked first among all grades and severe AEs, respectively. Alopecia, regardless of grades, had the highest estimated incidence of non-hematological AEs. The estimated incidences of AEs of Nab-paclitaxel tended to be higher than other formulations, especially neutropenia (46.53, 35.01-58.42). Docetaxel had the least signals but alopecia and depression have quantified several signals. Conclusions The safety of nab-paclitaxel was beyond expectation and unusual signals of alopecia and depression of docetaxel need to be paid attention to. Results of clinical trials and FAERS indicated consistency between premarket and postmarket studies.

A Meta-Analysis of the Impact of Using Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II Receptor Blockers (ARBs) on Mortality, Severity, and Healthcare Resource Utilization in Patients with COVID-19

Objective: The primary objective of this study is to explore the potential link between the utilization of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and its impact on mortality, disease severity, and healthcare resource utilization in individuals diagnosed with COVID-19. We aim to establish a solid theoretical foundation for safe and effective clinical medications. Methods: We conducted a comprehensive search of various databases, including CNKI, PubMed, Science, Cell, Springer, Nature, Web of Science, and Embase. We also traced the literature of the included studies to ensure a thorough analysis of the available evidence. After applying a set of inclusion and exclusion criteria, we ultimately included a total of 41 articles in our analysis. To determine the overall effect size for dichotomous variables, we used the Mantel–Haenszel odds ratio in random effect models. For continuous variables, we calculated the inverse variance SMD using random effect models. To assess the outcomes and heterogeneity, we considered p-values (p < 0.05) and I2 values for all outcomes. We performed multivariate and univariate meta-regression analyses using the maximum likelihood approach with the CMA 3.0 software. Results: The results of our analysis indicated that the use of ACEIs or ARBs did not significantly influence mortality (OR = 1.10, 95% CI 0.83–1.46, p = 0.43, I2 = 84%), severity (OR = 0.99, 95% CI 0.68–1.45, p = 0.98, I2 = 84%), or healthcare resource utilization (SMD = 0.03, 95% CI 0.06–0.12, p = 0.54, I2 = 37%) in patients with COVID-19 compared to those not taking ACEIs or ARBs. The multivariate meta-regression analysis model explained 63%, 31%, and 100% of the sources of heterogeneity for the three outcome indicators. Conclusions: The use of ACEIs and ARBs is not significantly correlated with mortality, severity, or healthcare resource utilization in patients with COVID-19, indicating safe clinical use of the medications.

Reversal of head and neck cancer risk after the cessation of use of smokeless tobacco and betel quid use: meta-analysis

Abstract The use of smokeless tobacco and betel quid is a significant risk factor for head and neck cancer (HNC) posing a major global public health concern. This meta-analysis evaluates the impact of cessation of the use of these products on HNCs risk to guide interventions. Case-control and cohort studies were found through PubMed, Scopus, and Embase databases. Two independent reviewers screened studies and then extracted data. Relative risks (RRs) and 95% confidence interval (CI) for different products cessation was calculated from raw data and meta-analyzed by using random effects models. A total of 13 studies met the inclusion criteria. Findings were predominantly derived from Asian (n=9) studies where betel quid use is widespread. Results showed reduced HNC risk following cessation of betel quid use with RR=0.66 (95% CI: 0.54 - 0.81) or without tobacco RR=0.73 (95% CI: 0.56-0.95). However, other tobacco chewing products showed a RR of 1.07 (95% CI: 0.75-1.53). Long-term cessation (≥20 years) conferred substantial benefits RR 0.37, (95% CI: 0.22-0.61, risk estimates =4). The study highlights the importance of cessation programs and targeted interventions to encourage smokeless tobacco quitting. Future research includes conducting detailed subgroup analyses based on cancer subsites and smokeless tobacco product types.

Assessing the Vulnerability of Splenectomized Patients to Severe COVID-19 Outcomes: A Systematic Review and Meta-Analysis

Background: Splenectomized/asplenic individuals are at a heightened risk for severe infections due to compromised immune function. However, the impact of splenectomy/asplenia on COVID-19 outcomes remains underexplored. This study aims to systematically review and meta-analyze the association between splenectomy/asplenia and severe COVID-19 outcomes. Methods: Following the PRISMA guidelines, databases including Scopus, MEDLINE/PubMed, and Web of Knowledge were searched for relevant articles published between January 2020 and June 2024. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for severe COVID-19 outcomes, with a random-effects model being used to account for heterogeneity. Out of 749 identified studies, 4 met the inclusion criteria. Results: The meta-analysis revealed a significant association between splenectomy/asplenia and overall severe COVID-19 outcomes (OR = 1.92; 95% CI = 1.06–3.47). Specifically, splenectomy/asplenia was significantly associated with increased COVID-19-related hospitalization (OR = 2.06; 95% CI = 1.21–3.49), while the association with COVID-19-related death was not statistically significant (OR = 1.52; 95% CI = 0.78–2.99). COVID-19 vaccination is strongly recommended for these patients. Conclusions: Splenectomy/asplenia significantly increases the risk of severe COVID-19 outcomes, particularly hospitalization. The findings underscore the need for vigilant clinical management and targeted interventions for this vulnerable population. Further research is warranted to fully understand the risks and to develop effective guidelines for the protection of splenectomized individuals against COVID-19.

Co-Occurrence of Cytogenetic Abnormalities and High-Risk Disease in Newly Diagnosed and Relapsed/Refractory Multiple Myeloma

PURPOSE Survival for patients with multiple myeloma (MM) has improved but outcomes remain heterogeneous. Consistent diagnostic identification of high-risk disease is desirable to address unmet patient need. The aim was to investigate the consistency of association of co-occurrence of high-risk cytogenetic abnormalities (HRCAs) with prognosis in patients with newly diagnosed MM (NDMM) and relapsed/refractory MM (RRMM), and across a range of treatment modalities. METHODS A systematic review of randomized controlled trials of MM that reported testing for HRCA between January 1, 2000, and December 9, 2021, was performed. Groups were contacted and asked to locally perform a novel, federated analysis of their data for single hit (one HRCA) and double hit (≥two HRCAs), using a centrally provided algorithm. Analysis results were centrally collated and meta-analyzed to assess the hazard ratio (HR) for progression-free survival (PFS) and overall survival (OS) for one/≥two HRCAs across patient subgroups using random-effects models. RESULTS Twenty-four trials including 13,926 patients were included. The median age of participants was 66.5 years (IQR, 59-72) and 56.5% were male (IQR, 52-60). The HR for PFS was 2.28 (95% CI, 2.05 to 2.54) for patients with ≥two HRCAs and 1.51 (95% CI, 1.38 to 1.65) for patients with one HRCA. The HR for OS was 2.94 (95% CI, 2.49 to 3.47) and 1.69 (95% CI, 1.52 to 1.88) for the two subgroups, respectively. In studies initiated since 2015, the effect abides (≥two HRCA PFS, HR, 2.39 [95% CI, 1.96 to 2.91]; OS, 3.10 [95% CI, 2.10 to 4.60]) both for NDMM and RRMM. Heterogeneity related to transplant eligibility and relapsed/refractory status was as expected. CONCLUSION The association of ≥two HRCAs with the poorest outcome in NDMM and RRMM, and across treatment modalities, as demonstrated here for the first time to our knowledge, allows for more focused development of novel approaches to these patients with high unmet need.

Prevalence of stress and associated factors among students in Ethiopia: a systematic review and meta-analysis

IntroductionStress is an increasing public health issue among the student population. This stress affects their academic performance, mental health, and overall well-being. As a result, we conducted a systematic review and meta-analysis to determine the pooled prevalence and associated factors of stress among students in Ethiopia.MethodsAn extensive search of electronic databases such as PubMed, Google Scholar, Semantic Scholar, HINARI, and Science Direct, cross-referencing, and Google manual search was conducted to identify cross-sectional studies published from 1998 to 2024. The preferred PRISMA guideline was used to report items for this systematic review and meta-analysis. To extract data, Microsoft Excel 16 and to analyze STATA 17 software were used. The JBI quality assessment tool was used for the included studies with medium to high-quality scores. To estimate the pooled prevalence of stress and its associated factors, a random effects model was used. The funnel plot and Egger’s regression test were used to assess publication bias, and I2 test statistics were used to determine heterogeneity of the included studies. The protocol for this review has been registered with PROSPERO (ID: CRD42024578490).ResultsA total of 23 studies with 8,946 study participants met the inclusion criteria. The pooled prevalence of stress among students in Ethiopia was 37.64% (95% CI: 29.61–45.66; I2 = 98.8%). Female gender (OR = 1.82, 95% CI: 1.57–2.12), rural resident (OR = 1.51, 95% CI: 1.22–1.87), living outside university dormitory (OR = 2.02, 95% CI: 1.34–3.05), the habit of alcohol consumption (OR = 1.46, 95% CI: 1.12–1.91), being a cigarette smoker (OR = 2.36, 95% CI: 1.49–3.74), being a khat chewer (OR = 1.35, 95% CI: 1.02–1.80), working in an unfavorable environment (OR = 1.80, 95% CI: 1.20–2.71), and having poor social support (OR = 1.93, 95% CI: 1.39–2.68), were significantly associated with an increased risk of stress.ConclusionThe findings of this systematic review and meta-analysis indicated a high prevalence of stress among students. The study identified female gender, being a rural residence, living outside a university dormitory, khat chewing, having the habit of alcohol consumption, working in an unfavorable environment, poor social support, and cigarette smoking as significant risk factors for stress. To develop coping skills and resilience, integrating mental health education into the curriculum could help students to prevent stress. Furthermore, strategies such as academic support programs, substance use reduction programs, counseling services, and stress management workshops could be beneficial.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024578490, CRD42024578490.

Dietary factors associated with breast cancer among women in Ethiopia: a systematic review and meta-analysis of case–control studies

BackgroundDiet is the primary and largely modifiable factor associated with breast cancer risk. However, inconsistent findings were evidenced in many epidemiological studies and resulted in a lack of conclusiveness. Therefore, this systematic review and meta-analysis aimed to explore dietary risk factors that may predict breast cancer among Ethiopian women.Design, data source and eligibility criteriaA systematic review and meta-analysis was carried out. The articles were retrieved through electronic databases searching, including PubMed/Medline, Web of Science, Science Direct, EMBASE and Google Scholar. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was applied for the critical appraisal. All case–control studies conducted in Ethiopia and reporting dietary factors of breast cancer in women were included in the final analysis.Data extractionTwo independent reviewers extracted the data using a standardized data extraction format in Excel software. Stata version 17 software was used for the data analysis. Cochran’s Q statistic with inverse variance (I2) was used to assess the presence of heterogeneity. A random effect model was used to estimate the odds ratio with a 95% confidence interval.ResultsOverall, eight eligible articles with 2,774 women were included to explore the dietary predictors of breast cancer in Ethiopia. As a result, alcohol consumption (OR: 1.26, 95% CI: 1.01, 1.57), packed food intake (OR: 6.83; 95% CI: 4.56, 10.24), saturated fat/oil intake (OR: 1.51; 95% CI: 1.13, 2.02), meat consumption (OR: 6.08, 95% CI: 3.62, 10.22), and vegetable consumption (OR: 0.75, 95% CI: 0.49, 0.89) were identified as significant predictors of breast cancer among women in Ethiopia.ConclusionThe current study revealed a significant relationship between dietary factors and breast cancer. Avoiding the consumption of alcohol, saturated fats/oils, packed foods, and meat, coupled with promotion of vegetable consumption, could substantially contribute to reduce the burden of breast cancer among women in Ethiopia. Therefore, policymakers and other concerned bodies should provide routine community-based nutrition education to raise public awareness about the contribution of women’s dietary practices on their breast cancer risk.

The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

Background Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity). Methods A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models. Results In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12). Conclusion VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

Association between Geriatric Nutritional Risk Index and survival outcomes in patients with urological cancers: an updated meta-analysis

ObjectivesThis meta-analysis aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI) and survival outcomes in patients with urological cancer.DesignSystematic review and meta-analysis of observational studies.Data sourcesA comprehensive...

Effect of Nutritional Supplements for Reducing Homocysteine Levels in Healthy Adults: A Systematic Review and Network Meta-Analysis of Randomized Trials

Abstract Context There are various therapeutic approaches available to reduce homocysteine (Hcy) levels. However, it remains unclear which intervention is more effective for healthy adults. Objectives A systematic review and network meta-analysis (NMA) were conducted to comprehensively investigate the efficacy of different nutritional supplements in reducing Hcy levels in healthy adults. Data Sources The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to July 2023. Data Extraction The lead author, year of publication, sample size, population characteristics, intervention measures, duration, and mean difference of Hcy levels from baseline to endline were extracted. Data Analysis Data were pooled using a random-effects model. Network meta-analysis was conducted by integrating direct and indirect evidence. A total of 16 studies were included in this analysis. The nutritional supplement combination that achieved the highest ranking (surface under the cumulative ranking curve [SUCRA] = 75.8) was superior compared with a single supplement. Among similar or closely dosed folic acid (FA) supplements, 800 μg FA (SUCRA = 93.7) was the most effective option. When comparing various doses of different supplements, 1 mg of FA plus 7.2 mg of vitamin B6 (B6) plus 20 μg of vitamin B12 (B12; SUCRA = 83.9) ranked first and 800 μg of FA (SUCRA = 78.3) ranked second. In comparison with placebo or no-treatment control groups, interventions such as 1 mg of FA plus 7.2 mg of B6 plus 20 μg of B12 (mean difference [MD] = –1.03; 95% CI –1.71 to –0.36), 400 μg of FA plus 400 μg of B12 (MD = –0.87; 95% CI –1.46 to –0.27), and 800 μg of FA (MD = –0.84; 95% CI –1.12 to –0.56) were more effective in reducing Hcy levels. The random-effects summary MD for all interventions compared with placebo was –0.59 (95% CI –0.71 to –0.48; P < .0001). Conclusions The NMA demonstrated that the combination of FA with other vitamins is more effective in reducing Hcy levels, particularly when the dose of FA is close to 800 μg. The combination of 1 mg of FA, 7.2 mg of B6, and 20 μg of B12 is considered the most favorable option. Systematic Review Registration PROSPERO registration no. CRD42023453123.

Statistical Heterogeneity in Oral Health Meta-Analyses

Providing the summary effect size and its uncertainty, a prediction interval, and a measure of statistical heterogeneity constitute good reporting practices in meta-analyses. Popular statistical heterogeneity measures comprise the τ2 and I2 statistics. However, researchers often rely unduly on the I2 statistic, using naive categorizations to gauge the extent of heterogeneity, leading to misuses of the meta-analysis models, deficiencies in reporting, and misleading conclusions. The present study aimed to provide empirical evidence on the reporting and interpretation of statistical heterogeneity in systematic reviews of oral health published between 2021 and 2023 in 21 leading specialty and general dental journals. Systematic reviews with at least 1 meta-analysis on binary or continuous outcomes with the most studies were identified. Characteristics were extracted at the systematic review and meta-analysis levels. In total, 313 systematic reviews with meta-analyses were analyzed. Within this cohort of meta-analyses, the random-effects model (89%, n = 278) was frequently applied. Almost all meta-analyses (98%, n = 308) reported the I2 value, and 51% ( n = 160) reported the τ2 value. For this sample, the median I2 was 76% (range: 0%–100%), and the median τ2 was 0.29 (range: 0–2,632), with 13% ( n = 20/160) of these meta-analyses reporting zero τ2. Most of the meta-analyses (96%, n = 299) based the heterogeneity interpretation on I2 and only 21 (7%) on τ2. Although 49% ( n = 152) of the meta-analyses chose the meta-analysis model a priori, only 41% ( n = 63/152) justified this choice. Furthermore, 42% ( n = 131) of the 313 meta-analyses chose the meta-analysis model based on the I2. Within oral health meta-analyses, there is evidence of overreliance on I2 when reporting and interpreting statistical heterogeneity and selecting the meta-analysis model. The inappropriate use of I2 in meta-analysis model selection and interpretation of statistical heterogeneity may have implications for the quality of conclusions delivered to the end users of systematic reviews.

Burden of peripheral artery disease and risk factors among patients with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundDiabetes is a non-communicable disease that presents a substantial public health challenge on a global scale. Peripheral artery disease is a significant macrovascular problem in diabetes mellitus characterized by atherosclerotic narrowing of the artery in the lower extremities, leading to compromised distal perfusion, primarily caused by atherosclerosis, and resulting in impaired functional capacity. Although existing studies on, peripheral artery disease among patients with diabetes mellitus are available, the results have been inconsistent.ObjectiveTo determine the pooled burden and associated factors of peripheral artery disease among patients with diabetes mellitus in sub-Saharan Africa.MethodsA systematic review and meta-analysis were performed following the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To identify papers published in English up to August 10, 2024, the electronic databases of Medline, Science Direct, Excerpta Medica Database, Cochrane Library, African Journals Online, and Google Scholar were searched. A random-effects model was employed to estimate the pooled prevalence and associated factors of peripheral artery disease. To test for heterogeneity between studies and publication bias, forest plots and funnel plots were used.ResultsThis study revealed that the pooled prevalence of peripheral artery disease among patients with diabetes mellitus was 32.97% (95% CI 29.7, 36.24), reflecting the significant impact of diabetes mellitus on vascular health. Age (OR = 2.51, 95% CI = 3.41–12.09), increased level of low density lipoprotein (OR = 1.64, 95% CI = 1.05–13.09), BMI (OR = 3.03, 95% CI = 1.74–7.56), and illness duration exceeding 10 years (OR = 2.44, 95% CI = 1.12–5.13), were the significant predictors.ConclusionDespite the alarming prevalence of peripheral artery disease among patients with diabetes in sub-Saharan Africa, it remains underdiagnosed; therefore, increased awareness, proactive screening initiatives, and management strategies within the clinical setting are necessary.Clinical trial numberNot applicable.PROSPEROCRD42024594577

A Systematic Review and Meta-Analysis of Fracture-Related Infections in Maxillofacial Trauma: Incidence, Risk Factors, and Management Strategies

Background/Objectives: Fracture-related infections (FRIs) are a significant complication in maxillofacial trauma, leading to adverse outcomes such as prolonged healing, nonunion, and osteomyelitis. Despite advancements in surgical techniques, the incidence of FRIs remains concerning, particularly for mandibular fractures. This systematic review and meta-analysis aims to evaluate the incidence, risk factors, and management strategies for FRIs in oral and maxillofacial trauma. Methods: A systematic search of Medline and Embase databases was conducted, including studies up to February 2024, adhering to PRISMA guidelines. Eligible studies included randomized controlled trials, cohort studies, and case-control studies focusing on the incidence, risk factors, or treatment outcomes of FRIs. Data on patient demographics, fracture type, infection rates, and management strategies were extracted and analyzed. Statistical analyses included pooled infection rates, stratified by anatomical sites, using fixed and random-effects models. Results: A total of 72 studies were included, with a pooled FRI rate of 5.6%. Mandibular fractures exhibited the highest infection rate at 8.9%, while midface fractures had the lowest at 0.9%. The significant risk factors identified included smoking, substance abuse, and comorbidities such as diabetes. Delayed surgical intervention and poor periodontal health were also associated with higher infection rates. The use of prophylactic antibiotics did not show significant differences in infection prevention. Conclusions: FRIs in maxillofacial trauma are influenced by multifactorial risks, including anatomical, patient-specific, and procedural factors. Mandibular fractures are particularly vulnerable, requiring targeted preventive strategies and timely intervention. Standardized definitions and guidelines are essential for improving consistency in diagnosis and management. Future research should focus on high-quality trials to establish evidence-based approaches for FRI prevention and treatment.

Impact of Altitude Training on Athletes’ Aerobic Capacity: A Systematic Review and Meta-Analysis

Purpose: This study systematically evaluated the effects of altitude training on athletes’ aerobic capacity, focusing on optimal training modalities and intervention durations. Methods: Eight databases (CNKI, CSPD, PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus) were searched for randomized controlled trials on altitude training and aerobic capacity following PRISMA guidelines, covering publications up to 15 October 2024. The risk of bias was assessed using Cochrane tools, and a meta-analysis was conducted using Review Manager 5.4 with a random-effects model. Sensitivity and subgroup analyses were performed to identify heterogeneity and influencing factors. Results: Thirteen studies involving 276 participants (aged 18–35) were included. Meta-analysis revealed that compared to low-altitude training, altitude training significantly increased hemoglobin (SMD = 0.7, 95% CI: 0.27–1.13, p = 0.03) and hemoglobin mass (SMD = 0.49, 95% CI: 0.1–0.89, p = 0.16) but had no significant effect on maximal oxygen uptake (SMD = −0.13, 95% CI: −1.21–0.96, p = 0.68). Altitude training also improved performance in trial tests (SMD = −28.73, 95% CI: −58.69–1.23, p = 0.002). Sensitivity analysis confirmed the robustness of hemoglobin and trial test results. Subgroup analysis showed that the “live high, train high” (LHTH) approach and interventions lasting longer than three weeks were most effective in enhancing aerobic capacity. Conclusions: Altitude training improves athletes’ aerobic capacity by enhancing hematological indicators and trial test performance, though its impact on maximal oxygen uptake is minimal. LHTH and interventions exceeding three weeks yield superior outcomes. However, the findings are limited by the number and quality of the available studies.

The effect of perioperative probiotics and synbiotics on postoperative infections in patients undergoing major liver surgery: a meta-analysis of randomized controlled trials

Objective To evaluate the effect of perioperative probiotics or synbiotics on the incidence of postoperative infections following major liver surgery. Design Meta-analysis Data sources PubMed, Embase, Scopus, and the Cochrane Library for relevant English-language studies published up to February 21st, 2024. Eligibility criteria Randomized controlled trials evaluating perioperative probiotics or synbiotics for preventing postoperative infections in patients undergoing major liver surgery. Data extraction and synthesis Outcomes included postoperative infection incidence, antibiotic therapy duration, length of stay in intensive care unit (ICU) and hospital. A random-effect model was adopted for the meta-analysis. The quality of included studies was evaluated using the Cochrane risk of bias tool. Results Ten studies involving 588 patients were included. Pooled analyses revealed that perioperative probiotics or synbiotics significantly reduced postoperative infection incidence (RR 0.36, 95% CI [0.24–0.54], P < 0.0001, I2 = 6%) and antibiotic therapy duration (MD −2.82, 95% CI [−3.13 to −2.51], P < 0.001, I2 = 0%). No significant differences were observed in length of stay in ICU (MD −0.25, 95% CI [−0.84–0.34], P = 0.41, I2 = 64%) or length of stay in hospital (MD −1.25, 95% CI [−2.74–0.25], P = 0.10, I2 = 56%). Conclusions This meta-analysis suggests that perioperative administration of probiotics or synbiotics may reduce the incidence of postoperative infections and duration of antibiotic therapy. Their use as adjunctive therapy during the perioperative period could be considered for patients undergoing major liver surgery.

A systematic review and meta-analysis of treatments and outcomes of primary localized cutaneous amyloidosis.

Primary localized cutaneous amyloidosis (PLCA) is a skin-limited disorder characterized histologically by amyloid deposition in the papillary dermis. This study aimed to review current treatment strategies and provide an updated perspective on the treatment of PLCA. We searched the PubMed, EMBASE and Cochrane Library databases for eligible studies. Cohort studies were meta-analyzed using a random effects model to evaluate the outcomes of different treatments, while case reports and case series were evaluated using the Mann-Whitney U test. Overall, 117 studies (535 patients) were included. Surgery favoured nodular amyloidosis (NA), with statistically significant differences for the other therapies. For the non-NA group, 62 case-level studies (79 patients) and 20 cohort studies (418 patients) were analyzed separately. Although there were no statistically significant differences between therapies in the case-level studies, biological agents and JAK inhibitors may be a promising treatment for refractory lesions. Of the cohort studies, the partial response (PR) rate was 100.0%, 100.0%, 97.5%, 96.9%, and 94.4% of transcutaneous electrical nerve stimulation, micro-needling, laser therapies, topical therapies, and systemic immunosuppressants; the complete response (CR) rate was 22.2% and 2.5% of surgical interventions and laser therapies. This study suggest that surgery is the most effective option for NA and laser therapy is recommended for non-NA patients. Biologic agents and JAK inhibitors may be promising treatment options for lesions that do not respond to conventional therapies.

Gendered time use, body mass index, and well‐being among adolescents in resource‐poor settings in India: The adverse role of domesticity

AbstractWe investigated how adolescents' time allocation across daily activities influences their body mass index and well‐being by paying explicit attention to gender and activities relevant to low‐ and middle‐income countries (LMICs). We hypothesized that the inequitable domestic burden shouldered by girls adversely affects their health and well‐being. Using data from three waves of the Young Lives Longitudinal Survey (2009, 2013, and 2016) tracking 1891 children aged 8, 12, and 15 from predominantly rural, low‐income households from South India, we analyzed gendered time use patterns and their implications. Girls spent more time on caregiving, housework, and studying at home, while boys allocated more time to school, leisure, and sleep. Random effects models revealed that time spent on caregiving and housework increased the likelihood of being overweight or obese among girls, whereas leisure time reduced it. Time in school was positively associated with girl's thinness, as was time spent on sleep for both boys and girls. Gender moderated the effects of time spent on housework and unpaid economic tasks on thinness, reducing its likelihood for girls. Subjective well‐being improved with time spent in school and studying for all adolescents. Fixed effects models revealed it worsened for girls engaged in paid work and boys engaged in leisure. Longer sleep hours improved boys' well‐being. These findings underscore that gendered time use patterns, particularly girls' unequal burden of domestic responsibilities, contribute to their increased risk of overweight and obesity. Addressing these disparities is crucial for improving adolescents' health and well‐being in resource‐poor settings in LMICs.

A Systematic Review and Meta-Analysis Comparing the 2019 and 2005 Bosniak Classification Systems for Assessing Renal Cysts and Cystic Renal Masses: Diagnostic Accuracy and Inter-rater Agreement Evaluation

Abstract Objectives The Bosniak Classification System (BCS) is integral in clinical decision-making for Renal cysts and cystic renal masses, with updates in 2005 and 2019 aiming to enhance diagnostic accuracy and clinical utility. Despite these revisions, challenges in inter-rater agreement and practical applicability persist, underscoring the need for comprehensive evaluation of both versions' effectiveness in guiding patient care. Methods This meta-analysis adhered to PRISMA guidelines and systematically reviewed studies comparing the 2005 and 2019 BCS versions using CT or MRI. We searched PubMed, Embase, Scopus, and Web of Science, and used QUADAS-2 for quality assessment. In this study, we focused on diagnostic performance and inter-observer agreement. Statistical analysis involved bivariate random-effects modeling and assessing pooled sensitivity, specificity, and inter-rater reliability. Results We included eleven articles. The 2019 Bosniak classification showed higher diagnostic performance for CT (sensitivity: 85.7%, specificity: 81.9%) and MRI (sensitivity: 96.2%, specificity: 70.9%) compared to the 2005 version. Inter-rater reliability was better with the 2019 classification (CT kappa: 0.813, MRI kappa: 0.601) than with the 2005 version. The quality assessment indicated low risk of bias overall, though some studies had high risk in specific areas. Conclusion The Bosniak 2019 classification provides improved diagnostic specificity and inter-rater reliability compared to the 2005 version. Its adoption may enhance clinical decision-making and reduce overtreatment in managing cystic renal masses. Advances in knowledge This paper is novel in being the first meta-analysis to demonstrate that the Bosniak 2019 classification system significantly enhances inter-rater agreement, and overall diagnostic performance compared to the 2005 version, particularly in CT imaging, thus offering a more accurate and reliable tool for evaluating cystic renal masses.

Effect of restrictive fluid resuscitation on severe acute kidney injury in septic shock: a systematic review and meta-analysis

ObjectivesSepsis-associated hypotension or shock is a critical stage of sepsis, and a current clinical emergency that has high mortality and multiple complications. A new restrictive fluid resuscitation therapy has been...

Ambient Air Pollution and Parkinson’s Disease and Alzheimer’s Disease: An Updated Meta-Analysis

Background: Previous epidemiological evidence regarding the associations between ambient air pollution and two major neurodegenerative diseases, Alzheimer’s disease (AD) and Parkinson’s disease (PD), remains inconclusive. Objective: This study aimed to evaluate the associations between long-term and short-term exposure to PM2.5 and PM10 (i.e., particulate matter with an aerodynamic diameter of, or smaller than, 2.5 μm or 10 μm), nitrogen dioxide (NO2), ozone, sulfur dioxide, and carbon monoxide and the risks of AD and PD. Methods: A random-effects model was used to summarize individual effect estimates in the meta-analysis. A subgroup meta-analysis was further conducted to explore the potential sources of heterogeneity. Results: In total, 42 eligible studies were included. For each 5 μg/m3 increase in long-term PM2.5 exposure, the odds ratios (ORs) were 1.16 (95% CI: 1.04, 1.30; I2 = 95%) and 1.10 (95% CI: 1.03, 1.17; I2 = 95%) for AD and PD, respectively. For each 5 μg/m3 increase in short-term PM2.5 exposure, the OR was 1.01 (95% CI: 1.002, 1.01; I2 = 77%) for PD. For each 1 ppb increase in long-term NO2 exposure, the OR was 1.01 (95% CI: 1.0002, 1.02; I2 = 79%) for PD. Conclusion: Ambient air pollution, particularly PM2.5, may contribute to the increased risks of neurodegenerative diseases including AD and PD.