Randomized Control Studies Research Articles

P-433 Endometrial cavity fluid and clinical pregnancy outcomes in assisted reproduction cycles. A systematic review and meta-analysis

Abstract Study question Does Endometrial cavity fluid (ECF) presence affect clinical pregnancy rates in assisted reproduction (ART) cycles? Does ECF aspiration improve clinical pregnancy outcomes? Summary answer ECF aspiration appears to improve clinical pregnancy outcomes by 56%. What is known already Accumulation of ECF has been a notable finding in ART cycles. The origin of ECF is up to debate; nonetheless, it is frequently associated with a concurrent diagnosis of hydrosalpinx, gonadotropin therapy, subclinical uterine infections, polycystic ovary syndrome amongst other causes. A recent meta-analysis of nine studies highlighted that the presence of ECF substantially diminishes the rates of implantation and clinical pregnancy following embryo transfer, particularly when exceeding 3.5 mm. However, the benefit of ECF aspiration upon clinical pregnancy remains obscure. Study design, size, duration The present meta-analysis aimed to compare clinical pregnancy rates between patients with ECF on the day of embryo transfer undergoing ECF aspiration vs. those who did not. The study was conducted according to the PRISMA guidelines. Six databases (Embase, MEDLINE®, APA PsycInfo, Global Health, HMIC Health Management Information Consortium and Google Scholar) and two additional sources were searched from inception to 23rd November 2023. Participants/materials, setting, methods Observational and Randomized Control Trials meeting inclusion criteria underwent analysis. Quality assessment for observational studies utilised the ROBINS-I Risk of Bias (RoB) tool, and Cochrane RoB V2 tool was used to assess RCTs. Certainty of evidence was evaluated through the GRADE framework. The Meta-analysis was conducted by computing Odds Ratio (OR), Random Effects (RE) using the Haensel-Mantel method. Summative and subgroup data were analysed via the web-based Cochrane RevMan platform. Main results and the role of chance A total of 3 studies were deemed eligible for inclusion, of which 2 were observational (Hou et al., 2022; Hussaini et al., 2018) and a single RCT (Saad et al., 2019). Observational studies were deemed of moderate RoB while the RCT of low RoB. Certainty in overall evidence (GRADE) was deemed moderate. A total of 379 patients were included in the meta-analysis, of a median age 29 [IQR 24.45, 34]. Previous diagnoses of endometriosis, adenomyosis or uterine surgery were not reported in any of the included studies, while only two studies reported the percentage of tubal factor infertile patients in their respective included sample (73% and 25%, Ntotal=125). When aggregately analysed, ECF aspiration resulted in a significant increase in clinical pregnancy rates, OR 1.56 [95% CI 1.04, 2.33], I2= 1%, P = 0.03. Additionally, subgroup analysis of low RoB studies, OR 1.61 [95% CI 1.08, 2.40], I2= 0%, P = 0.02, successfully controlled for heterogeneity whilst also yielding statistically significant results. Limitations, reasons for caution Inherent to the nature of observational studies, our meta-analysis suffers from the scarcity of robust randomized control studies and adequately powered observational evidence. Wider implications of the findings Our study suggests that ECF aspiration at embryo transfer may improve clinical pregnancy outcomes. However, robust RCTs are required to assess the degree of clinical impact as well as the patient subgroups and their clinical characteristics that may benefit more from such an intervention. Trial registration number not applicable

No increased complication rate with the use of soft tissue quadriceps tendon autograft for primary ACL reconstruction – a systematic review

BackgroundThe autograft of choice for anterior cruciate ligament reconstruction (ACLR) remains debateable. Recently there has been increased popularity of soft tissue quadriceps tendon (s-QT) autograft due to less donor site morbidity, reduced anterior knee pain and comparable re-operation and complication rates. The aim of this review was to analyse functional outcomes of primary ACLR using s-QT in adult population without the bone plug and to report its complication profile against other autografts. Patient and methodsThis systematic review was performed in accordance with PRISMA guidelines and a review of literature was conducted on four online databases (Medline, EMBASE, Cochrane and Google Scholar). Clinical studies reporting on patients undergoing primary ACLR with s-QT autograft or in comparison to BPTB or HS autografts with a minimum of 6 months follow-up were included. The studies were inclusive of only all soft tissue QT autograft regardless of the implants or fixation method used. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool. ResultsFourteen studies were eligible. There were three randomised control studies (RCT) and 11 non-randomised comparative studies with 1543 patients who underwent ACLR. 682 underwent s-QT, 498 had hamstring tendon (HT) and 174 had bone-patellar tendon-bone (BPTB). 60% (n = 930) were males and mean follow up was 23.6 months (6–65). Eight studies reported post-operative patient reported outcome measures (PROMs). The mean International Knee Documentation Committee (IKDC) score was 91.5 ± 15.1 whereas mean Lysholm score was 90 ± 3.9. Five studies reported on laxity with mean anterior tibial translation (ATT) of 1.28 ± 1.09 mm. Overall complication rate of s-QT ACLR was 6% with 3% graft failure, 0.52% arthrofibrosis, 0.2% infection, 0.75% revision ACLR. There was no significant difference in functional outcome scores, knee stability and range of motion (ROM) between s-QT, HT and BPTB. Conclusions-QT for ACLR has a comparable functional outcome, laxity, failure and with overall graft failure rate of 3%. Level of evidenceIII; Systematic review and meta-analysis.

Torsemide versus Furosemide Therapy in Patients with Chronic Heart Failure: An updated Meta-analysis

Introduction: Torsemide’s oral bioavailability and half-life theoretically render it a more efficient diuretic than Furosemide, but the clinical outcomes of torsemide compared with furosemide remain unclear. A rigorous meta-analysis performed by Bishoy et al 2019 showed Torsemide as compared to Furosemide improved hospitalization though it was not statistically significant. We performed an updated meta-analysis to evaluate the effects of Torsemide vs. Furosemide in heart failure hospitalization and mortality. Methods: In addition to the studies included in previous meta-analyses, we performed a literature search using Medline from 2019 till 07/25/2023. We used the MESH term ‘Torsemide’ AND ‘Furosemide[Mesh]) AND ‘Heart Failure’. Eligible studies were 1) Randomized control studies (RCT), non-RCT, and observational prospective and retrospective cohort studies, 2) with English abstract 3) compared torsemide with furosemide, and 4) assessed outcomes of all-cause hospitalization or all-cause mortality. When studies reported both short-term and long-term outcomes, a preference was given to long-term outcomes. Study quality was assessed by the Ottawa scale. RevMan 5.4 was used for analysis. Study results were analyzed using a random effects model. I2 statistics were applied to assess the between-study heterogeneity. Further subgroup analysis was performed for RCTs only. Results: In addition to the previous studies, our literature search returned 27 studies. Two studies met the inclusion criteria. A total of twenty studies (8 randomized control trials [RCTs] and 12 observational studies) with a total of 22,749 patients were included. New-Castle Ottawa scale was used to assess the quality of each study, score of each study ranged from 7 to 9 which reflected high quality. Intra-study risks of bias were also assessed. During a mean follow-up duration of 12 months, risk of hospitalization due to heart failure in patients treated with Torsemide was not different from those treated with Furosemide (odds ratio [OR] 0.80, 95% confidence interval [CI] [0.59, 1.07], p< 0.23, I2 = 24%) also no difference in risk of all-cause mortality (odds ratio [OR] 0.94, 95% confidence interval [CI] [0.87, 1.02], p< 0.001, I2 = 96%, respectively) noted between the two groups. The results remained consistent when subgroup analysis was conducted using only RCTs. Conclusions: Compared with Furosemide, Torsemide use was not associated with a significant difference in hospitalization for heart failure or all-cause mortality in patients with heart failure. The studies included in hospitalization analyses showed lower heterogeneity while for all-cause mortality a higher heterogeneity was noted.

The Effectiveness of Adaptive Coping Strategies for Work Stress: A Meta-Analysis

Work stress is a significant global health problem, negatively impacting employee physical and mental health as well as company productivity. Adaptive coping strategies can be an important intervention in reducing the negative effects of work stress. This research aims to evaluate the effectiveness of adaptive coping strategies in reducing work stress and improving employee well-being through meta-analysis. A systematic literature search was conducted on electronic databases (PubMed, PsycINFO, Scopus, Web of Science) to identify randomized controlled studies (RCTs) published between 2018 and 2024. Studies that met the inclusion criteria (working adult participants, adaptive coping strategy interventions, outcomes work stress and/or well-being) data were extracted and analyzed using a random effects model. Twenty-five RCTs involving 4,852 participants met the inclusion criteria. Meta-analysis showed that adaptive coping strategies significantly reduce work stress (pooled effect size = -0.45, 95% CI [-0.58, -0.32], p < 0.001) and improve well-being (pooled effect size = 0.38, 95% CI [0.25, 0.51], p < 0.001) compared with the control group. Subgroup analyzes revealed that adaptive coping strategies focused on problem-solving, social support, and relaxation had the greatest effectiveness. Adaptive coping strategies are effective in reducing work stress and improving employee well-being. These findings support the implementation of adaptive coping strategies as an occupational health intervention to reduce the negative impact of work stress.

Functional outcomes and quality of life following open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: a systematic review and meta-analysis

BackgroundThe standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients’ functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients’ functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME).MethodsA systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses.ResultsNineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] –0 .15 [− 0.24 to − 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques.ConclusionsThis systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques.

Effectiveness of chatbots in increasing uptake, intention, and attitudes related to any type of vaccination: A systematic review and meta-analysis.

This systematic review and meta-analysis analyzed and summarized the growing literature on the effectiveness of chatbot-delivered interventions in increasing uptake, intention, and attitudes related to any type of vaccination. We identified randomized controlled studies (RCTs), quasi-experimental studies, and non-experimental studies from the following platforms: PubMed, Web of Science, MEDLINE, Global Health, APA PsycInfo, and EMBASE databases. A total of 12 eligible studies published from 2019 to 2023 were analyzed and summarized. In particular, one RCT showed that a chatbot-delivered tailored intervention was more effective than a chatbot-delivered non-tailored intervention in promoting seasonal influenza vaccine uptake among older adults (50.5% versus 35.3%, p = 0.002). Six RCTs were included in the meta-analysis to evaluate the effectiveness of chatbot interventions to improve vaccination attitudes and intentions. The pooled standard mean difference (SMD) of overall attitude change was 0.34 (95% confidence intervals [CI]: 0.13, 0.55, p = 0.001). We found a non-significant trivial effect of chatbot interventions on improving intentions of vaccination (SMD: 0.11, 95% CI: -0.13, 0.34, p = 0.38). However, further evidence is needed to draw a more precise conclusion. Additionally, study participants reported high satisfaction levels of using the chatbot and were likely to recommend it to others. The development of chatbots is still nascent and rooms for improvement exist.

OPTIMIZING LEARNING: A META-ANALYSIS OF TIME MANAGEMENT STRATEGIES IN UNIVERSITY EDUCATION

This meta-analysis rigorously investigates time management strategies within university education and their impact on academic performance, student satisfaction, and self-efficacy. Covering two decades (2004-2024), it synthesizes findings from both random and nonrandom controlled intervention studies, providing a comprehensive examination of pedagogical impacts. The analysis reveals nuanced but significant enhancements across academic and personal development dimensions, with varied effect sizes (average g values). Interventions were categorized based on their primary focus—either direct time management skills enhancement or integration within broader academic and personal development strategies. Directly targeting time management proficiency was pivotal in bolstering academic performance and self-efficacy, while broader interventions significantly elevated student satisfaction. This analysis highlights the critical interplay between time management strategies, self-efficacy, and satisfaction, suggesting that tailored, skill-specific interventions can yield substantial benefits in academic contexts. The findings advocate for a holistic approach in higher education pedagogy, emphasizing the necessity of embedding effective time management training within university curricula to optimize learning outcomes and student development. This study contributes to the academic discourse on educational strategies and underscores the imperative for empirical, evidence-based approaches in curriculum design and student support services, guiding future research in educational psychology.

Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease.

Despite the decreased rates in inflammatory bowel disease (IBD) colectomies due to high advances in therapeutic options, a significant number of patients still require proctocolectomy with ileal pouch-anal anastomosis (IPPA) for ulcerative colitis (UC). Pouchitis is the most common complication in these patients, where up to 60% develop one episode of pouchitis in the first two years after UC surgery with IPAA with severe negative impact on their quality of life. Acute cases usually respond well to antibiotics, but 15% of patients will still develop a refractory disease that requires the initiation of advanced immunosuppressive therapies. For chronic idiopathic pouchitis, current recommendations suggest using the same therapeutic options as for IBD in terms of biologics and small molecules. However, the available data are limited regarding the effectiveness of different biologics or small molecules for the management of this condition, and all evidences arise from case series and small studies. Vedolizumab is the only biologic agent that has received approval for the treatment of adult patients with moderately to severely active chronic refractory pouchitis. Despite the fact that IBD treatment is rapidly evolving with the development of novel molecules, the presence of pouchitis represents an exclusion criterion in these trials. Recommendations for the approach of these conditions range from low to very low certainty of evidence, resulting from small randomized controlled trials and case series studies. The current review focuses on the therapeutic management of idiopathic pouchitis.

Exercise as a means of preventing musculoskeletal problems in musicians, a systematic review

Abstract Introduction The lifetime prevalence of performance related musculoskeletal disorders in musicians is reported to reach a very high rate (93%) and many times affect the music performance, playing efficacy, the quality of their work or their career progression. It can also have a significant financial burden on the musicians as well as on the organizations/orchestras. Purpose This systematic review summarizes the evidence available from randomized clinical trials investigating the effect of exercise in the prevention of musculoskeletal disorders in musicians. Methods The search was performed in the PubMed database and the specialized Journal of Medical Problems of Performing Artists, Science & Medicine, Inc. until March 2022. The keywords used were decided by Mesh terms. Studies that had titles and abstracts related to exercise or prevention programs in musicians to reduce or treat PRMDs were selected for detailed analysis. Exclusion and inclusion criteria were used for the final outcome. A qualitative assessment was also carried out with the PEDro scale. Results Of the 1050 articles found, 138 were selected by title for relevance and their abstracts were studied. Of these 22 randomized studies were selected for full reading. The criteria of the systematic review were met by 7 articles, which were examined in detail. Parallel searches were conducted with different combinations of keywords to cross-reference the selected randomized studies. Three clinical studies showed a reduction in the frequency of musculoskeletal disorders and a reduction in pain and symptom intensity with a statistically significant difference. Two clinical studies have had a positive effect on physical effectiveness. A control group in one study showed significant statistical significance in aerobic capacity. The same clinical study had a positive effect on the playing performance of the instrument. Another clinical study showed reduced inability related to music performance in both groups. Three clinical studies had an educational intervention together with the exercise intervention. No clinical research was found to assess the health costs of musculoskeletal disorders in musicians. Conclusions This systematic review provided evidence for the effect of exercise training in preventing musculoskeletal disorders in musicians. Prevention programs with exercise intervention had significant clinical value such as reducing the occurrence of musculoskeletal disorders in intensity, frequency and pain as well as improving their functional capacity and their quality of musical performance. Additional clinical randomized control studies are necessary with a larger number of participants and duration of follow-up of the results to confirm the above findings.

Embolization alone is as effective as TACE for unresectable HCC: systematic review and meta-analysis of randomized controlled trails

BackgroundDespite transarterial chemoembolization (TACE) was recommended as first line therapy for intermediate hepatocellular carcinoma (HCC), the efficacy of transarterial embolization (TAE) has not been widely recognized. This work was to determine whether TAE was as effective and safe as TACE for unresectable HCC.MethodsWe performed a systematic search of electronic databases and other sources for randomized controlled studies (RCTs) comparing TAE with TACE for unresectable HCC. Results were expressed as Hazard Ratio (HR) for survival and Odds Ratio (OR) for dichotomous outcomes using RevMan 5.4.1.ResultsWe included 6 trials with 683 patients. The risk of bias of included RCTs was from unclear to high risk. There were no significant differences between TACE and TAE for progression-free survival (HR 0.83, 95% CI 0.45–1.55; p = 0.57), overall survival (HR 1.10, 95% CI 0.90–1.35; p = 0.36), and objective response rate (OR 1.17, 95% CI 0.80–1.71; p = 0.42) without obvious publication bias. Sensitivity analyses confirmed the robustness of the results. TAE group reported similar or less adverse effects than TACE group in all the studies.ConclusionsOur study demonstrated that TAE was as effective as TACE. Since TAE was simpler, cheaper and had less adverse effects than TACE, TAE should be a better choice in most cases where TACE was indicated for unresectable HCC.

Selective Serotonin Reuptake Inhibitors and Symptoms of Depression in Patients on Chronic Hemodialysis: A Systematic Review.

Objective: The use of selective serotonin reuptake inhibitors (SSRIs) is common among hemodialysis patients who receive treatment for depression. However, studies on the efficacy of SSRIs in patients on chronic hemodialysis are few and have led to conflicting results. The present systematic review aims to evaluate, in randomized, controlled studies (RCSs), the efficacy of SSRI administration in reducing symptoms of depression in patients on chronic hemodialysis when compared with placebo or psychological interventions. Method: Research was run on December 2023 in the following databases: Ovid MEDLINE (1985 to present); Ovid EMBASE (1985 to present); Cochrane Library (Wiley); and PubMed (1985 to present). The primary outcome was the frequency and severity of the symptoms of depression assessed through the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HAMD). The secondary outcome was the prevalence of adverse events. Results: Seven studies totaling 433 patients were included. The number of patients in each individual study ranged from 13 to 120. The length of studies ranged from 8 weeks to 6 months. Heterogeneous data precluded informative meta-analysis. Three studies compared sertraline with a placebo. Of these, two demonstrated that sertraline was better than the placebo in reducing the symptoms of depression while one showed no statistically significant differences between sertraline and the placebo. One study, comparing fluoxetine with a placebo showed that the symptoms of depression did not differ significantly at 8 weeks. In another study, escitalopram administration led to a significantly greater reduction in the Hamilton Depression Rating Scale score compared to a placebo, as well as in the Hamilton Anxiety Rating Scale score. In one study, citalopram and psychological interventions were both effective in reducing the symptoms of depression and anxiety and, in another study, sertraline was modestly more effective than CBT at 12 weeks in reducing the symptoms of depression. Conclusions: SSRIs may be effective in reducing the symptoms of depression in patients on chronic hemodialysis. SSRI administration, at the dosage used in the studies included in the present systematic review, seems safe in most hemodialysis patients. However, the paucity of studies and the limited number of patients included in the trials may suggest that further randomized, controlled studies are needed to determine if SSRIs may be used routinely in daily clinical practice in such a population.

Effectiveness of anastomotic reinforcement sutures in reducing anastomotic leakage risk after laparoscopic rectal cancer surgery: a pooled and integration analysis.

Anastomotic leakage (AL) is one of the most serious complications after laparoscopic anus-preserving surgery for rectal cancer, which significantly prolongs the patient's hospital stay, leads to dysfunction, and even increases the patient's perioperative morbidity and mortality, and little is known about the effectiveness of anastomotic reinforcement sutures to prevent AL. Thus, this study was conducted to evaluate the efficacy of anastomotic reinforcement sutures as a means to prevent AL during laparoscopic surgery for rectal cancer. A comprehensive and systematic search was performed in the literature database by combining subject and free terms up to 10 October 2023. The overall literature included was integrated and analyzed using Stata 12.0 software and Review Manager version 5.4 software to assess the effect of anastomotic reinforcement sutures on the incidence of AL. A total of 2,452 patients from 14 studies were included, and an integrated analysis showed that the use of anastomotic reinforcement sutures significantly reduced the incidence of AL [odds ratio (OR) = 0.26; 95% confidence interval (CI), 0.18-0.37; P < 0.00001; I2 = 0%]. However, the findings confirmed whether or not the anastomosis reinforced with sutures did not affect the incidence of anastomotic stenosis (OR = 0.69; 95% CI, 0.37-1.32; P = 0.27; I2 = 0%). We performed subgroup analyses of the results of the study, the randomized controlled studies (OR = 0.31; 95% CI, 0.15-0.65; P < 0.001) as well as retrospective studies (OR = 0.28; 95% CI, 0.19-0.41; P < 0.001), 3-0 sutures (OR = 0.28; 95% CI, 0.17-0.45; P < 0.001) versus 4-0 sutures (OR = 0.26; 95% CI, 0.13-0.53; P < 0.001), barbed wire sutures (OR = 0.26; 95% CI, 0.14-0.48; P < 0.001) versus non-barbed wire sutures (OR = 0.30; 95% CI, 0.20-0.46; P < 0.001), interrupted (OR = 0.30, 95% CI, 0.20-0.46; P < 0.001) versus continuous sutures (OR = 0.29, 95% CI, 0.16-0.51; P < 0.001) to the anastomosis, full-thickness suture (OR = 0.29; 95% CI, 0.16-0.51; P < 0.001) versus sutured with the seromuscular layer (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001), anastomotic sutured in one (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001) versus non-one circle (OR = 0.30; 95% CI, 0.20-0.44; P < 0.001), and reinforcing sutures to the dog-ear area (OR = 0.26; 95% CI, 0.14-0.50; P < 0.001) versus the non-dog-ear area (OR = 0.30; 95% CI, 0.20-0.45; P < 0.001), which have suggested that there is no significant difference between each other and that all of them reduce the incidence of AL. This study provides evidence that performing reinforcement suturing of the anastomosis during laparoscopic rectal surgery significantly lowers the incidence of postoperative AL but has no significant effect on anastomotic stenosis. It is important to note that further randomized controlled studies are required to confirm this conclusion. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022368631.

Efficacy and safety of Shenmai injection for acute ischemic stroke: a systematic review and meta-analysis.

Ischemic stroke is a serious and sudden cerebrovascular condition that significantly affects individual's health and imposes a substantial economic burden on medical management. Despite its widespread use in China, there is still a lack of reliable evidence regarding the efficacy of Shenmai injection (SMI) in acute ischemic stroke (AIS). We aimed to comprehensively assess the effectiveness and safety of SMI in treating AIS through a systematic review and meta-analysis. Randomized controlled studies (RCTs) investigating the efficacy of SMI in treating AIS were searched for in eight databases from the inception of each database till January 2024. We utilized the ROB 2.0 to assess the risk of bias. A meta-analysis was conducted using Review Manager 5.4, while sensitivity analyses and publication bias assessments were conducted using Stata 16.1. A total of 17 studies involving 1,603 AIS patients were included in our meta-analysis. Our results showed that SMI plus conventional treatments (CTs) was more effective than CTs alone in improving the total effective rate (RR 1.22, 95% CI: 1.14 to 1.30, p < 0.00001), the Barthel index (BI) (MD 12.18, 95% CI: 10.30 to 14.06, p < 0.00001), and reducing the National Institute of Health Stroke Scale Score (NIHSS) score (MD -3.05, 95% CI: 3.85 to -2.24, p < 0.00001) and Modified Rankin Scale (mRS) (MD -0.68, 95% CI: 0.86 to-0.49, p < 0.00001). In addition, SMI combination therapy was better than CTs alone in decreasing the levels of IL-6, IL-18, and hs-CRP. SMI therapy also enhanced the cerebral hemorheology of patients by reducing levels of fibrinogen and plasma viscosity. However, there was no significant difference in the incidence of adverse events, including elevated transaminase, rash, nausea, bleeding, urticaria, headache, vomiting, chest tightness, and facial flushes. Moreover, no serious adverse effects or life-threatening events were reported. Our study shows that combining SMI with CTs effectively enhances the neurological function of patients with acute cerebral infarction. However, our findings should be interpreted considering the significant heterogeneity and suboptimal quality of the analyzed trials. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024504675, Identifier PROSPERO, CRD42024504675.

Traditional Chinese Medicine for Acute Migraine: A Systematic Review and Meta-Analysis

Objectives: A meta-analysis of traditional Chinese medicine in the treatment of acute migraine was conducted to obtain a consistent evaluation of its efficacy. Methods: The search databases were China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese Biomedical Literature Database (CBM) and PubMed. The publication time of randomized controlled studies (RCT) documents is limited to before June 30, 2023. Results: Data from 399 patients from 5 RCTs were included. Compared with Western medicine, Traditional Chinese medicine has a higher efficacy ([RR=0.81, 95%CI (0.75, 0.89), P&lt;0.00001]), a lower adverse reaction rate ([RR=1.37, 95%CI (0.74, 2.54), P=0.32]) and an improved VAS ([MD=-1.37, 95%CI (-2.00, -0.75), P&lt;0.00001]). Conclusion: Traditional Chinese medicine in the treatment of acute migraine can enhance clinical efficacy, reduce treatment side effects, and improve patients’ visual analogue score.

Glycosaminoglycan replacement therapy in preventing women’s recurrent urinary tract infections?: A systematic review and meta-analysis

The aim of this study is to systematically review the published literature and pool the data to evaluate the effectiveness of glycosaminoglycans (GAGs) replacement therapy in preventing women’s recurrent urinary tract infections (rUTIs). A systematic search of PubMed was performed to identify comparative and randomized controlled trials that compared the efficacy of GAG replacement therapy with control groups (placebo/antibiotics/standard therapy) in preventing rUTI in women. The evaluated outcomes included risk of rUTI, rUTI episodes per patient-year, time to urinary tract infection recurrence, pelvic pain and urgency/frequency, and the quality of life (Short Form-36 questionnaire). The Cochrane Collaboration Review Manager software (RevMan, version 5.4) was used for statistical analysis. Seven trials, including 2 randomized control studies and 5 retrospective comparative trials, met the inclusion criteria and were enrolled into our meta-analysis. A total of 702 patients were included in the analysis. Five studies adopted intravesical instillations and 2 used oral-administered hyaluronic acid. The synthesized results revealed that GAG replacement therapy significantly reduced the risk of rUTI (odds ratio: 0.31), reduced urinary tract infection-associated symptoms on pelvic pain and urgency/frequency scores (WMD: −6.70), and contributed to nonsignificant influence in quality of life, prolongation of time to rUTI, and the risk of rUTI per patient-year. In conclusion, the current meta-analysis revealed that GAG replacement therapy might serve as an alternative treatment strategy for rUTI. Further studies should focus on the durability of the protective effect of hyaluronic acid and the optimal protocol for dosage and administration route for GAG replacement therapy.

HRQoL in patients with GBM: The impact of tumor treating fields.

e24049 Background: Glioblastoma (GBM) is the most common malignant glioma with a dismal prognosis. Patients experience a range of progressively worsening symptoms, including headaches, nausea, seizures, and cognitive deficits throughout their disease course. Initial treatment for newly diagnosed patients consists of maximal safe surgical resection followed by fractionated radiation treatment with concomitant temozolomide. Presently, there are two approved adjuvant treatment modalities following chemoradiation: temozolomide and tumor-treating fields (TTFields). In this poster, we explore the impact of TTFields on the quality of life, assessed through health-related quality of life (HRQoL), in patients with GBM. Methods: Using PubMed, Medline-indexed articles were collected using this structured query: Glioblastoma[MeSH] AND (("Electric Stimulation Therapy*"[MeSH]) OR ("Transcranial Direct Current Stimulation*"[MeSH]) OR "Tumor Treating Fields" OR "TTF") NOT "RAT" This yielded 233 results before the search date (2023). Collected sources were uploaded to Covidence to allow for multi-reviewer screening, review, and extraction. For completeness, limited forward and back citations using the ResearchRabbit tool and limited addition of non-Medline indexed articles via unstructured query yielded four additional results. Sources were filtered by study type and included/excluded based on accessibility, sample population, design, outcome measures, and interventions. Five randomized control studies remained. From this subset, bias, effect size, I2-index, and forest analysis with random effect model estimation were calculated. Results: Data analysis showed that TTFields therapy has demonstrated associations with increased progression-free survival and enhanced overall survival rates without negative effects on HRQoL. Some patients have reported improvement in mobility, self-care, and carrying out regular activities. One notable side effect observed in these patients was increased skin itchiness, which was expected due to the use of transducer arrays. Conclusions: This project identified a research gap in standardizing the assessment of quality of life in patients treated with TTFields. A significant limitation in research on TTFields is an overall lack of HRQoL data, often due to patients failing to follow-up with surveys. Future research should prioritize patient follow-up to obtain more comprehensive and precise longitudinal data on HRQoL while considering disease and treatment characteristics.

What is the impact of simulation-based training for paediatric procedures on patient outcomes, cost and latent safety threats?

Simulation-based training (SBT) provides a safe space for medical trainees to experience realistic scenarios. SBT has been found to improve trainee performance in paediatric procedures. However, limited evidence exists regarding its effects on higher-level outcomes. This scoping review aims to identify studies that investigate the impact of SBT for procedural skills on T3 (patient outcomes) and T4 level outcomes (latent safety threats [LSTs], and hospital level costs) in paediatrics. Full-text articles were included if they focused on medical trainees, used simulation training for paediatric procedures and reported T3/T4 level outcomes. Six databases were searched from January 2011 to September 2022. Search strategies were developed with the assistance of a librarian. Three independent reviewers performed pilot screenings before title/abstract and full-text screenings. A data extraction sheet was created to gather information on interventions, outcomes, research design, and other study characteristics. After title/abstract screening of 4,076 sources, 50 were included for full-text review, with 15 articles selected for data extraction. Four were randomised control studies (RCTs), fourteen focused on T3 level outcomes including mortality rates, and one measured LSTs. There were no studies reporting cost-related data. Three of the studies focused on bag-and-mask ventilation, and eight mentioned the use of mannequins. We highlight the potential effectiveness of simulation-based training of paediatric procedural skills in improving patient outcomes, such as reduced mortality rates and incidence of illness/injury. Though the quality of research designs was low, researchers used different simulation modalities and outcome measures and showed a positive impact of SBT(e.g., decreased mortality rates).

Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis.

The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed (I2 statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, p < 0.001, I2 = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, p < 0.001, I2 = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, p = 0.023, I2 = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.

Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study

IntroductionAdolescents and young adults (AYAs) affected by cancer are an understudied group. Effective interventions are needed to support coping with the late effects of cancer, its treatment and to promote...

The revolution and future frontiers of reproductive management of dairy cattle

The 21-d pregnancy rate is determined by an interaction be­tween the AI service rate and pregnancies per AI (P/AI) and is a key performance indicator for the reproductive efficiency of dairy farms. Over the past 2 decades, the reproductive per­formance of lactating dairy cows increased. A greater under­standing of endocrinology and the physiology of lactating dairy cows generated fertility programs (the Presynch-Ovsynch and Double Ovsynch protocols for TAI) that increase the service rate and P/AI compared with detection of estrus. Previously, synchronization of ovulation in heifers was associated with poor reproductive performance compared with detection of estrus. Several modifications determined through randomized-controlled studies gave rise to the 5-d CIDR-Synch protocol that has similar and more P/AI when heifers are inseminated with conventional and sexed semen, respectively, compared with detection of estrus. A hierarchy of reproductive needs exists for dairy farms that require fulfillment before a new need can emerge. Dairy farms must have a high 21-d pregnancy rate and good heifer management before adopting other advanced re­productive technologies such as genomic selection, sexed and beef semen, and in vitro-produced embryos. Adopting these ad­vanced reproductive technologies benefits dairy farms, howev­er, challenges still exist that need further investigation through randomized-controlled experiments to maximize the benefits