Randomized Controlled Trials Research Articles (Page 1)

Randomized controlled trials (RCTs) are designed to achieve balanced distribution of baseline characteristics across study arms through random allocation, rendering null-hypothesis significance testing on these characteristics unnecessary and potentially misleading. Despite longstanding guidance discouraging this practice, its prevalence and patterns within anesthesiology and pain medicine literature remain unclear. The authors conducted a meta-research study of parallel-group RCTs published from 1996 to 2025 across 101 journals indexed under the "Anesthesiology and Pain Medicine" category in Scopus (Elsevier, The Netherlands). Data extraction included study characteristics, reporting of baseline testing, number of variables tested, and statistical significance. Multivariable logistic regression was used to identify factors associated with baseline testing, and a binomial test assessed whether the observed rate of significant findings exceeded the expected false-positive rate under the null hypothesis. Of 2,453 eligible RCTs, 1,186 (48.3%) reported statistical testing of baseline characteristics. Among studies performing such testing, 228 (19.2%) reported at least one statistically significant difference, and 58 (25.4%) discussed it as a study limitation. A total of 11,516 variables were tested, with 424 (3.7%) reported as statistically significant-below the 5% expected by chance ( P < 0.001). Larger author teams were associated with lower odds of baseline testing (odds ratio, 0.95; 95% CI, 0.93 to 0.97), while a higher number of variables tested increased the odds of finding at least one significant difference (odds ratio, 1.10; 95% CI, 1.07 to 1.12). Despite methodologic guidance and Consolidated Standards of Reporting Trials (CONSORT) recommendations, statistical testing of baseline characteristics remains common in anesthesiology RCTs and has not declined over time. This practice likely reflects persistent misunderstanding of randomization and may lead to misinterpretation of study validity. Education and stronger editorial policies are needed to align reporting behavior with best practices and improve trial transparency.

To compare the effectiveness and safety of oral misoprostol vs vaginal dinoprostone for the induction of labor (IOL) using an individual participant data (IPD) meta-analysis. We used a Cochrane review and searched Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL Plus, Scopus and ClinicalTrials.gov to identify randomized controlled trials (RCTs) that compared oral misoprostol with vaginal dinoprostone for IOL in viable singleton pregnancies. We invited the authors of eligible trials to share their anonymized data. Primary outcomes were vaginal delivery, a composite measure of adverse maternal outcomes and a composite measure of adverse perinatal outcomes. IPD meta-analysis was conducted using a two-stage random-effects model. An intention-to-treat approach was used for all analyses. Aggregate-data meta-analysis was undertaken with RCTs stratified by Trustworthiness in RAndomised Clinical Trials (TRACT) score. Of 18 eligible RCTs, eight provided IPD, of which five (1892 participants) met the TRACT criteria for trustworthiness. IPD meta-analysis showed similar rates of vaginal delivery after IOL with oral misoprostol or vaginal dinoprostone (odds ratio (OR), 0.99 (95% CI, 0.80-1.22); I2 = 0%). The rates of composite adverse perinatal outcome (adjusted odds ratio (aOR), 1.02 (95% CI, 0.61-1.72); I2 = 0%) and composite adverse maternal outcome (aOR, 1.39 (95% CI, 0.72-2.69); I2 = 0%) were also comparable between the groups. Of 10 RCTs that did not share IPD, seven met the TRACT criteria. Aggregate-data meta-analysis of the 12 RCTs (five with IPD and seven without IPD) meeting the trustworthiness criteria also showed comparable rates of vaginal delivery after oral misoprostol and after vaginal dinoprostone (OR, 1.08 (95% CI, 0.92-1.27)). In contrast, six studies not meeting the trustworthiness criteria (three with and three without IPD) reported a higher rate of vaginal delivery following oral misoprostol (OR, 1.34 (95% CI, 1.22-1.48)), resulting in an inflated overall estimate of the vaginal delivery rate after oral misoprostol based on all data (OR, 1.19 (95% CI, 1.05-1.36)). IOL with oral misoprostol or vaginal dinoprostone results in comparable rates of vaginal delivery and composite perinatal and maternal adverse outcomes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Normobaric hyperoxia (NBO) has emerged as a potential adjuvant therapy for enhancing cerebral oxygenation and neuroprotection in patients with acute ischemic stroke (AIS). The combination of endovascular treatment (EVT) with NBO may offer synergistic benefits by mitigating ischemic injury and improving tissue reperfusion outcomes. This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the therapeutic efficacy and safety profile of NBO therapy in AIS patients undergoing EVT. We searched five databases (PubMed, Embase, Cochrane Library, Web of Science, and Scopus) from their inception to 15 March 2025, for RCTs comparing NBO vs. control in EVT-treated AIS. The primary outcomes were 90-day functional independence and all-cause mortality. The safety outcomes comprised symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage, and early neurological deterioration. Data synthesis was performed using random-effects models. Risk of bias and evidence certainty were assessed with the Cochrane tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. This meta-analysis incorporated five RCTs comprising 730 patients. The NBO group demonstrated a significant enhancement in 90-day functional independence (RR = 1.27, 95% CI: 1.10-1.47, p = 0.001) and a reduction in mortality (RR = 0.61, 95% CI: 0.40-0.93, p = 0.02). Subgroup analyses revealed that initiating NBO therapy pre-EVT improved functional outcomes (RR = 1.38, 95% CI: 1.13-1.68, p = 0.001), whereas post-EVT NBO administration lowered mortality rates (RR = 0.44, 95% CI: 0.21-0.93, p = 0.03). The safety outcomes, including sICH, any ICH, and early neurological deterioration, did not exhibit significant differences between groups. NBO as an adjuvant therapy to EVT improves functional independence and reduces mortality in AIS patients, without an increase in safety risks. These results support the potential integration of NBO into EVT protocols to enhance patient recovery. However, further high-quality, multicenter RCTs are warranted to validate these findings and optimize NBO application.

Wearable technologies for mental health monitoring older adults: systematic review.

Endovascular thrombectomy (EVT) is the standard of care in acute ischemic stroke (AIS), yet functional outcomes remain suboptimal. Normobaric hyperoxia (NBHO) is a potential neuroprotective strategy. This study is the first systematic review and meta-analysis to assess NBHO as a potential neuroprotective adjunctive to improve outcomes in EVT-treated patients. A comprehensive search of electronic databases, including PubMed, Scopus, Cochrane, and Web of Science, was performed in February 2025. The inclusion criteria targeted randomized controlled trials (RCTs) comparing NBHO and EVT to EVT alone or with sham oxygen therapy. Statistical analyses were performed using RevMan software. Four RCTs comprising 648 patients with AIS due to large vessel occlusion in the anterior circulation were included in the study. For the primary efficacy endpoint of excellent functional outcome, defined as the number of patients who had a Modified Rankin Scale (mRS) score of ≤ 1 at 90 days, the overall odds ratio with a subgroup based on the oxygen delivery duration at 2, 4, and 6h was in favor of the NBHO group compared to the control (OR = 1.66, 95% CI [1.13, 2.45], P = 0.01, I2 = 0%). The subgroup of 4-hour oxygen delivery duration was the only significant subgroup (OR = 1.6, 95% CI [1.01, 2.51], P = 0.04). Safety outcomes showed no significant differences between the NBHO group and the control group across all reported measures. NBHO as an adjunct to EVT appears to be effective and safe. A 4-hour duration was found to be the most effective. Further RCTs are needed to confirm our results and establish the optimal treatment protocol.

Abstract Randomized controlled trials (RCTs) provide high-quality evidence but often lack generalizability to real-world populations. Although real-world evidence (RWE) studies help to bridge this gap but retrospective design and heterogeneous outcome measures still limit their standardization in Crohn’s disease (CD). Building on the recent ECCO Position Paper, this study aimed to identify the most relevant outcomes for real-world CD studies. An international panel of inflammatory bowel disease (IBD) specialists participated in a structured two-round Delphi e-survey using the RAND/UCLA Appropriateness Method. Experts rated outcomes across eight domains, including disease activity, patient-reported outcomes, and treatment safety. Agreement was assessed using the Disagreement Index (DI), where DI &amp;gt; 1 indicated disagreement, and DI ≤ 1 indicated agreement or no disagreement. Weighted scoring prioritized key outcomes. A total of 51/85 experts (60%) completed Round 1 and 48/51 (94%) Round 2. No disagreement was observed (Disagreement Index &amp;lt;1) in both rounds. The highest-ranked outcomes were Abscess or Fistula (10.6%), Endoscopic Remission (10.3%), Corticosteroid-Free Clinical Remission (8.9%), Disease Progression (6.7%), and Colorectal Cancer (5.9%). The top 10 outcomes accounted for 61.5% of the weighted score. For combinations, the top four outcomes: Corticosteroid-Free Clinical Remission (16.2%), Endoscopic Remission (15.6%), Disease Progression (14.1%), and Health-Related Quality of Life (11.9%), represented 57.8% of selections. When considering the top five and top six outcomes, the cumulative proportions were 55.4% and 57.6%, respectively. This expert-driven Delphi study provides a standardized framework for selecting outcomes in CD RWE studies, improving consistency, and comparability across future research in this field.

This review aimed to fill the literature gaps and provide a robust and up-to-date account of the efficacy of mindfulness-based interventions on the quality of life and psychological well-being of individuals with obesity.The prevalence of overweight and obesity are gaining more prominence globally; and several studies have highlighted the effectiveness of mindfulness-based interventions (MBIs) in assisting psychological issues associated with obesity. However, the awareness of MBIs' impact is yet to be established globally. A systematic review adhering to the PRISMA protocol was conducted, involving searches across five electronic databases. The review encompassed English language publications from January 2013 to July 2023. The inclusion criteria were met by twenty-two eligible randomized controlled trials (RCT) and quasi-experimental studies, involving a total of 1,729 participants. These studies assessed the impact of MBIs on quality of life and various psychological well-being components. The majority of the reviewed studies revealed a positive effect of MBIs on the quality of life and psychological well-being among individuals with obesity. However, more research is needed, particularly studies incorporating an active control group, focusing on Asian populations, and utilizing larger sample sizes, in order to ascertain the effectiveness of MBIs comprehensively.The findings of this review have significant implications and offer directions for the development of MBIs tailored to address weight-related challenges and enhance both physical and psychological well-being.

Abstract Introduction Knee osteoarthritis (KNOA) is a chronic and burdensome disease associated with chronic pain, reduced physical function and increased joint stiffness [1]. KNOA’s clinical management is complex, and there remains considerable debate about the comparative performance of pharmacotherapeutics for core outcomes, including physical function and joint stiffness, which are essential in clinical decision making to improve patient outcomes. This Network Meta-analysis (NMA) addresses this critical gap in the clinical literature. Aim To evaluate the relative effectiveness of pharmacological interventions for joint stiffness and physical function among adult patients with KNOA using standard NMA and additive component NMA (CNMA). Methodology We performed a comprehensive search of major electronic databases and trial registries from inception to January 2021 for randomised controlled trials (RCTs) that evaluated treatments for KNOA listed in NICE guidelines [2] including: paracetamol, NSAIDs, COX2-inhibitors, opioids, duloxetine, capsaicin, hyaluronic acid (HA) and corticosteroids (CS), administered via oral, topical, transdermal or intra-articular (IA) routes at four time windows: immediate, short, medium and long term. A random-effects NMA and additive CNMA estimated relative treatment effects within a frequentist framework using mean differences (MD) on a 0–10 scale [3]. Certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) with risk of bias (RoB) assessed using the revised Cochrane RoB2 tool. This study does not require ethical approval as it is a systematic review and CNMA of already approved trials and is registered with PROSPERO, CRD42020184192[4]. Results Of 33298 citations, 202 RCTs were eligible for inclusion after a full-text review. Of these, 202 reported on pain, 126 on physical function, and 98 on stiffness. We have previously reported findings for pain[5]. Here, we report findings on physical function and joint stiffness. For physical function, in the immediate-term (32 RCTs), significant improvements were observed only for IACS (MD, -1.05 [95% confidence interval, -1.48, -0.61), oral NSAIDs -0.68 (-0.89, -0.46), and COX2 inhibitors -0.60 (-0.82, -0.38); IACS ranked highest, IAHA lowest. In the short-term (105 RCTs), all interventions except IAHA+oral NSAIDs/gastroprotection demonstrated significant effects, topical+oral NSAIDs ranked highest and oral opioids lowest. In the medium (28 RCTs) and long-term (6 RCTs), only IAHA showed a significant benefit, while IACS showed a non-significant worsening; however, evidence was sparse and of very low certainty. For stiffness, in the immediate-term (26 RCTs), topical and oral NSAIDs, COX2 inhibitors, and duloxetine showed significant effects. Oral NSAIDs ranked first, followed by COX2 inhibitors, while IAHA ranked lowest with MDs of -0.76 (-1.06, -0.46), -0.68 (-1.02, -0.34), and 0.22 (-0.39, 0.83), respectively. In the short-term (78 RCTs), all interventions except IACS, IAHA+oral NSAIDs/gastroprotection, and paracetamol were associated with a significant improvement. In the medium (20 RCTs) and long-term (4 RCTs), only IAHA significantly improved stiffness; however, evidence was sparse and of very low certainty. Discussion Results suggest that anti-inflammatories are the optimal pharmacotherapeutic options, with oral NSAIDs, topical NSAIDs and COX2 inhibitors superior for up to three months, and IACS as a single injection only. Findings serve as a foundation to guide prescribing practices and inform future guidelines, but should be interpreted cautiously given few trials with low risk of bias and the complex nature of KNOA in clinical practice.

Adolescence and early adulthood represent a critical phase for management of chronic diseases, including obesity. To improve transition of care in adolescents and young adults with obesity (AYALwO), the main goal was to summarize the current evidence on transition of care interventions (T-interventions) for obesity management. Anticipating a lack of evidence on T-interventions for AYALwO, we expanded the patient population to include individuals with other chronic diseases that can be appropriately transferred, such as diabetes. We searched three databases and one trial registry from 01/2013-07/2025 onwards and screened reference lists of included trials, i.e. randomized-controlled trials (RCTs) and non-randomized-controlled studies of interventions (NRSI) enrolling AYALwO, type 1 (T1D)/ 2 diabetes and RCTs only for inflammatory bowel disease (IBD), arthritis or asthma (effects for these populations were considered transferable in case of lack of trials in AYALwO). We evaluated outcomes of T-interventions, e.g. HbA1c, quality of life, self-management or transition readiness. The review process was completed by two reviewers, independently. Results were summarized via random-effects meta-analysis or descriptively. We included 14 RCTs (n=9 T1D, n=2 mixed population, n=1 IBD, n=1 arthritis, n=1 asthma) and four NRSI (n=2 T1D, n=2 mixed population). Prespecified outcomes were mostly reported infrequently and/or heterogeneously. Effect measures were mostly inconclusive or not meaningful. No effect was shown for HbA1c in seven RCTs (mean difference 0.12% [95%-confidence interval -0.59; 0.83]) or in two NRSI. A higher transfer rate by appointment reminders (one RCT) or consultation at the same physician for pediatric and adult care (one RCT) and an improvement of transition readiness for transition-oriented patient education programs (one RCT, one NSRI) was found. Certainty of evidence (CoE) was very low for all outcomes, mainly due to a high risk of bias, indirectness and imprecision. We found no trial for AYALwO. Evidence on other chronic diseases was limited, showing that T-interventions lead to improvements in transfer rate or transition readiness (very low CoE). This highlights the need for future research regarding T-interventions in AYALwO. CRD42024513411.

Exercise is the primary choice for managing age-related sarcopenia. However, many exercise intervention subtypes are currently used to manage age-related sarcopenia with little published evidence comparing their efficacy, meaning the optimal exercise intervention subtype for sarcopenia remains unclear. We performed a Bayesian network meta-analysis addressing these uncertainties. We searched eight databases for literature through to 5 June 2023 to identify randomized controlled trials (RCTs) of exercise interventions for age-related sarcopenia. Skeletal muscle mass index (SMI), handgrip strength (HGS), knee extension strength (KES), gait speed (GS), chair rise test (CST) and time up and go test (TUGT) were used as outcomes. Effect estimates were expressed as standardized mean differences with 95% confidence intervals. We performed a Bayesian network meta-analysis using a random effects model and the R package gemtc to compare the relative efficacy of various exercise intervention subtypes. We also used surface under the cumulative ranking curve (SUCRA) to estimate relative treatment rankings. This systematic review is registered in PROSPERO, CRD42023474627. We included 37 RCTs with a total of 2322 subjects and 10 unique exercise intervention subtypes. Most RCTs (72.9%) displayed unclear risk of bias. According to the value of SUCRA, whole-body vibration high frequency (WBVH) ranked first in SMI (99.8%), HGS (96.5%) and GS (76.5%), suggesting it is the most comprehensive and effective exercise intervention subtype for managing age-related sarcopenia. Combined training (CT) ranked first in CST (76.5%) and TUGT (75.2%), suggesting it is the most effective exercise intervention subtype for improving muscle function. Resistance training (RT) ranked first in KES (99.3%) and also performed well on TUGT and HGS. Our network meta-analysis revealed that certain exercise intervention subtypes are more effective for specific muscle-related outcomes. WBHV, CT and RT are the most promising exercise intervention subtypes for managing sarcopenia, with WBHV providing the most comprehensive improvement in sarcopenia, CT the best improvement in muscle function, and RT the most common exercise intervention subtype for sarcopenia, which remains quite effective in enhancing muscle strength and function. Our meta-analysis provides a valuable reference and guidance for clinicians, researchers and policy makers, but it is limited by the heterogeneity and quality of the included RCTs.

To compare the effects of different rehabilitation therapies on the scores of Fugl-Meyer assessment of motor recovery (FMA), the action research arm test (ARAT), and modified Barthel index in hemiplegic patients with stroke by a network meta-analysis. We searched Embase, PubMed, Web of Science, and Cochrane Library from their inception until April 1, 2024 for randomized controlled trials (RCTs) on the effects of rehabilitation therapies on upper extremity motor function and activities of daily living in hemiplegic patients with stroke. Data analyses were conducted using R software. Seventeen RCTs were included, involving 901 patients and 10 rehabilitation therapies. The network meta-analysis revealed that mirror therapy (mean difference [MD] = 4.94, 95% confidence interval [CI]: 4.3-5.59, P < .05), neuromuscular electrical stimulation (NMES) + robotic therapy (RT) (MD = 7.1, 95% CI: 3.15-11.10, P < .05), RT (MD = 4.7, 95% CI: 0.98-8.41, P < .05), and transcranial direct current stimulation (MD = -4.92, 95% CI: -6.12 to -3.72, P < .05) outperformed conventional therapies in the improvement of FMA. NMES + RT (MD = 4.6, 95% CI: 0.42-8.76, P < .05) and repetitive facilitative exercise (RFE) + botulinum toxin type A (BoNT-A) (MD = 8, 95% CI: 4.43-11.52, P < .05) outperformed conventional therapies in the improvement of ARAT. Action observation (AO) (MD = 6, 95% CI: 0.11-11.85, P < .05) was superior to conventional therapies in the improvement of activities of daily living. RFE + BoNT-A had the highest surface under the cumulative ranking curve value for FMA improvement and ARAT improvement. The surface under the cumulative ranking curve value for modified Barthel index improvement was the highest for AO. RFE + BoNT-A and AO exhibit advantages in improving upper extremity motor function and AO, respectively. Due to some limitations in this study, more high-quality RCTs are still required to validate our findings.

To compare clinical outcomes and complications between sensor-assisted and manual balancing techniques in total knee arthroplasty, focusing on randomized controlled trials (RCTs). A systematic search of the Cochrane Library, Medline, Embase, Scopus, and Web of Science databases was conducted through February 22, 2024. RCTs comparing sensor-guided and manual balancing methods in primary TKA were included. Outcomes assessed include patient reported outcome measures, range of motion, and total complications. Data from four RCTs (667 knees: 334 sensor-guided, 333 manual) were extracted and analyzed using RevMan V.5.4 with random- and fixed-effects models. The meta-analysis revealed no significant improvement in functional scores for sensor-guided balancing compared to manual techniques (SMD 0.10; 95% CI - 0.15-0.34; I2 = 57%). No significant differences were observed in complication rates (OR 0.84; 95% CI 0.46-1.54; I2 = 0%) or postoperative range of motion (MD 1.20; 95% CI - 0.26-2.65; I2 = 0%). Sensor-guided balancing did not significantly enhance functional outcomes, reduce complication rates, or improve range of motion compared to manual techniques. While the clinical impact of intraoperative sensors remains limited, they hold promise as training tools to standardize soft tissue balancing. Further high-quality, long-term studies are required to explore their potential benefits and establish definitive guidelines for TKA procedures.

This study aimed to systematically evaluate the clinical efficacy of virtual reality (VR) technology in patients with chronic low back pain (CLBP), focusing on its effects on pain, disability, kinesiophobia, and inflammatory markers. A systematic search was conducted in 6 Chinese and English databases (PubMed, Web of Science, Cochrane Central, Embase, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure) to identify randomized controlled trials (RCTs) published before January 2025 that compared VR interventions with conventional treatments for CLBP. Meta-analysis was performed using RevMan 5.4 and Stata software. Primary outcomes included Visual Analog Scale (VAS), Numeric Rating Scale, Oswestry Disability Index, Tampa Scale for Kinesiophobia, and biomarkers such as C-reactive protein, adrenocorticotropic hormone, and the cross-sectional area of the multifidus muscle. Heterogeneity analysis, subgroup analysis, sensitivity analysis, and publication bias assessment were also conducted. A total of 15 RCTs involving 711 patients were included. Meta-analysis revealed that VR intervention significantly reduced VAS (MD = -1.69, 95% confidence intervals [CI]: -2.47 to -0.88, P < .0001), Numeric Rating Scale (MD = -0.91, 95% CI: -0.97 to -0.85, P < .00001), Oswestry Disability Index (MD = -5.92, 95% CI: -7.97 to -3.86, P < .00001), and Tampa Scale for Kinesiophobia scores (MD = -9.04, 95% CI: -14.08 to -4.00, P = .0004) compared with control groups. VR also significantly decreased C-reactive protein and adrenocorticotropic hormone levels and improved the cross-sectional area of the multifidus muscle. Subgroup analysis indicated that short-term, high-frequency, and immersive VR interventions were more effective. Moderate to high heterogeneity was observed in some outcomes, and potential publication bias was noted for VAS scores. VR interventions demonstrate positive clinical value in the treatment of CLBP by effectively alleviating pain, improving function, and reducing fear of movement, with favorable safety and feasibility. Future high-quality RCTs with long-term follow-up are warranted to explore standardized and personalized intervention protocols to further enhance clinical application and dissemination.

Immunomodulation and respiratory health have a critical role in the offspring well-being. Maternal status of vitamin D during pregnancy seems to have immunomodulatory and respiratory protective effects in children. However, evidence regarding respiratory and allergy-related outcomes remains conflicting. Therefore, this study aimed to synthesize the available data in this regard to provide a firm direction. Comprehensive searches were made in the databases of PubMed, Scopus, the Web of Science, and the Cochrane Library until August 2025. We included randomized controlled trials (RCTs) to evaluate the effects of maternal intake of vitamin D during pregnancy on outcomes in children with respiratory and allergy conditions. Also, the quality of evidence was evaluated using GRADE method and the Cochrane risk-of-bias tool was used to evaluate study quality. Seven RCTs were included. Prenatal supplementation of vitamin D did not affect respiratory outcomes in the children who followed: RTI (RR: 1.04; 95% CI: 0.99, 1.09; P = 0.122, I2 = 0.0%), asthma (RR: 0.94; 95% CI: 0.67, 1.31; P = 0.701, I2 = 64.9%), and wheezing (RR: 0.82; 95% CI: 0.62, 1.09; P = 0.176, I2 = 0.0%). Similarly, vitamin D supplementation in pregnant women was associated with non-significant effects on eczema (RR: 0.95; 95% CI: 0.83, 1.10; P = 0.524, I2 = 0.0%), allergic condition (RR: 0.95; 95% CI: 0.85, 1.06; P = 0.324, I2 = 0.0%), and immunoglobulin E (IgE) (RR: 0.94; 95% CI: 0.73, 1.21; P = 0.639, I2 = 52.6%) in children. Overall, the vitamin D supplementation during pregnancy has no significant effect on respiratory and allergy-related outcomes in children.

Percutaneous kidney biopsy is a key diagnostic tool in nephrology but carries a risk of post-procedure bleeding, with complications ranging from minor hematomas to life-threatening hemorrhages. Desmopressin (DDAVP), a synthetic vasopressin analogue, has been used as a prophylactic agent to reduce the risk of bleeding. This systematic review and meta-analysis aims to resolve uncertainties by evaluating efficacy and safety outcomes in diverse cohorts, informing evidence-based practice for desmopressin use in native renal biopsy care. A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov, covering all records up to May 2025 for randomized controlled trials that compared Desmopressin with placebo before native kidney biopsy. The primary outcome was bleeding events following kidney biopsy, with secondary outcomes focusing on adverse effects associated with Desmopressin use. A total of five randomized controlled trials (RCTs), including 717 patients undergoing native renal biopsy, were included in our study. The study found that desmopressin was significantly effective than placebo in reducing total bleeding events in 157 participants (RR 0.51, 95% CI [0.31, 0.83], P = 0.008). However, there was substantial heterogeneity, with no significant improvement in hematoma formation or blood transfusion needs. The safety parameters, including flushing incidence, systolic and diastolic blood pressure, and hemoglobin, were not significantly different between the desmopressin and placebo groups. The point estimates for the endpoints were generally consistent with no clinically significant difference between treatments. Evidence available suggests that while desmopressin reduces the cumulative incidence of bleeding after native renal biopsy, its negligible effect on clinically significant complications does not support its routine use in this setting. It did not affect clinically important endpoints such as hematoma formation or need for transfusion, and no difference in safety between the two groups was noted. It is concluded that there is no existing evidence to support the routine premedication with desmopressin before native renal biopsy, but in certain high-risk cases, its use may be contemplated until further research is pending. Further, adequately powered randomized trials are required to establish a definitive therapeutic benefit.

In the absence of long-term research with respect to the impact of a ketogenic diet (KD) on liver disease progression, further investigation into the screening for liver enzymes is useful in attempting to elucidate whether a KD may result in positive or negative effects. The goal of this study was to thoroughly examine how a KD affects liver health. The PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase databases were searched to find pertinent randomized controlled trials (RCTs). This systematic review featured 20 RCTs investigating the impact of a KD on liver enzymes and liver stiffness. A random-effects model analysis was undertaken, yielding pooled weighted mean differences and 95% CIs. A quantitative meta-analysis showed that a KD has a significant lowering effect on levels of aspartate aminotransferase (AST) [weighted mean difference (WMD): -3.56 U/L; 95% CI: -6.61, -0.51], alanine aminotransferase (ALT) (WMD: -3.03 U/L; 95% CI: -5.26, -0.81), gamma-glutamyl transferase (GGT) (WMD: -12.25 U/L; 95% CI: -22.08, -2.42), and alkaline phosphatase (ALP) (WMD: -5.29 U/L; 95% CI: -9.85 to -0.74). However, the findings obtained from the meta-analysis showed that a KD has no significant effect on liver fibrosis (liver stiffness) (WMD: 0.40; 95% CI: -0.23, 1.04). The findings also showed that a KD followed for a duration of less than 12 weeks caused greater reductions in liver enzymes, including AST, ALT, and GGT, in people with a BMI of less than 30. In general, KDs can reduce traditional liver enzyme levels (ALT, AST, ALP, and GGT), but they appear to have no significant effect on liver stiffness.

A comparison between mandibular overdentures retained by a single midline implant and by two implants: A systematic review.

The management of glenohumeral osteoarthritis (GHOA) is challenging, particularly in patients who are not eligible for surgery. In recent years, several injectable therapies, including hyaluronic acid (HA), corticosteroids (CCs), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs), have emerged as potential options for managing pain and improving joint function. This systematic review aims to summarise the current evidence on infiltrative strategies to manage GHOA in adults. This review followed the PRISMA 2020 guidelines. PubMed, Web of Science, and Embase were systematically searched in May 2025. All clinical studies investigating infiltrative strategies to manage shoulder arthritis in adults were considered for inclusion. Only studies with a minimum follow-up of six months were included. The methodological quality of the included studies was assessed using the Cochrane RoB2 tool for randomised controlled trials (RCTs) and the ROBINS-I tool for non-randomised studies. Data from 1125 patients (1126 shoulders) were analysed. The mean age of the patients was 63.4 ± 5.8years, and 34.1% (384 of 1125 patients) were women. The most commonly studied intra-articular treatments included HA and CCs. The rate of surgery for persistent symptoms or functional impairment was 3.2% (35 of 1079 reported procedures). The overall rate of complications was 7.2% (56 of 780 reported procedures). Infiltrative management can provide symptomatic relief in adults with GHOA. Current evidence supports the potential role of different injectable therapies, with hyaluronic acid demonstrating consistent, though modest, benefits. In contrast, the evidence for orthobiologics remains limited, mainly because of heterogeneity in study design, outcome measures, and patient characteristics. High-quality comparative trials with long-term follow-up are required to establish optimal treatment strategies and to identify patient subgroups most likely to benefit from specific interventions.

Efficacy, all-cause discontinuation, and safety of serotonergic psychedelics and MDMA to treat mental disorders: A living systematic review with meta-analysis.

Chronic subdural haematoma (CSDH) is a common neurosurgical condition with an increasing incidence due to an aging population. Given the expanding research landscape, assessing the state of recent trials is essential. This systematic review updates a previous review, which included randomised controlled trials (RCTs) up to 2019, by summarizing recently published and ongoing RCTs in CSDH, highlighting key areas of investigation and identifying directions for future research. Clinical trial registries - including the Cochrane Controlled Register of Trials, WHO ICTRP, clinicaltrials.gov, and Clinical Trials Information System - were systematically searched for RCTs on CSDH from June 1, 2019, to February 18, 2025. Both published and ongoing trials were included in this review. This review identified 41 recently published RCTs and 54 ongoing RCTs, compared to 26 ongoing trials in 2019. Of the earlier review, eleven studies have been published, five remain active, and the remainder were either abandoned or did not adhere to their initial RCT design. Middle meningeal artery embolisation (MMAE) has become the most extensively studied intervention, with active trials increasing from 2 in 2019 to 21 in 2025. Trials investigating perioperative management (3 versus 7) and surgical techniques (5 versus 10) have also increased. In contrast, corticosteroid trials have decreased (7 versus 3), likely reflecting findings from recent high-impact studies. Research on tranexamic acid has increased (5 versus 7) as have studies on other pharmacological agents (4 versus 8). The number of ongoing RCTs in CSDH has increased substantially, with a notable shift in research focus. MMAE now dominates the field, though the surge in studies may suggest research saturation. Future investigations may benefit from more collaborative efforts, consolidating resources into fewer, but larger and adequately powered trials.