ROBIS Tool Research Articles

Efficacy and safety of platelet-rich fibrin combined with diced cartilage in rhinoplasty: a systematic review and meta-analysis.

The purpose of this study was to evaluate the efficacy and safety of combining platelet-rich fibrin (PRF) with diced cartilage (DC) in patients undergoing rhinoplasty. A systematic search of MEDLINE/PubMed, Cochrane Library, Web of Science, and Scopus was conducted, including studies published through August 9, 2024. We included observational studies and clinical trials of rhinoplasty using the DC technique with PRF. Primary outcomes were cartilage resorption, nasal dorsum/tip irregularity, and patient satisfaction. Secondary outcomes included postoperative complications such as edema, hematoma, infection, erythema, displacement, and extrusion. Risk of bias (ROB) was assessed using the ROB2 tool for randomized trials and the MINORS checklist for observational studies. Seven studies with 286 participants were included. Results showed minimal cartilage resorption in five studies. The pooled incidences of nasal dorsum/tip irregularity, erythema, and displacement were 0.43% [95% CI: 0.00-1.95%], 1.63% [95% CI: 0.00-4.99%], and 0.63% [95% CI: 0.00-2.22%], respectively. Patient satisfaction was high, with a pooled rate of 94.33% [95% CI: 89.28-99.38%]. The addition of PRF to DC in rhinoplasty was associated with favorable postoperative outcomes and high patient satisfaction, with a low incidence of complications. However, the lack of comparative studies makes it difficult to determine whether PRF provides significant benefits over DC alone. Larger randomized controlled trials with longer follow-up are needed to further validate these findings.

The effect of fruits and vegetables on children's mental and cognitive health: A systematic review of intervention studies and perspective for future research.

ObjectiveTo synthesize evidence from fruit and vegetable intervention studies investigating mental and/or cognitive health outcomes in children ≤10 years. Our aim was to understand the efficacy of such interventions in improving measures of cognitive performance or mental health, and to identify successful intervention elements to inform future research. Research MethodsWe conducted a systematic search of Cochrane, Embase, PubMed, and CINAHL databases for articles published before August 2022 (PROSPERO registration: CRD42022356571). A narrative synthesis was conducted according to SWiM (Synthesis without Meta-Analysis) guidelines. ResultsFrom 4686 articles identified, only 7 of the 17 full texts screened were included in the final review. No studies investigated the efficacy of interventions using ‘whole’ fruits or vegetables. Six studies examined the effects of blueberries using drinks made from fresh (1 cup) or freeze-dried (30g) blueberries, and one study evaluated a mulberry powder-based drink. Sample sizes ranged from 14-54, and most studies were acute interventions with outcomes measured in a 2–3-hour window (n=6). Through a narrative synthesis of direction of responses, measures of executive function appeared sensitive to intervention effects in both acute and longer-term settings. Some concerns with risk of bias were evident according to the ROB2 tool, related to incomplete reporting of methodological aspects. ConclusionsThe studies identified through this systematic review could not directly address the planned research question, resulting in a poor certainty of evidence. Future research with whole fruit and vegetable interventions could better inform population health strategies for improved mental and cognitive health outcomes in children.

Optimal dose and type of exercise improve walking velocity in adults with Parkinson’s disease: a systematic review and Bayesian network meta-analysis

To examine the dose–response relationship between specific types of exercise for improving walking velocity in Parkinson’s disease (PD). This systematic review and network meta-analysis included searches of PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 18th, 2024. Data analysis was performed using R software with the MBNMA and RJAGS packages. Outcome indicators were measured as mean standard deviation (SMD) along with 95% confidence intervals (95% CrI). The network’s risk of bias was independently evaluated by two reviewers employing the ROB2 tool. Our review encompassed 54 studies with 2,828 PD patients, examining the dose–response effects of different exercises on walking velocity. Aerobic Exercise (AE) demonstrated the greatest improvement at an optimal dose of 1,400 METs-min/week (SMD:1.215, 95% Crl: 0.113 to 2.306). Both Multicomponent Exercise (Mul) (SMD: 1.202, 95% Crl: 0.193 to 2.231) and Sensory Exercise (SE) (SMD: 0.649, 95% Crl: 0.139 to 1.183) showed optimal outcomes at a dose of 1,000 METs-min/week. Resistance Training (RT) was most effective at 750 METs-min/week (SMD:0.778, 95% Crl: 0.062 to 1.549), while Mind–Body Exercise (MBE) yielded significant improvements at a lower optimal dose of 500 METs-min/week (SMD: 0.580, 95% Crl: 0.218 to 1.137), offering valuable insights for exercise prescription in PD management. Various types of exercise showed specific optimal benefits at corresponding doses, among which AE was the most effective in improving the walking speed of PD patients at 1,400 Mets*min/week.Trial registration: PROSPERO (CRD42024506919).

Neuroendoscopic surgery versus craniotomy for basal ganglia hemorrhage: a systematic review and meta-analysis of randomized controlled trials.

Basal ganglia hemorrhage (BGH) is a prevalent site for intracerebral hemorrhage. Although neuroendoscopy (NE) surgery has emerged as a less invasive alternative to craniotomy (CT), the optimal surgical method remains debatable. This systematic review and meta-analysis aimed to compare the efficacy and safety of NE versus CT in the management of BGH. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to identify eligible randomized controlled trials (RCTs) comparing NE surgery with CT in BGH patients. Outcomes included mortality, hematoma evacuation rate, good functional outcome (GFO), operative time, infection, pulmonary infection, and postoperative complication. Risk of bias was assessed with Cochrane's ROB-2 tool. Four RCTs were included, comprising 423 patients. NE surgery showed no significant benefit in mortality (p = 0.12) and GFO (p = 0.18). However, NE was associated with a higher hematoma evacuation rate (p = 0.007), shorter operative time (p < 0.00001), and lower rates of infection (p < 0.0001), pulmonary infection (p < 0.0001), and postoperative complications (p < 0.00001). Future research should be designed to assess whether hematoma evacuation using either technique improves outcomes in comparison to optimal medical management in this population.

Efficacy of N-Acetylcysteine in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age and requires better treatment. N-acetylcysteine (NAC) is known to be beneficial under such conditions owing to its antioxidant potential and insulin-sensitizing properties. The effect of NAC on the reproductive outcomes of PCOS patients was examined in this meta-analysis. In accordance with PRISMA standards, this meta-analysis included studies that compared N-acetylcysteine, metformin, clomiphene citrate, and a placebo in patients with POCS. The main indicators were follicular growth, endometrial thickness, and hormone level. The risk of bias was evaluated using the Cochrane ROB2 tool. Twenty-two studies (n = 2515) were included. NAC was associated with a statistically significant increase in progesterone (SMD 0.95, 95% CI: 0.13-1.77, p = 0.02) and endometrial thickness (SMD 0.58, 95% CI: 0.10-1.06, p = 0.02) compared to the placebo and other drugs (SMD 0.71, 95% CI: 0.48-0.94, p < 0.0001). LH levels were significantly increased by NAC compared to metformin (SMD 0.67, 95% CI: 0.23-1.12, p = 0.003). However, no significant differences were observed in the estradiol, SHBG, or FSH levels. NAC had a major effect on progesterone, endometrial thickness, and LH levels in women with PCOS. Therefore, it may be a potential treatment option.

Efficacy and safety of non-pharmacological, pharmacological and surgical treatments for hand osteoarthritis in 2024: a systematic review

BackgroundWe aimed to update the 2018 systematic literature review on the efficacy and safety of treatments for hand osteoarthritis (OA), which was based on 126 studies.MethodsWe performed a systematic literature...

Efficacy of melatonin on drug- or contrast-induced acute kidney injury: a systematic review and GRADE-assessed meta-analysis of experimental and clinical studies.

The objective of this systematic review and meta-analysis was to assess the efficacy of melatonin in drug- or contrast-induced AKI in preclinical and clinical studies. PubMed, Embase, Scopus, Web of Science (WOS), the Cochrane Database of Systematic Reviews (CDSR), and clinical trials.GOV from the beginning until August 1, 2024. On the basis of the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, the number of patients with and without AKI, and the means and SDs of the serum creatinine and BUN levels were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, standardized mean differences, risk ratios and risk differences. I2 and chi-square tests were used to assess heterogeneity between studies. Funnel plots, Egger tests and the trim-and-fill method were used to evaluate small study effects (publication bias). The risk of bias of the included clinical and preclinical studies was assessed via the Cochrane ROB tool and SYRCLE tool, respectively. The credibility of the results was evaluated via GRADE. Sensitivity analysis was performed via the one-out removal method. We identified 1,696 nonduplicate records, of which the full texts of 159 articles were examined. Twenty-nine animal experimental studies and 5 clinical trials met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that melatonin was significantly effective at reducing the serum creatinine level (standardized mean difference: -3.04; 95% CI -3.904 to -2.183, with 95% prediction interval: -7.201 to 1.163) and the BUN level (standardized mean difference: -3.464; 95% CI -4.378 to -2.549, with 95% prediction interval: -7.839 to 0.911) in drug-induced AKI animal studies. Melatonin did not have a significant effect on the serum creatinine level (standardized mean difference: -2.67; 95% CI -9.69 to -4.35, with 95% prediction interval: -42.618 to 37.278) or the BUN level (standardized mean difference: -1.77; 95% CI -5.533 to -1.994, with 95% prediction interval: -22.943 to 19.404) in contrast-induced AKI animal studies. Furthermore, in clinical studies, melatonin had no significant effect on reducing the serum creatinine level (standardized mean difference: 0.183; 95% CI -1.309 to 1.675, with 95% prediction interval: -7.975 to 8.340), BUN level (standardized mean difference: 0.206; 95% CI -0.0871 to 1.283, with 95% prediction interval: -5.115 to 5.528) or risk of AKI incidence (risk ratio: 0.877; 95% CI 0.46 to 1.64, with 95% prediction interval: -0.238 to 3.174; risk difference: -0.06mg/dl; 95% CI -0.259 to 0.40mg/dl, with 95% prediction interval: -0.467 to 0.348). There were no significant publication biases, and after sensitivity analysis, no considerable changes were observed, indicating the robustness of the results. This meta-analysis indicates that melatonin may protect against drug-induced AKI in animal models but is not effective in clinical studies and that melatonin has no significant effect on contrast-induced AKI. Owing to the inconclusive results in clinical trials and very low certainty of evidence, further research with higher methodological quality is needed to reach a more certain conclusion.

Feasibility and Effectiveness of Vaccines for COVID-19: An Umbrella Review.

In January 2020, WHO declared the 2019 Coronavirus Disease (COVID-19) a pandemic. Though COVID-19 vaccines are recommended, ongoing surveillance is crucial due to potential unforeseen events. Evaluation of long-term effectiveness and safety and addressing emerging variants are vital. This study integrates systematic reviews to assess COVID-19 vaccine efficacy, immunogenicity, and safety comprehensively. This study was an umbrella review study on the feasibility and effectiveness of vaccines for COVID-19. We conducted a comprehensive search in PubMed, Web of Sciences, and Scopus, using MeSH terms and keywords related to COVID-19 vaccines. Inclusion criteria comprised peer-reviewed systematic reviews and meta-analyses in English, focusing on feasibility and effectiveness. Exclusion criteria targeted non-systematic reviews exclusively on vaccine safety and duplicates. Two independent reviewers screened and resolved discrepancies. Data extraction included key details. Methodological quality was assessed using the ROBIS tool. Data synthesis involves narrative and, if applicable, quantitative synthesis (meta-analysis). Reporting followed PRISMA guidelines. A total of 32 systematic reviews were included in the study, of which 20 also conducted a meta-analysis. The studies investigated in the included reviews ranged from 7 to 74. The included articles were conducted in various countries around the globe. The findings indicated that COVID-19 vaccines are generally safe and effective for individuals with various medical conditions. The overall risk of bias for the included studies was assessed as low risk. The study outcomes indicated that mRNA vaccines exhibit a higher incidence of adverse events but demonstrate greater efficacy. Conversely, inactivated and protein subunit vaccines are safer but exhibit lower efficiency. Moreover, the vaccine is considered safe for individuals with specific conditions such as inflammatory bowel disease, solid organ transplant recipients, children, pregnant individuals, and those with hematologic problems. Ultimately, the acceptance of the COVID-19 vaccine among individuals is influenced by various factors, including geographic, socioeconomic, and pandemic-related considerations.

The Use of Omics in Untangling the Effect of Lifestyle Factors in Pregnancy and Gestational Diabetes: A Systematic Review.

To synthesise the evidence from clinical trials and observational studies using omics techniques to investigate the impact of diet and lifestyle factors on metabolite profile in pregnancy, and in the prevention and management of gestational diabetes mellitus (GDM). A systematic literature search was performed using PubMed, Ovid, CINAHL, and Web of Science databases in October 2023 and updated in September 2024. Inclusion criteria were randomised controlled trials (RCT) or non-RCTs in pregnant women with or without GDM, that measured diet and lifestyle factors, and which applied post-transcriptional omics approaches. Risk of bias was assessed using the ROBINS-I for non-RCTs and ROB-2 tool for RCTs. The results of all studies are narratively synthesised. Of 6293 studies identified, eight observational studies and three RCTs comprising 2639 pregnant women were included. Three studies reported on changes in diet-related metabolic phenotypes during pregnancy; however, the impact of certain foods on the metabolome and risk for GDM was less clear. Compared with women without GDM, women with GDM had a worse deterioration in metabolites, including saturated fatty acids, branched chain amino acids and purine degradation metabolites. There is limited evidence that conventional dietary treatment for GDM may modify the metabolome in women with GDM. Metabolome profiles in pregnancy may be altered by certain dietary choices; however, it is inconclusive whether improved diet related metabolite profiles have a beneficial impact in the prevention or management of GDM. High quality studies with larger sample sizes are needed to better understand the role that maternal nutrition plays in modulating the maternal metabolome, not only for a healthy pregnancy but also for the prevention and management of GDM.

Efficacy of melatonin for treatment and prevention ofneonatal necrotizing enterocolitis: a systematic review.

The purpose of this study was to systematically review the available literature evaluating the use of melatonin for preventing and treating neonatal necrotizing enterocolitis (NEC). A systematic review of studies examining the effect of melatonin on neonatal NEC was conducted. The databases of Medline, Scopus, WOS, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant studies. For risk of bias and applicability, The ROB2 tool was used for randomized controlled trials, and the ROBINS-I tool was used for non-randomized controlled trials. Three studies, comprising 106 preterm neonates, were included in the review, whose mean gestational ages ranged from 31.8 to 33.53weeks. Melatonin doses varied among the studies. A randomized, double-blind, placebo-controlled study revealed that early administration of melatonin in preterm newborns resulted in a decrease in lipid peroxidation during the initial days of life. Two studies evaluated the role of melatonin in NEC. Both reported significant clinical and laboratory improvements in the melatonin groups, including reduced abdominal distension, metabolic acidosis, thrombocytopenia, hyponatremia, and lower mortality rates compared to control groups. This systematic review suggests that melatonin may be a potential therapeutic approach for NEC in preterm infants. However, further RCTS are needed to establish its therapeutic or preventive role.

Histone Deacetylase Inhibitors as a Promising Treatment Against Myocardial Infarction: A Systematic Review.

Background/Objectives: Acute myocardial infarction (AMI) is a critical medical condition that requires immediate attention to minimise heart damage and improve survival rates. Early identification and prompt treatment are essential to save the patient's life. Currently, the treatment strategy focuses on restoring blood flow to the myocardium as quickly as possible. However, reperfusion activates several cellular cascades that contribute to organ dysfunction, resulting in the ischaemia/reperfusion (I/R) injury. The search for treatments against AMI and I/R injury is urgent due to the shortage of effective treatments at present. In this regard, histone deacetylase (HDAC) inhibitors emerge as a promising treatment against myocardial infarction. The objective of this systematic review is to analyse the effects of HDAC inhibitors on ventricular function, cardiac remodelling and infarct size, among other parameters, focusing on the signalling pathways that may mediate these cardiovascular effects and protect against AMI. Methods: Original experimental studies examining the effects of HDAC inhibitors on AMI were included in the review using the PubMed and Scopus databases. Non-experimental papers were excluded. The SYRCLE RoB tool was used to assess risk of bias and the results were summarised in a table and presented in sections according to the type of HDAC inhibitor used. Results: A total of 18 studies were included, 10 of them using trichostatin A (TSA) as an HDAC inhibitor and concluding that the treatment improved ventricular function, reduced infarct size, and inhibited myocardial hypertrophy and remodelling after AMI. Other HDAC inhibitors, such as suberoylanilide hydroxamic acid (SAHA), valproic acid (VPA), mocetinostat, givinostat, entinostat, apicidin, and RGFP966, were also analysed, showing antioxidant and anti-inflammatory effects, an improvement in cardiac function and remodelling, and a decrease in apoptosis, among other effects. Conclusions: HDAC inhibitors constitute a significant promise for the treatment of AMI due to their diverse cardioprotective effects. However, high risk of selection, performance, and detection bias in the in vivo studies means that their application in the clinical setting is still a long way off and more research is needed to better understand their benefits and possible side effects.

Efficacy and acceptability of pharmacological interventions for tardive dyskinesia in people with schizophrenia or mood disorders: a systematic review and network meta-analysis.

Tardive Dyskinesia (TD) can occur in people exposed to dopamine receptor antagonists (DRAs). Its clinical management remains challenging. We conducted a systematic review/random-effects network meta-analysis (NMA) searching PubMed/MEDLINE/PsycINFO/ClinicalTrials.gov/Cochrane Central Register (22/05/2023, pre-defined protocol https://osf.io/b52ae/ ), for randomized controlled trials (RCTs) of pharmacological/brain stimulation interventions for DRA-induced TD in adults with schizophrenia or mood disorders. Primary outcomes were TD symptom change (standardized mean difference/SMD) and all-cause discontinuation (acceptability-risk ratio/RR). Sensitivity analyses were conducted. Global, local inconsistencies, risk of bias (RoB-2 tool), and confidence in evidence (CINeMA) were measured. We included 46 trials (n = 2844, age = 52.89 ± 9.94 years, males = 59.8%, schizophrenia = 84.6%, mood disorders = 15.4%), all testing pharmacological interventions versus placebo. We identified three subnetworks. In network 1, several treatments outperformed placebo on TD symptoms with large effect sizes (k = 34, n = 2269), encompassing 22 interventions versus placebo, but 18 had 1 RCTs only, and 15 had n ≤ 20. High heterogeneity (I2 = 57.1%; tau2 = 0.0797), and global inconsistency (Q = 32.64; df = 14; p = 0.0032) emerged. No significant differences emerged in acceptability. When restricting analyses to treatments with trials with n > 20 and >1 RCT, only valbenazine (k = 5, SMD = -0.69; 95% CI = -1.00, -0.37) and vitamin E (k = 7, SMD = -0.49; 95% CI = -0.87, -0.11) were superior to placebo. Deutetrabenazine outperformed placebo considering AIMS score and in low risk of bias trials only and with a moderate effect size for 24/36 mg (k = 2, SMD = -0.57/-0.60). Confidence in findings was low for deutetrabenazine and valbenazine, very low for all others. In network 2 (k = 2, n = 63), switch to molindone (k = 1, n = 9) versus switch to haloperidol worsened TD (SMD = 1.68; 95% CI = 0.61,2.76). In network 3 (k = 3, n = 194), antipsychotic wash-out+placebo (k = 1, n = 25) versus TAU+placebo (k = 1, n = 27) worsened TD (SMD = 1.30; 95% CI = 0.36,2.23). Despite large effect sizes for some treatmentswith very low quality/confidence, when considering higher quality evidenceonly valbenazine or deutetrabenazine are evidence-basedfirst-line treatments for TD, and potentially vitamin E as second-line. Switching to molindone and antipsychotic washout should be avoided. More treatment options and higher-quality trials are needed.

Comparison of safety and efficacy of femoropopliteal arterial disease using different dose drug-coated balloons: Systematic review and meta-analysis.

Endovascular therapy with balloon percutaneous angioplasty (PTA) in the femoro-popliteal segment is frequently performed, however, long-term favorable outcomes and patency remain challenging, with restenosis rates reaching 60% post-standard balloon angioplasty. Drug-coated balloons (DCBs) have shown promise in improving these outcomes; Paclitaxel, used in DCBs, inhibits hyperplasia and smooth muscle cell proliferation, reducing restenosis; however, the optimal dose of Paclitaxel remains unclear, with high-dose (HD-DCB [>3mg/mm2]) and low-dose (LD-DCB [<2.0mg/mm2]) options available. This meta-analysis aims to compare the efficacy and safety of HD-DCB and LD-DCB in treating femoropopliteal arterial disease. We followed PRISMA guidelines and conducted a comprehensive search of PubMed, EMBASE, Cochrane, Scopus, and Mendeley up to May 27, 2024. We included randomized controlled trials and cohort studies comparing HD-DCB and LD-DCB in patients with femoropopliteal arterial disease. Data were extracted on baseline characteristics, outcomes, and study quality. The Newcastle-Ottawa Scale and ROB2 tool were used for bias assessment. Outcomes included overall survival (OS), limb salvage (LS), freedom from clinically driven target lesion revascularization (CD-TLR), and major amputation. Six studies comprising 2563 patients were included. HD-DCB showed a significant benefit in limb salvage at 6 months (RR = 0.38, 95% CI = 0.18-0.78, p = .009) but not at 12 months (RR = 3.08, 95% CI = 0.14-67.13, p = .47). No significant difference was observed in overall survival between HD-DCB and LD-DCB at either 6 months (RR = 1.53, 95% CI = 0.25-9.57, p = .65) or 12 months (RR = 1.21, 95% CI = 0.17-8.84, p = .85). HD-DCB was associated with an increased risk of perioperative complications (RR = 1.90, 95% CI = 1.14-3.17, p = .01) and a higher, though not statistically significant, risk of major amputation (RR = 4.73, 95% CI = 0.54-41.52, p = .16). HD-DCB may offer advantages in limb salvage over LD-DCB in the short term, but this comes with an increased risk of perioperative complications. These findings underscore the need for careful patient selection when considering HD-DCB for femoropopliteal artery disease.

Safety and efficacy of Dexmedetomidine in preoperative and postoperative settings during transsphenoidal resection of pituitary Adenoma: A systematic review and meta-analysis of randomized controlled trials

Background Pituitary adenoma, a benign tumor of the pituitary gland, represents 10-15% of intracranial tumors. Although non-cancerous, its size and location can cause significant health issues, including hormonal imbalances and compression of nearby structures like the optic chiasm, leading to conditions such as Cushing’s disease, acromegaly, and visual disturbances. The prevalence ranges from 46 to 95 per 100,000 individuals. This study evaluates the effectiveness and safety of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenomas. Methods A systematic review and meta-analysis following PRISMA guidelines included 10 RCTs with 633 patients. English-language RCTs were sourced from PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library. Risk of bias was assessed using the ROB2 tool, and statistical analyses were performed using RevMan 5.3. Results Dexmedetomidine significantly reduced heart rate after intubation (MD: -6.61 bpm, 95% CI: -8.98 to -4.24, p &lt; 0.00001) and post-extubation (MD: -6.77 bpm, 95% CI: -8.59 to -4.96, p &lt; 0.00001). Mean arterial pressure decreased after intubation (MD: -10.49 mmHg, 95% CI: -12.73 to -8.26, p &lt; 0.00001) and post-extubation (MD: -12.97 mmHg, 95% CI: -14.37 to -11.57, p &lt; 0.00001). Dexmedetomidine also reduced surgical duration (SMD: -0.23, 95% CI: -0.41 to -0.05, p = 0.01), blood loss (MD: -109.49 mL, 95% CI: -152.60 to -66.38, p &lt; 0.00001), propofol dose (SMD: -1.04, 95% CI: -1.72 to -0.37, p = 0.002), extubation time (SMD: -0.70, 95% CI: -0.93 to -0.47, p &lt; 0.00001), and postoperative nausea and vomiting (OR: 0.45, 95% CI: 0.25 to 0.80, p = 0.007). Conclusions Dexmedetomidine enhances perioperative outcomes in transsphenoidal resection of pituitary adenomas, supporting its use as an effective anesthetic adjunct.

Plaque cleaning efficacy of waist-shaped interdental brushes among individuals with open interproximal spaces: a systematic review.

The shape and design of interdental brushes are crucial for appropriate adaptation to the interproximal areas, despite their excellent cleaning efficacy. The aim of this review is to assess and compare the available data on the plaque cleaning efficacy of waist-shaped interdental brushes with any other shaped-interdental brushes among patients with wide interdental spaces. Scopus, PubMed, Cochrane, Science Direct, EBSCO Host, Lilacs, Science Direct, Web of Science, and Google Scholar were searched from the earliest available year (2011) till May 15, 2024. PICO Strategy: P: Individuals with open interproximal spaces; I: Waist-shaped interdental brushes; C: Any other shaped interdental brushes; O: Interproximal plaque cleaning efficacy. The review only comprised randomized controlled trials. The risk of bias assessment and quality of evidence was assessed using the RoB-2 Tool and GRADE Tool respectively. Three full-text publications that met the requirements for eligibility underwent additional processing for data extraction. The overall results of the review suggest that the plaque cleaning efficacy of waist-shaped interdental brushes is better than straight/cylindrical-shaped interdental brushes in patients with open interdental spaces; especially on the buccal and lingual line angles. However, the pooling of data was not possible due to the high heterogeneity between the studies. The current review suggests that the plaque cleaning efficacy of waist-shaped interdental brushes could be better than straight or cylindrical shaped-interdental brushes in patients with open interproximal spaces, especially in buccal and lingual line angles. However, further research should focus on appropriate methodological techniques to increase overall reporting quality and limit the possibility of bias.

Development of a risk of bias assessment tool specifically for meta-analysis of trials for surgical site infection

Background: Surgical site infections (SSIs) significantly impact patient outcomes, with rates reaching up to 20% after surgery, leading to higher morbidity, prolonged hospital stays, and increased costs. The assessment of randomized controlled trials (RCTs) related to SSIs has been challenging due to the lack of a specialized Risk of Bias (RoB) tool, as existing tools like the RoB-2 are not surgery-specific. To address this gap, we developed an adapted SSI-specific RoB-2 tool. Methods: This tool was created through a four-stage consensus process involving surgeons, trial statisticians, and methodologists with extensive experience in international SSI trials. Results: The process identified ten critical domains relevant to assessing RCTs on SSI interventions. Of these, eight domains were prioritized as essential for the final tool, while two were considered desirable but less critical due to the challenges of blinding in surgical contexts. Conclusion: The adapted RoB-2 tool is tailored to the unique aspects of SSI trials, offering a more focused and practical means of evaluating RCT quality. It not only improves the assessment of existing studies but also guides the design of future RCTs, enhancing the quality of evidence in SSI research. The tool's application in meta-analyses will likely lead to more reliable and generalizable results, informing clinical practice and policy decisions related to SSI prevention and management.

GLP‐1 receptor agonists for Parkinson's disease: An updated meta-analysis

IntroductionTreatments for Parkinson's disease (PD) focus on symptom reduction through dopaminergic therapies, without clear evidence of disease-modifying effects. Glucagon-like peptide-1 (GLP-1) receptor agonists may reduce neuroinflammation by decreasing microglia activation in PD. Clinical trials suggest these agents have disease-modifying potential in PD. ObjectiveEvaluate the efficacy of GLP-1 receptor agonists in PD. MethodsPubMed, Embase and Cochrane Library were searched to identify randomized controlled trials (RCTs) of GLP-1 agonists for PD, up to July 2024. The risk of bias was assessed using the RoB-2 tool, and statistical analysis was performed with RevMan 5.4.1 software. ResultsGLP-1 receptor agonists showed a beneficial effect on MDS-UPDRS part III motor scores compared to placebo. Off-medication state, there was a −1.22 point improvement (95%CI -2.46, 0.22; P = 0.05). On-medication state, scores improved by −2.52 points (95%CI -4.02, −1.01; P = 0.001). The global MDS-UPDRS score showed a −3.43-point difference (95%CI -6.48, −0.48; P = 0.02). Cognitive performance, assessed via the Mattis DRS-2, improved by 1.32 points (95%CI 0.16, 2.52; P = 0.03). There were no significant differences in the NMSS (−0,19; 95%IC -3,44, 3,05; P = 0.91), in MADRS (−1,04; 95%IC -2,57, 0,48; P = 0.18), or PDQ-39 (−0,91; 95%IC -2,22, 0,39; P = 0.17). ConclusionGLP-1 receptor agonists improved motor and cognitive performance in PD, suggesting potential symptomatic benefits. However, further studies are needed to evaluate their long-term effects and their role in disease modification, especially considering ethnic and disease severity variations.

Effect of yoga on balance, falls, and bone metabolism: a systematic review of randomized controlled trials in healthy individuals.

Yoga's effects on interconnected bone health parameters viz balance, falls, fear of falling (FOF), bone mineral density (BMD), and bone turnover markers (BTMs) in healthy individuals are unclear. We critically evaluated randomized controlled trials (RCTs) that compared yoga to no intervention control (NIC) or comparators such as Tai Chi, on these parameters in healthy individuals. We systematically searched multiple scientific data bases using a predefined protocol. We summarized data qualitatively when there was heterogeneity in reporting. A meta-analysis of those studies comparing yoga to NIC was done. Since the included studies used different scales for the same outcomes, we used standardised mean differences (SMDs) to allow pooling. We assessed the risk of bias with the Cochrane RoB2 tool for randomized trials and graded certainty of evidence using the GRADE approach. Eighteen RCTs with 1408 participants were evaluated. Fifteen explored yoga's effects on balance and/or falls or FOF, and three RCTs, its effect on BMD and BTMs. Yoga types included Hatha, Vinyasa, Ashtanga, Iyengar, Bikram, and specially designed yoga protocols. Twenty-four kinds of balance assessment tools were used in the studies. Study durations varied from 6weeks to 14months. Almost all the studies reported positive effects of yoga on balance compared to NIC, and non-inferiority when compared to active interventions such as Tai Chi. Meta-analysis of four RCTs comparing yoga to NIC demonstrated significant improvements in static balance with yoga (SMD = 2.36; 95% CI 1.13-3.58; P = 0.0002, I2 = 93% ⊕ ⊕ ⊝ ⊝). Yoga's effects on falls and FOF were mixed. Two studies showed a positive effect of yoga on bone formation. Yoga was found to have a positive effect on BMD in only one study. Meta-analysis of two RCTs showed no significant effect on BMD for yoga compared to NIC. The studies exhibited substantial heterogeneity in terms of yoga styles, intervention durations, and assessment methods. In healthy adults, low certainty evidence shows that yoga has a beneficial effect on balance. Its effect on BMD remains unclear. Standardised protocols and longer-term research are necessary to facilitate more definitive conclusions on yoga's role in enhancing skeletal health and preventing falls.

Efficacy and safety of daratumumab for the treatment of refractory/relapsed multiple myeloma. A systematic review of meta-analyses.

Several meta-analyses (MAs) of the efficacy and safety of daratumumab in refractory/relapsed multiple myeloma (RRMM) exist. They include different types of populations, Daratumumab regimens, and outcomes. Moreover, there is a wide variation in methodological quality and risk of bias. This study aimed to conduct a systematic review of MAs to summarize the literature on the efficacy and safety profile of daratumumab use in RRMM, and also provide an assessment of the quality and risk of bias of the MAs if sufficient data is available. The literature databases Pubmed, Embase, Web of Science, and Cochrane were searched since inception. The quality of methodology was assessed by the AMSTAR-2 tool, and the risk of bias was assessed by the ROBIS tool. Eight MAs were included in the SR. Most studies reported ORR and CR improvement by adding daratumumab to the chemotherapy regimen. Five MAs reported improvement in PFS in daratumumab-based regimens compared to non- daratumumab-based regimens. Only two MAs reported molecular response, favoring daratumumab. Dara was associated with adverse drug events (ADEs), including pneumonia and diarrhea. Conflicting evidence regarding hematological ADEs association with daratumumab exists. The overall quality of the studies is poor, but the MAs had a low risk of bias overall. Despite including low-quality MAs, this SR provides a summary that simplifies clinicians' access to efficacy and safety outcomes of daratumumab in RRMM patients. Future studies are required to reduce the uncertainty and produce higher-quality Mas, particularly regarding daratumumab's safety.

A meta-analysis and systematic review based on perioperative management of elderly patients: is ciprofol an alternative to propofol?

With the rising number of elderly surgical patients, selecting an appropriate anesthetic tailored to their specific needs is essential. Ciprofol, a novel intravenous anesthetic, has garnered attention due to its low injection pain rate and minimal impact on the circulatory system. This meta-analysis aims to examine the efficacy and safety profile of ciprofol during perioperative management of elderly patients. Comprehensive searches of PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases from inception to March 23, 2024, were conducted. Eligible studies were included, data extracted, quality assessed using the ROB2 tool, and analyses performed with Stata 17.0. Analysis of eleven randomized controlled trials (RCTs) comprising 1715 patients demonstrated that ciprofol outperformed propofol regarding injection pain (RR: 0.13, 95% CI: 0.09-0.20, p < 0.001), hypotension (RR: 0.72; 95% CI: 0.56-0.94; p = 0.014), bradycardia (RR: 0.64, 95% CI: 0.48-0.85, p = 0.002), respiratory depression (RR: 0.29, 95% CI: 0.19-0.43, p < 0.001), hypoxemia (RR: 0.38, 95% CI: 0.26-0.55, p < 0.001), and body movement (RR: 0.73, 95% CI: 0.56-0.96, p = 0.022). No significant differences were observed in induction time(SMD: 0.11,95% CI: -0.39-0.61, p = 0.655), sedative success rate(RR:1.01,,:95% CI:0.97-1.06, p = 0.669)), time of leaving the operating room(SMD-0.21,95% CI: -0.83-0.40, p = 0.497), bucking(RR:0.56,:95% CI:0.27-1.17, p = 0.134)), nausea and vomiting(RR:0.69,95% CI:0.43-1.11, p = 0.143)). Ciprofol demonstrates comparable efficacy to propofol in general anesthesia for elderly patients, with an enhanced safety profile, making it a viable clinical alternative. Further well-designed large RCTs are required to substantiate its safety profile.